Case Study
Transforming Value-Based Quality Metrics and Care
- Client: Arrowhead Regional Medical Center
- Challenge: Arrowhead Regional Medical Center (ARMC) sought to fully capitalize on the revenue potential associated with California’s managed care payment program.
Key Outcomes
- Achieved a 65% increase in revenue-generating quality metrics.
- Increased the number of metrics qualifying for over-performance by 250%
- Created performance monitoring tools for 50+ metrics at the executive, clinic, and provider levels
Our experience with Tegria has been exceptional. Tegria developed new quality reports that were actionable and guided our organization toward data-driven decisions that improved our quality metric performance across the board.
SAMANTHA HUANGVP/Associate Administrator, Population Health, Arrowhead Regional Medical Center
Background and Challenge
For organizations navigating the complexities of value-based care, optimizing performance in quality metric-based revenue streams is critical to financial sustainability. Difficulty aligning clinical workflows, data systems, and governance processes often creates inefficiencies that hinder progress, making it challenging to meet the demands of value-based reimbursement models.
ARMC recognized the need to partner with someone to address these challenges. “We saw a significant opportunity to improve our performance and realized we would continue leaving substantial revenue on the table without the right support to guide us,” shared a leader of value-based programs when discussing prior results.
Solution
With these goals in mind, ARMC embarked on a comprehensive initiative to redesign governance, enhance operational effectiveness, and ensure quality-driven care delivery remains at the forefront of its strategy. To achieve this, ARMC partnered with Tegria to evaluate and optimize their EHR build and operational strategies, focusing on population health and value-based care priorities.
The team was easy to work with, seamlessly collaborating with our doctors, IT specialists, and operational leaders to tackle challenges from every angle. Tegria introduced innovative strategies for performance improvement and ensured sustainable success once their engagement ended. Tegria has played a vital role in the recent success of our value-based programs, and we couldn’t possibly have achieved these results without them.
SAMANTHA HUANG
This collaboration resulted in the development of advanced performance monitoring tools incorporating enhanced logic to provide actionable insights. Additionally, the partnership delivered updated EHR functionality to improve patient identification and tracking, enabling more targeted and efficient care interventions. To further support quality metric compliance, ARMC introduced alternative care models designed to align with value-based care principles, ensuring sustainable and measurable improvements in patient outcomes and operational efficiency.
Results
The evaluation of ARMC’s population health program and the subsequent performance improvement initiatives resulted in updates to both technical functionality and operational strategies, achieving a 65% increase in the number of quality metrics that exceeded thresholds for incentive reimbursement.
- Achieved a 65% increase in revenue-generating quality metrics
- Increased the number of metrics qualifying for over-performance by 250%
- Created performance monitoring tools for 50+ metrics at the executive, clinic, and provider levels
- Increased patient outreach to over 50,000 previously uncontacted individuals
- Standardized organizational governance and change management strategies
- Introduced alternative care management strategies that reduced provider burden and improved quality metrics