Cone Health faced delays in pay-for-performance (P4P) metrics, hindering revenue optimization. By leveraging the Health Catalyst® Data Platform, the organization was able to unify payer rules and quality data into a single analytics application, enabling leaders to visualize performance against P4P targets and forecast contract achievement. This resulted in improved contract performance, higher quality scores, and significant financial benefits.
Cone Health, like every healthcare organization, received annual pay-for-performance (P4P) metrics from its payers. Often, P4P metrics and goals were not received until mid-way through the performance year, substantially limiting the opportunity to improve, and leaving potential revenue unrecognized.
Leveraging the Health Catalyst® Data Platform, Cone Health’s contract management and quality teams collaborated to unify payer rules and quality data in a single analytics application.
Leaders can visualize current performance in relation to P4P targets and use Healthcare.AI™ to forecast achievement levels for each contract. For the first time, Cone Health can identify improvement opportunities that will positively impact patients and contract performance, driving smarter strategies and achieving higher results.
The Health Catalyst data platform enabled Cone Health to improve contract performance and quality scores, while generating measurable financial benefits. With AI-driven forecasting, the team can now prioritize future opportunities to sustain momentum and maximize value.
"By aligning payer rules with quality data, we gained clarity and foresight—Healthcare.AI forecasting gave us confidence to act decisively and maximize performance outcomes."
- Emily Paula, DHA, MBA/MHA, CPHQ, Director Quality Informatics, Cone Health
