Cedar Gate’s Value-Based Care Analytics and Capitation Adjudication software helped a large national ACO monitor key quality metrics, accurately assess risk, reconcile capitated payments, and succeed in their first year as an ACO REACH organization.
THE CHALLENGE
When an existing accountable care organization (ACO) was ready to enter the new ACO Realizing Equity, Access, and Community Health (REACH) program, they knew their software would be the key to success. Due to the size of the organization, and the volume of data they had to bring in, the implementation window would be long. Cedar Gate started working with the ACO to bring in multiple data types with 23 levels of data aggregation. Bringing all the data together into Cedar Gate’s single data lake – where it is enriched, homogenized, and stitched to each member – was essential to ensure the organization’s 18 nationwide provider networks could access critical information on aligned beneficiaries in the ACO REACH program.
With detailed and enriched data available on tens of thousands of aligned beneficiaries, the ACO would be able to create more effective programs to increase access to care and improve care quality, particularly for underserved populations. Cedar Gate’s data ingestion process includes the ability to pull together information from multiple sources, including the Area Deprivation Index (ADI) and social determinants of health (SDoH) data from the Centers for Medicare and Medicaid Services (CMS).
These two additional data sources allow providers in the ACO REACH entity to monitor quality performance against key ACO REACH metrics, helping them capture and code risk, and collect accurate capitated per-member-per-month (PMPM) payments.
To make use of all the data available, the ACO REACH organization implemented Cedar Gate’s Value-Based Care Analytics and Capitation Adjudication products alongside other point solutions in their full tech stack. Cedar Gate’s unique composable design allows the organization to share data from the single data lake with external vendor applications, so that enriched data is shared across their entire tech ecosystem.
RESULTS
The ACO entered the ACO REACH program in January 2023 and was able to effectively manage tens of thousands of aligned beneficiaries. Cedar Gate’s Value-Based Care Analytics software helped providers identify potential care gaps and opportunities to improve access and meet quality metrics. Its capitation payment technology helped reconcile eligibility lists to ensure accurate PMPM payments and financial viability in the program.
The first year was so successful that the ACO REACH entity was able to expand its beneficiary network by 180% in 2024, ensuring better care for more beneficiaries in years to come.
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