Success in today’s dynamic health care marketplace requires informatics tools that help identify opportunities for improvement based on meaningful and actionable information and enable provider organizations and Harvard Pilgrim to collaborate to create meaningful change strategies. Harvard Pilgrim invests in data and tools to improve the ability of our provider partners to provide high quality, cost effective, patient centered care.
Harvard Pilgrim provides information to provider organizations on both HPHConnect (structured report outputs) and on the secure SFTP server (data extracts). The reports available via these methods are depicted in the LCU Reporting Framework.
Harvard Pilgrim’sProvider eBusiness team will establish an HPHConnect account for any user requesting access to structured report outputs (see User Access Management section). Once the account is established, you’ll receive a secure email with the account name and a temporary password. The account name is then entered into the relevant security tables to establish access rights to the requested reports.
You may access the the structure LCU reports via HPHConnect, once your account is established. Please refer to the Accessing HPHC’s Secure Service Guide.
Secure Server Reporting
Harvard Pilgrim posts files to its secure server (sftp) to support automated loads of these files to your data warehouse.If you would like access to Quality Measure Reporting (QMR) files posted on the Harvard Pilgrim Secure Server, Provider Reporting Support will send the necessary software and account information to you via secure email.
If you would like access to Claims and Membership Extracts, the Harvard Pilgrim Provider Reporting Support team will coordinate with Harvard Pilgrim Network Contracting to identify the appropriate claims extract governed by the contract with the provider organization and will send the software and account name information via secure email.
You may access the extracts posted on the Harvard Pilgrim secure server via any sftp software tool (while Harvard Pilgrim typically uses WinSCP, the choice is up to the user). Please refer to the Accessing HPHC’s Secure Service Guide for more information.
Harvard Pilgrim provides a suite of reports that support provider group staff in managing the care of patients during transitions of care.
Authorization and Notification Report (ANR)
This report suite enables users to view authorizations and notifications for inpatient care, as recorded in the Harvard Pilgrim Care Management system, which is updated each business day. The user may select current or future time frames to support prospective care management activity. This suite supplies 3 levels of information: by admission type, by facility, and a detailed patient roster. The User Guide to Authorizations and Notifications Report provides more detail on accessing and using this reporting tool.
Inpatient Discharge Report (IP-DC)
This report enables users to view patient level information for patients discharged during the time window selected by the user. This report supports care management in ensuring appropriate transitions between care settings. The User Guide to Inpatient Discharge Reporting provides more detail on accessing and using this reporting tool.
Inpatient Census Report (IP-C)
This report enables users to view patient level information for patients who have been hospitalized in the time window selected by the user. The roster contains information about patients who may currently still be in the hospital and those who were discharge during the time window. This report supports care management in ensuring appropriate transitions between care settings. The User Guide to Inpatient Census Report provides more detail on accessing and using this reporting tool.
Care Management Disease Management Participation Report
This report enables users to view patient level information for patient status in Harvard Pilgrim’s disease management/care management programs during the time window selected by the user. This report supports care coordination with local care management initiatives and PCP involvement. The User Guide to CMDM Report provides more detail on accessing and using this reporting tool.
Referral and Authorization Transaction Report
This report provides LCU clinical leadership with information about referral and authorization transactions in the Harvard Pilgrim system in three views. The User Guide to the Referral Authorization Transaction Report provides more detail on accessing and using this reporting tool.
Provider Analytics Interactive Dashboard [PAID]
This dashboard allows the user to examine three-year trends in:
- Visual Display of Cost and Utilization, by Expense Type Codes (aligned with budget categories) and service categories (industry standard)
- Vital Statistics: membership, % adult, % Fully Insured, % professional payments retained in LCU, % hospital payments in community setting
- High Cost Claimants
- Readmissions and Return to ER
- Admissions and ER visits related to Ambulatory Sensitive conditions
Several components of the dashboard enable drill down to patient level data.
The dashboard output can be exported to an interactive flash format pdf, for distribution to non-users. However, PHI level content is only accessible via the online dashboard and is not accessible in the flash format pdf. Data from the dashboard can also be exported to an Excel format spreadsheet.
The User Guide to the Provider Analytics Interactive Dashboard provides more detail on accessing and using this performance reporting tool.
The financial and utilization report suite also contains the Provider Analytics Self Service (PASS) report which provides summary and detail utilization and cost data for current and prior periods, as defined by the user. The user guide User Guide PASS Cost and Utilization provides more detail on this report.
The ER Utilizers Provider Report identifies patients who may benefit from an intervention to reduce emergency department utilization. This includes patients who have had a high volume of ER visits and return visits with a certain timeframe, as well as patients who have had potentially avoidable ER visits. More information on this report is available in the User Guide to the ER Utilizers Provider Report.
Harvard Pilgrim provides reports that assist staff in contracted groups in managing changes in provider information.
This report enables users to view MD information about primary care and specialty practitioners within the contacted group. Accurate MD rosters impact many critical business processes, including cost & utilization reporting, member attribution, clinical reporting, and performance based payments (for eligible groups) on P4P measures with MD participation components.
The User Guide to LCU Roster Reporting provides more detail in accessing and using this report.
For most of these reports, the Medicare data is accessed by either a Medicare version report option within the report suite or by setting a user parameter to the Medicare Advantage population. In addition, there is a standalone Medicare report providing the member roster at a desired point in time. This Medicare member roster is also posted to the secure server on a monthly basis. More information on this report is available in the User Guide Medicare Advantage Membership.
The Member Detail Report identifies each patient eligible for the measure (including demographic information), the PCP of the member, and their compliance status (1 indicating compliance). In addition to the member level record for each measure, this report also enables the user to drill into the data to view underlying the compliance status (e.g, date of last mammogram, antidepressant prescription, etc.) Data is exportable to Excel to support incorporation of the information into population health workflows.
These reports are available via HPHConnect. The Member Detail Report is also posted to the secure server. The User Guide to Quality Measures Reporting provides more detail on accessing and using this reporting tool.
Provision of this data is governed by the privacy and security agreement which outlines Harvard Pilgrim’s expectations and provider group responsibilities for safeguarding member data. Harvard Pilgrim has implemented user access management policies and processes to ensure compliance national and state regulations and the privacy and security agreement.
Requesting Access to LCU Reporting
Requestors must complete the User Request Form to identify which LCU reporting tools they wish to access. The LCU Reporting tools are available on both HPHConnect (structured report outputs) and on the secure SFTP server (data extracts).
In addition, individual requestors must complete a User Agreement Form outlining the obligations of the user related to LCU reporting. This online form is presented to the new user upon initial logon.
Requests for user access (or termination of access) should be sent to Network Medical Management. Upon receipt of the documentation, the request will be triaged to the appropriate Harvard Pilgrim team. All communications related to user access should be directed to this mailbox so tracking and triage can occur in a timely way.
If a user has not accessed their HPHConnect account for 120 days, the account will be locked and the user will need to re-establish the account. If the account has not been used for 180 days, the account will be terminated.