Objectives. Participants will learn how to:

1. Collect HEDIS data, understand measure numerators and denominators and report clinic achievement against goals
2. Produce standard and ad-hoc eligibility reports (e.g., membership trends, payments for ineligible members)
3. Analyze capitation payments and reconcile capitation payment with eligibility files, changes and carve-outs
4. Develop standard and ad-hoc financial reports (e.g., PMPM expenditures, cost categories, cost trends, denials, high-cost claims)
5. Develop, track and report key member service performance metrics (e.g., response time, time on hold, call volumes)
6. Develop standard and ad-hoc utilization and care management reporting capabilities (e.g., Days/000, admits/000, ALOS, bed types, ED visits, visits/000, specialty consult trend reports,)

 Curriculum Description

1. Claims/encounters, capitation payment reporting and reconciliation:
   1. Reconciling capitation payments with eligibility files (See also: Member Eligibility, Reconciliation & Management section)
   2. Dashboard reporting best practices
   3. Encounters reporting trends (e.g., submissions, rejections)
   4. Capturing point of care lab testing and on-site pharmacy fills and samples in discrete fields in the EHR
2. Cash flow dashboard development and implementation:
   1. Developing KPIs
   2. Historical and trended financial reporting (e.g., cash flow, P&L, capitation, FFS, wrap payments)
   3. Resource and staffing requirements, including development of staffing ratios cost analysis for care team and panel management
3. Eligibility dashboard reporting:
   1. Membership trends, including identification and trending of eligible members not seen or assigned
   2. Trending of retroactibe adds, deletes and changes
4. Population health management, registries, quality and member services:
   1. Satisfying required quality metrics
   2. Linking EHR alerts to population health management programs and priorities
   3. Developing and using registries
   4. Creating and managing support reports, identifying and working lists of members “out of compliance” with care guidelines and quality measures
5. Utilization and care management dashboard and trend reporting:
   1. Member access to primary care and other services (e.g., including wait times, days to next available appointment)
   2. Chart closures
   3. Encounters
   4. Hospital and ED utilization
   5. Ancillary and high-cost service identification and trend analyses

Suggested team member participants:  C Suite (CEO, COO), IT Staff, Quality Improvement and Assurance, Reporting and Analytics, Finance

If you have any dietary restrictions, please email Charlotte Reische, atcreische@cpca.org.