The power of data organization and standardization

The Delaware Valley Accountable Care Organization (DVACO) aims to deliver better healthcare at a lower cost to around 250,000 members in the Greater Philadelphia region.

DVACO is currently the region’s largest ACO, with more than 2,000 primary care physicians and 250,000 attributed patients. DVACO participates in the Medicare MSSP program, and six additional risk-based contracts including commercially insured and Medicare Advantage populations.

Every month, DVACO receives 150 claim files across six contracts. These files all come from several sources and in various formats.

The challenge

DVACO recognized a need for better data management. Every month, DVACO receives 150 claim files across six contracts. These files all come from several sources and in various formats.

The approach

The organization turned to the comprehensive data warehousing and analytics capabilities of Milliman MedInsight to tackling the multitude of input files into cleaned data ready for analysis.

DVACO has developed and maintains a data warehouse that houses data derived from claims, clinical feeds and other misc. data sources. In their partnership with MedInsight, they receive ingestion and standardization of their claims data, a standardized file to populate their data mart, and the ability to use their own analytics tools and resources to interpret that data in various ways depending on different business needs.

Analysts at MedInsight receive all 150 claim files each month, process them, and put them into a single standardized format. After this thorough cleaning process, MedInsight runs groupers to add site of care designations, benchmarks, risk scores, and several other key analytic measures. Then, MedInsight returns to DVACO a comprehensive data mart, which the organization can use as a platform for its own data analysis and distribution.

Grouping patients by level of risk to provide better care

In addition to cleaned and standardized data, these data mart files contain MedInsight’s powerful grouping categories, particularly Milliman Advanced Risk Adjusters (MARA), a proven methodology for analyzing patient claims and predicting the level of risk for each patient.

DVACO uses the MARA risk score, combined with their own algorithm, to put patients into seven distinct risk bands, ranging from very low to medium, to extreme risk.

Clear communication with clinicians

DVACO uses the data mart they receive each month from MedInsight to distribute high quality, standardized data to their providers via three main channels: ADT (real-time) workflow, EMR roster/claims to tag patients in different contracts, and a cloud-based business intelligence reporting tool.

Tracking key metrics of performance

In addition to using the data mart provided by MedInsight to inform physicians at the point-of-care, DVACO also uses it to create provider scorecards, a series of reports tracking key metrics and targets that have been set across their different contracts.

The solution

The process

DVACO

• Sends 150 claim files over six different contracts, all in different formats, on a monthly basis

Milliman MedInsight

• Collects, cleans, integrates, and standardizes data across all 150 files
• Sends back a comprehensive, standardized data mart containing claims data and
• The MARA risk score and other rich groupers that allow for classification of data to meet different business needs

DVACO

Uses that data mart to analyze and push out information to clinicians in its system via channels such as the EMR and care management systems

Outcomes

At the point-of-care, access to quality data enables clinicians to provide more efficient high-value care to the patients who most need it.

Retrospectively, provider scorecards help them stay on track with key metrics and find opportunities to provide more efficient, lower-cost care to patients.

Better data management

“Having MedInsight enriched and cleansed claims data in a consistent data mart format provides us with a foundation to aggregate our individual contracts into a single multi-payer dimensional model. This allows us to provide powerful analytical capabilities to our stakeholders enabling them to see broad population health trends, as well as the capability to drill through into individual contracts layers down to regions, practices and even further into patient level detail,” says Robert Kagarise, Vice President of Operations at DVACO.

Grouping patients by level of risk to provide better care

Grouping capability helps clinicians identify which patients are at relatively high risk, so they can add services, keep up to date with their appointments, and ensure chronic conditions are not left unchecked.

“A lot of our workflow is real-time,” says Mary Tun, manager of data governance and integration at DVACO. “The MedInsight risk score helps us stratify,” enabling providers at the point of care to instantly know each patient’s risk level. This ensures they can focus on the highest-risk patients first and allows them to provide the highest-value care in a more efficient way.

Clear communication with clinicians

With the data standardization that MedInsight provides, DVACO can communicate clearly with their providers about how best to treat patients, regardless of which contract those patients fall under. This transparency and clarity around complex clinical data helps providers deliver the same high quality of care to all their patients.

By loading data processed by MedInsight, DVACO can flag medium to high-risk patients and get alerts when they show up at different places within the healthcare system.

Additionally, the standardization of MedInsight allows files from DVACO to be easily pulled into their EMR system. This facilitates key ACO functions like risk scoring, registries, and reports. Additionally, access to comprehensive claims data within the EMR ensures that care coordinators have a complete picture of all the care the patient has received up to that point.

Tracking key metrics of performance

With this retrospective analysis of data, DVACO can let their doctors know exactly how they have been performing relative to these benchmarks and highlight areas for future focus.

Going forward, DVACO plans to increasingly leverage MedInsight to drive cost-savings initiatives, particularly around the Medicare Shared Savings Program. “It’s about making MedInsight [data] actionable to clinicians,” says Robert Kagarise. “Serving up information to the right person at the right time and place, so they can make better decisions when treating patients.”