Harnessing discreet data from across the care continuum, ALERT Analytics™ develops an accurate diagnosis profile for a targeted population and monitors what care is delivered to that population.
This feature uses proprietary analytics to identify members of interest (MOIs)—those individuals at risk for possible gaps in care. Using criteria such as risk scores, prior admissions, number of medications, chronic conditions and frailty indicators, ALERT Analytics™ clearly establishes MOI populations and generates risk/cost profiles.
Once MOIs are identified, registered nurses and certified coders conduct event-level monitoring using all available data sources, including claims/encounter files, enrollment files, chart abstractions and more. This “active listening” occurs every day all year long and helps zero in on member-specific gaps in care, data and quality, including non-compliance on any member-eligible HEDIS® measure.
When disparities in care and quality are discovered, ALERT Analytics™ generates a member-specific alert to signal the need for immediate member and provider action. Such action occurs when organizations leverage other aspects of MA365™, including On Premise™ and the Health Advocacy Programs (HAP™).
ALERT Analytics™ assists organizations in truly understanding the health of a target population and focuses attention on those patients who need it most, resulting in greater efficiency at less cost.