Jan 2008
President's Letter
Happy New Year to all of you, and welcome to 2008! Here at ManagedCare.com, we are
extremely excited about the coming year and we hope to share that enthusiasm with
all of you. This year will see the culmination of a whole range of investments that
we've been making in personnel, technology and especially – client service.
We are confident that our progress will be self-evident, but nonetheless, we're
going to take this opportunity to update you on many of our key accomplishments
and outline our plans for an even more successful future.
At ManagedCare.com, we subscribe to a very simple
Corporate Mission:
. . . to provide our business partners
with the most dynamic and affordable range of managed care reporting solutions available
anywhere
This means that we must not only develop tools that are responsive to client needs,
but they must simultaneously prove more cost-effective than either "making" them
internally or "buying" them from another vendor. If you have been working with us
for more than a year, you know that we're serious about this commitment. We are
constantly striving to expand our range of features, functionality, and report presentations.
I am proud of the progress we've made, and I also take great stock in the fact that
we've done all this without compromising our commitment to affordability.
Please take a few minutes to review the announcements that follow. You will find
a table of contents outlining the key developments which have occurred in the past
year. Use the embedded links to learn more about any of the topics that might be
of interest to you. Some were entirely completed in the preceding year while others
represent ongoing "works in progress". Taken together, I am hoping that they effectively
describe the direction of our reporting solutions and stimulate some thinking about
ways that we can better serve your organization.
Best wishes to you and your associates in the year ahead. As always, we thank you
for the opportunity to serve you, and look forward to working ever more closely
with you in the future.
Sincerely,
Curt Hatch, President
ManagedCare.com
OUTLINE OF ANNOUNCEMENTS – JANUARY 2008
(Click to Follow Hyperlinks)
HEDIS
As you may know, ManagedCare.com's Pay-for-Performance programming was granted limited
NCQA software certification in 2005 and 2006. This means that our software code
(for the subset of measures included in California's IHA Pay for Performance program)
was subjected to – and successfully met – NCQA's rigid testing requirements.
We were one of only a handful of vendors nationally to earn this distinction. We
will obtain this same certification for the 2007 reporting year during Feb/Mar 2008.
NEW FEATURE
– This week, we are also pleased to announce the implementation of a dramatic
expansion to our quality reporting tools. You will find a new suite of "Quality"
reports (on a new tab between DM/CM Tools and the Claims Query Tool) on your menu
bar this week. These reports are the result of many months of programming and provide
summary data (and drill-through detail) on all HEDIS measures as reflected in the
administrative claims data. The central presentation is the Q-01 Report (HEDIS Performance
Summary). The underlying programming conforms precisely to NCQA specifications and
has been thoroughly tested against last year's authorized "test decks".
NEW FEATURE
– In addition to completing the programming of all HEDIS measures, we are
on a parallel track to: 1) complete the initial release of our
Chart Abstraction Tool (CAT) for organizing hybrid data collection, and
2) obtain our Full HEDIS certification for our
reporting system, and 3) begin offering a complete range of HEDIS measurement and
submission services to our clients. The initial release of the CAT will occur in
January, as will the final certification of our HEDIS code.
Service Overview
ManagedCare.com's 2008 HEDIS (2007 reporting) support package includes two discrete
elements:
Reporting Tools
- Capture (and related validation reporting) of all data sources including claims,
pharmacy and lab values;
- Complete on-line reporting of all measures from administrative data throughout the
year, including presentations at the organizational, PCP, and patient levels;
- Presentation of exception patients in physician dashboards and other reports;
- Support of periodic mailings to target members and physicians;
- Drill-down to allow easy validation of relevant "numerator" events;
- Access to all report presentations by both administrative staff and physicians;
- NEW FEATURE
– On-screen input of administrative data from chart reviews or other data
sources
Submission Tools
- Generation of CAHPS® survey samples and samples for hybrid measures;
- Software tools for collecting chart data and importing it into our data warehouse;
- Automated submission of measure results to NCQA Data Submission Tool (and Medicare);
- Reports and graphs profiling final measure performance; and
- Completion of the Vendor portion of the Baseline Assessment Tool (BAT)
There will be NO CHARGE for our HEDIS Reporting Tools. All related presentations
– including physician-level and member-level dashboards and inclusion
of any HEDIS measures in your P4P programs – will be offered as part of our
standard monthly service package.
