Data-Driven Solutions That Optimize Government Health Plans and Transform Organizational Performance

HealthEC is dedicated to improving patient outcomes and reducing costs by revolutionizing how healthcareforMedicare and Medicaid populations is delivered, managed and monitored in the digital age. Our comprehensive system empowers government health plan leaders and their partners with aggregated data fromall sources (including claims, clinical and community-based), next-level analytics, and optimized care coordination solutions – providing a platform for managed care organizations and the state to share the same data and deliver care in the most efficient and cost-effective manner.

Armed with cutting-edge technology, real-time data and access to HealthEC’sexpert advisory services, the system allows health plan leaders to compare performance across providers, health plans and MCOs, using regional, state and national benchmarks.

Users gain uncommon industry insightsand have the unmatched flexibility to implementkey functions, including:

  • Evaluating plan and provider performance across clinical, financial and operational metrics
  • Detecting fraud and abuse
  • Identifying beneficiaries for targeted care programs
  • Generating reports in real-time for quality improvement initiatives and data submission requirements
  • Developing risk management strategies and quality programs based on population demographics

Building Modern Data Warehouses

HealthEC is a valuable partner in aggregating data into an enterprise data warehouse. Our data analysis tools can be used to evaluate performance across financial and utilization metrics, assess quality scores, and facilitate care coordination for patients with two or more chronic conditions. By transforming data into actionable reports, HealthEC empowers health plan leaders to make clinical, quality, and business decisions based on data that has been properly attributed, benchmarked, and calculated.


Expediting Data Analysis to Inform Quality Programs

Our platform delivers real-time financial, operational, utilization, and clinical analysis. It supports executives monitoring the performance of MCOsand providers, and measures cost, utilization and compliance. Key analytical insights include:

  • Member distribution across plans/MCOs, providers and organizations
  • At-risk member identification and risk level determination
  • Gaps in care identification
  • Utilization metrics across quality programs such as Health Homes, Quality Improvement Project (QIP), Chronic Care Improvement Program (CCIP), etc.
  • Identification of beneficiaries that are eligible for quality programs, such as those with multiple chronic conditions
  • Member behavior prediction
  • Beneficiary engagement

Evaluating Performance Across Providers, Health Plans and Managed Care Organizations (MCOs)

HealthEC’s flexible system allows users to compare providers, organizations, health plans and MCOs across regional, state and national benchmarks.

We support a wide variety of cost/utilization metrics and measures that cover programs such as Healthcare Effectiveness Data and Information Set (HEDIS), Medicare Shared Savings Program (MSSP), Merit-Based Incentive Payment System (MIPS), Health Homes, Prevention Quality Indicators (PQI), National Quality Foundation (NQF), National Committee for Quality Assurance (NCQA), and Accountable Care Organizations (ACOs). The solution supports comparisons at all levels – from health plan to health plan, organization to organization, organization to practice, practice to provider, and provider to members.

Results are displayed on richly populated dashboards that highlight quality metrics and benchmarks at the provider, practice, organizational and health plan level. This translated data enables well-informed discussions with health plans/MCOs and providers. Examples include:

  • Compliance by quality measure with comparison to benchmarks
  • Enrollment, which can also be sorted by health plan
  • Gaps in care identification
  • Visits/encounters including ER visits, admissions, and home health visits – all of which can be analyzed by month and year-over-year
  • Financial data including total spend and cost per type of care (ER visits, ancillary services, tests, etc.)
  • Pharmacy data

Optimizing Care Coordination

HealthEC’s analytics-driven care management dashboards and patient-specific workflow prompts promote high-priority care interventions to drive patient engagement and smarter resource utilization. The tool consolidates all relevant clinical and claims data to summarize the patient’s programs, any gaps in care, current medications, upcoming appointments, admissions and discharges, problem lists, goals and barriers. Built-in resources include social determinants of health assessments, care team task assignment tools and value-based care program reporting assistance

BECAUSE TRANSPARENCY MATTERS
HealthEC empowers government health plan leaders with high quality data to:
  • Evaluate plan and provider performance across clinical, financial and operational metrics
  • Detect fraud and abuse based on beneficiary’s diagnosis and documented care
  • Identify beneficiaries for targeted care programs
  • Generate reports in real-time for quality improvement initiatives and data submission requirements
  • Develop risk management strategies and quality programs based on population demographics



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