Flowchart Naming Conventions, Enrollment Flagging & 2025 Reporting Prep

Introduction / Meeting Context

  • Call facilitated by Dan (host) and Joe (primary presenter)

  • Purpose: Prepare teams for 2025 (PMY ’25) reporting season and review:

    • Flowchart naming standards

    • Weekly/retrospective run cadence

    • Measure-list strategy (CE vs non-CE)

    • "Look-ahead" catalog, TPL, and Duals flagging processes

  • Audience participation encouraged via chat; slide deck to be distributed post-call

Project Timeline & Scope

  • Current active project: PMY ’25 (Prospective)

  • Upcoming project: Retro MY ’25

    • Testing late-year → first production run January 2025

  • Goal: Ensure all markets ready for both Medicaid and non-Medicaid (Marketplace & Medicare) reporting

Flowchart Naming Convention (Standardized Structure)

  • Ensures consistency across project tracking, reporting, downstream systems

  • Components (left → right):

    1. Project (e.g., pmy25, retro_m y25)

    2. Line of Business (medicaid, nonmedicaid)

    3. Flowchart Type (std vs adhoc)

    4. CE Flag (ce / nonce)

    5. Wildcard / Extra Detail (state code, comparison note, etc.)

  • Example (standard): pmy25_medicaid_std_ce

  • Example (ad hoc w/ wildcard): retro_my25_nonmedicaid_adhoc_nonce_TX_compare
    Wild-card portion used for state-specific runs, special analysis, etc.

Lines of Business & Population Buckets

  • Medicaid

  • Non-Medicaid
    Marketplace (ACA)
    Medicare Advantage / PDP

  • Population logic tied directly to line-of-business selection within naming convention

Flowchart Types

  • Standard

    • Run every week (prospective) or defined cadence (retrospective)

    • Calendar-driven, baseline production processing

  • Ad Hoc

    • One-off or irregular runs for:

    • State reporting mandates

    • Comparison / validation exercises

    • Custom study windows

Measurement Periods (MP)

  • Standard MP: Calendar year Jan→Dec\text{Jan} \rightarrow \text{Dec}

  • Rolling-Year MP: 12-month window with a moving anchor date
    Example: July 2023 → June 2024

  • Both MPs supported in standard & ad hoc flowcharts; designated inside run name

Measure Lists & Continuous Enrollment (CE)

  • Platform limit: N<em>measuresmax=350N<em>{measures}^{max}=350 per run Current inventory N</em>current≈500N</em>{current}\approx500 → split required

  • Active lists:

    1. CE – Standard MP

    2. CE – Rolling-Year MP

    3. Non-CE – Standard MP

  • Definition:

    • CE = Continuous Enrollment logic strictly applied per spec

    • Non-CE = CE rules relaxed → useful for new plans with limited historical data

Scheduling & Cadence Q&A

  • Question (Jody): desire for "rolling-year, 90-day lag, monthly" run on first weekly run of each month

    • Joe: Open to scheduling but dependent on incoming flowchart requests & overall capacity

    • Early submissions ⇒ easier to lock into cadence

"Look-Ahead" Measure Catalog

  • File name: cent_custom_my22_catalog (current version)

  • Purpose: Shift anchor date +1 year ⇒ produces 2026 prospective gaps during 2025 runs

  • Linked for all markets; outputs appear in every PMY ’25 standard run

  • Upcoming release:

    • Updated catalog based on MY ’24 HEDIS tech specs

    • Target deployment: First August 2024 weekly run

Third-Party Liability (TPL) Flagging

  • Definition: Member’s primary coverage is external to Centene (not the same as Duals)

  • Data Sources & Workflow

    • External enrollment data from AMISYS → stored in OniStage schema within EDW

    • Pulls old_policy_span.coverage_array & member_alt_coverage_span for date alignment

    • When match found → enrollment span sliced; member_enrollment_alt_id_4 set to Y

    • Default flag value = N

  • Usage Notes

    • Population definitions must explicitly incorporate the flag; otherwise no impact

    • Implementation varies by state; many markets already leverage it

Duals (Medicare–Medicaid) Flagging Process

  • Identifies Medicaid members who also hold Medicare coverage

  • ETL Procedure: population_dual_flag

    • Filters: active, non-deleted eligibility within last 3 years

    • Match on plan types/descriptions: SNP, HMO, PPO, etc.

  • Flag Assignment (Snowflake layer)

    • member_enrollment_alt_id_5 = Y → Dual relationship exists (source agnostic)

    • member_enrollment_alt_id_6 = Y → Dual and Medicare coverage through Centene

    • Both flags default to N

  • Best-Practice Population Logic

    • Use group-by conditions on Alt ID 5/6 rather than simple = 'Y' filter

Snowflake Data Processing Overview

  • Pipeline handles simultaneously:

    • TPL slicing/flagging

    • Duals identification

    • Continuous Enrollment segmenting

  • Source data extracted from Teradata → transformed → loaded to Snowflake → appended into Member Enrollment tables consumed by flowchart runs

Implementation Tips & Practical Implications

  • When requesting new flowcharts:

    • Provide run purpose, MP, CE flag, state/LOB, and timing early → smoother scheduling

    • Clarify whether TPL or Duals logic must be activated in population definitions

  • For new health plans lacking 12-month history, choose Non-CE runs to avoid attrition

  • Using look-ahead catalog helps markets pre-empt 2026 gap-closure strategies (e.g., CIS, OMW)

Key Dates & Action Items

  • Late 2024 – Complete Retro MY ’25 testing

  • Jan 2025 – Launch production Retro MY ’25 run

  • 1 Aug 2024 (target) – Deploy updated look-ahead catalog (MY ’24 specs)

  • Ongoing – Markets submit flowchart & measure-list change requests ASAP

Abbreviations & Glossary

  • CE – Continuous Enrollment

  • MP – Measurement Period

  • TPL – Third-Party Liability (external primary coverage)

  • Duals – Members with both Medicaid & Medicare eligibility

  • HEDIS – Healthcare Effectiveness Data & Information Set

  • EDW – Enterprise Data Warehouse

Q&A / Closing Remarks

  • No outstanding questions at end of call

  • Deck will be emailed to participants

  • Next session will revisit dynamic look-ahead measure set & any cadence adjustments