Lesson - Experience Report Retriever

AVAILABLE NOW! The Experience Report Retriever allows Users to benchmark each individual healthcare practitioner (HCP), healthcare organization HCO Group Practice and or HCO Facility and provide peer-to-peer comparisons based on temporal analyses of each provider’s volumes of diagnoses and/or procedure claims. Experience Report Retriever projects are uniquely customized by each user to produce analyses by their specific area of clinical interest as well as to provide reliable, peer-to-peer comparisons of their providers of interest. The Experience Report Retriever is intended to provide event (claim, case or patient) counts by year, counts by setting, total counts across years, trends, forecasts and projections.  Provider volumes have been linked to provider outcomes.  As such, this report retriever type is intended to give researchers across the healthcare continuum quick, reliable, peer-to-peer comparisons of providers’ experiences and acquired expertise across and within virtually unlimited set of pre-built and custom clinical groups of interest.  Providers can be compared to other provides at national, regional or local levels.  Standard benchmarking criteria includes: (i) claim level benchmarking using equal counts of claims (where each unique code within a code group counts as one claim for that patient for that year)(e.g., if two codes match within a code group for that patient and that provider, then each would register as their own claims); (ii) episode or case-level benchmarking using equal counts of cases (where any one or more unique code within a code group counts for that patient for that year counts as a single claim)(e.g., if two codes match within a code group for that patient and that provider, then both would register as one single case or claim)episode or case-level benchmarking); (iii) equal counts of patients or patient-level benchmarking (where no matter how may unique codes within a code group register, it only matters that at least one code matched for each unique patient).

  • Segmentation Reports include: Numbers of HCPs, GRPs and HCO Facilities by segment (e.g., decile). For each segment, min and max claim and patient number ranges are provided along with the summaries counts of patients or claims that the deciling algorithm produces. The “cumulative” counts and percentages enable quick reference to combining each segment (e.g., decile 8) with the preceding segment(s) (e.g., deciles 9 and 10).
    • Deciling: where there are 10 segments with each segment representing 10% of either all claims or all patients;
    • Quintiling: where there are 5 segments with each segment representing 20% of either all claims or all patients;
    • Quartiling: where there are 4 segments with each segment representing 25% of either all claims or all patients; and
    • Tertiling: where there are 3 segments with each segment representing 33% of either all claims or all patients.
  • Trend Slope and Trend Indicator. Trend Slope is supplied by a proprietary regression algorithm that uses the annual counts by year (for Grand Totals as well as by individual Settings)(e.g., IP, OP, etc).
    • Where the Trend Slope is within 20% of the mean, the Trend Indicator is “0” which indicates that although there is some perturbation of differences in annual counts of claims/patients, that overall, the trend is “stable”. Stable”,
    • Where the Trend Slope is greater than 20% below the mean, the Trend Indicator is “-1” which indicates that the trend is “declining”.
    • Where the Trend Slope is greater than 20% above the mean, the Trend Indicator is “1” which indicates that the trend is “increasing”.
  • Star type Reports include: Numbers of HCPs, GRPs and HCO Facilities by Star type (e.g., Rock Star or Shining Star, etc). For each Star type, min and max claim and patient number ranges are provided along with the summaries counts of patients or claims that the Star type algorithm produces. The “cumulative” counts and percentages enable quick reference to combining each Star type (e.g., Proto Star) with the preceding Star type(s) (e.g., Rock Star, Shining Star and Rising Star.
    • Deciling Star type rules: with deciling there are 10 segments with each segment representing 10% of either all claims or all patients. We use the decile along with the trend indicator to establish the Star types as follows:
Segment

