Dimensional Insight

Solution: Healthcare

Operational Management

Administration Costs

Administrative costs soak up a much smaller fraction of premiums than medical costs. But, when costs have to be brought into line quickly to balance income, MCO's generally have much more flexibility to act on SG&A costs. However, acting fast to balance the books can only be done with precision if you have highly quality information that is timely.

That's exactly what the Diver Solution provides - fully diveable, departmental P&L details that are refreshed automatically with up-to-date information, when it becomes available. Also, if you choose, financial statements can be automatically distributed to department heads and managers. So, everyone with direct fiscal responsibility can have current information on their departments' performance - actual versus budget, year-to-date, this year versus last year, etc.

Medical Costs - PMPM

Although medical costs consume by far the largest fraction of a managed care organizations budget, they can also be the hardest to control and constrain quickly when the need arises. Consequently, it's important that MCO's have timely, high quality management information so you can react promptly when prescription drug costs - for example - rise unexpectedly. How long would it take you to determine if the increase is due to a switch from generics to branded, a seasonal pattern linked to a flu outbreak, or attributed to a new IPA that only recently established a contract?

<p>Diver can provide the answers to these questions - and more - because it can tap multiple data sources, presenting a summarized view of information that instantly reveals lower level details with just a few mouse clicks. Other medical costs - primary care, acute care, home health care - and so on, can all be analyzed in the same way. </p>

Use Diver to:

• Gain insight into per member/per month costs.
• Use accurate, easily manipulated historical cost information to aid premium rate development.
• Determine how benefit plans could be developed to reduce medical costs while minimizing the impact on member and physician satisfaction.

Utilization

With overall physician costs determined by both fee schedules and utilization, it's critical that you can integrate and analyze both types of data simply and flexibly. Diver provides this for all types of utilization - physician, pharmacy, inpatient, outpatient acute care - whatever utilization data you have, you'll be able to gain insights that you never thought possible.

You'll be able to accurately track key performance indicators to obtain rapid insights into all areas of utilization:

• Are increasing pharmacy costs simply due to higher utilization or a shift from generics to branded?
• Can you immediately identify which physicians or physician groups are responsible for higher inpatient utilization?
• Which inpatient services have a negative trend in patient days or ALOS, when compared this year to last?

Claims Analysis

Claims analysis is at the core of managed care operations, helping to ensure the delicate balance between premiums, medical costs, and member and provider satisfaction. Providing the necessary aggregation and summary level data can be almost impossible to perform in a timely way. But, MCO's using Diver can update and analyze their claims lag on a daily basis, if desired.

A timely summary like this is just the starting point. Starting from the claims triangle, managers can access the detailed data immediately.

Use Diver to break down the claims lag details by:

• Service type
• Line of Business
• Rating
• Incurred Charges