Analytics
Welcome to the Analytics Overview Page. This page will give an overview of the most used Analytics tools used in Health Endeavors. Click on the tabs below to review each section.
Analytics Dashboard
Analytics Dashboard Key Terms
Click here to download a Key Terms PDF
Patient Population Dropdown: Select the patient payer population you want to view, e.g., Medicare, Medicare Advantage, Self-Insured Employer, Commercial or Medicaid. You may only select one population at a time.
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Effective Period Dropdown: Select the period for the patients you want to view e.g., the active/attributed patients during that period. Effective periods apply to Accountable Care Organizations (ACOs), Primary Care First (PCF), and Direct Contracting Entity (DCE) but not commercial populations as it shows only the most recently imported membership list. Effective Period is intended to display patients for the time period selected and the current year of data unless the Data Year is changed to a different year.
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For ACOs:
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QASSGN: A quarterly assignment file supplied from CMS. Note this naming convention was used for Q4 2018 or prior.
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QALR: A quarterly assignment file supplied from CMS. Note this naming convention started in Q1 2019 and after.
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HALR: An annual assignment file supplied from CMS. Note this naming convention started in 2019 and after.
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For DCEs:
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Year MMonth example is 2021 M12 for December 2021
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For PCFs:
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Q1, Q2, Q3 and Q4
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Data Year Dropdown: Select the year of claims data you want to view, e.g., selecting 2021 will show claims from 2021 calendar year. Data Year is intended to display the data for the year selected. To select patients, use the Effective Period Dropdown.
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Aggregate Expenditure & Utilization: This button allows the user to drill down to the interactive Aggregate Expenditure & Utilization tool.
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PAC Dashboard: This button allows the user to drilldown to the PAC and SNF Dashboards.
Displays aggregated data at the access level. For example, a Master ACO user will see the bar for all ACO participants combined or a commercial Master user will see data for all commercial participants combined. A clinic or facility user will only see aggregated data for their assigned patients.
Provider NPI Analytics Buttons: Display aggregate data at the National Provider identifier (NPI) / individual provider level, Subgroup / location level, Tax Identification Number (TIN) / facility level, or Division level.
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View NPI: View individual providers within the organization. A provider or NPI is the specific provider billing under the given National Provider Identifier.
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View Subgroup: View groups of NPIs setup in a group, created in the Network Manager.
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View TIN: View Individual Facilities designated by a Tax Identification Number (TIN). A facility is a single TIN with access to all provider data under the TIN.
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View Division: View groups of facilities setup in a group, created in Network Manager.
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All Patients - This button will bring users to the Patient Master Dashboard showing all patients that make up data in the Analytics Dashboard.
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Columns - The columns button allows the end user to define the columns to view.
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Export to Excel - Export to Excel to view the filtered information.
Division, Facility/TIN, Subgroup, and Provider/NPI networks are configured by your organization to better organize and group the many practices and providers within it.
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Division: A group of facilities. This column has a "Contains" filter. Type in a portion of the division name and the solution will filter and display.
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Subgroup (Facility Location): E.g., a TIN may have 2000 patients and 5 locations. This column has a "contains" filter. Type in a portion of the subgroup name and the solution will filter and display.
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Practice Name: Name of the practice for the shown NPI
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Provider/NPI: A specific provider that is billing under the given National Provider Identifier.
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NPI Utilization: Clicking on the NPI number allows a drilldown to the aggregate expenditure and utilization benchmarks for the NPI. ​
Scorecard: Click scorecard 'Go' button to view the scorecard for the organization, NPI, Subgroup or TIN shown. The scorecard shows financial and quality performance for the hierarchy selected.
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KPI Suite: Click KPI Suite 'Go' button to view the KPI Suite for the organization, NPI, Subgroup or TIN shown. The KPI Suite shows financial performance and identifies targets for health outcome improvement, cost reductions and more.
#No. Patients with Claims: Shows the number of patients that are active/attributed and have claims data. Patients with no encounters or that have opted out of data sharing will not display in this number. Click No. Patients with Claims to view the Patient Master Dashboard with those specific patients shown.
#No. Patients Opted Out: Shows the number of patients that have opted out of data sharing. Click No. Patients with Claims to view the Patient Master Dashboard with those specific patients shown.
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#No. Costly Patients: Patients costly today or trending to be costly in the future. Risk score in the top 30% this year or previous year, 1 or more hospitalizations in last 12 months, 3 or more emergency department visits in the last 24 months and 3 or more chronic conditions. Click No. Costly Patients to view the patient Master Dashboard for those specific patients.
Hospital Benchmark: The ratio of observed (actual) versus expected (benchmark) of hospital discharges. A negative number indicates below the benchmark (green color) and a positive number indicates above the benchmark (red color) for acute hospitalizations. Clicking on the number in a row will bring you to the Acute Hospital Utilization quick report for review.
Average Hierarchical Condition Categories (HCC) Risk Score: The Average HCC risk score for the assigned patients calculated for TIN, Subgroup or NPI. An average above 1.5 is a moderately sick population. An average above 2.0 is a very sick population. Click on the button to expand to past year scores. The risk scores are calculated using the diagnoses for the year displayed.
