Employer & Plan Tools
What’s the best way to navigate health care today? Technology. We provide
you with advanced tools and services that can bring real knowledge and confidence
to your decision-making and real, measurable results.
Key Benefits
Actionable Employer & Plan Information
- Improves the speed while decreasing the cost of decision-making
- Provides employers and plans with actionable information – analyze, benchmark,
model & profile in seconds not hours, days, weeks or months
- Consolidates and controls your health plan data
Features
Analysis & Benchmarking
Analysis and Benchmarking Tools give you complete and accurate data about your plan,
members, claims and usage. A snapshot of your entire benefits landscape, delivering
actionable information that can help you make better decisions.
Analysis & Benchmarking Tools
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Health Plan Key Indicator
Compares actual plan and group-level enrollment and medical and drug-plan key indicators
to local, regional and national benchmarks.
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Cost Driver Analyzer
Detailed cost-accounting from submitted, total and net medical and drug payments
to specific service, procedures and providers.
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Claim Distribution
Determines the claims and claimants by standard and user-controlled payment ranges.
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Network Analyzer
Analyzes contractual, benefit plan and coordination of benefit deductions and payments
by provider.
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Pharmacy Analyzer
Analyzes the total and net payments by retail, mail order, formulary brand, non-formulary
brand and generic drug.
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High Cost Claim Analyzer
Provides a list by de-identified member code of diagnoses, utilization and net plan
payments for user-defined claim level.
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Condition & Episode of Care Analyzer
Measures and benchmarks the total cost of disease.
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Enrollment Analyzer
Analyzes membership by coverage type.
Modeling
Modeling Tools allow you to predict how different benefit plans and risk options
will play out in terms of coverage and cost. Realistic comparisons in seconds for
quicker, more confident, more informed decision-making.
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Medical Plan Modeler
Using your actual medical data, model different benefit plans, network participation
rates and contribution scenarios.
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Prescription Drug Modeler
Using your actual pharmacy data, model different tiered coinsurance and co-payment
benefit scenarios.
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Stop-Loss Modeler
Using your actual claims, determine which stop-loss quotes are most cost effective
for you.
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Trend
Using your actual membership and claims, measure the trends of your medical and
drug trends over time by plan, employee group and status.
Profiling & Pricing Transparency
Profiling and Pricing Transparency Tools help you get to the real health care bottom
line. What is the total cost to your organization? All the costs, from providers
to prescription drugs. Once you know that, real change and real improvement can
take place.
Profiling & Pricing Tools
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Medical Provider Profiler
On a real-time basis and using your data, compare provider-specific total and net
payments by episode of care, specific service and procedure utilization and unit
price. Develop specific high cost claimant lists by provider and claim distribution.
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Medical Price Lists
Develop a price list for employees to help them make informed healthcare decisions
in a consumer driven world. Let them know how much it costs to go the emergency
room versus a routine doctor visit. With our Cost Driver & Episode of Care reports,
you can do that quickly and easily using the most current pricing information directly
from your data.
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Prescription Drug Price Lists
Develop a prescription drug price list down to the National Drug Code (NDC). Drive
change by giving your employees the most current information about things like the
difference in price between a mail order prescription versus retail prescription
for the top 10 maintenance medications that your employees and their dependents
need. Insert your data into employee newsletters demonstrating the difference between
a generic versus brand name drug. Or use this information strategically to evaluate
your Pharmacy Benefit Manager’s performance.