Prisoft covers the whole nine yards of Health Care Analytics Value Based Care Financials Hospital length of Stay Prediction using ML Quality

1. Prisoft HealthCare Analytics
Framework
Priyadarshy Dash
Prisoft Inc.

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Health Care Analytics Data Model

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Value Based Care

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Member Analysis
• The 1st report shows the Total Medicare, Medicaid and Commercial members.
• The 2nd report shows the organization's exposure to different insurers based on the
number of patients they cover.
• Total Members by Primary Care Physician. This report shows each primary care
physician's exposure to different insurers based on the number of patients they cover.
• Total Members by Attributed Provider. This report shows each attributed provider's
exposure to different insurers based on the number of patients they cover.

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Membership Demographics

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• This report helps you understand the PMPM
costs that attributed physicians generate
through the average monthly cost per
member and the total number of members
assigned. The distribution between
emergency and inpatient members also helps
to understand the associated costs.
PMPM Analysis
• PMPM drug cost in dollars. This
report allows you to see the average
monthly costs per member and
their distribution between medical
and drug PMPM costs. It also allows
you to evaluate your total costs and
the cost of a typical procedure.

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Risk Score Analysis
• Total number of patients with risk score, average scoring events per patient and average days
since last scoring event. This report helps you understand the scoring activity volume based
on the number of patients it is performed on, the number of scoring events per patient and
their frequency.
• Risk analysis by gender, ethnicity, and age band. Correlate this report with the total numbers
of patients in each category to understand which genders, ethnic groups and age bands are
more exposed to risks.

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Rx Claims Analysis
• Prescription count and cost analysis - This report helps you understand how
often different medicines are prescribed and the costs that these
prescriptions generate.
• Out of pocket costs report shows the average out of pocket cost that patients
pay for a given set of medicines along with the breakdown of the total cost
by total copay, deductible, and patient responsibility amounts.

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Derived Measures
• ACO Quality Measures - Graphical representation of the percentile rating for the
selected organization providers for specific measure types. This report allows you to
compare how organization providers compare to each other on different measures.
The detailed tabular report below the chart also includes the percentile variance from
the previous year to the current year, providing insight into the progress of an
organization over different ACO quality measures.

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Patient Caregiver Experience
• Patient Satisfaction Survey - Shows patients' surveys during their encounters with the caregiver.
It displays the performance score for each area. For example, "During the hospital stay, how
often doctors explained in a way that the patient could understand?" has a score of 80%, which
means 80% of patients agreed that the doctors explained clearly.
• Survey Category - Shows the survey response results rolled up to the categories, such as
cleanliness of hospital environment, communication about medicines, and communication with
doctors, nurses.

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Financial

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Claim Analysis
• Total claim charge amount
versus total non-covered
claim charge amount. This
report allows you to see the
extent to which the charges
claimed by each organization
service provider are covered
by insurers and to evaluate
the risk of overdue or
delinquent payments.
• The second report shows the
detailed view.

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Encounter Charges Analysis
• Total charges over time. This report helps you understand the trend in
organization spending for patient services over a chosen period of time.
• Charges by department. This report helps you understand the charging
distribution between departments.

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Billing Analysis
• Total billed amount for stroke treatment by organization service provider - You can modify this
report to use any diagnosis or procedure. This report helps you compare the costs that
organization service providers spend on stroke treatments.
• Total billed amount for stroke and endovascular procedure treatment by organization service
provider. This report helps you compare the costs that organization service providers spend on
stroke treatments and endovascular procedures.
• Patient bill details - Tabular report showing the patient bill details for a selected patient account.
This report allows you to drill-down to the detailed billing information of individual patients.

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Hospital Length Of Stay

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This report shows all patients still in the facility today. This page summarizes the facility
load and gives predictions for how much longer they will stay.
Predicting Hospital Length of Stay - CMIO

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This page shows information about patients still in the facility today. Select
your ward above, and use the Pred Days Left filter to examine your
population over the coming week.
Predicting Hospital Length of Stay – Care Line Manager Daily Report

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This is the clinical analytics dashboard which tells us hourly visits of patients
throughout the week and their medical conditions.
Clinical Analytics Dashboard

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This dashboard gives us the regular insulin dosage level(Pre-meal dosage) of
the patients suffering from diabetes with the increase in their glucose
levels.
Diabetes Analysis

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Prediction using ML

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• This is a Breast Cancer detection workbook which predicts the
cancer as “Benign” or “Malignant” by changing the value of the
parameters provided in the workbook.
• It uses a python model for prediction.
Prediction Using ML

22. Prisoft health care , QUALITY and
revenue Reports
www.prisoft.com
Kaushik Dash

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• To open Report Server navigate to http://eniac/Reports on browser.
• Enter the Credentials when asked.
• After Successful connection, Home Page of the Reporting Services will appear as below.

