Data & Scoring
Employer sponsored health care plans are the financial backbone of the health care system. We call them “payers of last resort”. Health care providers are constantly dealing with payments from Medicare, Medicaid and the uninsured that are less than their costs. To make up the difference they rely on overpayments made by employers and their covered people. As the result the amounts paid through insures or PPO’s bear little resemblance to the true costs of care.
Preventable Illness Burden
Driving the utilization of care is the illness burden of the people covered by the employer sponsored plans. The majority of that needed care arises from medical conditions that are brought on by lifestyles. We are doing it to ourselves and expecting the employer plan to pay for the results.
Self-funding Generates “Big Data”
Many employers use self-funding to finance their medical benefit plans in the hope of managing their costs. Perhaps the most important benefit of self-funding is the access it should give to using the “Big Data” that arises from paying claims to identify ways to manage risks and costs. To maximize the value of the data the employer should use Data Warehouse technology. The warehouse allows for the accumulation and integration of many different data elements which then can be sliced and diced and turned into useful information. Not only are today’s data warehouse technologies powerful, they have become very inexpensive.
Attached to the Data Warehouse are analytic programs that provide sophisticated reporting capabilities in regard to the factors driving health benefit costs. The Data Warehouse, available through Innovation Programs, LLC uses the most useful analytic tool for any organization managing health care populations including:
- Self-funded Employers
- Insurance Carriers
- Health and Welfare Funds
- Accountable Care Organizations
- Physician Group Practices
- Wellness and Care Management organizations
- Work-site Clinics
Scoring Methodology – Power Tool for Risk Management
What makes this product so attractive is its ability to produce a “Score” for each covered person that reflects the three most important issues around their costs and future health status:
- Current disease state,
- Health risk status in regard to future illness, and
- Behavioral engagement in the management of their own health
The Score works like a Credit Score, low is bad, high is good. It is a simple but effective measure of health plan performance. The individual scores for the covered people are rolled up to an employer score. For the first time the most important question can be answered.
In consideration of all the money spent in the last twelve months for illness related benefits and lost time, are the people any healthier today than they were twelve months ago?
The data warehouse also affords the opportunity to report on many other questions around health care benefits:
- Transparency of provider costs of care
- Presence of gaps In care such as medication adherence
- Documentation of Return On Investment from Wellness and other Care Management programs
- Patient compliance with treatment recommendations
- Access to care
- Financial trends
- Success of on-site clinics
- Value Based Benefit Plan provisions
To see a presentation describing the scoring product and to use an on-line sample scoring calculator please click on the following link:
For a detailed demonstration of the system and/or a pricing proposal please contact us at: