The healthcare analytics industry is undergoing a revolutionary change from volume to value orientation. The sudden emphasis on an improved quality healthcare, reduced length-of-stay at hospitals, lower costs of healthcare, and fraud detection, are some of the primary requirements of the customers. Accessibility is a major concern for governments and organizations working in this field. Hence, a better quality healthcare facility accessible to each and every one is motivating the public and private organization to adopt analytics.
Mile High Healthcare Analytics (MHHA) is one such company which provides a practical approach towards population-oriented healthcare data analysis to insurance plans, exchange issuers, ACOs, and risk-bearing provider groups. It is focused on helping clients optimize their government-regulated programs; Medicare Advantage, Medicaid and health insurance exchanges. It emphasizes on providing business process assessments, data quality, and management support, and advanced analytics on risk adjustment operations, quality improvement, and value-based payment designs to help clients best manage patient care and ensure appropriate reimbursements. MHHA’s focus is on ensuring that the data collected by these initiatives is complete and totally compliant with all the nuances of risk adjustment and quality improvement systems.
The Mastermind Behind the Success
Richard Lieberman, the chief data scientist at MHHA, has dedicated the overwhelming majority of his career to the design, development, and deployment of risk adjustment systems and methodologies. He began his risk adjustment foray in 1991 after becoming a consultant at the Johns Hopkins Bloomberg School of Public Health. Over subsequent years, Richard has supported a variety of health plans, provider groups, and ACOs as they try to navigate the nuances and complexities of risk adjustment to integrate it into their operations.
Richard along with his partners chose to build a business encompassing risk adjustment and quality because they saw that most plans and provider groups did not adequately grasp all the details for achieving adequate margins or remaining compliant with the government’s regulations. As a “data scientist” who writes algorithms and codes to traverse enormous amounts of data, Richard serves as an “artist-explorer”, navigating content and synthesizing findings. With 20 plus years of experience as an applications programmer, data warehouse designer, and business intelligence system developer, he is able to produce unique analytical work products as well as direct the work of other analysts and programmers.
Mile High Healthcare Analytics builds and deploys technology solutions for government-regulated health plans struggling with risk adjustment, quality measurement, and value-based payment operations.
Mile High Healthcare Analytics has formed Cortex Data Analytics, the software division of Mile High, and has recently announced the release of an entire suite of software solutions. The Cortex-Data Warehouse is the central data repository as well as the “brain” of all software suite deliverables. It incorporates a vast array of clinical, financial, and socioeconomic data into a fully normalized data warehouse.
The Cortex Data Warehouse is designed to collect, transform, and normalize EMR data, claims, pharmacy, lab, and population-level geo-specific data from multiple sources.
Connected to the Cortex Data Warehouse are the following products:
Cortex-Connect: Cortex-Connect is a smartphone application that serves as a connection between the member, their providers, and the health plan. It has real-time data flowing from the Cortex Data Warehouse which synthesizes data transmitted by the health plan, provider EMRs, and social determinants impacting patient engagement. The app alerts the member of changes in their medical record, chronic conditions, pharmacy usage, and upcoming appointments.
Cortex-Scope: It provides visibility across any healthcare data submission regardless of market. Cortex-Scope addresses the key driver of risk adjustment and quality measurement programs-the need for complete and accurate data. It is the system that allows everyone who is responsible for maintaining or overseeing the risk adjustment process to see the contribution that is being made to the final risk score at every step of the data pipeline.
Cortex-Risk: Designed to identify and normalize claims, pharmacy, lab, and population-level data from multiple sources. After the data has been prepared Cortex-Risk applies multiple analytic models to identify clinically significant issues at either the member or the population level. Further, it applies various risk-based revenue models giving a much more definitive view of member/population disease profile for better management, reporting, and financial view into the actual cost of care.
Cortex-QM: It is designed to simulate, plan, and track multiple quality programs across multiple quality measures for all lines of business. Cortex-QM provides comparisons between multiple entities within a given organization, comparison across multiple competitive organizations, and multiple comparisons between past, present, and future possibilities.
Cortex-Focus: It helps government-regulated health plans and provider groups to increase visibility into the members that need attention. Cortex-Focus identifies members predicting their future possibility of an acute hospital admission or ER encounter, assessing their compliance with medication treatment routines and identifying undocumented morbidities that render the enterprise’s risk score to be inaccurate.
Mile High Healthcare Analytics has been successful because they have the extensiveness of knowledge to serve as an honest broker on behalf of government-regulated health plans and provider groups. “We don’t just deploy software and head off to the next prospect! We offer operational consulting services that health plans rely on to solve operational problems,” assures Richard. Clients appreciate the fact that they are policy wonks, data geeks, and operational experts all wrapped up in one company. MHHA works with clients to identify and then solve their operational pain points. Providing such service requires them to be very active and consistent with their performance which is valued by their clients.