Measure value, identify actionable items and develop fully dynamic custom analytics to track performance and gauge improvement.
While health insurers are transitioning rapidly towards rewarding health care providers for value instead of volume, employers must be able to measure and track the benefits to their employees, project trends and capitalize on immediate cost saving opportunities.
- Provide gaps in care reporting to measure ongoing performance improvement.Measure compliance rates between sub-groups and benefit classes.
- Support outreach efforts of external member health initiatives
- Track additional administrative charges for value based benefits.
- Monitor network access standards and provider availability
Inherent price variations for specific services can be identified at the local market level. By understanding these differentials, employers can design benefits that encourage efficiency.
- Identify provider price differentials to promote transparency and empower members
- Track provider volume to assess value of bundled payment and case rate options.
- Report price differentials by place of service to flag savings options
- Measure center of excellence utilization by disease category to identify alternate reimbursement opportunities.
Identifying actionable areas for expense reductions and focusing upon effective management of chronic care/high cost cases, offer employers the best options for bending the cost curve. Timely, accurate reporting and robust monitoring of medical managements initiatives are the cornerstones of such efforts.
- Apply advanced predictive modeling to focus case management efforts
- Identify clinical conditions driving cost trends
- Provide large case tracking and savings reports
- Measure changes at the provider level for utilization and price changes.
Objectively evaluate cost, quality and utilization performance of programs.
- Quantify impact of wellness/care/case management programs
- Independently and objectively evaluate the performance of health benefit and program venders.
While employee benefit costs can be projected consistently over time, actual cash disbursements often vary widely from month to month. As the frequency of high cost claims increase, it is important to have a process that continuously tracks, reconciles and identifies the root cause of this variation.
- Differentiation between new utilization drivers vs payment timing
- Provide customized actuary designed completion factors to mirror group experience and refine accrual estimates
- Analysis of payment lags by business sub group or division.
- Create dynamic point and click variance analysis.
- Develop reconciliation template for actual vs expected periodic cash disbursements.
We support your internal workflow process through the development of practice level reporting modules that can be tailored to your existing web portal. In addition, we can support external workflow development efforts by the export of relevant data sets for inclusion in customized workflow applications.
- Develop dynamic patient level gaps in care performance improvement tracking.
- Provide supplemental patient demographic and benchmark data for inclusion in ACO web portal.
- Create PCP level performance reports for inclusion into overall ACO “score card” type development process.
Identify cost drivers by disease category. Identify actionable items and track network utilization. Monitor program expenditures to budget and track cash outlays.