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

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Overview

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.

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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.

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High level summary

The high level summary includes population characteristics such as counts, risk scores, and annual per member/beneficiary costs.

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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.

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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.

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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.

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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).

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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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Services

Services related to ACO Insight

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Products related to ACO Insight

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Model, establish, and measure medical management outcomes to achieve performance targets and make sound decisions.

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Bundled Payment Reporting Interface

Manage episodes of care under Medicare bundled payment models using the same logic and claims data employed by CMS.

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Want to learn more about ACO Insight?

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Insight

Industry insight

Topics

Alternate payment models

Explore all expert thinking from Milliman related to alternate health care payment models

White paper

"Pathways to Success" MSSP final rule: Faster movement to downside risk increases focus on reducing population costs

This paper focuses on supply management and, in particular, data mining tactics that identify medically unnecessary services.

Read the paper

White paper

"Pathways to Success" MSSP proposed rule: Beneficiary assignment

This paper highlights the distinct trade-offs between the two beneficiary assignment methodologies in the CMS Pathways to Success proposed rule.

Read the paper

White paper

"Pathways to Success" MSSP final rule: Key revisions to the proposed rule

Key changes in the final Centers for Medicare and Medicaid Services Pathways to Success rule compared to the proposed rule.

Read the paper

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Resources

ACO Insight resources

Brochure

ACO Insight Reporting Interface

Download PDF

Issue brief

Why accurate claims coding for MSSP ACOs has become increasingly important

Download PDF

Research brief

Preference-sensitive surgical procedures for preference-sensitive conditions

Download PDF

Issue brief

The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences

Download PDF

ACO Insight

Milliman ACO Insight

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Get better answers from your data

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Interactive dashboards give you full control

Multiple ways to view your data

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High level summary

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Claims utilization & expenditures

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Leakage by Service Category

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Post-Acute Care (PAC)

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Chronic conditions

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Prescription drugs

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Services related to ACO Insight

Actuarial consulting: healthcare

Advanced analytics for accountable care organizations

Financial projections

Medicare ACOs

Stop loss/reinsurance/capital requirements

Benchmarking

Data analytics support, contract reconciliation/settlements

Physician incentive models and surplus distribution

Operational consulting

Value-based reimbursement strategy

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Products related to ACO Insight

MedInsight

ACO Care Management Impact Model

Bundled Payment Reporting Interface

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Want to learn more about ACO Insight?

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Industry insight

Alternate payment models

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"Pathways to Success" MSSP final rule: Faster movement to downside risk increases focus on reducing population costs

"Pathways to Success" MSSP proposed rule: Beneficiary assignment

"Pathways to Success" MSSP final rule: Key revisions to the proposed rule

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ACO Insight resources

ACO Insight Reporting Interface

Why accurate claims coding for MSSP ACOs has become increasingly important

Preference-sensitive surgical procedures for preference-sensitive conditions

The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences

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Contact us

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Milliman ACO Insight

Get better answers from your data

Multiple ways to view your data

High level summary

Claims utilization & expenditures

Leakage by Service Category

Post-Acute Care (PAC)

Chronic conditions

Prescription drugs

Services related to ACO Insight

Actuarial consulting: healthcare

Advanced analytics for accountable care organizations

Financial projections

Medicare ACOs

Stop loss/reinsurance/capital requirements

Benchmarking

Data analytics support, contract reconciliation/settlements

Physician incentive models and surplus distribution

Operational consulting

Value-based reimbursement strategy

Products related to ACO Insight

MedInsight

ACO Care Management Impact Model

Bundled Payment Reporting Interface

Want to learn more about ACO Insight?

Industry insight