What is Included

Nascate Personas ™ use imperfect data to stratify an entire population into groups that each represent different types of healthcare users based on clinical information and social determinant drivers. These person-centric groupings are intended to group members into like categories based on an organization’s ability to have impact and intervene.

What It Is:

Nascate Personas™ consist of nine all-encompassing groups that stratify an entire population. They are our person-centric way of understanding members based on the complexity of a person’s treatment burden and his/her interaction with the healthcare system. They do not rely on clinical classifiers and are not optimizing for cost, which helps make them stable over time. Nascate Personas™ serve many purposes, including improved individual and population-level understanding, focused interventions, and improved predictive modeling.

How We Did It:

Every member is assigned only one Nascate Persona™. They are grouped based on patient demographics, diagnoses, and locations of services. Nascate Personas™ are built longitudinally, using a meaningful history, and they are tagged every month so that important changes can be detected earlier.

Why We Did It:

Organizations often rely on clinical classifiers to segment and analyze their population. But a person’s health is impacted by social determinant drivers that must be considered. Nascate Persona’s operationalize the use of social determinant drivers in analyzing a person and population, predicting risk, and micro-targeting interventions and determining the next best action for optimal outcomes.

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Nascate intakes your data, analyzes it, and delivers it to you understood, enhanced, and teeming with insights.

Every client receives this custom strategy session and can choose the delivery mechanism that best suits their needs: Nascate Aware™ Application, or Nascate Aware™ Data Exchange. From there, based on Nascate’s Opportunity Analysis, a client is provided the solutions and solution combos that will give them the best results.

Nascate Solutions:

• Alignment & Accountability
• Network Management
• Person-Targeted Actions
• Medicare Bundle

Nascate focuses on capturing relationships between consumers and providers over time, and understanding the differences in the strength of these relationships. Through AI and Graphing capabilities, Nascate evaluates current and historical attribution so you can better understand how consumers and providers are working together, and what natural behaviors exist.

Unique Nascate Data Science:

• Performance and influencer scores
• 360 degree views of people
• Social Graphs
• Understanding relationship strength
• Advanced Machine learning/AI

The Nascate Action Builder™ allows for a set of rules to be applied to a population to target people for action.

Using this tool, you can make selections to customize an action set based on an organization’s priorities, resources and objectives to match actions to the right beneficiaries for maximum benefit.

The Nascate Action Manager™ examines the actions built in the Action Builder to identify how selected actions overlap, determine necessary resources, and assess engagement opportunities for beneficiaries.

Nascate has developed an improved assignment methodology based on the strength of the relationship between a person and his/her provider.

What Is the Nascate Attribution Engine:

The Nascate Attribution Engine is an innovative methodology that is based in capturing relationships between members and providers, and understanding the differences in the strength of these relationships. The attribution process allows for up to 10% of people to be associated with a provider for attribution. Client choice in the specific rules for who gets Attributed and what utilization and behaviors are to be expected at different levels, helps to create an Attribution program that can be successful for both the Plan and Providers.

What We Did: 

We evaluated claims utilization for attribution, but rather than focusing on volume we chose to focus on the relationships between Individuals and Providers as well as Providers and Provider. Our longitudinal view of connections and strength of relationships between individuals and providers allows us to better understand how members and providers are working together and what natural behaviors exist.

Why We Did It: 

Traditional attribution rules are limited to a narrow window of activity. This results in weak, unstable assignment and poorly represents provider performance. It also fails to assign a large subset of a population, neglected growth and revenue opportunities. An attribution model that provides more stability over time, focuses on relationships, and makes logical assignments of those previously unassigned will be a win for both plan and provider as accountability is more clear and consistent.

How to Use It: 

The Attribution Engine builds a strong foundation for value-based care to succeed. By using the insights it provides, gaps and areas of opportunity can be identified in current attribution, performance can be maximized and compensation can be allocated properly.

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Our secure application is cloud-based, allowing for low-overhead and quick implementation for your workflow integration. Our self-service modules enable you to segment your population, match individuals to appropriate actions, and measure the outcomes for success.

These modules include:

Nascate Explorer™
Nascate Population Dynamics™
Nascate Market Scanner™
Nascate Medicare Explorer™
Nascate Action Builder™
Nascate Action Manager™

Nascate consumes client’s data, applies proprietary enrichment processes, and returns enhanced data to the client. A data dictionary is provided for reference.

The Nascate Data Exchange Service allows clients to incorporate Nascate content into their own systems, such as the client’s CRM and data warehousing.

All data is received and delivered via secure channels, and encrypted while at rest and in transit. Notifications are sent to the client when data is received and sent.

The term “care density” refers to the degree of patient sharing among a set of providers.

