As a prominent health plan with a strong reputation, our client’s nationally recognized value partnership and collaborative quality incentives programs – Practitioner Care Medical Home (PCMH) and Provider Group Incentive Program (PGIP) – are leading the way in controlling health care costs and improving health outcomes. In a continuing effort to grow and evolve their programs, X by 2 collaborated with the client and developed advanced medical informatics and reporting capabilities that enabled them to better evaluate the impact of systemic improvements in care processes and more quickly adapt to industry-wide changes that result from health care reform.

Through its promotion of a PCMH model, our client worked to dramatically improve care quality, lower costs, increase satisfaction by providing incentives for physicians to focus on the overall health and wellness of each patient, and empower members to take more control of their own health outcomes and costs. The health insurer’s ability to grow its programs; however, had become hindered by its inability to efficiently collect and analyze data for various initiatives.

To help maintain its edge and continually evolve the incentive programs, our client required advanced data, analytics, and reporting capabilities to enable the identification and evaluation of systemic improvements in care processes. A key element of this was the measurement of initiative effectiveness from the perspective of results, incentive payout, projected savings and impact on the quality of care.


X by 2 led the strategy and development efforts to deliver advanced analytics and reporting capabilities for our client’s value partnership programs. In close collaboration with key business and IT leadership, X by 2 developed a single clinical program and medical informatics approaches that consolidated the insurer’s vast amount of core data related to its incentive programs into a new data mart that enabled streamlined, accurate, and consistent analytic capabilities and reports in just nine months.

The platform consolidated core membership, claims and provider data from disparate sources (e.g. Commercial, Medicare Advantage, etc.) into a single repository and automated advanced methods to enable analysts to identify and better understand the relationships between concepts such as:

  • A Unified Person: identification and tracking of a person’s membership over their lifetime.
  • Care Relationship: identification and tracking of a person’s Primary Care Physician (PCP) over their lifetime.
  • Encounter: identification of inpatient, emergency, and outpatient encounters and the tracking of a person’s interactions with a health facility.
  • Disease Identification: using claims history, person concepts and industry standards such as Hierarchical Chronic Condition (HCC) to identify patients with chronic illness

Using these concepts X by 2 was able to build provider performance reports such as:

  • Generic drug usage
  • Diabetic patient care
  • Cardiological care for patients
  • Transfer of care between hospital and PCP

As part of the overall strategy and implementation, X by 2 developed an integration strategy for external data and data enrichment sources that included:

  • EHR Systems
  • HEDIS Engines
  • Groupers (medical condition episode, clinical risk)
  • Labs (Quest and JVHL)
  • State Immunization Registry
  • EDGE Server

This combination of data allowed our client to more thoroughly evaluate a person’s health experience, holistically view a person’s care ongoing care and create advanced reporting that is shared internally and with providers. These reports are related to evidence-based care, generic prescription dispensing, inpatient use, claims, etc.


With the implementation of the platform, the health insurer is better equipped to evolve and grow its industry leading physician incentive and PCMH programs with advanced analytics. What X by 2 delivered became the single source for all analytics and reporting for our client’s cross departmental data scientists, statisticians, etc. Additionally, as industry-wide changes continue via health care reform (e.g. performance-based payments), our client will be well-positioned for competitive advantage.