Large multistate health plan implements healthcare analytics platform expanding quality management and risk reporting capabilities

Client background

A large multistate health plan covering over 15 million lives.

The business challenge

As part of an enterprise-wide effort aimed at helping transform how our client supports and collaborates with healthcare providers, an initiative was launched to deploy a new cloud-based healthcare analytics platform intended to expand quality management and reporting capabilities by managing quality and risk score calculations and reporting. The initiative is one of many that client leadership has invested in, which is designed to enhance care quality and help ease the transition of providers to value-based reimbursement models.

A suite of products from a third-party software vendor was selected as the core technology for this initiative, most notably a certified HEDIS quality engine and a reporting platform with Tableau data visualization capabilities. Two of the critical reporting components for this effort involved the ability to associate member level quality scores with individual rendering providers, both primary care physicians and specialists, and associate those individual providers with higher-level entities (e.g. clinics, health systems, etc.) such that individual provider and health system level quality and risk scores can be evaluated.

The client required robust end-to-end testing of the data in the platform before they could rollout to providers, so they partnered with Baker Tilly to plan and execute a wide-ranging testing effort targeted to validate a custom member attribution process and provider hierarchy reporting functionality. A chief point of emphasis throughout overall testing efforts involved ensuring data security standards were met to allow all providers to utilize the same platform while only viewing data they were allowed to view.

The Baker Tilly approach

Baker Tilly worked with this client to understand their quality and risk outcome measurement dashboards and provider analytics requirements in order to help lead the software implementation, focused on attribution and provider hierarchies. The Baker Tilly team assisted with requirements and design definition as well as vendor management in these areas. The team also developed and executed a complete set of test cases to ensure the platform had a high degree of data accuracy before rolling out to providers.

Baker Tilly planned and executed a comprehensive, repeatable, large-scale testing effort for our client, which included:

  • Building detailed test data conditions specific to member attribution and provider hierarchy reporting requirements
  • Identifying appropriate test cases from the above approach to support unit, system, regression and user acceptance testing
  • Executing test cases within the third-party software test and production environments, working directly on-site at vendor locations with their engineering team members to prioritize and resolve all identified software defects
  • Providing weekly status updates to stakeholders to provide insight into overall progress against the test plan

Baker Tilly played a significant role in facilitating communication between the client and the third-party software vendor and implementing a structured software development lifecycle process. Through end-to-end scope collaboration, major risks were mitigated and together implementation success was achieved.

The business impact

Baker Tilly drove a successful go-live of the healthcare analytics platform for an initial pilot group of over 20 medical groups with 100+ individual provider users. The implementation of the new reporting platform expands our client’s quality management and risk reporting capabilities and improves the operational efficiency and effectiveness of their quality reporting to providers, accrediting agencies, government programs and internal departments. The platform delivers timely data and trends and provides increased transparency to provider partners. The benefits of the platform align with the company’s priorities of growing revenue, improving line of business performance and increasing overall provider satisfaction. Through the deployment of this platform, our client is ready to scale this capability out to their full provider networks, providing a key data set to help drive value-based program adoption.

Download the full case study >

For more information on this topic, or to learn how Baker Tilly specialists can help, contact our team.