Hexplora’s Predictive Modeling module provides advanced capabilities in the following areas:
- Disease Identification and Stratification Disease Registries
- Incidence and Prevalence trend for disease conditions and comorbidities
- Risk Scores and future Expenditure Forecast
Our Predictive Modeling module was built by leveraging the Medicare HCC model. The HCC model identifies 83 disease conditions and comorbidities at the patient level and creates Disease Registries. This model includes most of the medical conditions that are clinically significant or chronic or generally high-cost such as Cancer, Diabetes, COPD, CHF, Coronary Heart Disease, Hip Fracture etc. In addition, the model also identifies comorbid conditions that have an interactive effect such as CHF and COPD.
Dashboards and Reports offer insights into cost, and utilization metrics by disease condition. ACOs can utilize this information to prioritize Intervention strategies that are specific to their population and implement targeted Care Management and Disease Management programs
For Medicare ACOs, one of the key components in the calculation of Shared Savings is the establishment of Expenditure Benchmarks from prior years. To reflect the changing risk profile of the ACOs’ assigned beneficiaries, CMS uses the HCC model to “risk adjust” benchmarks for every performance year. Hexplora, with our implementation of the HCC model, provides the ACOs with the ability to forecast shared savings using risk adjusted benchmarks