Tag Archives: healthcare analytics

Benchmarking analytics for provider reimbursements

Managing provider reimbursement levels is an important function for health plans. Provider reimbursement analytics can offer health plans the foundation they need to effectively manage reimbursements.

In their article “Provider reimbursement analytics,” Milliman consultants David Lewis and Charlie Mills highlight the advantages and disadvantages of the two primary analytical approaches for evaluating provider reimbursement levels. The authors also discuss the pros and cons of the three main baseline fee schedules used in provider contract benchmarking, one of which includes Milliman GlobalRVUsTM.

Developing population health management programs under risk-based contracts

Risk-based contracts are driving the development of population health management programs (PHMPs) that are designed to achieve the Institute for Healthcare Improvement’s Triple Aim goals. Health systems may need to redesign how they deliver healthcare to meet these goals. Risk-based contracts often give providers both the financial flexibility and incentive to redesign care.

In the article “Population health management program development: The path to the Triple Aim,” Milliman’s Nick Creten and Blaine Miller discuss the following five steps healthcare organizations must address when developing a PHMP in a risk-based contracting environment.

Step 1: Assess population costs, utilization, and risk
Step 2: Identify opportunities
Step 3: Segmentation
Step 4: Intervention development
Step 5: Monitor, assess, and improve

Milliman MedInsight’s analytic platform named a leader in IDC MarketScape report

Milliman today announced that its popular healthcare analytic platform, MedInsight, has been named a leader in the IDC MarketScape study, entitled “U.S. Payer Data Analytics 2015 Vendor Assessment, doc #HI255269, April 2015.” The company is one of eight vendors evaluated in the report.

MedInsight is positioned as a leader of this IDC MarketScape report—which provides an evaluation of the leading payer data analytic platforms—because of high satisfaction ratings from clients in terms of the high degree of flexibility, advanced analytics, and analytic tools supporting multiple types of users.

The report notes that Milliman’s strengths include the MedInsight Data Confidence Model—a methodology applied as a data warehouse is being created, and then leveraged on an ongoing basis for client data management—as well as the MedInsight benchmarking function that enables clients to benchmark organizational performance against Milliman’s health research database.

MarketScape image_HI255269_blog op

 

“The MedInsight mission is to provide analytic leadership and decision confidence to our clients. The fast-moving and uncertain nature of the healthcare industry demands a nimble and growing analytic platform,” said Kent Sacia, Milliman principal. “The IDC MarketScape report affirms the MedInsight team’s hard work toward that mission as we continuously commit to adding value to our clients.”

The IDC MarketScape vendor analysis model is designed to provide an overview of the competitive fitness of information and communications technology (ICT) suppliers in a given market. The research methodology utilizes a rigorous scoring methodology based on both qualitative and quantitative criteria that results in a single graphical illustration of each vendor’s position within a given market. The capabilities score measures vendor product, go-to-market, and business execution in the short term. The strategy score measures alignment of vendor strategies with customer requirements in a timeframe of three to five years. Vendor market share is represented by the size of the circles. Vendor year-over-year growth rate relative to the given market is indicated by a plus, neutral, or minus next to the vendor name.

For more information about Milliman’s MedInsight products, click here.

Milliman MedInsight releases employer group reporting solution for health plans

Milliman has announced the formal launch of its new MedInsight Employer Group Reporting (EGR) Solution. The MedInsight EGR Solution is designed for health plans to support the key function of client reporting; helping a health plan’s employer clients accurately understand the value they receive from their benefit spends and also providing realistic performance comparisons with other employers in the region.

MedInsight is Milliman’s popular healthcare analytic platform used by over 250 health plans, employers, at-risk providers/accountable care organizations (ACOs), state governments, community health coalitions, and third-party administrators (TPAs).

The MedInsight EGR Solution delivers clients the benefits of confidence and control, while reducing the time and energy required to achieve them. As an extension of the MedInsight Analytic Platform and a beneficiary of our MedInsight Data Confidence Model, it means that health plans and TPAs can feel confident the information they are providing is accurate and meaningful, even as it’s made available to employer clients through a self-service portal.

