Moving from reactive reporting to proactive insight through better health analytics
Your health plan is likely finding that in today’s highly competitive and fast-changing marketplace, you need analytics solutions that help you go beyond reactive reporting to proactive insight that everyone across your organization can easily access. Regulatory reporting requirements-such as for The Healthcare Effectiveness Data and Information Set (HEDIS) – can provide opportunities for your organization beyond simply meeting your compliance goals. Increasingly, health plans are using proactive compliance monitoring to uncover opportunities to improve member health resulting in improved internal and external insights and increased revenue opportunities.
Today’s modern analytic tools can help you gain actionable insight by tapping into and meaningfully combining vast stores of diverse data-including claims experience, medical records, social sources, and public data sources such as health and environmental data. Further, these advanced analytics can be easily made available and understandable to professionals across your organization with interactive, self-service business intelligence (BI) tools-via applications they’re already using, such as Microsoft Excel.
MMM Healthcare LLC / PMC Medicare Choice (both known as MMM), a subsidiary of InnovaCare Health, is a leading insurer in Puerto Rico currently managing over 200,000 Medicare Advantage (MA) beneficiaries, with over 50% being low-income, dual-eligible individuals. Facing the challenge to meet the required quality ratings with Center for Medicare and Medicaid Services (CMS) Five-Star Quality Rating Program, MMM chose to address these challenges by implementing the STARSTrack analytic solution from Nagnoi, LLC.
STARSTrack provided interactive, easy-to-use dashboards and analysis tools to MMM. Using STARSTrack’s analytical capabilities and action-based reporting, MMM developed a Pay-For-Performance (P4P) Program to align providers with the quality goals of the institution. By leveraging the tool’s data sharing capabilities, MMM now delivers up-to-date clinical data to dozens of medical groups (IPAs) and 3,000+ Primary Care Physicians (PCPs) on a pre-determined timeframe or on-demand. MMM network providers were able to identify, prioritize, and close gaps in care across multiple quality measures. To name a few examples, in the measure Osteoporosis Management in Women (OMW) who had a fracture, MMM experienced a 21 percent improvement, while in Rheumatoid Arthritis Management an 11 )percent improvement was experienced, increasing the overall star ratings results, which impacts the bottom line. As Christian Caballero, Director of Five Star Operations at MMM, puts it: “STARSTrack has helped our Star Rating Intervention Team be better prepared to address care gaps with members, providers, and IPAs. We are now equipped with the data needed to stratify our population, develop specific action plans, and measure the effectiveness of our initiatives.”
Proactive engagement of member populations is just one example of how an organization can take advantage of today’s powerful, yet easy-to-use analytics to manage in a rapidly changing health marketplace. Leading health institutions are using analytics derived from the Microsoft business intelligence platform to analyze and act on diverse challenges from ACO management to individual facility financial performance.
Blue Granite, a leading Microsoft partner has helped many healthcare clients, including Life Care Centers of America to successfully tackle such challenges. Eric Wozniak, Principal at Blue Granite software, recently hosted a webinar on Driving Better Consumer Health and Customer Service Engagement through Advanced Analytics. In the webinar, Wozniak detailed not only how Life Care managed to improve its financial performance through advanced analytics, but also tips for how you can plan and execute a successful analytic strategy within your own organization.
You can access the webinar here where you can learn how:
- Analytics can be presented in simple, easy-to-use tools such as Excel that are driven by advanced analytics engines.
- Member data can be combined with public sourced data quickly and easily to provide new insights.
- Regulatory reporting can be turned into a proactive asset and not just a reactive reporting exercise.
- The tools you own and use today can be your gateway to both on-premises and cloud-based resources that put the power of advanced analytics in the hands of your front-line resources.
- Customers are using these tools to succeed in today’s rapidly changing healthcare marketplace.
In addition to the webinar, learn more from videos that demonstrate the use of the Microsoft analytics tool suite in real-world health plan scenarios, specifically HEDIS reporting and Medicare Provider reporting which were developed by Microsoft with assistance from Blue Granite and published to the Microsoft in Health YouTube Channel.
We hope that you find the webinar and videos helpful and learn new ways to empower everyone across your organization with relevant, timely intelligence for improved compliance reporting, care management, member engagement, financial performance, and more. Please let us know if you have any questions or feedback. We’d love to hear from you via email, Facebook, or Twitter.