Pricing for Submission Support
For health plan clients seeking full-scope support (including the Submission Tools
outlined above), we have structured this service to be the single most affordable
HEDIS solution on the market. These services will range in price from $15,000 to
$30,000 depending on the associated enrollment. The fee would be payable in two
installments: 50% at signing and 50% at completion of the submission process.
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PROGRAM MANAGEMENT TOOL (PMT)
The PMT has been evolving steadily over the course of 2007, and is now a fully-functional
disease management application. Once again, there is no additional charge for configuration
and support of most PMT programs . While many new features will be added in the
coming year, all core components of the application are on-line and fully functional.
Among the capabilities that are available in the system today:
-
Auto-population of member registries:
- Utilizing either HEDIS or client-defined rules
- Patients' class status is defined by client-specific interventions or characteristics
-
Member risk stratification:
- Flagging high-risk members based on client specs
- Risk can be defined in classes or on objective "point" scores
- Users can pull, sort and review members with defined risk criteria in the MSU (Member
Selection Utility)
-
Disease-specific profiling:
- Key Indicators (in Patient Overview screen) summarize all related medical services,
pharmacy and lab values;
- Users can screen on key characteristics in the MSU
-
Input and tracking of patient contacts, referrals and other interventions:
- Classes/specific activities are custom defined by the client
- Intervention chronologies are summarized at the patient level
- Significant treatment "steps" can define classes of patients (for comparative benchmarking)
- Open tasks are used to define user-specific daily work logs
-
Custom-designed on-line forms and patient assessment surveys:
- Selectable document "libraries" to assist in patient management process
- Form responses can drive risk stratification, interventions, etc.
- New web forms environment (Feb/Mar ‘08) will enhance the flexibility and ease of
use
-
Clinical data entry options (e.g. smoking status, weight, BP, etc.)
-
Program status indicators:
- Tracking key outcomes for each program at the Program, PCP and patient levels
- Longitudinal views to support program performance evaluation
Importantly, all these tools are completely integrated with our physician dashboards
and other reporting to allow sharing of important data on high priority patients.
Dozens of ManagedCare.com clients have already deployed PMT programs with us. We
are accumulating an increasing number of disease "templates" in diabetes, asthma,
CHF, ESRD, CAD, and low back pain. The capabilities of the PMT will advance further
over the coming year, so we encourage you to contact us and let us build a program
that is customized to your objectives and workflows.
NEW FEATURE
– Our PMT database can be synchronized with virtually any historical data
feed. If you have a historical feed involving: 1) non-claims clinical or biometric
data (from an EMR or registry), 2) prior patient management interventions, or 3)
a database of forms completed by patients in care management; we can integrate this
data into the PMT and make it available to your care management team. Just let us
know what information you want to import, and we'll work with you to get it done.
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AD HOC PROGRAMMING SERVICES
One of our greatest strengths is our knowledge of managed care data and the standardized
tools we have developed for extracting information from this data.
Let us save you time and money by putting these skills to work for you!
As part of your ManagedCare.com Reporting Agreement, you have access to our personnel
for up to 5 hours per month for analysis, queries, and custom report development.
If you don't use it, you lose it! Believe it or not, we want our clients to take
advantage of this service. It cements our long-term relationships, and these tasks
are often no more than 15 minutes work on our end. Even if you exceed the 5-hour
monthly threshold (and we'll always notify you in advance if this is a possibility),
our rates for additional time are still extremely reasonable ($125/hour). Because
of our expertise and efficiency in this area, we can almost always do the simple
stuff more cost-effectively than your own analytics staff.
OLAP
After considerable evaluation, we have "shelved" our OLAP project for 2008. Because
a highly effective OLAP interface must also have a fairly high degree of complexity/sophistication,
we are concerned that the user base for this application would be very limited.
We have opted to re-deploy these resources to a combination of:
- More aggressive marketing of our ad hoc analytical support, and
- Steadily expanding the structured drill-down options available in core reports
The next time you have a question that you'd like analyzed, please think of us.
If your question sounds anything like the following, don't wait on your IT staff
to put it in next month's request queue, get a rapid-turnaround answer from ManagedCare.com:
- I know what the national averages are, but what are best-practice use rates for
these services in other markets?
- Can you tell me what the utilization trends for these 3 providers have been for
the past 24 months?
- How percentage of the time does this type discharge result in a follow up ER visit,
and how does that compare to other organizations in this line of business?
- I need to see a report every month that tells me the following . . .
