In the U.S., Medicaid provides health coverage to more than 68 million low-income men, women, and children, and is funded jointly by states and the federal government. Growing at an unsustainable rate, Medicaid programs have left many states with the challenge of finding new ways to create fiscally stable systems of care that also improve health outcomes.
Oregon established an accountable care model unique to the state composed of coordinated care organizations (CCOs) which are local organizations charged with managing care for members of the Oregon Health Plan—Oregon’s Medicaid program—in addition to finding innovative ways to meet the goals of the Triple Aim: better care, smarter spending, and healthier people. Like all CCOs, Health Share of Oregon required accurate and timely data to support forecasting for rate-setting to remain financially solvent and limit liability in this innovative model. Health Share leveraged analytics to obtain a holistic evaluation of the drivers of per member per month (PMPM) payment performance. Through improved access to this strategic and timely data, Health Share has successfully minimized liability, improved the accuracy of rate-setting utilization data, and reduced analyst time spent compiling complex regulatory reports.
Timeliness of rate-setting utilization data improved from two years to just a few months.
Identified opportunities to effectively reduce liabilities, helping to ensure ongoing financial viability of the organization.
Rapid integration of new member cost data.