Case Study
Outgrown Homegrown System
This MCO faced unique challenges in efficiently assessing and ensuring network adequacy and provider data accuracy for its Medicaid program.
Who We Helped
A Medicaid Managed Care Organization (MCO) in Hawaii
Their Challenge
This MCO faced unique challenges in efficiently assessing and ensuring network adequacy and provider data accuracy for its Medicaid program.
Solution
This MCO worked with Quest AnalyticsTM to transition from the Quest Analytics SuiteTM (QASTM) desktop solution to our SaaS Quest Enterprise ServicesTM (QESTM) to address their network adequacy requirements more effectively. Through the migration to QES, MCO achieved cleaner and more accurate data, streamlined reporting processes, and proactive gap identification and remediation.
Book a Strategy Session:
THE SITUATION
This MCO was faced with implementing new network adequacy report requirements under a recently awarded Medicaid contract. This MCO had previously relied on a manual process using a homegrown system that relied on subject matter experts who were impacted by staff turnover. This led to the organization seeking a more sophisticated solution through Quest Analytics®.
THE SOLUTION
This MCO decided to transition from the Quest Analytics SuiteTM (QASTM) platform to Quest Enterprise ServicesTM (QESTM) to address its network adequacy requirements more effectively. The decision was influenced by the introduction of a new contract with a large health care provider, which necessitated additional metrics and a GeoDistance-based measurement approach. They engaged with Quest Analytics to explore the feasibility of achieving its goals within the QES provider network management platform.
The Outcomes
Enhanced Reporting and Data Quality: QES provided this MCO with 38 reports, including specific Provider Network Adequacy reports, offering in-depth insights into their network adequacy. The platform eliminated the need for manual calculations of drive times, improving the accuracy and reliability of reporting. The platform also gave them the ability to identify and rectify data /discrepancies, leading to increased data accuracy and quality.
“Data speaks louder than anything – we can hear anecdotally through grievances. But with more accurate measures of network adequacy, we can see more across the board.”
Improved Efficiency and Proactive Gap Identification: With QES, this MCO experienced greater efficiency in identifying network gaps and was therefore able to fill them quicker.
“With Quest Analytics we finally got some clarity. Once the data was clean, we were able to use tools to help us not only address existing gaps but get ahead of them .”
The platform’s advanced analytics empowered this MCO to proactively address network inadequacies, reducing member grievances and ensuring timely access to care. The ability to export data for further analysis also facilitated more comprehensive decision-making.
Cross-LOB Support and Collaboration: This MCO appreciated the dedicated support from Quest Analytics, which extended across its other lines of business. The availability of a dedicated team and compliance resources contributed to a smoother onboarding process and improved user experience. The QES platform’s accessibility to historical data also allowed for comprehensive analysis and empowered the organization to derive actionable insights across these lines of business.
“Historical data is more accessible and easier to dive into. We now have insights into how many providers there are for certain specialties and where they are located. The QES platform makes that so much easier to present. And, I’m also confident that I am using the right data.”
Trust in Data and Advanced Analytics: This MCO emphasized the trust they place in the data quality of QES, enabling accurate reporting and decision-making. The platform’s advanced analytics capabilities helped the organization identify trends, measure network adequacy, and gain deeper insights into provider availability and distribution. This newfound visibility into provider data supported proactive decision-making and efficient resource allocation.
“We trust the data quality in QES for reporting and decision-making. It also showed the power of analytics to drive efficiencies and do data clean up.”
CONCLUSION
By leveraging the QES platform, the team was able to successfully address the challenges associated with network adequacy assessment for its Medicaid program. The transition from a manual approach to an advanced analytics solution streamlined reporting processes, enhanced data cleanliness, and facilitated proactive gap identification. The collaborative partnership between the organization and Quest Analytics exemplified the value of leveraging the QES platform to drive efficiencies and improve customer satisfaction. Further, because of their successful collaboration with Quest Analytics, this organization is now looking into extending QES into their commercial line of business.
“This process made me realize that through this, we are creating sustainability and historical knowledge.”