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WEB SITE REDESIGN
This week, we are rolling out a new version of the ManagedCare.com web site. Our
goal here is to continue to advance our image as a leading-edge technology company
and effectively present the benefits of our reporting solutions. While this development
may not offer immediate benefits to our existing clients, the longer-term impact
of a more [effective] marketing image is positive for all of us. We hope you've
noticed that more clients means more rapid advances in our product capabilities!
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HCC/RAF REPORTING
Many of our HMO clients are either planning an initial entry or expanding their
presence in the Medicare Advantage arena. Margins in this line of business have
narrowed in recent years, and are becoming increasingly dependent on the plan's
ability to accurately capture the severity of its population (and thus maximize
risk-adjusted revenue opportunities).
We know that many organizations are hiring expensive consultants or making permanent
staffing investments to ensure the sufficiency of their revenues in this area. Recognizing
this trend, we have been developing a set of tools in this area that we believe
will constitute a viable (AND FREE!) alternative. We have built an initial
methodology and a suite of reports that represent only a first step into this realm.
In the next several months, we will be rounding out both the sophistication of the
methodology as well as the range of presentations available to help manage the entire
process of Medicare revenue maximization.
Outline of Methodology
The following is an excerpt from our September, 2007 Medi-Cal Working Group Meeting,
from which this concept originally emerged:
- The initial methodology – of interviewing clinical experts and building customized
clinical logic for each HCC – was suspended after 4 interviews. Preliminary
findings suggested that this process would prove extremely laborious, and participants
were consistently pointing to the possibility of a more promising, purely quantitative
approach.
- We decided that a mathematical/"data mining" foundation could be developed that
would then be augmented with the specialized clinical input furnished by
the Medical Directors and other clinical experts.
- A subset of ManagedCare.com's Medicare risk data universe (approximately 250,000
members in the first pass) was isolated and utilized to develop the alternative
methodology
- First, individual HCC categories ("conditions") were correlated with "treatments"
(which could include individual CPT/HCPCS codes, revenue codes, and prescription
drugs). These individual treatments were characterized as potential "markers
" of a given condition.
-
These treatments were evaluated for:
- Prevalence – focusing on the particular condition, the % of
time that each treatment occurred in conjunction with that condition, and
- Exclusivity – focusing on the particular treatment, the degree
to which that treatment was exclusively associated with a single condition. Instances
of high exclusivity suggested that given markers were potentially robust indicators
of a particular condition
-
A preliminary model for accumulating patient-level HCC indications (essentially
a simplified Discriminant Analysis) was developed, tested and refined. Its basic
characteristics were as follows:
- The greater the number of markers for a specific patient/condition combination,
the higher the accumulated score (termed the CI – Condition Indicator –
score).
- The contributing value of any individual marker was a function of both its prevalence
and its exclusivity.
- Markers with fewer than 50 occurrences in the test data were rejected as statistically
unreliable
- Markers with both a high prevalence and a high level of exclusivity were utilized
to accumulate a total CI score for each patient/condition combination
- CI scores were manually evaluated to identify candidates for a final threshold value.
Below this total value, the patient/condition association was viewed as potentially
tenuous, while CI scores above this value could be judged as substantially reliable.
Clearly, the threshold value was not an absolute concept, but rather would be used
to define a continuum of certainty which could be selectively used by the organization.
All associations with CI scores exceeding the threshold level were captured as Probable
Patient/HCC Associations.
-
The previous methodology (utilizing "markers") was augmented by adding two additional
dimensions to the analysis:
- Adding prior period associations – for the vast majority of conditions,
the prior existence of that condition in the patient's claims history will suggest
that they should still be associated with that HCC. We therefore queried the prior
history of each patient and supplemented the marker-based methodology with these
additional patient/condition associations.
- Eliminating current period associations – if, using the standard HCC
methodology, the patient has already been connected to a particular condition, that
patient/condition association was eliminated from the listing of Probable Patient/HCC
Associations. There is obviously no value to a "probable" association when the association
has already been demonstrated in the current year's data.
- The final listing of Probable Patient/HCC Associations was presented by means of
a drill-down from the standard P-01 report. It presented all the patients in a physician's
panel for whom legitimate HCC associations may have been overlooked in the current
year's claims data. It included patient name, HCC, and the dates/descriptions of
each individual marker.
