Physician Cost and Utilization

Gain deep visibility into provider metrics.

Healthcare reimbursement reform is creating a shift from pure Fee-For-Service (FFS) to Fee-For-Value (FFV), fundamentally changing the healthcare delivery business model.

Now you can readily manage population health and value-based reimbursement—and gain comprehensive insight into services provided, quality of care delivered, and health system

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PQRS tools to help maximize your Medicare reimbursements.

ZirMed’s comprehensive PQRS Toolkit is designed to help you successfully meet PQRS reporting requirements. The PQRS Toolkit includes:

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Optimize P4P and FFV reimbursements by easily identifying variations in care and cost trends.

As payers base more and more reimbursements on pay for performance (P4P) and fee for value (FFV) models rather than on services, your organization’s income will increasingly derive from a combination of services rendered, quality of care delivered over a period of time, and health system utilization.

That makes it more important than ever to manage risk and measure your organization’s performance to drive continuous improvement of the quality and efficiency of care.

ZirMed positions you for success in this rapidly changing environment by delivering powerful hierarchical cost and utilization analytics designed specifically for ACOs, IPAs, hospitals, and health systems.

ZirMed provides Santé with sophisticated and credible cost and utilization data analytic capabilities which we are able to readily apply to the real world in which our physicians practice. ZirMed turns our data into actionable information that impacts both the cost and quality of care delivered.”
Daniel L. Bluestone, MD, MBA
Santé Health System
Chief Medical Officer

Cost and Utilization Reporting

With pay for performance and accountable care growing, your organization bears more risk while having to manage increasingly complex networks across the entire care continuum.

ZirMed helps you succeed by creating a virtual integrated network—and providing a comprehensive analytics tool set for risk and population management that offers:

Organization-level analytics:

  • Cost: overall and PMPM cost by specialty, provider, and procedures
  • Utilization: multi-year utilization trend by specialty and procedures
  • Leakage: based on scope of Medicare and commercial claims

Comparative analytics:

  • Provider-to-provider cost comparison within specialty, adjusted for case-mix and by specific treatment groups and expense types
  • High-cost case by diagnosis code group, health plan, age, and sex

PCMH-type analytics:

  • PMPM costs by PCP and specialty, case-mix severity adjusted
  • Specialty utilization and costs for patients attributed to a PCP
  • Primary physician comparison for FFS and CAP PMPM costs by specialty, case-mix adjusted and without outliers

Readmission analytics:

  • Readmissions: 30-day readmits by attributed physician
  • Comparison of readmit KPIs among providers

Risk Stratification—from the health system to the patient level

Now you can identify unwanted outcomes and target them to mitigate their impacts. With ZirMed’s episode-treatment and risk groupers, it’s easy to summarize costs and risk by specialty—enabling your physicians and administrators to improve disease management, understand the cost and quality of care provided, identify variation across all your systems, and risk-adjust your patient population to compare costs across physicians.

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