Hexplora
Hexplora Product Overview
Hexplora offers a comprehensive
end-to-end Data Warehousing and Business
Intelligence solution for Health Plans, ACOs,
and IPAs. Based on years of experience
implementing Data Management solutions
for large payers and providers, Hexplora has
been designed as a foundational platform
for healthcare organizations for all their
Reporting and Analytics requirements.
Hexplora helps healthcare organizations
achieve faster ROI by reducing unmanaged
costs and improving Interventions and
Outcomes.

HEXPLORA DATA REPOSITORY
  • Centralized Data Repository as a single source of truth
    Integrates and transforms data into Actionable Information
  • Provide a 360 degree longitudinal view of members
  • Full history tracking with as-was and as-is views of data
  • Scalable infrastructure with superior performance and
    response time
  • Flexible and extensible to facilitate insights and efficient
    analytics
  • Timely information for proactive engagement

HEXPLORA DATA SUBJECT AREAS
  • Members: Eligibility & Enrollment, Demographics,
    Socio-economic data
  • Providers: Demographics, Contract/Fee Schedule, Networks,
    Profiles, Credentialing
  • Plans: Plans, Plan benefits, Employers, Groups, Client
    contracts
  • Claims: Summary and Detail Claim data, Multiple
    roll-ups/ Categorizations
  • Pharmacy: Prescription Claims, Drugs
  • Lab Results: Lab Results, Lab Values
  • Care Management: Activities, Interventions, Outcomes
    across CM/UM/DM, HRA
  • Value Added Metrics: RVU, DRG, MDC, Admission Build,
    Clinical Conditions, Disease Category, Disease Staging,
    Analytic Classifications, Age Groupings

HEXPLORA FUNCTIONAL AREAS

REGULATORY REPORTING
  • Medicare RAPS reporting
  • Medicare Part C & D Reporting
  • Medicaid Encounter Reporting
  • Medicare ACO Reporting
  • HEDIS Reporting


ENTERPRISE REPORTING
  • Pre-defined reports for Membership, Claims, and Provider
    reporting
  • PM and trending reports for internal analysis
    Scorecards and Dashboards for Management Reporting
  • Standardized reports for monthly Customer Reporting
  • Seamless integration with Microsoft Office and SharePoint
  • Personalized Alerts and Scheduling with self-service
    capabilities

PERFORMANCE ANALYTICS
  • Analytics on multiple financial categories such as
    billed/allowed/paid amount, in/out network, member
    demographics, provider, network etc.
  • Analytics on multiple clinical categories such as procedure,
    diagnosis, disease condition etc.
  • Event methodologies with consistent rules for defining
    events of care which can be related back to the individual
    services which make up an event
  • Data roll-ups, categorizations, and derived data for faster
    and more efficient analytics across multiple dimensions
  • Support both retrospective and prospective analysis
  • Better understand the drivers of medical costs and
    utilization by condition from both financial and clinical
    perspectives

PREDICTIVE ANALYTICS
  • Improve prospective analytical capabilities based on predictive models and risk assessments Improve capabilities around interventions and outcomes analysis
  • Provide 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
  • Gaps in Care

QUALITY AND P4P
  • End-to-end solution for collecting, validating, and
    aggregating data from individual physicians
  • Comprehensive Quality Reporting and Analytics at
    Population, Provider, and Member level
  • PQRS Tracking, Reporting, and Submission
  • HEDIS Tracking and Reporting

PROVIDER ENGAGEMENT
  • Facilitate coordination and cooperation among providers to improve the quality of care and reduce unnecessary costs
  • Empower Providers by providing visibility into the overall healthcare cost and utilization metrics along for their members
  • Provider Performance Reports support information transparency and allow payer organizations to individually engage physicians in implementing provider specific intervention strategies

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.