Health Care Excel

At HCE, we understand that effective performance measurement provides information about how well processes are working to deliver patient care in a given organization. Our staff of highly skilled professionals is adept at the development of evidence-based and meaningful performance measures, sound statistical and analytical approaches to data analysis, and the identification of performance improvement and patient safety strategies. HCE provides its clients with a broad range of services; all designed with the ultimate goals of reducing or containing health care costs, improving the quality of care, and creating operational efficiencies in complex systems. Our analysts and health care quality improvement specialists can help identify trends and opportunities for positive change. In addition, we offer outreach, education, utilization review, and other services that can help you convert data to action.

Measure Development

Development of well-defined and carefully constructed performance measures is vital in order to evaluate a provider’s actual performance and compare that performance with a targeted objective or standard. HCE has extensive experience working with providers to develop performance measures that will effectively assess the degree to which the appropriate and expected course of action is being followed and the degree to which the expected outcomes are being met.

Medical Record Abstraction

Your data are gold. Let HCE mine it. Our expertise in medical record abstraction and review can provide you with feedback that will enhance your clinical performance and add to your bottom line. Services include core measure abstraction, Medicare risk adjustment and custom medical record reviews.

HCE offers extensive experience in providing medical record review services that seek to ensure the care delivered to patients is appropriate, necessary and meets professionally recognized standards. For over thirty years, HCE has performed independent medical record reviews for a variety of settings, including acute inpatient and outpatient facilities, ambulatory surgery centers, skilled nursing facilities, home health agencies, physician offices, and managed care organizations. Our broad based experience covers both fee-for-service and managed care reviews. Whether you are seeking training for your own staff on case review or wish to employ our services to complete the review or abstraction, we can assist you.

Data Collection

HCE provides an array of data and analytic services supporting healthcare quality improvement and patient safety, including:

• Advising providers and consumers on collection and use of valid and reliable data for quality assurance and improvement; 
• Assisting provider organizations in submitting data for public reporting; and 
• Maintaining extensive and detailed lists of providers through HCE’s contact management system, which may be used for surveys, mailings, maps, and other analysis. 

HCE fully understands data privacy and confidentiality requirements and is HIPAA compliant. Data security is a high priority for HCE. We maintain physical, electronic, and procedural safeguards in connection with the receipt and storage of electronic data. Compliance with secure data management is documented in a HCE Security Management Plan.

HCE has an extensive Confidentiality and Disclosure Policy based on applicable Social Security Act, Code of Federal Regulations, and Medicare Quality Improvement Organization Manual citations.

Data Analysis

The ability to make decisions regarding appropriate improvements in health care delivery is often hampered by the lack of good information on the outcomes of current practices. HCE seeks to support performance improvement efforts of the health care providers in each community we serve. We are dedicated to pursuing effective, efficient, and economical delivery of quality health care services, through the availability of professional resources combined with accuracy in data evaluation, analysis, and reporting. Our staff of Masters-level statisticians works with clinical information and administrative claims data to conduct a variety of program assessments. These health care analytics include quality improvement measures, establishing metrics and baselines for program design, and analyzing health care trends. In doing this, HCE provides our customers with the following:

• Conduct statistical analysis of Medicare data (both administrative and chart-based), publicly reported data on Home Health, Nursing Home and Hospital Compare CMS Web sites; MDS and OASIS data; hospital and outpatient claims; and health plan data  
• Provide high level summaries and aggregate rates  
• Serve as a neutral party to combine, analyze, and present aggregate data from a variety of sources or entities (e.g. health plans, providers) not able to share confidential data with each other 
• Create reports of results customized for individuals and/or respondents (e.g., individualized reports for each nursing home or hospital) 
• Plan and organize data collection for projects, including interpreting data collection guidelines (standard), and developing tools 
• Statistical/data expertise includes:  
  • Comprehensive analysis using SAS (e.g., frequencies, means, variance, regression, significance tests)  
  • Study design and analysis methodology: trend, program evaluation, program monitoring, and run and control charts o SAS code for routine analysis  
  • Large- and small-scale databases o Data received in various formats o Cleaning and validation of data 
• Create formatted Excel spreadsheets or Access databases for data input, output reports including charts, graphs, maps, and other formats that display outcomes and results, and templates and charts to use for output in data monitoring and tracking 
• Suggestions for quality improvement and cost containment. We can help identify trends and opportunities for positive change.  
• Experience with health claims data. We understand the strengths and limitations of health care data, as well as the various methodological approaches used to answer tough policy issues.  
• Identification of high-cost patients with similar characteristics. We can help find “clusters” or subgroups of resource-intensive patients with similar characteristics for intervention to improve care coordination and control costs.  
• Focused studies for quality or cost-containment into disease-specific conditions and medication use issues.  
• Fraud and abuse detection. We analyze areas of concern and profile procedure code billing patterns to estimate savings if providers’ billing patterns more closely matched normal distributions. 

Data Validation

We conduct a test of inter-rater reliability of data abstraction for Medicaid managed care plans. With all data collected and analyzed, HCE takes measures to assure the validity of results presented to providers and partners. HCE reviews claims data and other records to validate and improve the quality of diagnostic and procedural coding. In addition, we are skilled at measuring regulatory compliance.