Highlights: The provider score is based on the number of shared patients between providers. The tighter the relationship, the higher the score. Tighter relationships between the providers that a member sees yields a better experience and better care for that member overall.
Nascate delivers a provider list with Low/Medium/High Care Density scores indicated for each provider.

High Care Density Score: This is given to providers who are tightly connected, which results in the best patient experience and lowest cost/utilization.

Medium Care Density Score: This is given to providers who have some connections, but have members seeing providers outside of their community.

Low Care Density Score: This is given to providers who have minimal connection to other providers.

Results in Action: Nascate Care Density helps health care providers steer members toward high-scoring providers, and work with low-scoring providers to educate and support improvement in care density.

Nascate has developed a series of strict and rigorous that ensure data accuracy and reliability. Our end-to-end testing and interrogation process ensures the validity of all internal calculations and reduces rework and reprocessing, while increasing the velocity between initial access and use.

This comprehensive regime- refined over the past 20 years across multiple payers, lines of business, and geographies- serves as the standard for all claims database submission and quality assurance.

What We Do:

Comprehensive, end-to-end testing:

• Pre-Processing  Upon data receipt, a suite of tests and checks are run that concentrate on: Clinical Completeness, Population Rates, Referential Integrity.
• In-Line  Nascate utilizes numerous in-line checks during and after each metric and measure calculation. This ensures the outcomes are in line with established thresholds prior to moving on.
• Post-Processing  When processing is complete, a QA team (Data Operations, Data Quality, and data content experts) further analyzes and reviews the database. This ensures that the process (and the hundreds of checks used to get to this point) produces a dataset that meets quality expectations and is fit for purpose, prior to being released.

This layered protocol is synergistic and combines individual tests, the most appropriate order of these test series, and the validation of final outputs.

Why It’s Important:

Data increasingly drives decision-making. Before it can be transmitted for analysis, it must undergo a variety of changes and processes, leaving plenty of room for error. Nascate has integrated years of experience, across a diverse mix of data sources, into our advanced QA protocol. This process provides cross-sectional and time series integrity and assures the information at hand is reliable and accurate.

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The Nascate Early Action (EA) Churn Model helps predict which members are likely to churn and which members are likely to be retained in your network. It also quantifies risks associated with churn and assigns the probability of a person’s likelihood to leave the network.

Highlights:

• The Nascate EA Churn Model can predict risk of churn for anyone, regardless of their characteristics.
• Nascate provides early insight into why a person is at risk for churn, so you can direct outreach and engagement.

Results in Action: Reducing churn and retaining the right members increases revenue now and maximizes your existing investment in a member for long-term value. The Nascate EA Churn Model helps you engage members at risk of churning by leveraging existing member-provider relationships.

The Nascate Early Action (EA) Risers Model gives you the ability to intervene on high-risk and emerging high-risk members before their cost and utilization dramatically increase. The model predicts which members are “Risers” — i.e., likely to substantially rise in utilization in the near future, and provides information on where to target interventions.

Highlights:

• Our proprietary methodology analyzes a member’s encounters over time to capture meaningful trends and changes.
• Nascate provides early insight into why a person is at risk so you can direct outreach and engagement.
• Nascate leverages a 360-degree person view to account for social determinant drivers (geography, support at home, access, and more).

Results in Action: The Nascate Early Action (EA) Risers Model gives you the data you need to effectively engage members at risk and provide person-centric support and action.

The Nascate Explorer™ application connects insights to actions that are focused, guide decision making, and deliver impact.

The app utilizes person-centric metrics to enable self-directed exploration and analysis at common levels such as county, provider and mechanical neighborhoods. This exploration is through a lens that looks at important factors driving healthcare consumer behavior.

Nascate Healthcare Days is an innovative metric used to fuel Nascate’s tools. It measures the true impact of the healthcare system on a person while capturing information related to the traditional cost and utilization metrics.

Highlights: The metric is longitudinal, meaning it analyzes a meaningful span of data over time, and accounts for the order in which events occur along with the pattern in which they change.

Results in Action: This metric is very effective in allowing you to identify what appropriate actions to take while there is still time to make a difference.

The Nascate Market Scanner™ identifies trends impacting network leakage, including provider referral patterns and services received outside of network by specialty and provider.

This data analysis provides insights into network strength and leakage by identifying where and why beneficiaries are going outside of the network.

Nascate Medical Neighborhoods™ are proprietary communities of physicians who share connections of individuals and families. These networks of association are created by combining claims and public CMS data to infer physician referral patterns.

