Empower Your ACO With HEX ACO
Transforming Data Into Actionable Insights
Empowering CMS ACOs To Thrive Through
Informed Decision Making
HEX ACO is meticulously engineered to cater to the unique needs of Medicare ACOs, offering invaluable insights that drive tangible improvements in patient care and resource management. ACO leadership relies on these timely and actionable insights daily to enhance performance outcomes. Particularly for CMS ACOs venturing into shared savings managed care models, Hexplora presents a comprehensive overview of population health, cost, and utilization trends, whether at the ACO or individual level. The success or failure of ACOs pivots on their adeptness in harnessing and interpreting patient-level data provided by CMS. Converting this raw data into actionable insights stands as a pivotal yet daunting task. Fortunately, with Hexplora, ACOs can efficiently monitor their assigned population, pinpoint outliers, track quality metrics, delve into disease states, conduct ROI analyses, and craft targeted interventions with precision.
HEX ACO Module
The ACO Operational Process
Provider engagement
ACOs foster collaboration among providers to enhance care quality and cut costs. Hexplora boosts ACO effectiveness through provider engagement, providing PCPs with crucial visibility into healthcare costs for their members. When physicians access comprehensive metrics, including performance against national benchmarks and granular cost data, it’s enlightening. Hexplora’s analytics and reports offer insights at both the ACO and individual physician levels. Physicians armed with these reports can optimize care and reduce costs. ACO management utilizes provider performance reports to pinpoint underperforming physicians and implement tailored intervention strategies.
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 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 members. 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.
