As of April 2017, 39 regions and states have contracted with a MMIS solution or module, and an additional 16 (including Ohio and Michigan) remain operated by the state.
Everyone is talking about Big Data, but how can it really help you understand your exchange membership?
The Affordable Care Act (ACA) requires health plans to upload de-identified enrollment, medical claims, and pharmacy claims data to EDGE Servers for accurate risk score calculators, for both Risk Adjustment (RA) and Reinsurance (RI). These advanced analytical methods can offer diverse insight into consumers’ healthcare consumption behaviors and cost utilization by using numerous key performance indicators (KPIs) such as demographics, age, and gender.
Recently, there has been a national trend in healthcare payers relying on factual data to drive down costs. Insurance companies are able to do so by relying on software to compile a detailed medical profile of all enrollees. Big data is a big effort! How do you build that operation? Why are we seeing such a big transition from traditional data to big data? How can we visualize and present this data in the most meaningful format? What is the right approach?