Nascate Medical Neighborhoods are:

• Person-Centric: Behavior-based and independent of formal provider affiliation
• Geographically Relevant: Geographically relevant, as individuals are deeply influenced by where they live and their interactions with medical providers
• Longitudinal: The data algorithm utilizes multi-payer referral patterns over time to fill in gaps

Nascate Medical Neighborhoods™ get a Nascate Performance Metric (NPM) score that ranges from 0-100 to quantify the performance of the Neighborhood (relative to the county where the providers are located).

The Nascate Medicare Explorer™ application combines public and client data to provide necessary insight into how people and providers behave, existing relationships (person-to-provider and provider-to-provider), and the impact of geography, support, and social determinants of health on attributed medicare beneficiaries.

The Nascate Network Designer analyzes member-provider relationships for specified populations to understand where strong connections exist.

Highlights:

• Leverage augmented view of provider behavior and practice/ referral patterns to evaluate providers for inclusion/exclusion in a network
• Make predictions about how a decision point might affect a key performance indicator for that network

The Nascate Network Manager identifies potential partner provider organizations for risk-sharing models.

Highlights:

• Understand current provider performance with reliable insight into member-provider relationships and behaviors, which are the key factors that impact outcomes.
• Measure “influence” to estimate your share of the provider’s total business, assess the level of impact, and target your actions and focus according to these insights
• Monitor on-going performance, and invest in change over time

Nascate’s Performance Metric (NPM) is built as a composite of performance measures proven to be associated with better member outcomes, and carefully selected to measure the members’ experience.

NPM scores Nascate Medical Neighborhoods™ (communities of Primary Care Physicians) based on how strong the provider-to-provider relationships are, within that neighborhood.

• Higher NPM scores for a neighborhood indicate better neighborhood performance
• NPM scores are calculated relative to the neighborhood’s county
• NPM is calculated utilizing public and claims data for a more complete picture of referral patterns in a given region

Target actions: Drive members toward high-performing neighborhoods; work with low-performing neighborhoods to improve

The Nascate Person Profile™ tool gains insights into a member based on the Nascate Persona module, basic demographics, healthcare days, family healthcare, complexities, utilization through a timeline, and action profiles assigned to that member.

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The Nascate Population Dynamics™ application tracks key populations of beneficiaries over time by utilization, demographics, persona, and illness burden to identify how policy/benefit decisions influenced or changed the beneficiaries.

Through analyzing year-over-year changes in population, insights are gathered to understand how program adjustments impact population churn and performance.

Our advanced data science provides the insights to anticipate and better manage post-acute care and produce significant improvement in any value-based scenario.

What Are Post-Acute Trajectories:

The Nascate Provider Recommendation Engine uses aggregated referral decisions, across multiple data sources, to develop recommendations that best align with improving performance.

What It Is:

Providers continuously make referral decisions that must account for a variety of expressed and latent clinical, social and temporal preferences. We develop and organize the collective intelligence embedded in these referrals to recommend provider choices that will promote value. These insights can be used to curate networks and inform provider referral decisions.

How We Did It:

We analyze specialist referrals made by primary care providers. By leveraging machine learning and social graphs, this analysis helps us understand the relationship between a PCP’s choices and performance. The social graph represents an aggregation of local referral decisions that are measured by performance and serve as the basis for recommendation. We replicated a similar process for post-acute referrals. We observed substantial improvement in overall network performance. Performance is reflective of supply of providers, access, and geography.

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The Nascate Social-Complexity Index (S-CI) Score accurately predicts which members are high-risk and most in need of support following an inpatient event.

The data algorithm scores a member based on their likelihood of having an inpatient readmission(s) and ED visit(s) in the six months following an inpatient event. The score is determined by looking at a person’s social complexity and treatment complexity. Members with high S-CI scores present risk in both areas.

Results in Action: Knowing which members are at-risk helps you provide additional support following discharge (i.e., direct their care, help with transportation, pay a home visit, work to strengthen their provider relationship, and more).

When a member’s care is concentrated and consistent over time with one Primary Care Provider, outcomes improve including lower cost and better member experience.

Nascate’s Strength of Relationship Score measures the concentration of a person’s relationship with his/her main provider.

Highlights: The member score is based on the member’s activity with a main provider. Nascate delivers a member list with Strong/Medium/Weak Strength of Relationship scores designated for each member.

Results in Action: Nascate’s Strength of Relationship Score helps guide members towards the providers they have a strong relationships with, leading to a better member experience and improved provider performance. Members with weak relationships are moved to providers better suited to their needs.

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For organizations working to manage alignment, risk and changes, Nascate provides the insight and support needed for successful solutions and implementation.

Our value-based care framework builds on the work you’re already doing and provides you with innovative tools to tackle today’s challenges and grow toward sustainability.