-
Among the ideas for refining the methodology, the following are were suggested,
and have been the subject of additional development work by ManagedCare.com:
- Prior period associations should delve deeper into the historical data (the initial
model looked only at the prior year's data) [COMPLETE]
- Current period associations should be augmented using the HCC categories provided
by CMS for patients who have joined during the preceding year [COMPLETE]
- Patients who have had no (or minimal) provider contacts during the past year should
be independently flagged for inclusion in the listing of patients requiring further
review. [COMPLETE]
- Further analysis is needed on the extent to which other HCCs may serve as
potential condition markers (e.g. a high % of diabetics also have hypertension)
- Additional report cuts will clearly be needed to support this program. Subsequent
discussions have helped to identify these priorities.
Initial Reporting Outputs
The following is a quick overview of the initial set of HCC/RAPS reports that we've
posted to clients' current report suites:
- P-29 report – summarizing the RAF "opportunity" by-PCP (this will equipped
shortly with a link to the physician-level KPI/report showing each member);
-
2 PCP dashboard KPIs:
- PCP HCC Risk Score (KPIP00010) – which summarizes the PCP's overall HCC score
compared to his/her peers
- HCC Summary (KPIP05001) – presenting a member-by-member listing of their current
HCC value (from claims) and the potential score provided all inferred HCC associations
were documented (this will equipped shortly with a link to the member dashboard
so that each member's HCC associations can be further explored)
-
2 member dashboard KPIs:
- HCC Summary KPI (KPIM05001) – listing the HCCs that are identified through
the current period's claims data as well as those which have been "inferred" using
either current period claims markers or prior period HCC associations
- HCC Detail KPI (KPIM05002) – describing the individual markers and dates leading
to the inferred associations
- Medicare HCC Summary Report (this will be on-line during January) –
an organization-wide view of the HCC scores with drill-through to the PCP and then
member levels. This will function in a manner virtually identical to the Q-01 and
Q-02 reports.
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PAY FOR PERFORMANCE SUPPORT
As the national P4P agenda continues to gain momentum, we are committed to building
the necessary tools to support our clients' needs in this area. We have a number
of exciting service enhancements that are already in operation, and many more that
will be introduced in the months to come:
California P4P
We provided – at no additional cost – complete P4P reporting and submission
to several of our California clients for the 2006 reporting year. We will continue
to offer this option for participants, so please consider allowing us to run the
calculations (and even submit the data directly to DDD) on your behalf.
In 2006, we participated in the NCQA certification process for the 11 measures in
the California/IHA P4P program:
- Childhood Immunization Status w/ 24 month continuous enrollment
- Appropriate Treatment for Children with Upper Respiratory Infection
- Breast Cancer Screening
- Cervical Cancer Screening
- Chlamydia Screening in Women
- Use of Appropriate Medication for People with Asthma
- Diabetes Care: HbA1c Screening
- Diabetes Care: HbA1c Poor Control
- Cholesterol Management LDL Screening (Includes Pts. w/ Cardiovascular Conditions
and Diabetics)
- Cholesterol Management: LDL Control <130 (Includes Pts. w/ Cardiovascular Conditions
and Diabetics)
- Nephropathy Monitoring for Diabetic patients
This initiative – the largest and most prominent P4P program in the country
– paid out over $55 million to California IPAs in 2006. While a host of others
(including CMS) are beginning to deploy P4P models across the nation, virtually
all have tended to adopt formats similar to the IHA model.
We repeated this certification process again in 2007 and are busy expanding our
support services in this area. In the 2007 P4P reporting cycle (using 2006 data),
we are supporting 3 California clients in their self-reporting process. We are using
our software to calculate the measures, producing the output files to submit to
the State-wide intermediary (Diversified Data Design), and supporting the all aspects
of both the reporting and associated audit processes.
P4P in Other Markets
We are also actively supporting P4P projects in many other states. We've got clients
in a wide range of markets including Louisiana, Georgia, Texas, Colorado, and Michigan
that have developed and deployed P4P programs. In all instances, we are playing
a key role in reporting results at the member, physician and organizational levels.
We're developing specialized KPIs, drill-through features, and even computing performance
bonuses for many of these initiatives. If your organization has an interest in moving
in this direction, please let us know. We are truly at the forefront of the national
trends in this area and would appreciate the chance to help you design and implement
an effective system.
