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

SegmentTrend Indicator

Star

Type

Decile               101Rock Star
Decile91Rock Star
Decile81Rock Star
Decile71Rising Star
Decile61Rising Star
Decile51Rising Star
Decile41Proto Star
Decile31Proto Star
Decile21Fallen Star
Decile11Fallen Star
Decile100Shining Star
Decile90Shining Star
Decile80Shining Star
Decile70Shining Star
Decile60Shining Star
Decile50Proto Star
Decile40Proto Star
Decile30Proto Star
Decile20Fallen Star
Decile10Fallen Star
Decile10-1Fading Star
Decile9-1Fading Star
Decile8-1Fading Star
Decile7-1Fading Star
Decile6-1Fading Star
Decile5-1Fallen Star
Decile4-1Fallen Star
Decile3-1Fallen Star
Decile2-1Fallen Star
Decile1-1Fallen Star

Segment

Type

SegmentTrend Indicator

Star

Type

Quintile51Rock Star
Quintile41Rock 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

SegmentTrend Indicator

Star

Type

Quintile51Rock Star
Quintile41Rock Star
Quintile31Rising Star
Quintile21Proto Star
Quintile11Proto Star
Quintile50Shining Star
Quintile40Shining Star
Quintile30Proto Star
Quintile20Fallen Star
Quintile10Fallen Star
Quintile5-1Fading Star
Quintile4-1Fading Star
Quintile3-1Fading Star
Quintile2-1Fallen Star
Quintile1-1Fallen 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

SegmentTrend Indicator

Star

Type

Quartile41Rock Star
Quartile31Rising Star
Quartile21Proto Star
Quartile11Proto Star
Quartile40Shining Star
Quartile30Shining Star
Quartile20Proto Star
Quartile10Fallen Star
Quartile4-1Fading Star
Quartile3-1Fading Star
Quartile2-1Fading Star
Quartile1-1Fallen 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

SegmentTrend Indicator

Star

Type

Tertile31Rock Star
Tertile21Rising Star
Tertile11Proto Star
Tertile30Shining Star
Tertile20Proto Star
Tertile10Fallen Star
Tertile3-1Fading Star
Tertile2-1Fading Star
Tertile1-1Fallen 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.