Case Study: Medicaid Agency achieves cost- and quality-based provider rankings with SCIO Health Analytics

Medicaid Agency - Customer Case Study

Medicaid Agency engaged SCIO Health Analytics to support a shift to a Patient-Centered Medical Home (PCMH) model and to determine provider efficiency on both cost and clinical quality dimensions. The agency faced Medicaid costs and utilization not aligned with patient risk, provider incentives disconnected from efficiency, and wide practice-pattern variation. SCIO Health Analytics delivered provider profiling, care and quality measures, and reporting as the core services.

SCIO Health Analytics analyzed three years of detailed claims and eligibility data, created member-to-provider attributions, measured risk-adjusted costs by provider using utilization/RVU units, and ranked providers across cost and quality dimensions. The work gave the Medicaid Agency a repeatable methodology to rank providers or groups, demonstrated how a PCP-style model can improve patient care, and produced actionable provider rankings that align efficiency and quality for payment and management decisions.