Member Predicted Risk

This reporting dashboard presents member-level predicted risk information for all eligible MaineCare members who have had an encounter within the last 365 days. The information provided in the reporting can be filtered by a number of criteria based on user selection.

Before Getting Started

Before diving in, use of this reporting dashboard requires clear understanding of a few foundational components that we leverage in our analytics and reporting. If you haven’t already, be sure to read through some precursory definitions and methodologies. Those areas that we think may be helpful to review specific to the understanding of this reporting dashboard include:

Data Sources & Refresh Frequency

HealthInfoNet’s reporting dashboards combine a number of data files sourced from HealthInfoNet’s Health Information Exchange (HIE) data warehouse and MaineCare’s eligibility and claims information. For each dashboard available, users should understand the primary data source(s) and refresh frequency to instill confidence in and inform use of the reporting within their workflows. Learn more…

Member Eligibility Inclusion Criteria

HealthInfoNet’s data use agreement with the Maine Department of Health and Human Services permits the Office of MaineCare Services to view information from the statewide HIE according to specific member eligibility inclusion criteria. To meet this criteria, HealthInfoNet receives a daily eligibility file from MaineCare that is used to refresh each reporting dashboard on a daily basis. Learn more…

Member & Organizational Attribution

Attribution is the process of assigning members to individual organizations as well as identifying the hierarchical arrangements among the distinct types of organizations available within reporting. What results is the ability for users to view their members' healthcare utilization, predicted risks, and quality outcomes aggregated in different ways to meet various use cases and programmatic needs. Learn more…

Predictive Risk Modeling

HealthInfoNet delivers insights that help its customers predict the risk of future conditions, events, and types of utilization for their attributed patient populations. That means that providers can be alerted to high and rising risks for the patients they care for to help drive quality improvements, manage risk and population health, and inform operational decision-making. To start, users can read up on HealthInfoNet’s underlying predictive risk model methodology, including guidance on how to interpret those results to support follow-on action. Learn more…

Tips & Tricks

The more you know how to work the nuts and bolts of each reporting dashboard’s built-in functionality, the better you’ll be able to effectively and efficiently use the dashboards to your advantage. That’s why we’ve created a list of best practices, lessons learned, and other tips and tricks to optimize your experience while working in the platform. Learn more…

Dashboard Definitions

Not sure what you’re looking at? No problem! We’ve done the homework for you by detailing the definitions, use cases, and any other relevant notes about all charts and tables available in this dashboard.

🔢 Member Predicted Risk

Contains detailed information on the risk scores per available risk model for each eligible member.

Field

Definition

Notes

Medicaid ID

This field contains an ID that identifies a unique Medicaid member. Note: This is the ID referred more commonly by MaineCare as the 'A' number or the Member Secondary ID.

Member Name

This field contains the first and last names of the member.

[Risk Model]

There are 20 separate fields, one for each available risk model. For each risk model field, the field contains the member’s predicted risk class color-coded by 90-day change indicator.

For more information about each available risk model, see the section on Predictive Risk Modeling.

Risk Class values:

L = Low Risk
M = Moderate Risk
H = High Risk
V = Very High Risk
P = Present Risk

Color Coding:

Grey - No change in risk over last 90 days
Blue - Decrease in risk over last 90 days
Red - Increase in risk over last 90 days

Dashboard Filters

Want to tailor the dashboards to look at only a certain member population, risk model, risk class, or 90-day change indicator? Easy. We’ve got plenty of embedded and stock filters for you to use to meet various cross-cutting use cases and needs.

🔍 Stock Filters

Stock filters are the drop-downs, sliders, and free-text fields located at the top of each reporting dashboard that allow users to slice and dice the data contents in diverse ways.

Filter	Definition	Notes
Attribution Type	View our section onAttribution Selection from more information.	For more information on HealthInfoNet’s attribution methodologies, see the section on Member & Organizational Attribution.
Attribution Level	View our section onAttribution Selection from more information.
Attribution Entity	View our section onAttribution Selection from more information.
Model Name	The specific risk model for which member-level predicted risk information is reported.	For more information about each available risk model, see the section on Predictive Risk Modeling.
Risk Class	The categorization of numeric risk scores for each risk model into higher-level classifications of Low, Moderate, High, Very High, and Present (if applicable) groupings.	The Present risk class is only available for condition-based risk models; event-based and utilization-based risk models do not have such grouping. For more information on the definition and interpretation of risk classes per risk model, see the section on Predictive Risk Modeling.
90-Day Risk Change	The stratification of a risk model’s aggregate risk class distribution by whether underlying member-level risk scores have changed between the time of reporting and 90 days prior.	For each risk model, patients' current risk scores are compared against their risk scores 90 days prior. Between the two periods, risk scores can either Increase, Decrease, or have No Change.
Medicaid ID	The ID that identifies a unique Medicaid member. Note: This is the ID referred more commonly by MaineCare as the 'A' number or the Member Secondary ID.
Sex	The sex of the member.
Age Group	The age group of the member.
Race	The race of the member.
Ethnicity	The ethnicity of the member.

🔍 Default Stock Filters

For each stock filter available, there must be a default value assigned in order to populate the reporting dashboards for users to work from. Those default values are defined below per stock filter.

Filter	Default Value	Interpretation
Attribution Type	View our section onAttribution Selection from more information.	Retrieves risk data per members' attribution to organization(s) based on their encounter histories.
Attribution Level	View our section onAttribution Selection from more information.	Retrieves encounter data on all levels of organizations that are affiliated with members' attributed organization(s) based on their encounter histories.
Attribution Entity	View our section onAttribution Selection from more information.	Retrieves encounter data on all organizations that are affiliated with members' attributed organization(s) based on their encounter histories.
Model Name	All	Retrieves risk data for all available risk models.
Risk Class	All	Retrieves risk data for all available risk classes.
90-Day Risk Change	All	Retrieves risk data for all available 90-day risk change indicators.
Medicaid ID	All	Retrieves risk data for all eligible members.
Sex	All	Retrieves risk data for all eligible members, regardless of their sex.
Age Group	All	Retrieves risk data for all eligible members, regardless of their age.
Race	All	Retrieves risk data for all eligible members, regardless of their race.
Ethnicity	All	Retrieves risk data for all eligible members, regardless of their ethnicity.

Dashboard Linkage

Did you find an interesting trend or result that you want to explore more? Our reporting dashboards have been carefully linked together to allow for deeper dives and tangential investigation into available data. Continue reading to learn which of our other dashboards this report links to for continued study.

🔢 Table Linkage

By selecting a particular member within the table, a tooltip will appear with a variety of information, including the ability to allow users to view additional information about the member, including their:

Demographic/Eligibility Information (see Member Profile)
Encounters/Utilization Information (see Member Utilization)
Prescribed Medications Information (see Member Medication History)
Address History Information (see Member Address History)
DRG History Information (see Member DRG History)

Use Case: As a user, I just found that one of my members is at high-risk for 3+ conditions. I want to see their Inpatient and Emergency Department utilization over the last 365 days to identify whether they have had any significant medical events. To do so, I would select the member’s record in the table and the “View member’s encounters” hyperlink from the tooltip. Doing so will automatically redirect my reporting to the Member Utilization dashboard, filtered to just the selected member’s encounters.

Want to keep learning about our reporting dashboards? Great! There’s more predicted risk-related information for you to explore. Try checking out one of these dashboards to continue your study:

Predicted Risk Profile - Aggregate-level information on members' predicted risks.