Health Analytics is a unique health care system that offers a business approach to managing health plan design. Providing in-depth claims data analytics, the system is designed to improve the financial health of a company along with the wellness of its employees.
A powerful facet of Health Analytics is that it generates information against actual claims data as soon as it is updated. This allows you to examine the effectiveness of a health plan with relevant, up-to-date data. Additionally, you have the power to monitor the progress of your health care objectives and manage your health plan on a monthly basis, just as you would any other budget item. The system offers a wide range of claims analysis to determine areas of a health plan that can be addressed in order to mitigate claims expenditure, target cost savings and increase wellness within a workforce. There are two main components of the Health Analytics system:
• Data Analytics & Reporting
• Plan Modeling
The Data Analytics & Reporting capabilities provide dynamic, graphical dashboards and an array of reporting capabilities. In addition, data filters and drill down capabilities provide insight down to the member and condition-specific level. With rich analytics, the user has the ability to evaluate employee/member compliance levels based on best-practice standards and prevention screenings. With the ability to instantly view cost and condition factors that affect your overall health plan, the data analytics tools deliver an essential foundation for optimizing your plan design and managing population health The Plan Modeling tools provide comparative analyses on hypothetical plan strategies using actual claims experience. These tools enable organizations to forecast potential savings, predict changes in a proposed plan, and calculate the possible value in various wellness initiatives. By simulating plan modifications with real claims experience, these tools are designed to improve population health, save money and increase efficiency. The following sections provide a very topical overview of the Health Analytics system, and covers a selection of features that make up our analytical capabilities. With Health Analytics, the depth of data discovery is limitless.
We realizes that proficiency relies on the use of relevant information. One central feature of the system that drastically enhances the power of both the Plan Modeling and Reporting components of Health Analytics is the data filters, which provide complete control and navigation of population claims data. Data Filters enable users to isolate employee population cohorts, claimant behavior and claims cost ranges for further analyzing, reviewing and modeling purposes. Users can create and save customized filters using built-in filter elements to assemble tailored sets of filters as well as create customized treatment guidelines that are measurable within the Health Analytics system. Standard Filters include:
• Member Filters
• Medical Filters
• Aggregate Cost Filters
• Prescription Filters
• Conditions & Episodes Filter
• Wellness Filters (HRQ, HRA, Biometrics, Participation)
• Custom Filters (Company Division, Locations, Plans, Unions, etc.)
Treatment Groups (TGs) reveal a comprehensive clinical picture for a given plan population to determine the most beneficial plan design or intervention strategy to lower risk and severity across various health conditions. With the use of TGs, disease managers, nurses and wellness consultants are better equipped to analyze and monitor individuals on a health plan.
TGs were introduced in the mid-1990s as a condition classification methodology that combines related services into a medically relevant and distinct unit describing a complete episode of care. The clinical richness of episodes of care and their reliance on information readily available from medical and pharmaceutical insurance claims make them a sound unit of analysis to support transparency, measure health care quality and cost, and provide incentives for higher quality care.
• Calculate the true cost of long-term conditions
• Identify related prescriptions used to treat conditions and related episode costs
• Identify clinically homogenous episodes of care
• Organize pharmacy and medical claims/encounter data into intuitive units
• Identify effective medical interventions
• Quantify a plan’s or provider’s performance
• Score the severity of any given condition
Risk Groups (RGs) provide risk scores for members in a major medical health plan. These risk scores are incorporated throughout Health Analytics to support analytics geared toward identifying risk and mitigating plan costs.
• Calculated individual risk score (health index).
• Trending of risk and how certain interventions impact risk.
• Compare provider performance.
• Trending of risk and how certain interventions impact risk.
The Major Benefits of RGs as integrated within Health Analytics:
• Provide an overall risk snapshot of a plan’s population and compare to the prior time period; to Include retrospective risk, prospective risk and actuarial prospective risk.
o Show an expected cost based on prospective and actuarial prospective risks.
• Categorize members into ‘Risk Ranges’ based on their risk scores.
• Trend on a plan population’s retrospective risk and tie the trend to the prospective and actuarial risk (considering subpopulation groups or individual members) on a timeline.
• Show risk and cost by demographics (Gender, Age Range and Employee vs. Dependent).
Studies have proven that eliminating barriers to pharmacy adherence reduces medical cost. Health Analytics specifically addresses this, through analysis and utilization calculators, to determine incentives and investments by therapeutic drug class that improve adherence while measuring and forecasting long-term cost reduction. Health Analytics includes advanced pharmacy metrics and analytics to explore pharmacy costs and utilization in much greater detail, determine pharmaceutical cost drivers, and uses Medical Possession Ratio (MPR) to calculate maintenance medication pharmaceutical compliance for members with chronic conditions. These features of Health Analytics allow better management over a pharmaceutical plan and its members.