Administrative Data Entry
NEW FEATURE
– To improve P4P results, it is imperative that the MCO capture data from
beyond their standard transaction data. Our HEDIS, P4P and PMT presentations are
now equipped with links that enable the user to input key clinical and other data
that improve (esp. HEDIS) outcome scores. The Clinical Data Entry screens:
- Allow the user to select a measure or chronic condition;
- Pick out the specific data element they are entering;
- Select from a drop-down list that is pre-populated with numerator and denominator
events (for instance, selection of diabetes prompts options for over a dozen related
data elements such as HbA1c, LDL level, blood pressure, BMI, aspirin use, depression
screening, etc.);
- Specify whether this service is intended for inclusion in HEDIS/P4P results; and
even
- Upload a scanned image (e.g. a copy of pertinent chart information)
These data are then available to the broader reporting system for calculating physician-level
performance scores, program outcomes, HEDIS/P4P rates, etc. Many of our clients
are already employing these features to build their administrative data repositories
– please contact us if this capability could be a useful asset in your 2008
initiatives.
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REPORTING ENHANCEMENTS/NEW REPORTS
Because we design and release several new report formats each day, it is
always a challenge to keep all our clients abreast of these developments. Many are
simple permutations of an existing format, and are thus provided only to the requesting
client. If we conclude that they are likely to have sufficiently broad appeal to
warrant release to all clients, we will generally do so. Since there have been too
many new reports introduced in 2007 to cover here, I will only hit some of the high
points.
General
The following are important advances that we've made during the past year that,
while not impacting any one report, have broad implications for improving the functionality
of our overall reporting:
- Expanded data capture – increasingly, we are receiving lab values,
pharmacy claims and other data from our clients. These data are essential ingredients
to supporting quality, DM and pay-for-performance programs, and enrich our reporting
options dramatically.
- New parameter options – an increasing number of reports are being equipped
with by-plan and by-region parameters (in the upper-right corner of the screen).
We are steadily adding them to existing reports and are making an effort to include
them in all future additions as well.
- Regional comparative reports – for clients who have multiple delivery
systems or regions (or in the case of MSOs, multiple downstream clients), we have
created a number of reports that side-by-side the performance of each. Many will
also include comparative benchmarking values (national) as well. Views like the
F-05R, H-02R and others – especially when exported to Excel – enable
the user to spot unusual utilization and outcome patterns within their organization.
- P4P presentations – as outlined in this section above, we have developed
a nearly "turnkey" solution in this area. We can immediately combine physician-level
dashboard elements with member-level drill-down, bonus calculations and organizational
summary reports and automate all aspects of program management.
Highlights – New Reports
We will make no attempt to cover the many dozens of new reports released during
the preceding year. Instead, let me merely point to a short list of the "best of
breed" reports/KPIs from all dimensions of our report package. Most of these should
already be part of your report suite, but it is possible that you've not yet had
an opportunity to put them to use. Please note that this list is in addition to the
HCC/RAF, HEDIS and other new reports described in preceding sections.
|
V-09 |
Specialty Mapping – a convenient reference tool for determining specialty
mapping conventions in the reports |
|
V-13 |
Claims Utilization Summary by-Month of Service (the V-14 is a 24 month view
of this same data) – provides a central source for most major utilization
and dollar volumes |
|
O-09 |
Membership Turnover Report – describes member continuity in terms of
% new and existing members by plan |
|
P-11 |
Lab Utilization By-PCP – utilization rates PMPY for key lab services |
|
S-10 |
Specialist Efficiency Report – listing of severity adjusted cost outcomes
in order of specialist performance |
|
S-13 |
Specialty Cost Trend – graphical display of $PMPM costs by month of
service (36 months) |
|
S-16 |
Top 50 Diagnosis Codes – total $ by-ICD9 code within each specialty
(ranked by total $) |
|
C-01C |
High Cost Patient Summary (Last 90 Days) – presenting the members with
the highest level of spending (no lag) for the most recent quarter. |
|
C-10 |
Top Controlled Substance Utilizers – highlighting patients with the
highest use of narcotics and other controlled medications |
|
C-20 |
New Member Encounters By-PCP – the C-20, C-20a and C-20b reports monitor
PCP contacts within their first months of eligibility (the C-20b is designed especially
for Medi-Cal organizations, and utilizes the Institute for Healthcare Advancement
definitions for both qualifying visits and patient eligibility testing) |
|
C-21 |
By-Patient Physician Visit Utilization – flagging members with unusually
high provider contact rates |
|
KPIM00009 |
Claims Detail KPI (Member Dashboard) – provides chronological detail
of all member claims for the preceding 3 years. This KPI is the first in a number
of direct links to the Claims Query Tool database that are actuated by a single
hyperlink.
