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Client Analytics & Consulting. Panel Members Rocky Henisey – Director, Client Analytics &...
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Transcript of Client Analytics & Consulting. Panel Members Rocky Henisey – Director, Client Analytics &...
Client Analytics & Consulting
Panel Members
• Rocky Henisey– Director, Client Analytics & Consulting – BCBS Texas (HCSC)
• Darren Taylor– President, Cobalt Talon (Subsidiary of BCBS Kansas City)
• Recently VP, Enterprise Analytics & Data Management – BCBSKC
• Maureen Lowe– Director, Client Reporting & Analytics – BCBS Tennessee
• Sally Marier– Senior Director, Payer Solutions - MedeAnalytics
• Recently Director, Employer Reporting & Analytics – BCBS Minnesota
Panel Objectives
Client Analytics
• Client Consulting Overview – Providing Trusted Information and Actionable Insight.
• Medical Home – Answering client questions about ACO / PCMH growth and value.
• Prospect Analytics – Leveraging analytics to demonstrate differentiating value and win new business.
• Cost Savings Ideas – A few examples of creative solutions targeting the client’s specific trends.
Panel ObjectivesAnalytics & Information Management provides Client Analytics services to assist clients with their important and difficult employee health benefit plan decisions.
As an addition to the internal analysis, AIM also provides Client Consulting services which allow us to partner as benefit consultants with our clients helping them to identify their most valued opportunities, while addressing their critical healthcare challenges.
Analytics for the Health Care Industry
ConsultationAnnual Plan ReviewComprehensive Utilization AnalysisRecommendations & Actionable InsightsBlue Care Connection Analysis
Actuarial ServicesTrend AnalysisForecasting/Predictive ModelingRisk AssessmentActuarial Studies
CollaborationAccount ManagementMedical ManagementNetwork ManagementConsultants/Brokers
Research & AnalysisProject Based Reporting on Key DiseasesHigh Impact ClaimantsPopulation AnalyticsIndustry & Segment Trend Analysis
Client
What do Clients want?
Dif
fere
nti
atin
g V
alu
e Analytics
Reporting
Degree of Business Intelligence
Business Intelligence & Analytics
Information Insight
Dat
aG
uida
nce
Statistical Analysis / Benchmarking
Data Extracts
Standardized Reporting
Ad-hoc Reporting / Drilldowns
Discovery / Custom Reporting
Alerts / Responses
Forecasting / Predictive Modeling
Plan Optimization / Recommendations
Actionable Insight: ABC’s Condition Comparisons of Perinatal Conditions, Musculoskeletal, ESRD, MH/SA and Pregnancy Complications have higher PMPM’s than the BCBSTX’s Book of Business (PPO, ASO 500+).
Recommendations on Next Page:Perinatal ConditionsMusculoskeletalESRDMH/SA
Client Analytics
Cost Savings Ideas
• Current Trends for demonstrating value to clients• Population Health – integration of third party data
(biometrics, HAS, Medical Registry, EMR) to fully assess member health and value of programs
• Predictive work: risk adjustments, extrapolation, statistical modeling, trending (rocky, can we tag team here a bit?)
• More details and drill downs: account structures, high claims analysis, code level analysis, procedure analysis
• BHI Usage / Large Benchmark datasets• Account Histograms• SIC Reporting• Regression Analyses
• Client Specific Analysis – growing importance of adhoc support• Example: ER Frequent Fliers
Pre-Sale Consultation
• Empowerment of the account management team• Provides meaningful, actionable information to integrate into
proposals and presentations• Enables immediate collaboration capabilities with
prospective client
What value does Pre-Sale Analytics bring to the account team and to the prospective client?
Core Pre-Sale Package
• Use of standard proposal data files• Mapping based on diagnosis and procedure code • Provides insight into appropriate program opportunities
Pre-Sale Consultation
Enhanced Pre-Sale Package
• Allows for in-depth view of population health• Provides insight into opportunities for optimizing decisions and management • Enables projected impact based on prevalence and behaviors
What information can you derive from a Pre-Sale Analysis?
Information DerivedWhat information can you derive from a Pre-Sale Analysis, cont…
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Non-Preventive Visit Wellness Visit
87.0%
13.0%
89.6%
10.4%
Wellness Visits and Other Office Visits
Percentage of Total Members Book of Business Percentage of Members
Insight into Wellness and Preventive Care behaviors
55.0%
10.0%
17.0%
25.0%
28.0%
65.0%
Percentage of Members Percentage of Total Cost
Distribution of Health Status
Healthy Acute Chronic
Identification of Health Status
and associated costs15.0%
5.0%
3.0%
20.0%
30.0%
10.0%
7.0%
5.0%
15.0%
25.0%
Cardiac Surgery
Hip Replacement
Hysterectomy
Knee Replacement
Lumbar/Back Surgery
Percentage of Members by Type of Surgery
Percentage of Members Having Had Surgery
Book of Business Percentage of Members Having Had Surgery
Opportunities for Optimizing Decisions
0.1%
2.5%
3.0%
0.8%
0.4%
0.6%
0.2%
0.1%
2.4%
1.6%
1.1%
0.2%
0.4%
0.3%
Obesity and Overweight
Diabetes
Hypertension
Coronary Artery Disease
COPD
Asthma
Congestive Heart Failure
Targeted Chronic ConditionPrevalence Rate
Prevalence Rate Book of Business Prevalence Rate
Targeting appropriate chronic conditions
Questions• What value does Pre-Sale Analytics bring to the account team and to the
prospective client? • What information can you derive from a Pre-Sale Analysis?
Questions