Multiple ways to view your data
ACO Insight provides various reporting views that the user has the ability to control through numerous filters. The user can filter data based on time period, demographic characteristics, provider group or region, or other criteria.
High level summary
The high level summary includes population characteristics such as counts, risk scores, and annual per member/beneficiary costs.
Claims utilization & expenditures
Comparing utilization of a selected service category to benchmarks provides an ACO with the ability to evaluate whether there is a feasible opportunity to reduce utilization for that service. In order to credibly compare ACO performance to benchmarks, the benchmarks are risk- or demo-adjusted at the service category level to reflect the risk/demographic profile of the ACO’s assigned population.
Leakage by Service Category
This report allows users to identify the services with high out-of-network utilization. Users can drill into particular service categories to examine the providers patients are seeing out of the network or ACO.
Post-Acute Care (PAC)
These reports provide details on PAC episodes of care, with views that include PAC episode costs by anchor hospitalization DRG, utilization and costs by PAC category (e.g., skilled nursing facility, home health) and comparisons to Milliman-developed PAC benchmarks. Users can drill into PAC categories or episodes by DRG family to better understand not only what is driving costs but also the potential opportunity for savings.
Chronic conditions
Patients are flagged with common chronic conditions or potentially disabling conditions through historical claims-based algorithms based on the CMS Chronic Condition Warehouse (CCW) that look for specific diagnosis codes in the prior 12 months. The reports provide population-based statistics such as prevalence, risk scores and costs for these cohorts as well as individual member detail. Users can view any report within ACO Insight for a particular cohort of patients based on selected chronic condition(s).
Prescription drugs
The pharmacy dashboard details drug utilization, adherence and cost, if available, for prescription drugs. Drugs are classified as chronic or non-chronic and grouped by drug class or non-proprietary drug name. These pharmacy reports allow users to analyze high drug utilizers as well as utilizers who are less adherent to their drug regimen.
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