Your new vendor for care management has given you a long list of standard reports. Plus you have online access to even more data. Surely you have everything you need to keep track of their performance, right? Wrong.
If you don't have meaningful, valid reports, your performance guarantees are toothless. Here are three commonly used ploys:
A monthly report gets you a fat three-ring binder and the impression that you have timely information. The truth is you will have no useful data. One month is simply too short a time period. The data "chunks" are too small, like the pieces of mosaic that never get put into place. Even if the reports include 12 months of data, there is no need to look at it every month.
Your online access may also give you "real time" data. This, too, will be woefully incomplete because hospitals and doctors can take months to submit claims, and for the data to get into the system can take just as long.
If the vendor says that its measures are not the same as NCQA or HEDIS, it may be using invalid measures. There is a reason that no one else is using their measures - they don't mean anything.
For example, a vendor reported the number of people in inpatient specialty care on the last day of each calendar quarter. This measure is not useful for several reasons:
1. It does not give any measure of what happened during the quarter, (e.g., how many patients received care, or how many days of care).
2. The last day of the quarter might be a weekday or a weekend. Admission and discharge patterns may be different for a Monday than a Saturday.
3. It tempts you to track your numbers from one quarter to the next. There may be seasonal ups and downs. Don't congratulate your vendor for pushing admissions down in the winter - they probably go down every winter.
Slice and dice gone wild
The vendor may offer you too many different ways to "slice" the same data. For example, you might be able to see the data by geographic region, gender, age, race/ethnicity, provider type, day of week, admission type, and so forth. Even if your covered group is tens of thousands of people, you can quickly get to tiny numbers when slice-and-dice gets out of hand.
Too many different versions of the same data give you a lot of noise, but not a lot of insight. In fact, it's easy to get distracted by all the pictures and lose track of the goal.
The reporting part of the contract is your major opportunity to get a handle on the vendor. Don't be wowed by the long list and the whiz-bang options they offer. Focus instead on valid, science-based measures and competent reporting. With the right tools, you will be able to get the most out of your contract.
Linda K. Riddell is a principal at Health Economy, LLC. She can be reached at LRiddell@HealthEconomy.net. This article originally appeared on our blog, EBViews. Share your comments at ebn.benefitnews.com/blog/ebviews.
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