Milliman expects many of its existing commercial health plan licensees of MedInsight to add the EGR Solution to bolster client reporting capabilities.

With user-friendly dashboards, a preconfigured reporting library, and easy-to-publish summary performance reports, the MedInsight EGR Solution helps health plans satisfy employer reporting needs easily and confidently.

“The employer clients of health plans are demanding more transparency on the value of healthcare being provided to their employees,” said Rich Moyer, Milliman principal. “We believe the MedInsight EGR Solution will be a very effective tool for health plans to deliver healthcare information to their employer clients. The EGR portal is easy to use and integrated with the health plan portal MedInsight clients currently use.”

Specifically, the MedInsight EGR Solution helps health plans and TPAs demonstrate the value they provide, by reporting on data that will help employers make decisions related to:

• Managing current and future cost trends
• Quality of healthcare services provided to employees
• Wellness programs and population health management

The ability to effectively meet employer clients’ ever-increasing demands for information and transparency comes with competitive benefits for MedInsight clients. It strengthens relationships with employers and provides the meaningful information actually required to bend cost trends and improve health. And by including innovative features like the Health Waste Calculator and population health groupers, MedInsight is providing them with value-add that extends to their employer clients.

Milliman MedInsight®: Center of population health strategy

Milliman MedInsight® is a healthcare analytics platform used by payers, purchasers, providers, and other healthcare professionals. MedInsight products include solutions that provide preconfigured or custom reporting and data configurations, as well as individual tools that can address specific business needs. In this video, Chris Valerian, chief medical officer of QualCare, describes why MedInsight has become the center of QualCare’s population health strategy.

To learn more about Milliman MedInsight, click here.

Supporting patient-centered medical homes through healthcare analytics

Hay-LiliAlthough the concept of a patient-centered medical home (PCMH) has been around for more than 50 years, the last decade has seen a revitalization of the PCMH model and an increase in its presence across the nation. The model’s popularity hinges on an approach to providing comprehensive primary care and redesigning healthcare delivery processes. This is accomplished through an emphasis on team-based care delivery, a whole-person approach to patient care, collaborative relationships between individuals and their physicians, and the use of evidence-based medicine and clinical decision support tools.

In 2007, four nationally recognized physician organizations identified seven principles considered foundational to the PCMH model:

1. Personal physicians
2. Physician-directed medical practices
3. Whole person orientation
4. Coordinated/integrated care
5. Quality and safety
6. Enhanced access
7. Payment reform

Although the foundational principles of the PCMH have been largely agreed upon, there is no clear model for how to create a successful PCMH. One of the most widely recognized models in place today is sponsored by the National Committee for Quality Assurance (NCQA), though there are numerous different demonstration and pilot projects in process across the country. As stated in the Journal of General Internal Medicine paper “Defining and measuring the patient-centered medical home”:

“…The context for operationalizing the PCMH is still evolving based on what is being learned in many ongoing demonstrations,” underscoring the importance of evaluating and incorporating unique geographic, demographic, and economic considerations into the design of any new care model.

Successful care delivery transformation projects, especially PCMH implementation and sustaining activities, require significant emphasis on healthcare analytics to inform quality improvement activities in addition to managing cost and utilization control efforts. The use of structured and routine analysis of information from healthcare claims enables both established organizations and newly developed PCMHs to receive ongoing feedback on process effectiveness and health outcomes, facilitating rapid-cycle process improvement across the organization.

PCMHs typically focus their analytic resources on operational process improvements and patient outcomes, with the goal of driving improvements in support of the “Triple Aim.” Successful organizations understand that routine and actionable information is the key to driving improvements. Examples of PCMH-focused analytic approaches being used across the country, which typically focus on cost, utilization, and quality, include but are not limited to the following:

Continue reading