Data Analytics Xiaoling Huang, Data Analytics Director for Medicaid - - PowerPoint PPT Presentation

Data Analytics

Xiaoling Huang, Data Analytics Director for Medicaid and CHIP August 2016

Medicaid Overview

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4.1M

Members

Programs:

• Fee for Service 12%
• Managed Care 88%
• STAR 83%
• STAR+PLUS 15%
• STAR Health 1%

Budget

$67.9B

(fiscal year 2016-2017)

Medicaid is a jointly funded state-federal program that provides medical coverage to eligible needy persons.

Our Four Key Goals

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Mission: To proactively support Medicaid/CHIP programs in

making data-driven decisions in improving the health, safety and well-being of Texans

Data Analytics

Improve Health Outcome Strength Contract Management Contain Costs Reinforce Compliance

Our Mission

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Mission: To proactively support Medicaid/CHIP programs in

making data-driven decisions in improving the health, safety and well-being of Texans

Data Analytics

Improve Health Outcome Strength Contract Management Contain Costs Reinforce Compliance

How We Do It

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• Detect trends and identify anomalies
• Utilization of services
• Cost of services
• Adequacy of provider networks
• Monitor performance
• Establish performance measurement methodologies
• Evaluate program performance
• Provide technical consultation to program areas
• Enhance data analytics infrastructure and

capacities

• Increase data analytics maturity and adopt business intelligence

(BI)

Dashboards

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Dashboards

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Visits Ranked by Diagnosis

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Track Seasonality

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Frequency of Visits

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Follow Correlations

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The Steps taken

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• Clients
• Providers
• Claims/encounters
• Clinical
• Case management
• Financial
• Compliance
• Performance
• Assessment

Data

• Standardizing
• Linking
• Merging
• Aggregating

Data Quality

• Descriptive
• Statistical
• Predictive
• Prescriptive

Interpretation

Questions

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