Data Science & Advanced Analytics

DSAA's Advanced Analytics Department works in consultation with several customers, including state Medicaid agencies and federal clients, to develop novel methodologies that target the customers’ questions of program and policy effectiveness. The multidisciplinary team of statistical and clinical experts provides a wide-array of technical assistance on topics such as:

• Determining the impact of programs in which Medicaid pays for members to receive care through the state’s exchange.
• Developing infant mortality predictive models.
• Evaluating recidivism-reduction programs.
• Identifying and data mining of poor managed care plan performance.
• Developing novel tools to identify chronic conditions of populations and determine members’ risk scores.
• Developing risk-adjusted, clinician-level report cards.

The Advanced Analytics Department has extensive experience calculating a variety of performance measures for health plans and Medicaid  and Commercial populations, including Centers for Medicare & Medicaid Services (CMS) Core Measures, National Quality Forum (NQF), Agency for Healthcare Research and Quality (AHRQ), and custom measures for several state Medicaid agencies. DSAA developed and implemented the Performance Measurement Platform (PMP) used to calculate performance measures using administrative, registry, vital statistics, and medical record review data.

To improve the services provided by health plans to Medicaid beneficiaries, DSAA’s Advanced Analytics Department compiles required measure rates provided by the state Medicaid plans and often compared to various benchmarks to assess plan performance within the various deliverables. These deliverables evaluate the health plans individually, provide comparisons across health plans, and describe statewide performance—allowing consumers to make an educated choice when selecting a health plan to meet their healthcare needs. DSAA currently produces a number of reports for more than a dozen states.

DSAA’s Advanced Analytics Department develops quality rating systems (QRSs) to allow customers to make educated decisions when selecting a health plan. DSAA uses HEDIS data and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey results to compare plans to one another in key performance areas. DSAA currently produces QRSs for Illinois, Iowa, Michigan, and Virginia.

DSAA’s Advanced Analytics Department provides analytic support for HSAG’s External Quality Review- (EQR)-related services in over 16 states, including assistance with identifying project requirements, defining project methodologies, planning and executing analyses, and preparing final reports. The Advanced Analytics Department works in collaboration with HSAG’s State & Corporate Services (S&CS) Division to conduct the following types of projects:

• Encounter data validation (EDV) for physical and mental health programs in multiple states.
• Clinical and non-clinical focused studies, with topics including prenatal care and birth outcomes, clinical services among children in foster care, tobacco cessation, and Managed Long-Term Services and Supports (MLTSS).
• Evaluation design for Medicaid 1115(a) demonstration waivers.
• Evaluation of provider network adequacy using provider ratios, time/distance analyses, and secret or direct shopper surveys.

Through HSAG’s national and regional federal contracts, such as the Medicare Quality Innovation Network- Quality Improvement Organization (QIN-QIO) and Quality Reporting Support, the Federal Analytics and Surveys Department supports the CMS Quality Strategy to optimize health outcomes by improving quality and transforming health systems through better care, healthier people/communities, and smarter spending. The work performed under these contracts:

• Promotes patient-centered care and patient and family engagement at the provider level.
• Encourages providers to implement improvements in healthcare delivery and patient safety.
• Works to reduce disparities in care.
• Collaborates with stakeholders to improve healthcare and health outcomes.
• Equips consumers with quality-of-care information to make more informed decisions about healthcare options.

The QIO Program is one of the largest federal programs dedicated to improving health quality at the community level. The CMS QIO Program consists of two components: QIN-QIOs, and Beneficiary and Family Centered Care (BFCC)-QIOs. HSAG holds the QIN-QIO contracts in Arizona and California, representing nearly 12 percent of the Medicare population nationwide.

Collaborating with several divisions and offices of HSAG, the Federal Analytics and Surveys Department provides the data analyses to support teams’ efforts in performing technical assistance, sharing best practices, conducting targeted improvement initiatives, offering patient and provider education services, investigating grievances, supporting policies, determining annual payment updates, and monitoring program performance. HSAG’s S&CS Division uses the Federal Analytics and Surveys Department to oversee the administration and reporting of different surveys, including the following CAHPS surveys:

• Medicaid Health Plan
• Patient-Centered Medical Home
• Home- and Community-Based Services
• Medicare Advantage and Prescription Drug Plan (MA-PDP)
• Experience of Care & Health Outcomes (ECHO®)
• Dental

In addition to the standard CAHPS surveys, the Federal Analytics and Surveys Department has worked with customers to develop and administer novel survey instruments to assess providers, care management programs, and quality of life.

The measurement and evaluation of patient and provider perception of care helps to determine efficiency, efficacy, and quality of care-delivery systems, while guiding Medicaid agencies toward opportunities for targeted interventions.

DSAA's Audit Department performs audit services to ensure accurate, reliable, and publicly reported data. Audits provides HEDIS Compliance Audit™ services, AMP (Align. Measure. Perform.) Audit Review™ services, Performance Measure Validation (PMV), CMS Data Validation for Medicare Part C and Part D, and Information Systems Assessment/Readiness Reviews to HSAG’s External Quality Review (EQR) and private customers.

The Audits Department also ​​supports the CMS Financial Alignment Initiative, collaborating with cross-departmental teams to develop and update quality measure specifications for Medicare-Medicaid Plans (MMPs), monitor MMP performance on quality measures, and coordinate and assist with Performance Measure Validation activities for MMPs working with dual-eligible members in 10 states.