Milliman has worked with several clients to support the reporting and data analysis processes for Patient Centered Medical Homes. This is a brief discussion of one such client. We recommend you stay tuned to Milliman MedInsight for an upcoming white paper for additional information and detail of this project.
This particular patient centered medical home targets a population identified for utilizing extensive services due to serious illness or chronic disease. One of the primary goals for this PCMH Reporting Project is to provide physicians with actionable information to best manage this population and reduce the utilization of services as well as achieving shared savings.
Customized web-based reporting allows for trending analysis of medical home enrollee utilization by comparing the pre-intervention period (before enrollment in the PCMH) to the post intervention period (after enrollment in the PCMH) for the PCMH population for targeted measures. Upon completion of this initial project, an overall evaluation will be conducted to compare the PCMH population to a control group to evaluate the specific impact for the enrolled population.
The targeted utilization reports, based on claims data, include the following metrics and provide the opportunity to review the quarter over quarter trends in each of the target areas. Specific member level detail is also provided to allow the care management nurse to work specifically with these members and their primary care provider.
(CLAIMS UTILIZATION METRICS IMAGE)
Delivering these reports directly to the medical groups and the health plans via a web based portal on a quarterly basis allows direct access to timely and consistent information to all.
For some additional reading on related topics, please see the following:
- The Commonwealth Fund released a data brief in May 2012 titled, Recommended Core Measures for Evaluating the Patient Centered Medical Home: Cost, Utilization and Clinical Quality.
- From the Milliman Healthcare Town Hall, The Role of the Nurse in Accountable Care