A leading number of industry surveys indicate three critical challenges surrounding data analytics initiatives in healthcare:
- Building an Analytics and BI infrastructure is Complex, Expensive and takes a Long Time
- Internal IT resources are Overburdened with other Initiatives
- Consultants with true Hands-On Analytics and BI experience are Scarce
Analytics from PluralSoft is truly TO GO! PluralSoft’s pre-built Analytics in CareQuotient™, helps our customers overcome these challenges cost-effectively and reduces Time-To-Insight significantly. PluralSoft’s approach to building Analytics is driven by taking the most commonly demanded and utilized use cases in the industry, across the continuum of care, which address both tactical and strategic business decision support. It comes pre-built with hundreds of nationally vetted and industry accepted Analytics covering:
- Quality of Care Performance
- Provider Operational & Financial Performance
- Utilization, Cost and Access Performance
- Performance Reporting
Healthcare intelligence is a key change agent for organizations to adopt Outcome-centric and Value-based models. They can be procured by healthcare organizations incrementally based on their tactical or strategic business objectives and the problems they wish to solve as determined by the priorities they set.
Customers who procure the pre-built Analytical algorithms in CareQuotient™ are not only guaranteed continuous support and maintenance when industry standards underlying these algorithms change, but are also given the opportunity to quickly create derivative measure algorithms and share them within their organization, at no extra cost.
In addition to pre-built healthcare intelligence, organizations have access to a flexible, modular architecture in CareQuotient™ that helps bring quick insights iteratively and at a significantly reduced cost than current analytic products and practices. CareQuotient™ allows organizations to:
- Configure CareQuotient™ analytic data-driven rules engine or customize its reusable yet flexible analytic logic framework for organization or local collaborative specific adaptation of nationally vetted measure specifications.
- Leverage the robust Metadata Layer of “healthcare concepts” supported by a Semantic Information Model and an intuitive query, analysis, and reporting tool to explore data in CareQuotient™ using healthcare language, not a programming language.
- If needed, use Microsoft Excel or Microsoft Business Intelligence tool set or, for that matter, any chosen third party reporting or business intelligence tool to access CareQuotient™ Analytic structures.
Quality of Care Performance
Quality of Care analytics that come pre-built are comprised of both process of care and health outcomes addressing: Physical and Mental Health, Chronic, Acute and Preventive conditions. Pre-built measures for quality of care use industry standard definitions of population cohorts, based on national measure development standards organizations and programs/initiatives such as the following:
- National Committee for Quality Assurance (NCQA) HEDIS®
- National Quality Forum (NQF)
- Agency for Healthcare Research & Quality (AHRQ)
- CMS CMMI Accountable Care Organization (ACO)
- Patient Centered Medical Home (PCMH)
- CMS Physician Quality Reporting System (PQRS)
- CMS The Joint Commission (TJC)
- US Preventive Services Task Force (USPSTF)
- Human Resources and Services Administration (HRSA) – Health Disparities Collaborative (HDC), and Uniform Data System (UDS).
CareQuotient™ provides a flexible framework to define populations and it automatically creates care registries to enable identification of gaps-in-care based on evidence-based care guidelines underlying the implemented national standard(s).
Customers use this framework to modify or customize pre-built Analytics provided by CareQuotient™ to create their own derivative measures to suit their program or initiative objectives.
Provider Operational & Financial Performance
Healthcare organizations need to understand how efficient they are in running their businesses in a holistic manner. Whether a Physician Practice or a Hospital, these organizations need to know the efficiency of their service lines, clinical risk and service utilization of various patient populations served, and productivity of their care delivery staff compared to the demand for such services.These insights help them understand how optimally or sub-optimally they are performing. With reduced reimbursements and opportunities to increase payments based on demonstrated value, a different set of insights are required in near real-time as possible to manage a lean business model.
Using CareQuotient™, healthcare organizations get ready access to operational and financial intelligence through key performance indicators (KPIs) to manage a lean, yet profitable, business. A few examples include:
- Appointment Book capacity vs. Contracted Provider days
- Bed Days in various departments
- Health risk of patient panels assigned to each Physician / Clinician
- Efficiency and Productivity of Physician/Clinician mapped to Actuals vs. Budget
- Cost of providing care (facility and non-facility) by Service Type (such as ER, Inpatient, Outpatient, Physician Services, Specialist Services, Lab, Imaging, Prescription, etc)
- Billing and Collections KPIs including Denials Management
- Patient Census/Volumes by Financial Class
- Under and Over utilization of Services and Staff
- Rates of Potentially Preventable ER visits, Hospital Admissions, Hospital Readmissions, and Acute care Complications.
Utilization, Cost and Access Performance
An Integrated Delivery Network or a Payer including State Medicaid needs to understand their Member Census, Network Census, Cost and Utilization, Referrals in-network and out-of-Network, Clinical Risk, and many more. These insights help them manage their actuarial risk and accordingly manage capital reserves and medical loss ratio thresholds. Using administrative or claims data – depending on whether the organization has access to pre-adjudicated administrative data or post-adjudicated claims data – healthcare organizations using CareQuotient™ have access to a broad set of key performance indicators (KPIs) for utilization, cost and access that are nationally accepted and vetted.
Examples of such key performance indicators include:
- Utilization rates – Emergency Room, Inpatient, Outpatient, High-cost Imaging, Lab, Prescription, and more
- Cost (per K, PMPM) – Emergency Room, Inpatient, Outpatient, High-cost Imaging, Lab, Prescription, and more
- Readmission rates
- Access KPIs – Well-Child visits, Adult Preventive visits, Dental visits, Prenatal and Postpartum care, and more
- Provider Network Census by Provider Taxonomy, Geography, and more
- Patient/Member Census by Geography, Age, Gender, Race, Ethnicity, and more
Healthcare organizations typically use a combination of Quality of Care, Operational, and Financial Performance measures such as those above to satisfy most of the current Pay-for-Performance, Pay-for-Reporting, Pay-for-Value or Grant funded programs in which they may participate. Such measure sets include CMS ACO measures (quality and cost), CMS PQRS measures, HITECH Meaningful Use Stage 1 and Stage 2 measures (Eligible Professionals and Hospitals), and annual UDS reports by Federally Qualified Health Centers to continue their Section 330 (CHC, MHC, HCHP, PHPCP) funding.
CareQuotient™ computes these measures on a frequency determined by the healthcare organization. Organizations compute these measures more frequently than the periodicity of reporting prescribed by the program they participate in so that insights generated from these measures are truly used as mechanisms guide and to improve the impact of their business on overall quality of care, cost of care, and patient experience.