Hexplora
Hex IPA Management
HEX IPA is a robust solution for IPAs built by leveraging our strong
healthcare and technology expertise. Our solution supports the broad
ranging requirements of IPAs covering Data Integration, Business
Analytics, Risk Management, and Operational Management. HEX IPA
empowers IPAs with sophisticated analytical capabilities and enables
seamless information exchange with payers and providers. Hexplora
platform comes with pre-built interfaces that enable IPAs to integrate
data from different payers into the Hexplora Data Warehouse. From this
integrated data warehouse, Hexplora provides a comprehensive overview
of their population health, cost, and utilization trends at IPA, Payer, Provider,
and individual levels.
IPAs that are transitioning to Risk-based contracts with payers, will succeed or fail based
upon their ability to understand and leverage the patient-level data that Payers provide to
the IPA for managing risk. Transforming this raw data into meaningful insights is among
the most challenging and important tasks that an IPA has. With Hexplora, IPAs can
efficiently track their assigned population each month, identify patient and physician
outliers, track quality metrics, drill down on specific disease states, perform ROI analyses,
and develop targeted interventions.
HEX IPA supports the following IPA requirements:
  • Member Tracking
  • Provider Engagement
  • Quality Management and Reporting
  • Plan Reporting
  • Risk Management
Member Tracking
IPAs can significantly increase their leverage in contract negotiations with payers based
on the number of physicians and members that are in their IPA. This leverage is even
more significant in establishing preferred relationships with hospitals, labs, and care and
disease management organizations. Hexplora provides comprehensive member tracking
functionality both from Enrollment and Clinical perspectives. Enrollment analytics provide
pre-built dashboard and reports for monitoring enrollments, dis-enrollments, and
member demographics. Clinical analytics include disease conditions by member across
time and cost trends.
Provider Engagement
IPAs are responsible for facilitating coordination and cooperation among providers
to improve the quality of care and reduce unnecessary costs. Hexplora empowers the IPAs
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 IPA, sub-IPA, Plan, and individual Physician levels. Individual physicians
with access to these reports are able to manage care for their assigned members and
reduce the overall cost. IPA management can use the Provider Performance Reports to
identify physicians that are not meeting performance measures and individually engage
the physicians in implementing provider specific intervention strategies.
Quality Management and Reporting
Physician Quality and Performance Measurement and Tracking on important dimensions
of care and service has become an integral part of the current healthcare environment.
Physician Quality Reporting is the basis for incentive payments for EHR Meaningful Use
compliance, Medicare and Medicaid reimbursements, and Shared Risk payments at the
IPA level. For commercial payers, IPAs are also required to track and report 75 quality
measures across 8 domains of care for HEDIS Performance Measurement.
Data collection of quality measures from individual physicians cannot be a completely
automated process for most IPAs even if all their physicians are on a common EHR
platform. Hexplora includes a web based application that provides a guided solution for
individual physicians for reporting Quality Measures. Our Quality Management and
Reporting solution is an end-to-end solution for collecting data from the individual
physicians, validating and aggregating the collected data, and Reporting the aggregated
IPA level quality measures to CMS and other Payers.
Plan Reporting
Most IPA contracts are based on capitated payment models between the payer and
providers. In capitated models, providers rarely have a strong incentive to report all the
encounters to the payers since there is no encounter level reimbursement. However,
payers need to track all the encounters so that they can monitor utilization and quality
measures at the plan and provider level. Hexplora provides a comprehensive set of pre-
defined reports and interfaces that enable the providers to easily send the data that is
requested by the plans on an ongoing basis. Providers are not burdened with creating
new processes and reports to satisfy the Plan Reporting requirements allowing them to
focus more on providing care to their patients.
Risk Management
In the changing healthcare landscape, IPAs are increasingly entering into risk-based
contracts with payers, turning the IPAs into de facto payers, where they directly share risk
with the payers in managing their patients’ health and costs. Unlike Medicare ACOs that
are based on a standard Shared Savings Model common across all ACOs, IPAs have to
deal with payer specific risk contracts that are further customized for each IPA.
Monitoring the IPA’s performance under each risk contract is a complex task.The
problem is compounded when the IPAs have to deal with multiple contracts across
payers. Hexplora provides Risk Management functionality that allows the IPAs to track
each contract and forecast cost and savings trends under each contract and across all
contracts.
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Health Plans
Better Care through Better Analytics and Insights resulting in lower costs.

ACOs
Accelerated Shared Savings and Improved Interventions & Outcomes.

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