Type

Segment Trend Indicator Star

Type

Decile                10 1 Rock Star
Decile 9 1 Rock Star
Decile 8 1 Rock Star
Decile 7 1 Rising Star
Decile 6 1 Rising Star
Decile 5 1 Rising Star
Decile 4 1 Proto Star
Decile 3 1 Proto Star
Decile 2 1 Fallen Star
Decile 1 1 Fallen Star
Decile 10 0 Shining Star
Decile 9 0 Shining Star
Decile 8 0 Shining Star
Decile 7 0 Shining Star
Decile 6 0 Shining Star
Decile 5 0 Proto Star
Decile 4 0 Proto Star
Decile 3 0 Proto Star
Decile 2 0 Fallen Star
Decile 1 0 Fallen Star
Decile 10 -1 Fading Star
Decile 9 -1 Fading Star
Decile 8 -1 Fading Star
Decile 7 -1 Fading Star
Decile 6 -1 Fading Star
Decile 5 -1 Fallen Star
Decile 4 -1 Fallen Star
Decile 3 -1 Fallen Star
Decile 2 -1 Fallen Star
Decile 1 -1 Fallen Star
Segment

Type

Segment Trend Indicator Star

Type

Quintile 5 1 Rock Star
Quintile 4 1 Rock Star
  • Quintiling Star type rules:
    • with quintiling there are 5 segments with each segment representing 20% of either all claims or all patients. We use the quintile along with the trend indicator to establish the Star types as follows:
Segment

Type

Segment Trend Indicator Star

Type

Quintile 5 1 Rock Star
Quintile 4 1 Rock Star
Quintile 3 1 Rising Star
Quintile 2 1 Proto Star
Quintile 1 1 Proto Star
Quintile 5 0 Shining Star
Quintile 4 0 Shining Star
Quintile 3 0 Proto Star
Quintile 2 0 Fallen Star
Quintile 1 0 Fallen Star
Quintile 5 -1 Fading Star
Quintile 4 -1 Fading Star
Quintile 3 -1 Fading Star
Quintile 2 -1 Fallen Star
Quintile 1 -1 Fallen Star
  • With quartiling there are 4 segments with each segment representing 25% of either all claims or all patients. We use the quartile along with the trend indicator to establish the Star types as follows:
Segment

Type

Segment Trend Indicator Star

Type

Quartile 4 1 Rock Star
Quartile 3 1 Rising Star
Quartile 2 1 Proto Star
Quartile 1 1 Proto Star
Quartile 4 0 Shining Star
Quartile 3 0 Shining Star
Quartile 2 0 Proto Star
Quartile 1 0 Fallen Star
Quartile 4 -1 Fading Star
Quartile 3 -1 Fading Star
Quartile 2 -1 Fading Star
Quartile 1 -1 Fallen Star
  • with tertiling there are 3 segments with each segment representing 33% of either all claims or all patients. We use the tertile along with the trend indicator to establish the Star types as follows:
Segment

Type

Segment Trend Indicator Star

Type

Tertile 3 1 Rock Star
Tertile 2 1 Rising Star
Tertile 1 1 Proto Star
Tertile 3 0 Shining Star
Tertile 2 0 Proto Star
Tertile 1 0 Fallen Star
Tertile 3 -1 Fading Star
Tertile 2 -1 Fading Star
Tertile 1 -1 Fallen Star
  • HCP, HCP Locations, GRP, GRP Affiliations (HCPs matrixed within GRPs), HCO FAC and HCO FAC Affiliations reports are provided with counts of claims, cases or patients (i.e., User defined) by years of analyses. All reports feature aggregations of claim level data within timeframes defined in the reports and are compliant with CMS’s small cell size suppression policy.
    • NOTE: HCP and HCO_Facility volumetric data is derived via an analysis of the claim level data. Whereas HCO_Group data is derived via affiliations of HCPs to HCO_Groups.  Since HCPs can be affiliated to more than one HCO_Group, HCP level volumetric data can be flowed up to more than one HCO_Group.  For this reason (as well as other reasons) ggregated claims volumes will not match across HCP, HCO_Group and HCO_Facility analyses.

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