Case Study: Leading Physician Services and Population Health Organization achieves $100M+ annual savings opportunity through referral pattern management with Innovaccer

Value-Lever Assessment For Better Outcomes At A Leading Managed Services Organization

Leading Physician Services and Population Health Organization engaged Innovaccer’s consulting services to rapidly diagnose the major drivers of medical costs for an ACO client. The organization — a southern‑metropolitan MSO with several hundred physicians, two labs, 50+ locations and more than 300,000 managed lives — needed to identify which value levers would yield the biggest cost and quality impact across its network.

Innovaccer used its consulting framework and analytics (including InGraph and point‑of‑care InNote, with data processed via AWS Redshift, EMR and Apache Spark) to analyze claims and shortlist four high‑impact levers. The work identified referral pattern management and specialist tiering (notably around DRG‑470) as the dominant opportunity, representing about 90% of projected savings — roughly $90M+ from episodic cost variability and a total recurring opportunity exceeding $100M; additional opportunities included ~$10M from ED reductions, ~$2M from readmissions and ~$1M from modest generic substitution. Innovaccer also prepared preferred‑specialist lists and point‑of‑care guidance to enable PCPs to steer referrals toward lower‑cost, higher‑quality providers.