Cost and utilization analysis helps organizations understand how care is delivered, where resources are overused, and where interventions can improve outcomes while controlling costs. These insights are critical for value-based care success, financial sustainability, and improved patient experiences.
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Azara Cost & Utilization
Uncover resource utilization trends and drivers of high costs.
Azara Cost & Utilization (ACU) is a powerful addition to the Azara DRVS population health platform that leverages Azara’s ability to aggregate and integrate claims and clinical data, enabling provider organizations to confidently manage value-based care (VBC) arrangements. Through the use of advanced analytics and interactive visualizations, users can identify trends and outliers—from the population level down to the patient level—that are driving costs and contributing to excessive utilization. ACU also provides a view of network leakage, identifying in- and out-of-network services to deliver the information needed to manage provider networks more efficiently and effectively.
Azara Cost & Utilization Enables Your Organization to:
- Improve success in value-based care contracts through identification of high-cost/high-utilization patients who can benefit from care management or other more cost-efficient forms of care.
- Improve efficiency of workflows by helping staff identify members who may benefit from higher levels of care to send directly to Azara Care Connect (ACC) for care management.
- Recognize avoidable inpatient and emergency department (ED) episodes and implement remediation plans where appropriate.
- Stratify member population utilizing advanced risk algorithms or Social Drivers of Health (SDOH).
- Gain insight into a network’s usage and leakage patterns—identifying opportunities to expand the network and manage referral trends to help ensure providers are referring in-network when possible.
- Understand medical and prescription costs across all components of the provider network and identify opportunities for improvement at the network, practice, and provider levels.
- Track utilization for members seeking primary care outside of their assigned practice to identify members who may benefit from appointment scheduling or plan reassignment efforts.
Features & Benefits:
Features:
- Data Visualization and Reporting: Interactive dashboards with visualizations to track performance at an aggregated level down to the patient detail level.
- Integration with ACC: Send members who may benefit from higher levels of care directly to Azara Care Connect (ACC) for evaluation by care management personnel.
- Quality Scorecard Integration with DRVS: track quality performance by plan and LOB using a DRVS scorecard to monitor performance of measures included in VBC arrangements.
- Emergency and Inpatient Utilization Reporting: Provide insight into costs and utilization for emergency and inpatient admissions while identifying potentially preventable admissions and highlighting areas for improvement.
- Network Leakage Reporting: Monitor costs and utilization for encounters outside of the defined health system to gain insight into frequently visited locations, specialties, and providers with a high volume of leakage.
- Member Profile: Analyze a member’s costs and utilization to identify factors that influence utilization and potential cost-saving opportunities.
- Rx Utilization Reporting: Track costs and utilization for prescription claims while identifying highest-cost medications, costs related to brand-name drugs, and mail order vs. retail costs.
- Claim Lag Reporting: Understand claim cycle time from date of service to payer processing and receiving the claim in system—identifying which months are ready for reporting and those with data being processed.
Benefits:
- Lower Costs Per Member: Uncover opportunities for primary care providers to impact member utilization.
- Decrease Inappropriate Utilization of Healthcare Facilities: View trends for potentially preventable admissions to target patient populations with frequent utilization.
- Increase Visits to In-Network Providers: Identify areas of opportunity to increase visits to providers in your health system to increase revenue and provide members with a seamless experience by seeing providers at the same organization, promoting continuity of care.
- Monitor VBC Contract Performance Metrics: View measures and track progress toward value-based care outcomes.
- Understand Risk of Member Population: Compare risk distribution across your attributed members and quickly identify highest risk/highest cost patients.
- Reduce Costs Attributed to Pharmacy Utilization: Identify areas of opportunity to reduce prescription costs by prescribing generic over brand-name medications or using a mail order pharmacy.
- Operationalize Workflows for at Risk Members: Streamline processes to act upon members who may require higher levels of care by routing identified members directly to care management personnel for triage and evaluation—eliminating manual processes.
Frequently Asked Questions
How can I monitor the cost impact of high-risk patients?
Monitoring high-risk patients requires combining utilization data, claims, and clinical indicators. Azara enables organizations to track cost drivers such as ED visits, hospitalizations, and readmissions, helping care teams intervene earlier and manage complex patients more effectively.
How can I identify patients who need care management based on utilization trends?
Utilization trends such as frequent admissions, rising costs, or repeated ED visits can signal the need for care management. Azara’s analytics surface these patterns so organizations can enroll the right patients in care management programs and proactively reduce avoidable utilization.
Interested in learning more about Azara Cost & Utilization?
Azara Cost & Utilization is a separate application that leverages the data within Azara DRVS. It requires setup, configuration and a separate subscription.
Contact your practice, PCA/HCCN, Azara Representative or solutions@azarahealthcare.com for additional details, including pricing.
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