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Health Endeavors' Direct Contracting Entity (DCE) Program:

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Network Manager:  Patient Rosters and Hierarchy

Network Manager

Network Manager provides a platform for clients to determine how they want to view their quality and financial performance metrics.  DCE rosters were delivered to the 4i data hub in January 2021 for implementation period participants.

Financial Network Performance:  Analytics Dashboard

PCF Financial Peformance

  • We generate Analytics Dashboards using Medicare CCLF claims data (monthly 4i data hub feed referenced above) (estimated timeline to populate analytics once data is received is 1 week).   

    • –Features (View Video Series)

      • Analytics Dashboard:  Risk stratification and benchmarking using hierarchy defined by client.

        • Drill down to Provider Quality and Financial Performance Scorecard​

      • Aggregate Expenditure and Utilization Interactive Tool

      • Query Builder

        • Define your own reports using a query builder tool​

      • Visual Drill Downs

        • HCC Recapture Rate, Lost Revenue, Benchmark​

      • Quick Reports

        • Admissions, Readmissions, Emergency Room utilization and more

        • Out-of-Network Migration

        • Acute Hospital Utilization (AHU) Quality Measure

        • DCE Monthly Provider Patient Alignment Reconciliation Report: monthly reconciliation of actively aligned, actively aligned -newly added, removed, and deceased on a month-to-month basis using negotiated rate provided by client.  PDF friendly statement available for distribution to providers. 

        •  DCE Performance Report: Estimated capitation payment based on 3% of benchmark, risk score, financial benchmark vs. actual spend and PQEM in-and-out-of-network.

        •  DCE PQEM Patient Level: In and out-of-network PQEM alignment code tracking.

Quality Network Performance:  Performance Scoring, Gap Analysis, Provider Scorecard

Quality Network Performance

  • To ensure that DCEs meet the model goals of improved quality of care and health outcomes for Medicare beneficiaries, the Direct Contracting Model will include the assessment of quality performance during each of the performance years. The quality strategy is designed to provide achievable performance criteria that incent the care delivery transformations necessary to reduce unnecessary utilization while maintaining quality of care.

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  • The proposed quality measures for the PY 1 are as follows:

    • Core Set 1. Consumer Assessment of Healthcare Providers and Systems (CAHPS®) for Accountable Care Organizations (ACOs) surveys.

    • All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (Claims Based)

    • Risk-Standardized All Condition Readmission (Claims Based) 

Patient Lookup - Data Point of Care

Patient Lookup- DPC

  • Setup Medicare 4-year health history accessible in the EHR (point of care) or via PatientLookup.com

    • Why?

      • A 4-year health history refreshed every 7 days in the EHR or PatientLookup.com will assist your team with PCF success by using HCC Coding Assist, Risk Score, Benchmark, Cost and Utilization features during patient encounters (View Video Series).  

      • What we need to complete this task

        • Retrieve Medicare PCF patient roster and CCLF claims files for Part A, B, and D from 4i data hub and remit to Health Endeavors using SFTP.  Contact Tim@healthendeavors.com to setup SFTP account.  In the alternative, add Kristine Gates, 8955 E. Pinnacle Peak Rd, Suite 103, Scottsdale, Arizona 85255, gates@healthendeavors.com, 480.912.1209 as a contact in your 4i portal to obtain access directly to the Medicare CCLF claims files

        • Setup ConnectMyEHR kickoff call (estimated timeline is 6 weeks to complete EHR integration) and review your EHR Project Plan.  Request Here​

Select Security Official

Who is your Security Official?     

Identify the person(s) that will be responsible for managing users in our My Team solution

Security Official Information 

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