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Visualizations and Medicaid Value-Based Payments

Visualizations and Medicaid Value-Based Payments


About the NYS DOH

NYS Department of Health (DOH) oversees the NYS Medicaid Program which supports more than 6.4 million eligible recipients at any one time and pays out over 250,000,000 claims valued at more than $60 billion per year. For decades, the program has come under scrutiny, as costs have grown without commensurate improvements in patient outcomes. Recognizing that the present program was unsustainable, Governor Andrew Cuomo established the state’s Medicaid Redesign Team (MRT) shortly after taking office in 2011. Integral to the MRT's goals, was the capacity to leverage and transform data into actionable insights.

At the foundation of New York State’s strategic, data, and analytics architecture is CMA’s intellectual property, which has been integrated to support New York State’s Medicaid Data Warehouse (MDW) and Medicaid Analytics & Performance Portal (MAPP). The scalability and performance of this secure architecture has responded to the evolving requirements of New York’s Office of Health Insurance Programs, Office of the Medicaid Inspector General, the Attorney General’s Office, as well as countless contracting organizations and the underlying providers who participate the state’s 1115 (DSRIP) Waiver program. In doing so, CMA has facilitated extensive business value, as evidenced by the progress of New York’s DSRIP program.  

As New York State’s Office of Insurance Programs ushers in Value Based Payment arrangements across its Medicaid Program, the power and agility of CMA’s technology accelerators, and a mix of best-of-breed tools are once again being exploited to drive meaningful results.

Business Case

The healthcare ecosystem is amid fundamental transformation, as public and commercial payers shift from fee-for-service to value-based payment arrangements. Emerging business models are placing an increased emphasis on collaboration and coordination among an extended group of stakeholders, as they contract to support the holistic needs and drive improved outcomes within defined populations. Complex in nature, such initiatives need to be bounded through stakeholder access to trusted data sources, transparent reporting, and advanced analytics that provide a common prism for actionable insight.

Benefits of reliable healthcare data include improving clinical outcomes, assistance with fraud detection and revenue recovery, program management, cost avoidance, enhanced process for policy budget formulation, reduced risk of data loss and data compromise, and positioning as a leader in health system reform.

The Solution

CMA leverages Tableau to generate many of the performance improvement dashboards used by the State of New York and the 25 Performing Providers Systems operating under the Office of Health Insurance Program’s - 1115 (DSRIP) Waiver.

Tableau is unique among analytics platforms in that it serves both business users and data scientists. Its simplicity empowers non-programmers to conduct deep analysis without writing code. And its analytical depth augments the workflows of data science groups at cutting-edge analytics companies like Facebook and Amazon.

With a few clicks, users can create box plots, tree maps, and even predictive visuals. With just a few more clicks, users can create forecasts or complex cohort analyses. Users can even connect to R and use Tableau as a powerful front-end to visualize model results. This means nontechnical users can ask previously unapproachable questions, while data scientists can iterate and discover deeper insights faster, yielding better, more valuable findings.

Tableau’s flexible front-end allows knowledge workers to ask questions without needing to code or understand databases. Tableau also has the necessary analytical depth to be a powerful weapon in a data scientist’s arsenal.

Tableau is currently being used in all 50 States and is specifically used for self-service analytics in Healthcare and Medicaid agencies in NY, MA, NH, ME, MD, MI, TX, CA, VA, FL, and MN. 

The Results

As New York’s Medicaid program began transitioning to Value Based Payments, a whole new set of dashboards needed to be created to model, monitor, and measure the variety of value-based arrangements implemented across the state. Additionally, it’s critical that the Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs) participating in a variety of value-based payment arrangements can access and analyze broader sets of data than might exist within their own data stores. Such capabilities are essential to facilitating transparency and trust among the parties looking to improve outcomes, reduce costs, and mitigate contractual risk.

To accommodate such use cases, the value of CMA’s Intellectual Property has been extended with the deployment of the MAPP Analytics Console for New York State. This secure and dynamic environment enables authorized end-users to self-provision a virtual desktop, curated datasets from the state’s Medicaid Data Warehouse, and leverage the power of Tableau to conduct timely queries and analysis on their own. As a result, approved stakeholders can now to generate their own, customized dashboards reflecting any one of the important metrics for their value based payment arrangement. These dashboards can include visualizations of Potentially Avoidable Complications; Comparison of Cost of Services between their organization, and others treating the same episodic bundle; as well as High-Risk/High-Cost patient information, to better manage their care and identify “outlier” providers based upon cost or outcomes.

The powerful combination of CMA and Tableau is highly extensible to organizations outside of State Medicaid Operations. Whether it’s a commercial insurer moving to value-based benefit programs, or a research organization advancing new products and services, there are instances where individuals require access to unified data from a variety of sources, to visualize, analyze and advance their organizational missions.   

In response to these marketplace challenges, CMA once again leveraged its Intellectual Property to develop Mosaic Insights, a general purpose, commercialized product that facilitates an Amazon-like experience for knowledge workers. These workers can view and provision data for analysis and visualization on either their desktops or in a highly-secure virtual desktop interface. Mosaic Insights enables disparate sources of data to be transported at scale from systems of record to a unifying publication layer that serves much like a catalog. A subscription to a personalized desktop interface, which features Tableau, enables authorized users to quickly provision data from the publication layer and to conduct analyses on a self-service basis.  


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