Nest Cohort: Medicare/Medicaid Payer Analytics at Scale

A Medicare/Medicaid managed-care client needed executive-grade cohort and quality-measure analytics, but the incumbent Power BI model had ballooned to 380 measures — slow, opaque, and impossible to reconcile against source-of-truth data. Leadership could not trust the numbers enough to act on them.

A layered Power BI semantic model over Snowflake: a governed ingestion layer, a star-schema semantic core, and a measure library organized around population waterfall, eligibility expansion, and quality measures. The design deliberately collapsed redundant measures into a compact, auditable set.

A five-tier WBS drove delivery from Snowflake ingestion → semantic model → DAX → dashboard build → UAT, with version-controlled PBIP releases mapped to sprint-level deliverables and a clear path to CEO sign-off.

• Untangling 380 legacy measures without losing analytical fidelity.
• Reconciling dashboard outputs against source-of-truth Snowflake tables.
• Meeting HEDIS-adjacent quality-measure definitions across Anchor / Non-Anchor / Total splits.

Re-architected the model to 80+ optimized DAX measures, built HEDIS-adjacent dashboards for Withhold Care Gap, PPC, Well-Child Visits, and Childhood/Adolescent Immunizations with PMPM-lift analysis, and produced CEO-ready visual and tabular decks to brand standard.

• A 4.75x simpler model that leadership signed off on with confidence.
• Quality-measure reporting aligned to payer conventions and PMPM economics.
• Enterprise reporting decks adopted as the executive source of truth.

Simplicity is a feature. A smaller, auditable model is worth more than an exhaustive one — because decisions are made on trust, and trust requires reconciliation.

Extend into Snowflake ETL ownership, automated data-quality gates, and prospective risk-contract targeting views for provider and health-plan stakeholders.