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HealthEC’s Population Health Platform Provides State Medicaid Agencies with Powerful Analytics to Optimize Managed Care Organization Performance

 

MESC 2019
August 19 - 22 | Booth #85
McCormick Place, Chicago

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"HealthEC helped Washington D.C.'s Medicaid agency develop an enterprise data warehouse certified for reuse by CMS."

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"In a matter of 12 weeks, HealthEC was able to mitigate, scrub, cross walk and normalize 10 years of clinical and financial Medicaid data."

Monitor and improve MCO performance to drive meaningful population health outcomes by leveraging a solution that goes the extra MILE.

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Modular: Single-platform solution flexible enough to support your specific PIPs, with built in HEDIS, Health Homes and CMS quality measures.

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Interoperable: Extrapolate and configure data from any source for integration, including encounter/claims, labs, pharmacy, EMR, HIE and more, with social determinants of health and behavioral health assessments for a holistic, person-centric record.

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Leading: 2019 Best in KLAS Population Health Management solution.

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Easy-to-Use: Customizable reporting interface for risk stratification, identifying gaps in care, performance and provider benchmarking, and more.

Managed care is challenging. It requires continual improvement and must be responsive to population changes, the needs of providers, and technology that enables efficient, effective care.

With HealthEC's comprehensive population health platform, state Medicaid programs, MCOs,  and health plans have the targeting capabilities, evidence-based analytics, and reporting tools needed to proactively serve beneficiaries while reducing unnecessary costs and improving care outcomes.

HealthEC has developed a suite of tools that uniquely serves the following organization types and programs:

  • Commercial (including MCOs, ASOs and MSOs)
  • Medicaid
  • Medicare
  • Medicare Advantage
  • MSSP

Universal Data Warehouse

  • Helped develop universal data warehouse for Washington D.C. Medicaid agency certified by CMS for reuse
  • Aggregated claims, clinical, Rx, Lab, and other agency data in near real-time
  • Cleaned and normalized data
  • Built-in robust decision support system with configurable reports and performance dashboards
  • System generated CMS reports
  • Direct feeds from MMIS

Value Proposition:

  • Monitor budgets in near real-time
  • Explore spend by disease and procedures
  • Organization, practice (FQHC), and individual provider performance and quality dashboards
  • Single source of data for all stakeholders

Quality Reporting

  • Aggregate clinical and claims data for all measure capability
  • Intuitive benchmarked dashboard for the MCO, practice, and provider
  • Monitor MCO/FFS waiver performance

Value Proposition

  • Monitor HEDIS compliance by practice (FQHC) and provider for all MCOs
  • Near real-time monitoring for compliance
  • Enable Quality Improvement Program (QIP) changes on ad-hoc and MCO basis

MCO Performance Monitoring & Analytics

  • Monitor MCO comparable performance on KPIs and contract
  • Enable greater flexibility with QIP programs
  • Track all HEDIS and Star measures
  • Track effectiveness and efficiency in the plans' performance on access to care
  • Monitor the data to track claim denials, rejections, adjustments, appeals etc. by diagnosis or provider
  • Uniform Data System (UDS) metrics tracking and monitoring by FQHC

Value Proposition:

  • Enforce contract performance by MCO
  • Monitor near real-time access and delivery of care
  • Measure prospective and concurrent risk by member

Comparative Performance on KPI by Contract

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Benchmarked Performance

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Learn how managed care organizations are leveraging the power of population health management and value-based care

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Social Determinants of Health

  • Comprehensive, cloud-based, and mobile-accessible platform
  • Integration of available community and government agency services
  • Stratification with SDoH and medical co-morbidities (conditions)
  • Integrate with utilization, cost, and outcomes data
  • Automated creation and monitoring of referrals based on assessments

Value Proposition:

  • Work flow integration specific for each agency/provider
  • Integrate with community-based services
  • Automate credentialing and re-certification tasks

Value-Based Program and Care Management

  • Deploy provider facing tools for monitoring performance on value-based programs
  • Track financial, utilization, and clinical performance
  • Ability to push and pull data to smart devices in near real-time
  • Provider and care manager workflow integration
  • Member and provider mobile apps

Value Proposition:

  • Prioritize quality measures and maximize HEDIS and Stars tracking by MCO
  • Enable care coordination and document recommended interventions for high risk
  • Automated creation of individualized care plan for each member
  • Demonstrable ROI and Triple Aim compliance

Content Library

Medicaid Market

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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

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HealthEC's Russ Fendley on Key Takeaways from the 2019 State Healthcare IT Connect

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Ready to see how HealthEC can help your state address its unique Medicaid challenges?

Request A Demo