HEX MassHealth Community Partners

HEX MassHealth Community Partners (CP), built from the ground up to support MassHealth CPs and ACOs, is a cloud-based Enterprise Data warehouse (EDW) and Business Intelligence (BI) platform that ingests data from MassHealth claims files and integrates it with EHR data and other systems in the CP ecosystem. The front-end Analytics layer visualizes these data for Operational needs as well as the Analytics needs using a very intuitive and informative interface.

HEX MassHealth CP is being used by CP and ACOs to obtain timely and actionable insights that their leadership depends on every day to drive real performance improvement in how they care for patients and effectively manage resources.

For MassHealth ACOs and CPs that are embarking on capitated or shared savings managed care models, Hexplora provides a comprehensive overview of their population health, cost, and utilization trends at the ACO, CP, Provider, and individual member level.

HEX CP Management consist of the following:

  • CP Operational Analytics
  • CP Claims Analytics
  • CP Quality Analytics

CP Operational Analytics

Operational Analytics consists of dashboards namely Activity Trends, Team Metrics and CP Summary for both BH and LTSS population to show trend of various activities performed by the CP and CP Clinicians, trend and aggregation of Participation Forms signed, BH Assessments, Signed Care Plans and Summary Reports with all CP metrics in a format that can be used to directly report to MassHealth.

CP Claims Analytics

All the Claims Analytics are based on MassHealth provided Medicaid Claims. Claims Analytics consists of dashboards namely PMPM Trend, PMPM Details, ER visits by Member, Admit Trend by TIN, Readmissions Trend and Drug Utilization. This also includes various Reports that shows deep insights using claims data from Medicaid. These reports can be effectively utilized to see the trends and the utilization patterns over different periods in time and also see the effect of the any care management programs that are introduced by the CP in the future. The claims analytics dashboards provide insights into the total cost of healthcare as well as Utilization metrics stratified by many dimensions like ACOs, Plans, PCPs etc. The self-service dashboards provide for ease of use and useful interactivity. Many important metrics are provided on the Org. dashboard that give details of the Member Months, Admissions, ER visits. The algorithms behind all the metrics is derived from CMS provided specifications.

CP Quality Analytics

All Quality Analytics are based specifications provided by MassHealth. Quality Analytics consists of dashboards namely Score Summary, CP Quality Claim Score Summary and Gaps Member and Events. These help to identify care gaps, compliance trends, stratification of members across categories, condition trends, risk scores, members and events identified as Gaps by quality measures algorithms. The measures rely on NCQA HEDIS specifications. The star rating of the measure is calculated using the algorithms given by CMS and are typically used for Medicare line of business that have been applied here for reference.