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Case Study

Empowering MassHealth CP Programs with Hexplora’ s Integrated Data Analytics

By August 15, 2025No Comments

Background

Recent findings indicate that healthcare entities in 48 of 50 states are reimbursed through Value-Based measures, putting providers, payers, and government agencies under pressure to improve patient outcomes while reducing medical expenses. For MassHealth Community Partner (CP) programs, which started only recently, this transition presents a significant challenge. CPs are tasked with managing gigabytes of integrated medical claims data, previously unavailable to them, under a Value-Based reimbursement scheme. As CPs are typically unfamiliar with these data, they are not sure what to do with it and where to begin the analysis.

Challenge

CPs are typically unfamiliar with integrated medical claims data and face challenges in effectively managing them. With limited resources and a lack of experience in analyzing such data, CPs struggle to leverage it to manage effectively in a Value-Based reimbursement scheme.

Solution

Hexplora steps in to address this challenge by providing a cloud-based enterprise Data Warehouse (EDW) that ingests MassHealth claims files and integrates them with EHR data and other CP ecosystem systems. The platform’s front-end Analytics layer then visualizes these data for both operational and analytical needs through an intuitive interface. Moreover, Hexplora integrates with Health Information Exchanges (HIEs) to provide real-time monitoring of Admission, Discharge, and Transfer (ADT) events.

Enhancements

To further augment CPs’ capabilities, Hexplora introduced generative AI-based solutions that leverage clinical notes to identify members who have stopped taking medications. By analyzing clinical notes in real-time, Hexplora can identify potential medication non-adherence issues before they are reflected in claims data, enabling immediate intervention to address gaps in medication adherence.

Results:

The targeted approach led to measurable improvements across several key quality metrics:

1

Real-time ADT Events Using HIE Integration

Hexplora’ s integration with HIEs enables real-time monitoring of ADT events, facilitating proactive care coordination and intervention.
2

Reduction in ER Visits

CPs leveraging Hexplora’ s analytics observed a significant reduction of over 20% in Emergency Room (ER) visits among attributed members.
3

Reduction in Admissions

Hexplora’ s analytics contributed to a noteworthy 10% reduction in hospital admissions among attributed members.
4

Achievement of 100% in Quality Measures

Through Hexplora’ s Quality and Care Gaps Analytics, CPs achieved a remarkable 100% compliance with MassHealth and HEDIS Quality measures.
5

Clinician Productivity Reports

Hexplora’ s platform generates clinician productivity reports, providing insights into clinician performance and efficiency in delivering care services.
6

Chase List Report

Hexplora’ s platform generates chase list reports, identifying members requiring follow-up actions or interventions to address care gaps and improve health outcomes.

Conclusion:

Hexplora’ s integrated data analytics platform empowers MassHealth CPs to successfully navigate the transition to Value-Based care. By harnessing real-time insights, reducing ER visits and hospital admissions, achieving optimal quality performance, and providing clinician productivity reports and chase list reports, CPs can deliver improved patient outcomes while maximizing operational efficiency and cost-effectiveness. With Hexplora’ s generative AI-based solution for medication adherence, CPs can identify and address medication non-adherence issues promptly, further enhancing their ability to deliver proactive and personalized care to MassHealth beneficiaries.