A Quality of Care analytics solution that helps a state Medicaid program track care quality, flag preventable events, and control cost
Intuceo built a Quality of Care analytics solution, compliant with the Health Insurance
Portability and Accountability Act (HIPAA), that tracks recognized quality measures, surfaces
potentially preventable events, and analyzes utilization and hospital performance to drive
transparency and improve the quality and cost-effectiveness of Medicaid services.
Sector
State Government,
Medicaid
Focus
Quality of Care
analytics
analytics
Scope
Quality, preventable
events, utilization
Compliance
HIPAA compliant
Client Overview
The client is a state program accountable for the quality and cost of
Medicaid services
The client oversees Medicaid services at the state level and is accountable both for the quality
of care members receive and for the cost-effectiveness of those services. That accountability
depends on measuring care against recognized quality standards and on seeing clearly where
care or spending falls short.
The Challenge
The client is a state program accountable for the quality and cost of
Medicaid services
Improving quality of care while controlling cost across Medicaid services means measuring
performance against recognized national quality measures, watching for avoidable events,
and understanding how utilization and hospital performance affect both outcomes and spend.
Carrying that out across separate data, under strict privacy requirements, is difficult.
The program needed transparency and accountability across its services, quality measures it could benchmark, and a way to surface potentially preventable admissions, readmissions, and complications, all while handling protected health information in a HIPAA-compliant way
The Solution
Intuceo built a HIPAA-compliant analytics solution that tracks
recognized measures and surfaces avoidable events
Intuceo delivered a Quality of Care analytics solution for the state Medicaid program, built to be
HIPAA-compliant and organized around the measures and analyses the program is accountable
for.
Technology
The solution is organized around recognized measures, defined
analytics domains, and HIPAA-compliant handling of data
Outcomes
What the state Medicaid program now has in place after the
engagement
- Quality of care tracked and benchmarked against HEDIS®, HEDIS® Hybrid Measures, and AHRQ metrics.
- Potentially preventable admissions, readmissions, and complications made visible, so avoidable events can be acted on.
- Utilization and hospital performance analyzed together, showing where care and spend vary
- CMS core measures for Star Ratings kept in view, with performance against them tracked.
- Protected health information handled in a HIPAA-compliant way, supporting transparency and accountability across Medicaid services
Close the Gap Between Quality of Care and Cost
Quality of care and cost are two sides of the same problem. When quality slips,
avoidable admissions, readmissions, and complications follow, and the spend follows
with them. Intuceo tracks Medicaid quality against HEDIS®, AHRQ, and the core
measures behind CMS Star Ratings, flags potentially preventable events, and ties
utilization to hospital performance, so a quality gap can be acted on before it becomes
a cost, with the transparency your oversight stakeholders expect. Every part of it is
handled in a HIPAA-compliant way.