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Current Year HCC Risk Score: The average HCC risk score for the assigned patients calculated for TIN, Subgroup or NPI. An average above 1.5 is a moderately sick population. An average above 2.0 is a very sick population. The risk score is calculated using the diagnoses for the current year. Diagnoses not captured in the current year are not included in the current year risk score.
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HCC Diagnosis Recapture Rate: A comparison of the current year to past year recaptured HCC diagnoses codes. This column displays the total percentage of HCC diagnoses (recurring chronic condition codes) that have been captured again in the current year. Clicking on the button here will drill down to a quick report for additional review.
HCC Risk Score Change: Selected year risk score compared to the prior year.
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HCC Spend Allowance YTD: The financial benchmark calculated using the HCC Risk Score for the Organization, TIN, Subgroup, or NPI based on the Average HCC Score for assigned patients.
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Year to Date Average Per Patient Spend: Average year to date per patient spend for Part A and Part B (including DME) but not including Part D for assigned patients to a TIN, Subgroup or NPI.
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Percent of Spend Allowance Used YTD: Percentage of financial spend benchmark used year to date. What has actually been spent vs the total HCC benchmark.
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Benchmark Leakage: Loss in benchmark caused by not capturing a diagnosis in the performance year that existed in your previous benchmark years.
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Spend Allowance Predictor: A warning symbol indicates our algorithm is predicting the actual spend will exceed the financial benchmark before the end of the current year.
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Change in Spend (per patient): The per patient for the selected year as compared to the prior year.
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AWV Completion: The percentage of Annual Wellness Visits (AWV) completed during a rolling 12 months from Claims through date. You may click on the button to drill to the incomplete patients.
Switch Companies: Sometimes an organization has subsidiaries, sister companies, or companies they may merge with in the future for ACO and commercial lines. When they want the company accounts separate, this option allows the assignment of company access.
Provider Performance Scorecards (Smart Scorecard)
Quick Data Tools
Use the process outlined in this user guide to run reports on the Quick Data Tool for Medicare or Commercial populations.
Aggregate Expenditure and Utilization
In this user guide, you will learn how to use the Aggregate Expenditure and Utilization report.
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The purpose of the Health Endeavors aggregate expenditure and utilization is to provide a specialized charting report with a drill down to the division, TIN, Subgroup and NPI level based on the Medicare aggregate quarterly reports. The Medicare quarterly report only provides numbers at the ACO level. By utilizing this report, you are able to refine data down to more specific organizational levels.
FAQs
Q: How is the HCC score being calculated in Health Endeavors?
A: Risk Score = Patient Demographic Score + Health Status
Health Status are the weight of each HCC diagnosis assigned to a patient
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The demographic variables include:
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Age as of February 1st of the payment year.
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Sex of the beneficiary
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Disabled Status results in the inclusion of additional factors in the risk scores of community residents who are disabled beneficiaries under 65 years old.
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Original Reason for Entitlement results in the inclusion of a factor in the risk score for beneficiaries 65 years of age or older who were originally entitled to Medicare due to disability; the factor differs by the age and sex of the beneficiary.
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Medicaid Eligibility results in the inclusion of an additional factor in the risk score.
Q: Why are my deceased patients showing as living in Health Endeavors Database?
A: There are one or more patients who are deceased according to CCLF claims data or the QALR file, but this is not being updated in the Health Endeavors Database. The deceased status of a patient can sometimes be switched back and forth depending on what the CCLF and the QALR files say during imports. Their status is based on the most recent file of these two that are uploaded. Typically, the deceased status is confirmed and saved permanently by the next CCLF monthly claims import.
Q: Why does my patient have a { symbol in their Health Insurance Claim Number (HICN)?
A: According to CMS, the { character denotes a Railroad Retirement Board Beneficiary. For these beneficiaries you have received the internal RRB HICNO. They do not use a SSN as their Medicare HICN.
Q: Why is the PMPM Amount Different in the Historical Goal Benchmark (Summary by TIN & NPI) and PMPM Claims Summary (Summary by TIN & NPI) Quick Reports run on the same day?
A: Historical Goal Benchmark = Part A + Part B + Part B DME Spend for Attributed Patients / # of patients we have spend numbers for / # of Months that we have claims for.
PMPM Claim Summary = Part A + Part B + Part DME spend for attributed patients / member months (we check for each patient how many months they actually had in the reporting period)
Q: What do I do if my patient's profile information is incorrect?
A: First, check the following: Is the patient's information incorrect in CMS data? Or, was the patient manually added and the information entered is incorrect?
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If the patient's information directly from CMS is incorrect: Have the patient reach out to Medicare directly to correct the information. The patient is required to contact CMS in order to fix this issue with their profile data.
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If the patient was manually added into Health Endeavors and the information was incorrectly entered: Please submit a Submit a Request to send in a ticket and have this information corrected. As a general rule, please double-check patient data carefully before adding a patient into the system.