By Tori Yokoyama, FSA, MAAA
Principal, Actuarial Science and Predictive Modeling at Arbital Health
| Population health benchmarks often serve as an anchor point against how healthcare provider performance is measured. Whether they guide contract settlement calculations to help determine trend or directly set target prices, or to simply help explain the drivers of performance and identify areas of opportunity for improved performance, benchmarks bring clarity to complex data. |
This article will focus on the latter—how benchmarks can uncover performance insights and highlight opportunities for improvement (outside the scope of direct use in contract settlements, though many of the same principles will apply to both). In a risk-based contract, understanding appropriate benchmark data for a managed patient population ensures healthcare providers can proactively target interventions and optimize value-based care partnerships. But doing this accurately isn’t easy. Acquiring the right datasets and navigating modeling limitations can lead to wrong conclusions around performance results, and patient interventions can even be mistargeted!
It’s critical to understand the complexities of benchmarking so you can make confident, data-driven decisions. When developing benchmarks, there are three key factors that should be taken into consideration: compatibility, flexibility, and actionability.
Arbital Health has developed our Insights Module with statistical and actuarial rigor at all phases of the process. Beginning with a foundational data ingestion and quality assessment layer, data is cleaned and reviewed across four dimensions: completeness, accuracy, reasonability, and sufficiency. This data is then enriched to compare against benchmark data that undergoes the same enrichment process, adjusting for key population characteristics. This benchmarking process helps identify important gaps and provides detailed utilization benchmarks.
Finally, this population and benchmark data are summarized into actionable insights, with additional GenAI-enabled flexibility rapidly being developed—allowing users to generate customizable insights that meet their specific business needs. This process is driven by an industry-leading, robust automated technology.
At Arbital Health, we’ll handle the complexities of your value-based care contracts, so you don’t have to. Our goal is to accelerate the shift to value-based care by building the neutral platform that allows all stakeholders to centralize, measure, and adjudicate value-based care contracts. We aspire to be the trusted umpire adjudicating every outcomes-based contract in healthcare, whether contracts are between life sciences companies and payers, payers and providers, or employers and digital health companies. We make it simple to adjudicate contracts and unlock the trillion-dollar shift to value-based care.