Azara Cost & Utilization (ACU) is an analytics solution that integrates with the Azara DRVS platform to help provider organizations manage value-based care (VBC) arrangements. By aggregating and analyzing claims and clinical data, ACU enables users to identify trends and outliers at population and patient levels that contribute to high costs and excessive utilization. The software provides insights into network leakage, helping organizations manage in- and out-of-network services and optimize provider networks. It supports VBC contract success by identifying high-cost patients for care management, recognizing avoidable inpatient and ED episodes, and stratifying member populations using advanced risk algorithms and Social Drivers of Health (SDOH). ACU also offers visibility into medical and prescription costs across the provider network, aiding in improvement initiatives at various organizational levels. Furthermore, it tracks primary care utilization outside assigned practices to identify members who may benefit from scheduling or reassignment efforts.

Features & Benefits

• Data Visualization and Reporting: Interactive dashboards provide performance tracking from aggregated levels down to patient details.
• Integration with Azara Care Connect (ACC): Facilitates direct routing of members identified as needing higher levels of care to ACC for evaluation.
• Quality Scorecard Integration with DRVS: Monitors VBC arrangement performance metrics by plan and line of business.
• Emergency and Inpatient Utilization Reporting: Highlights costs and utilization for admissions, identifying potentially preventable episodes.
• Network Leakage Reporting: Tracks costs and utilization for out-of-system encounters to identify high-volume locations, specialties, and providers.
• Member Profile Analysis: Analyzes member costs and utilization to pinpoint influencing factors and cost-saving opportunities.
• Rx Utilization Reporting: Monitors prescription claim costs and utilization, identifying high-cost medications and brand-name drug expenses.
• Claim Lag Reporting: Assesses claim cycle times to identify data processing stages and reporting readiness.
• Lower Costs Per Member: Empowers primary care providers to impact member utilization and reduce costs.
• Decrease Inappropriate Utilization of Healthcare Facilities: Identifies trends for potentially preventable admissions to target high-utilization patient populations.
• Increase Visits to In-Network Providers: Identifies opportunities to drive in-network referrals, increasing revenue and continuity of care.
• Monitor VBC Contract Performance Metrics: Provides visibility into measures and progress toward value-based care outcomes.
• Understand Risk of Member Population: Enables comparison of risk distribution and quick identification of highest risk/cost patients.
• Reduce Costs Attributed to Pharmacy Utilization: Identifies opportunities to lower prescription costs through generic prescribing and mail-order options.
• Operationalize Workflows for at Risk Members: Streamlines processes for acting on at-risk members by routing them to care management personnel.