Hex ACO Management
HEX ACO, built from the ground up to support Medicare ACOs, is being
used by ACOs to obtain timely and actionable insights that the ACO
leadership depends on every day to drive real performance improvement
in how they care for patients and effectively manage resources. For
CMS ACOs that are embarking on shared savings managed care models,
Hexplora provides a comprehensive overview of their population health,
cost, and utilization trends at the ACO level or individual level.
ACOs will succeed or fail based upon their ability to understand and leverage the patient-
level data that CMS provides. Transforming this raw data into meaningful insights is
among the most challenging and important tasks an ACO has. With Hexplora, ACOs can
efficiently track their assigned population each quarter, identify patient and physician
outliers, track quality metrics, drill down on specific disease states, perform ROI analyses,
and develop targeted interventions.
HEX ACO module supports the following ACO operational processes:
  • Provider Engagement
  • PQRS Quality Reporting
  • Member Tracking
  • Shared Savings Forecasting
Provider Engagement
ACOs are responsible for facilitating coordination and cooperation among providers to
improve the quality of care and reduce unnecessary costs. Hexplora empowers the ACOs
through Provider Engagement. PCPs rarely have visibility into the overall healthcare cost
for their assigned members. When individual physicians are able to see overall cost and
utilization metrics along with a report of their own performance compared to national
benchmarks, including, hospitalization rates, re-admission rates, LOS, ER visits, and
granular cost data, it is a truly eye-opening experience. All Hexplora Analytics and Reports
are available at both the ACO population level and the individual Physician level.
Individual physicians with access to these reports are able to manage care for their
assigned members and reduce the overall cost. ACO management can use the Provider
Performance Reports to identify physicians that are not meeting performance measures
and individually engage the physicians in implement provider specific intervention
PQRS Quality Reporting
CMS measures quality of care using nationally recognized measures in four key
domains. Data collection of quality measures from individual physicians cannot be a
completely automated process for most ACOs even if all their physicians are on a
common EMR platform. Hexplora includes a web based application that provides a
guided solution for individual physicians for reporting Quality Measures. Our PQRS
solution is an end-to-end solution for collecting data from the individual physicians,
validating and aggregating the collected data, and Reporting the aggregated ACO level
quality measures to CMS.
Member Tracking
CMS Member Assignment is a multi-step process that uses quarterly Prospective
Member Assignments followed by year-end reconciliation that generates the final
Retrospective Member Assignment. ACOs are responsible for obtaining and managing
patient Consent for data sharing for all their membership. CMS does not share patient
demographics and overall claims data with the ACO without patient Consent. Accurate
member tracking is essential to maximize availability of data from CMS and for effective
population level data analysis for ACOs. Hexplora provides comprehensive support for
tracking prospective enrollments, terminations, and patient consent.
Shared Savings Forecasting
CMS uses complex algorithms that use a combination of Member disease conditions
(HCCs) and demographics to calculate Shared Savings for an ACO. Hexplora Shared
Savings Forecasting enables ACOs to monitor their expenditure trends in relation to
national benchmarks, forecast savings, and implement intervention strategies to meet
their performance and savings targets.
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Health Plans
Better Care through Better Analytics and Insights resulting in lower costs.

Accelerated Shared Savings and Improved Interventions & Outcomes.

Collaborative efforts and focused care resulting in improved health & savings.