Detailed data analytics provide tools to analyze the health of the population to mitigate cost increases through:
- Utilization review to uncover missed opportunities and plan design inefficiencies
- Model impacts of plan design changes before they are made
- Creating long-term benefits strategy and make impactful changes
Services include an annual review of health plan performance to aid in renewal negotiations and long-term cost management.
- Medical claims analytics and ongoing review to manage claims and long-term benefit plan costs.
- ROI and network-efficiency analysis, claims audits and underwriting review.
- Cost projections and budget / funding analysis, validation review of budget vs. actual claim trend and monitoring of large claims (self-funded).
Numbers Tell A Story: The data pulled through our reporting analytics allows us to determine which current members are at risk for a future event. This allows us to mitigate future large claimants and positively change the course of the member and health plan.
Investigating the members who aren’t following the recommended tests can help identify a potential large claimant.
The system allows us to identify these members and analyze their claim history. This can lead to significant savings through intervention of potential large claimants or high-cost events.
Members are segregated based on their claim history and current diagnoses. They are identified through the data analytics and can be managed through the plan’s disease management resources.