|
|
KPIM00010 |
Member Diagnosis History (Member Dashboard) – provides the viewer with
a succinct summary of all the diagnoses that have been associated with the subject
member over the past several years. |
|
KPIM70001 |
HEDIS Measures – shows all the HEDIS measures which include the subject
member in the denominator, and their status on each. |
|
H-15 |
SNF Days by-Facility – a SNF utilization report that is identical to
the H-05 (bed days by facility) |
|
H-16 |
Admit Rates by-Month – graphical presentation of admit rate by month
for the past 3 years |
|
H-17 |
Bed Days Per 000 Trend – bed day/000 line graph, monthly for the past
two years |
|
H-18 |
ER Visits Per 000 Trend – ER visits /000 line graph, monthly for the
past two years |
|
R-10 |
$PMPM Cost Trend – total $PMPM cost trend by month for the past 2 years |
|
R-11 |
Scripts PMPM Trend – # prescriptions PMPM monthly for the past 2 years |
|
R-12 |
$ Per Script Trend – $ per prescription monthly for the past 2 years |
|
R-05 |
PCP Total Costs by Drug Class – profiling total $PMPM utilization by
drug class for a PCP's assigned members (including specialty comparisons) |
|
R-08 |
Generic Utilization by PCP – enables identification of physicians with
inefficient prescribing patterns |
|
R-09 |
Generic Utilization by Specialist – specialist version of the R-08 |
|
S-14 |
Multiple E&M Encounters (Same DOS) – useful for identifying unusual
and potentially fraudulent billing practices |
|
S-14C |
Multiple E&M Encounters (Comparative) – National and regional comparisons
of the S-14 data |
|
Medi-Cal |
Medi-Cal Benchmarking Reports – as an outgrowth of our Medi-Cal Working
Group, we introduced a specialized suite of nearly a dozen benchmarking reports
that are especially designed to provide aid code-level comparative data to California
Medi-Cal organizations. |
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DASHBOARDS (DBs)
General
All our dashboarding environments have now been equipped with a new configuration
screen (complete with instructions on its use). Please keep in mind that you must
provide an initial configuration to any dashboard you intend to view. This is generally
termed your "default stratification". Once configured, you will always see this
same listing and arrangement of KPIs in the dashboard – until such time as
you re-set it. If you do not have a default stratification set up (and the system
does not know what dashboard arrangement to show you) you will be sent to the Configuration
screen to set up your dashboard.
NEW FEATURE
– Most dashboards are now enabled to allow multiple configurations. You can
set up a different dashboard for Family Practice vs. Pediatrics, large vs. small
employers, and establish multiple, special-purpose views in the member dashboard
(asthma, mental health, stop-loss, etc.).
We are steadily expanding our use of "dashboards" as an option for presenting data
in a more elegant, summarized fashion – especially to users whose range of
interest may be limited to a particular or specialized area. Each dashboard environment
consists of a "bulletin board" that is then populated with individual panels called
"KPIs" (Key Performance Indicators). A KPI is a nothing more than a specialized,
often graphical summary of some aspect of the data.
The dashboards have the benefit of being both user-defined and user-specific (meaning
that each user can have a different layout in the dashboard). Our approach in each
area of dashboarding has tended to involve the development of an initial inventory
of core KPIs, followed by a continuous flow of new KPIs flowing from subsequent
client demand.
Organizational DBs
All clients should now have an Organizational Dashboard option on their menu nodes
(under the Org Performance tab – soon to be re-named "Executive Dashboard").
You will also find an initial inventory of KPIs to populate the dashboard. Please
note that you will have the option to load KPIs that may rely on data that you do
not present us (e.g. pharmacy KPIs will be blank if you do not provide us pharmacy
data). This environment is particularly useful for developing custom presentations
around key initiatives that you're pursuing in the year ahead.
The range of data objects will be expanding steadily, but please contact us if you've
got a particular idea for a KPI or to obtain instructions on using the Organizational
Dashboard.
Employer DBs
We made reference to this project in our 2006 announcements. Employer dashboarding
functionality for self-funded/ASO and fully-insured is now a reality. Much like
the physician dashboards ("report cards"), the employer version features an inventory
of nearly 50 standard KPIs (Key Performance Indicators) plus customized panels
as required. Individual employers can log in and view a wide array of data pertaining
to their premium outlays, cost and utilization structure, quality metrics, etc.
