Advanced Managed Care Metrics

Many health centers participate in managed care contracts for Medicaid and other payors. The centers may receive basic reports on membership and payments, but most centers are unable to perform much analysis, often because there is too much data. This session will cover more advanced metrics, utilizing actual managed care claims files, membership files, and other reports. Presenters will evaluate panel size and demonstrate methodologies to track assigned but not seen members. A CEO from a large health center, with successful managed care contracts, will reveal how his health center analytics team has analyzed and leveraged managed care metrics for more effective outcomes with a focus on three areas – reconciling monthly patient assignment reports, quality metrics from claims data, and emergency room utilization reports.