Provider Intelligence

CareJourney’s Provider Intelligence data asset is the first comprehensive resource to help you improve provider performance and referrals, grow your network, and build data-driven care teams. Healthcare stakeholders have generally operated with insufficient data. Critical decisions regarding patient care, referrals, and provider performance have been made using incomplete, scattered, un-actionable datasets, resulting in patients and providers paying the price, both financially and with their most precious currency: patient health. By providing insights into care variation, and ensuring the data is keyed on 5 levels like NPI, Facility, and Group, CareJourney’s Provider Intelligence enables increased focus on making critical data-driven decisions around finding and recruiting the best providers who deliver high-quality, low-cost care. Data sources: - CMS Medicare fee-for-service claims details - Commercial claims details (add-on) - CMS Physician Compare - NPPES data - QPP eligibility data The following views are available as part of this listing: - Health Care Practitioner - Health Care Provider Organization - Health Care Practitioner APM Affiliation - Health Care Facility Practitioner Affiliation - Health Care Provider Organization Practitioner Affiliation - Health Care Provider Organization Facility Affiliation - Health Care Practitioner Claim Activity - Health Care Practitioner Cost and Utilization - Health Care Provider Organization Cost and Utilization - Health Care Practitioner Referral - Health Care Provider PPI Rollup - Health Care Provider PPI Rollup Commercial - Health Care Provider PPI Episode Quality - Health Care Provider PPI Episode Quality Commercial - Health Care Provider PPI Medical Setting - Health Care Provider PPI Medical Setting Commercial - Health Care Provider PPI Episode Cost Breakdown - Health Care Provider PPI Episode Complication - Health Care Provider PPI Episode Complication Commercial - Market Episode Variation Sample fields include: Demographic Metrics - Provider ID (NPI) - Geographic Details - Year - Practice Group Affiliation - Hospital Affiliation - Taxonomy (NPPES and CareJourney) - Number of Patients Performance Metrics - Medical Codes (procedure and diagnosis) - CareJourney Cost Index - CareJourney Quality Index - Allowed Amount - Number of Claims - Episode Type - Count of Episodes - Observed Allowed Amount - Expected Allowed Amount - Allowed Amount by Site of Service - Episode Cost & Utilization - Rate of Performance - Probability of Performing Better - Benchmarks - Complications - Episode Based Quality Measure Performance - Referral data including specialty, number of patients, allowed amounts etc.

搜集汇总

背景与挑战

背景概述

Provider Intelligence 数据集旨在帮助医疗利益相关者提升提供者绩效、优化转诊和构建数据驱动的护理团队，解决传统数据分散、不完整的问题。它整合了CMS医疗保险索赔、商业索赔等多源数据，提供基于NPI等关键标识的洞察，支持寻找高质量、低成本的提供者。数据集包含医疗从业者、组织、成本利用、绩效指标等多种视图和字段，如人口统计指标和绩效指标，以促进数据驱动的决策。