Since its founding in 2015, Equality Health, a Phoenix-based health system focused on value-based care, has considerably increased the number of value-based contracts and extended its network of independent primary care doctors. It now has a network of over 25 VBCs and 5,000 independent primary care physicians. Equality Health faced a difficult difficulty in managing, storing, analysing, and reporting the data received from all payers, as well as auxiliary data sources.
Member eligibility, pharmacy/medical claims, additional lab results, quality, and hospitalisation census are examples of data received. The VBCs cover the lines of business Medicaid, Medicare Advantage, and Expansion. Payers use distinct adjudication systems, thus even if they all used the same format, the logic of processing the data is unique, requiring manual coding on a regular basis. VBCs and accompanying data have also been impacted by health-plan mergers and acquisitions.
This is significant since, according to him, 5% of any group’s healthcare costs account for more than half of that group’s total spending. He explained that the existing Daraja ADW architecture will reduce Equality Health complicated payer and supplemental data sources into standardised forms, allowing providers to receive real-time actionable information.