ACO utilization & cost evaluation

ACO Insight

ACO Insight is a dynamic reporting interface that provides claims data insight to Medicare Accountable Care Organizations

Milliman ACO Insight

Overview

Features

Services

Get better answers from your data

Milliman’s ACO Insight reporting interface provides claims data insights to identify opportunities for efficiently managing the cost and quality of care provided to Medicare, Medicaid and commercial ACO populations.

Users can analyze utilization patterns over time and drill into the detail of individual patient cohorts to identify cost savings opportunities. This web-based data visualization tool contains a number of pre-defined data views along with benchmarks, where available. Users can log on to the interface at their convenience and access personalized, comprehensive reports prepared by Milliman.

FEATURES

Interactive dashboards give you full control

ACO Insight allows the user to control the views of data presented using a simple and straightforward set of predefined filters customized for each client population.

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.

Services