Using Data Visualization to Track Medicaid Program Measures

Dec. 12, 2016
Contra Costa Health Services in California is building data visualization “apps” for each measure in California’s Medicaid program called PRIME (Public Hospital Redesign and Incentives in Medi-Cal).

As health systems seek to maintain compliance with pay-for-performance measures from multiple payers, they are increasingly turning to data visualization tools to give clinicians and administrators snapshots of where they stand today and where they need to deploy resources to improve.

Most public health systems have traditionally lacked the infrastructure to allow for sophisticated analytics and reporting, but during a recent webinar, executives from Contra Costa Health Services in California described building individual business intelligence visualization “apps” for each measure in California’s Medicaid program called PRIME (Public Hospital Redesign and Incentives in Medi-Cal).

The projects associated with PRIME are focused on:

  • Outpatient Delivery System Transformation and Prevention
  • Targeted High Risk or High Cost Populations
  •  Resource Utilization Efficiency

The county’s 164-bed Contra Costa Regional Medical Center began a transition to Epic five years ago and it built its own data warehouse. Now it is turning to data visualization tools from Qlik to comply with the PRIME targets.

“For PRIME, we have 60 metrics we have to report on, and for the majority of them, we are showing year-over-year improvement. Visualizing that data was essential,” said Rajiv Pramanik, M.D., chief health informatics officer for Contra Costa County.

Those 60 measures involved in the projects include Depression Remission, Comprehensive Diabetes Care, Tobacco Counseling, Controlling Blood Pressure, Colorectal Cancer Screening, Influenza Immunization, Breast Cancer Screening, Cervical Cancer Screening, Postpartum Care, Timely Prenatal Care, and Medication Reconciliation. 

Pramanik has oversight of IT, analytics, informatics and EHR development. The dashboards give an idea of measures where you are not having good outcomes and gives you an idea of the size of the impact and how much work you have to do as an improvement team, he said.

“We can look at which areas are doing well and find out why they are doing better and see if that can be repeated. It can tell us where to intervene or see what is working great already and spread that,” he said.

Bhumil Shah, assistant IT director and director of analytics at Contra Costa Health Services, said that for each of the 60 P4P measures, Contra Costa has built apps in Qlik to give an overview. Individual teams can look at trending data over time and can drill down to patient level or look at the data by providers or clinics.

A high-level financial dashboard tracks what funding is at risk if the system doesn’t meet its targets.

For clinical measures such as A1C levels under control, team leaders can get high-level views to know how they are performing overall, but they can drill down to the clinic or provider level. They also can see what data makes up the numerator and denominator of the measure and where that data is being pulled out of Epic.

Shah said the 40-person business intelligence team uses agile processes for task allocation and management. It took a six- to eight-week process to build the first app and respond to initial user feedback. The steps involved included pulling the data from Epic, creating automated processes to support the data mart on which dashboard is built, and then creating the apps in Qlik.

One thing they heard from providers is that they wanted to be able to click on the app from within their workflow in Epic, and the developers were able to make that work. “Once we had a template, we were able to reuse it to build the other ones. The key was getting the initial one done. We took the template and applied it across other measures.”

“That integration to allow the apps to be available in the normal work flow is essential,” Pramanik said.