The data is updated at each reporting cycle, and you can create separate views for
small vs. large employers, self-funded vs. fully-insured.
Member DBs
We now also have a dashboard at the patient level (under the CM/DM Tools tab). You
can either cue the dashboard when you're viewing another patient-specific report
or you can use the member lookup feature. Current KPIs profile demographics, eligibility,
ER visits, drugs, hospital stays, a diagnosis summary, and a spending summary. For
members in the PMT, we're also introducing an increasing number of disease-specific
summaries and key indicators/program status KPIs. Some of the recent introductions
include:
- KPIM00009 (Claims Level Detail) – provides chronological detail for all a
member's claims for the past several years (which is easily exportable into Excel)
- KPIM7000(HEDIS Measures) – summarizes all the relevant HEDIS measures for
a patient,
- KPIM00010 (Member Diagnosis History) – profiles the number of claims submitted
for each diagnosis code over the past year.
We've added over 100 KPIs to the PCP inventory over the past year. A number of them
can now help to prioritize clinical care by identifying high-risk patients and patients
missing critical services (such as HEDIS-negative patients). If you're not giving
PCPs on-line access to this information today, considering working with us to configure
a program tailored to meet your needs.
NEW FEATURE
– Specialist DBs
We have set up specialist dashboards (and an initial set of KPIs to populate them)
for several clients now. As our 2008 development queue includes programming of the
74 PQRI measures recommended for physician (primarily specialist) quality profiling,
this environment will become increasingly robust throughout the year.
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CLIENT SERVICE INITIATIVES
Most of you have scheduled meetings with ManagedCare.com on no less than a monthly
basis. Invariably, these close working relationships result in our being able to
deliver the highest level of value to the client. They familiarize us with your
priorities and allow us to contribute our ideas/experiences, and design custom reporting
solutions to help facilitate your success. Over the years, we've developed a sophisticated
set of tools for tracking client initiatives and our role in supporting them.
For any of you who are not talking to us regularly, expect that we will be reaching
out to you in the next month or so. Our goal in 2008 is to establish a meeting rotation
(preferably every month at a minimum) with every client. There are only a
few of you who need this prompting, but we're asking for your cooperation –
and we promise to make these discussions worthwhile for you and your associates.
Thanks in advance for giving us the access necessary to make your relationship with
ManagedCare.com the best that it can be.
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WEB SPEED ENHANCEMENT PROJECT
We know that our application is a bandwidth "pig". It's reasonably snappy if you've
got a big pipe with plenty of capacity, but some of our clients compete for limited
bandwidth with other departments, organizations, etc. Many of our clients get the
best performance on their home cable or DSL service, which says a lot about the
priority that most organizations ascribe to investing in internet capacity! Nevertheless,
we're committed to helping improve this situation.
We have been working on a massive re-design of our web architecture since mid-2006.
What struck us initially as a fairly modest undertaking evolved into the most extensive
single project in our 8-year history. In the coming months however, this project
will finally (and thankfully) put to bed. We will be progressively releasing a completely
re-engineered web reporting model that will produce two major benefits going forward:
- Speed – through the use of client-side call backs, report page load
times should be reduced to 30-40% of previous levels (in other words, 2-3 fold speed
increase).
- Flexibility – we are implementing a dramatically more sophisticated
programming infrastructure that will allow for rapid and responsive creation of
new functionality in areas such as report parameters, drill-down options, mouse-overs,
"snap" presentations, etc.
We have determined that the roll-out of this new architecture will begin with the
Program Management Tool. PMT users have the most regular interactions with our reporting,
and have the greatest corresponding need for speed. We will be announcing the re-design
schedule for this application in the next month.
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DOCUMENTATION
As rapidly as we churn out new reports, we recognize that we don't always pay proper
attention to documentation (report notes, mouse-overs, client implementation summaries,
etc.). Please be assured that this has risen its way up the priority list in recent
months, and we are making steady progress toward our goals. We are adding documentation
to several new reports a week, and will be caught up in another several months.
If you go looking for information on the conventions behind a report and don't find
what you need, please drop us a quick e-mail (e.g. "document the counting convention
in the C-16 report"). We'll take the hint and move that one to the top of the queue.
In the meantime, we'll keep working on the inventory of the existing reports, and
documenting all new versions as they're released.
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