ACO Insight


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Dynamic reporting interface provides claims data insight to Medicare accountable care organizations

Background

The Center for Medicare and Medicaid Innovation (CMMI) accountable care organization (ACO) programs, including the Medicare Shared Savings Program (MSSP) and Next Generation ACO Models, are intended to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes. ACOs entering into these value-based payment arrangements have an opportunity to share in the savings generated.

As part of these shared savings programs, CMMI provides monthly claim and claim line feed (CCLF) data files and beneficiary assignment files to all participating ACOs. Using this data to understand opportunities for efficiently managing the cost and quality of the care provided to an ACO’s population is essential in order to be successful under these shared savings arrangements. Milliman has the expertise to process and analyze claims data to support ACOs in identifying opportunity for more efficient population management.

Milliman's monthly reporting interface

Milliman has developed a dynamic claims data reporting platform for ACOs in QlikView (a web-based data visualization and guided analytics interface). ACOs can log into their online portal at their convenience and access our comprehensive reports, which are updated monthly. These reports include detailed claims summaries of the data contained in monthly CCLF files. Also included are Milliman-developed benchmarks for over 80 service categories, including post-acute services by diagnosis related group (DRG). Table 1 summarizes the detailed reports included in ACO Insight.

Report functionality

ACO Insight is unique in that it allows the user to control the various views of data presented. The user can filter data based on the time period, beneficiary enrollment type, region, or physician group. The entire interface will dynamically adjust to meet the needs of the user based on a simple and straightforward set of filters.

Dashboard Included reports
Summary
  • Demographic information by enrollment type
  • Costs and trends by high-level service categories (IP, SNF, professional, etc.)
  • Cost distribution summary
  • Chronic condition cost summary
Utilization and cost by service category
  • Cost and utilization models with benchmarks (80+ categories)
  • DRG utilization details
  • Service line detail and trends
  • Utilization reduction impact
  • Leakage reports
Potentially avoidable services
  • Utilization and cost for ED visits, preventable versus non-preventable
  • Utilization and cost for preference sensitive and ambulatory care sensitive admissions
  • End of life metrics
  • Waste Calculator
Post-acute care (PAC)
  • Inpatient discharge by site of service
  • SNF & home health volume and costs by facility
  • PAC utilization and cost by DRG compared to benchmarks
  • PAC readmission rates and cost by DRG

Next Steps

For more information, contact: