|
The growth in healthcare expenditures, coupled with the lack of actionable
information to contain costs and improve quality of care, is creating an
unprecedented demand for a transparent healthcare environment. The
industry needs IT to create reportable information that is accurate and
timely to assist in the oversight and procurement of healthcare. [1]Employer
and employee contributions to premiums rose over 50% since 2000, and
businesses on average spend the equivalent of one half to one third of
after tax profits on healthcare. Even in light of these facts, employer
groups and other purchasers of healthcare services do not possess the
necessary data to make value based purchasing decisions. As a result,
these entities are seeking to attain efficiencies via data transparency
for both population and vendor management – putting employer groups
into the drivers seat through the use of data analysis.
Leveraging our knowledge and expertise of health plans, CareAdvantage developed a
comprehensive analytical reporting tool called RPNavigator that turns
captured raw medical and pharmacy claims data into actionable
information. RPNavigator categorizes and quantifies
a population’s disease burden and provides a clear picture of the
health status and severity associated with a given member population.
This facilitates report
development, targeted benefit design, improved vendor selection,
clinical analysis and population management. RPNavigator’s underlying infrastructure
incorporates a classification methodology from 3M Health Information
Systems to stratify the population and describe the associated risks in
intuitive ways. It also enables a valid assessment of which vendors are
most efficient at managing the diseases driving medical cost trends. RPNavigator also projects future risk from a resource
consumption and disease progression perspective. Taken together,
RPNavigator links the financial and clinical aspects of care.
Among the benefits of this solution is the ability of CareAdvantage clients
to:
- Access meaningful information via an Internet-based portal on trends in cost
and care
- Understand underlying root causes of cost drivers across various subsets of their
populations (i.e. region)
- Predict future medical costs and impact of disease burden for their population
- Benchmark disease burden and performance against regional and national data
- Identify care management opportunities
- Assess vendor performance (i.e. for employer clients this includes multi-carrier performance analysis)
- Evaluate impact of care management programs and benefit design changes
- Increase quality of care while controlling costs
The RPNavigator solution embodies several key characteristics for promoting
a transparent healthcare environment including a standardized performance metrics, nationally recognized/MD-approved set of rules governing claim coding/grouping
procedures, and automated data sharing and integration via the Internet. The RPNavigator approach uses chronic disease, in lieu of episodic
management, to demonstrate intervention
benefits in a credible way.
CareAdvantage supports its clients through the provision of a wide range of consulting
services to develop and implement the right solutions. These solutions provide health care organizations with strategies and tactical initiatives for effectively managing health care
consumption, reducing costs and improving the quality and cost benefit
of care.
| 