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Prisoft Health Care Analytics
• Prisoft Health Care Analytics have three different reports and all are
interactive in nature.
• Interactive refers to the drilling down to Detail levels to focus on a
particular value.
• Starting with the report: Claim Analysis (Action Filter)

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• The reports describes the Medicines for certain diseases along with the
Cost.
• The highlighted Blue Part allows you to drill down to the detail related to a
particular Medicine and the Disease.
Prisoft Health Care Analytics

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• The second report provides the Summary of Patient’s Visit Count in a Year.
• The Color Variance provides you an idea on higher or lower Patients visits
for a State.
Prisoft Health Care Analytics

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• The Map allows you to drill down to a particular State to view the related
Patients. Below is the drill down for State “California”.
Prisoft Health Care Analytics

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• The third report shows the interactive nature of Line of Businesses in the
same Report.
Prisoft Health Care Analytics

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• By clicking on the graph of Medicare the reports get filtered as below.
Prisoft Health Care Analytics

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PRISOFT QUALITY REPORTS

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Prisoft Quality Reports
• Quality Reports deals with the deep understanding of the technical
details, costs, and human-resource relationships of the organization.
• The snapshot attached below contains the summary of 6 Quality Reports
having the option to drill down to its details on the highlighted one.

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All Cause Readmission Report
• This provides the number of acute inpatient stays during the measurement
year that were followed by an unplanned acute readmission for any diagnosis
within 30 days.

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All Cause Readmission Detailed Report
• Clicking on any Bar of the graph allows you to drill down to details and shows
the exact count through which you are drilling down across HealthPlans.

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Cervical Cancer Screening
• The Cervical Cancer Screening Report shows the count of women within the age
group of 24 – 64 with the following Criteria:
• It shows the total number of female members excluded from Hysterectomy for all
Health Plans within a specified date range.

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Child Immunization Status Report
• This provides the information about the child who turns 2 years of age during the measurement
year.
• The percentage of children 2 years of age who had;
• four diphtheria, tetanus and acellular pertussis (DTaP);
• three polio (IPV); one measles, mumps and rubella (MMR);
• three haemophilus influenza type B (HiB);
• three hepatitis B (HepB),
• one chicken pox (VZV);
• four pneumococcal conjugate (PCV); by their second birthday.

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Encounter Data Timeliness Report
• This provides the rate of encounters submitted within 60 days from date of
Service.

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Initial Health Assessment Report
• This provides all new members who must receive an Initial Health Assessment
(IHA) within 120 days of enrolment into the plan as well as Staying Health
Assessment Questionnaire.

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Well Child Visits Report
• This provides the
percentage of
members 3-6
years of age who
had one or more
well-child visits
with a PCP during
the measurement
year.

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PRISOFT REVENUE REPORTS

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Revenue Dashboard
• The Revenue Dashboard shows the KPI summary for the Revenues, Expenses,
Claims Amount Paid.
• It also determines the number of Claims, Authorizations and Claims for a
particular Year or Month based on the filter applied.

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Revenue Dashboard
• There are 3 tabs and the yellow highlighted tab shows that particular tab is
chosen.
• Clicking on ‘HealthPlan’ tab results as below.

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Revenue Dashboard
• The Summary has been linked to the details of all Members.
• Clicking on the highlighted # Member ID in the table takes you to the detailed
report of Members involved.

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Revenue Trends
• The Revenue Trends displays a Line graph vs Month Name for the selected Year,
Month and Health Plans.
• To choose Trends, a drop-down is available at the top. The graph is visible only
after selecting the trends.

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Revenue Trends
• The Expenses Trend can be viewed too by selecting Expense from
“Choose Trends” drop down list.

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