A large multistate health plan covering over 15 million lives.
Before our client launched their current state value-based reporting platform, they attempted to reuse existing network level cost and utilization reports by running them against custom populations of members. The legacy reports required highly labor-intensive queries to produce datasets that were then manually processed through a reporting software package only used for formatting purposes. The reports lacked critical functionality for an ACO as they did not include a market comparison, did not support leakage reporting to identify where members receive treatment outside of the ACO, and contained no drill-through into underlying detail. All of these capabilities are critical to allow ACOs to understand their members’ utilization patterns and opportunity areas for improvement. With a rapid interest in expanding value-based programs, the pilot solution no longer met our client’s business needs.
Established quality reporting was at the network level and offered no flexibility into specific ACO results. To meet ACO financial quality incentive business needs, auditor certified quality reporting at an ACO population level was required.
Baker Tilly worked with our client and a vendor to create a comprehensive reporting and analytics solution designed to scale with our client’s quickly growing value-based program needs and helped them meet their business objectives in the following ways:
The rollout of the current reporting and analytics platform has allowed for detailed insight at an ACO and member level for over 60 ACOs on a single consolidated platform. Monthly, over 10 quality and member level detail reports are delivered to each ACO and quarterly, over 60 cost, utilization and leakage reports are delivered. Each report is dynamic, allowing for adjustable filters and offers reliable point-in-time reporting for those users that may need to look back at historical trends.
Our client has formed informal joint operating committees with their ACO partners, and these collaborative teams use the reporting platform to analyze results and opportunities to drive toward an overall higher quality of care for each member at a low cost.