Reliable Comparative Analytics for Financial and Clinical Performance Decision-Making

ikaProfyle is a clinical profiling solution that reliably measures and compares the economic and quality performance of primary care physicians (PCPs), specialists, hospitals and networks — even employer groups — using concurrent data and rigorously case-mix adjusted methodologies.

PCP performance is total membership based and adjusts for age, gender and case mix; reports also include comparisons of relative value unit (RVU) utilization. Specialists who perform procedures (Procedurally Related Group or PRG specialists) are compared on the basis of resource utilization for procedures performed, whereas specialists who medically manage (Medically Related Group or MRG specialists) are compared on the basis of resource utilization for the diseases they manage. Performance comparison includes both total membership based analyses (to evaluate the true gatekeeper role of PCPs) and event-based analyses (for PRG specialists).

The system automatically generates over 60 standard reports in the following categories:

• Provider Reports
  
• Primary Care Physician Performance
  
• Network Physician Analyses
  
• PRG Utilization Analyses
  
• MRG Utilization Analyses
  

In each report, data can be accessed at the most granular level and rolled up into larger units of analysis.

Plans have access to the foundational data elements to generate ad hoc reports with SQL queries or with any off-the-shelf reporting application. The new reports are always returned to the data repository and can be easily be combined to create endless report variations.

Sample ikaUA Reports

REPORT NAME	REPORT DESCRIPTION
PCP Relative Performance $20K	Bar Graph of Relative PCP Performance, with Actual Versus Expected and Textual Explanation (PDF)
Medical Utilization Graph	10 Trend Graphs Showing PCP Relative Performance, Case-Mix Adjusted (PDF)
In-Patient Analysis by PCP (Liability)	Statistical Analysis of In-Patient Utilization by PCP (Liability)
Actual Versus Expected PCP PMPM Utilization Categories $20K	Actual Versus Expected PCP PMPM Expense Categories Utilization Amount, Catastrophics Excluded @ $20K
PCP Case-Mix Index Analysis Excluding Catastrophics @ $20K	PCP Case-Mix Adjusted Analysis, Catastrophics Excluded @ $20K
PCP Relative Performance Based on RVU	PCP Case-Mix Adjusted Relative Performance Based on RVU Excluding Catastrophics @ $20K
PCP Cumulative Risk Tiers Individual PCP Tier	PCP Cumulative Risk Tiers, Excluding Catastrophics @ $20K Individual PCP Tier
Network Actual/Expect Expenses Categories	Actual PMPM / Expected PMPM Expenses by Network or Group Practice (Utilization)
PRG Performance Index by Specialists	Relative Procedurally Oriented Specialists Performance Index
MRG Relative Performance Index (Utilization)	MRG Performance Index by Specialty by Specialist (Utilization)