The Data Analysis and Reporting component of Health Analytics consists of several analytical tools that provide methodical analysis of claims cost and claimant behavior. From high-level, total population claims data, to low-level, individual patient and claims detail, you have ultimate control of how, and how closely, you view your data. Dashboards contain high-level, visually informative data displays designed for easy readability and total customization. With a simple click-and-drag design, you can easily customize your data displays in order to fit your company’s needs or claimant concerns. Information displayed in the Dashboards section of Health Analytics is calculated against the current health plan population.
Dashboards produce instant, measurable data by visually presenting claims information automatically. By ranking cost drivers and prevalence within specified populations, dashboards highlight opportunities to reduce cost and improve health. These findings lead to further inspection by drilling down in the Views and Reporting features, all of which are filterable using Data Filters, described under the Plan Modeling section of this document. A few dashboards include:
• Plan Summary Provides a birds’ eye view of your total population and total medical and pharmacy costs.
• Top Conditions This dashboard is used to summarize the most frequent claimant conditions throughout your plan population. Coupled with other dashboards, such as the Compliance to Standard of Care Dashboard, it is easy to locate the most costly and prevalent employee populations that are affecting total claims expenditure.
• Compliance to Standards of Care Shows the average compliance percentage scores for populations diagnosed with chronic conditions. Compliance is measured by individual (member) adherence to nationally accepted guidelines for treatment of respective conditions, all integrated into the Health Analytics system. Understanding the gaps in care within a population provides actionable information for lowering cost and maximizing utilization.
Views (Drill Down) is one of the most expansive features in the Health Analytics system. It offers tabbed and grid style formats that allow you to drill down into the deepest detail to uncover the most obscure metrics behind your claims data. With these capabilities, you can precisely pinpoint cost factors that are affecting your overall health care expenditure; easily identify gaps in care that are leading to unnecessarily higher claims in chronic condition populations; as well as customize data output for elaborate data requests. The Views feature uncovers answers hidden behind uncommon data trends, unexplainable cost increases, sporadic claimant behavior, and more.
Pivot Views (Custom Grids) enable a user to simply click and drag data points into columns and rows for unlimited, customized grids and reports, accessing multiple data fields available in the Health Analytics database. The custom pivot views offer simple creation of traditional pivot view grids that are easy to use, yet flexible enough to handle complex user-defined data needs.
Trending provides visual graphing to illustrate cost trends using data calculations over any given date range. By selecting a date range, data type and trend type, you can easily view historical trends of particular scenarios that are relevant to your plan population.
• Plan Recalculation Modelers
o Traditional Plan Design
o Detailed Benefit Design
o Wellness Investment
o Health Reimbursement Arrangement (HRA)
o Health Savings Account (HSA)
o Specific Stop-loss
• Health Savings Account Contribution Calculator
• Reinsurance Premium Calculator
• Specific/Aggregate Reinsurance Analysis
• Wellness Investment Calulator
o Set Compliance, Financial and Incentive Goals and Objectives
o Establish the Cost of more Efficient and more Effective Wellness Interventions
o Calculate ROI of Wellness Interventions
Plan Modeling Calculators can be used independently or conjunction with each other in the Plan Recalculation Section. Filters may also be applied to analyze targeted populations within a health plan.
Health Analytics’ Plan Recalculation contains comprehensive plan modeling capabilities that allow the changing of a plan’s deductible, co-insurance percentage, and out of pocket amounts. This allows the user to see the financial and personnel impact, whether negative or positive. Included in the plan modeler is the ability to model detailed plan designs, with stipulations such as:
• Co-Pays and Tiered Co-Pays
• Fixed Benefit Amounts or % Sharing
• Deductibles
• Co-Insurance
• Cost Limits
• Occurrence Limits
• 100% Coverage / No Coverage
• Applying / Not Applying to Out of Pocket
These stipulations can be applied to subsets of members (by age, plan, location, condition, etc.) as well as subsets of services (by procedure, benefit, provider, network, etc.). With this degree of flexibility, the user is able to model pharmaceutical plan designs with precision. Drug ‘tiers’, such as generic vs. retail, formulary vs. non-formulary, classes of chronic maintenance drugs, and many other drug classifications may be used to modify co-pays, limits, percentage sharing and other drug-specific stipulations that are present on a pharmaceutical health plan.Supported by the rich Data Analytics & Reporting capabilities, the Plan Modeling component is a core feature of Health Analytics. This piece of the system is designed to provide the information necessary to add value to health care planning. Whether you want to employ value-based plan design through employee intervention and wellness programs, or simply better track your high-cost populations in order to contain cost and retain higher cash flow, the Health Analytics Plan Modeling tool is where you capitalize on diligent data analysis. These tools provide comparative analyses on proposed plan strategies using historical claims data by simulating the effect of user-defined plan modifications. Here you can forecast and model both simple and complex strategy adjustments against actual claims experience in your health plan. These tools interactively support creativity in plan design, producing innovative approaches modeled for higher cost savings, increased cash flow and improved plan efficiency. The Plan Modeling tool set includes:
