Comprehensive Plan Analysis
Maintaining an affordable benefit program starts with identifying the aspects most ripe for optimization. Focus narrowly on reducing cost through identifying high risk members and you are likely to miss opportunities in optimizing network performance or benefit coverage. Ignore high risk members and you could end up paying 10x in disease treatment for what should have been a minor expense in disease prevention. A comprehensive look at a program's financial condition is key to keeping performance up and cost down.
Planwatch provides a balanced analysis of the major dimensions of your benefit program to aid in discovering the areas of the plan with the most financial impact. Instantly access over 20 interactive reports covering member demographics, diagnosis and lifestyle indicators, benefit usage, provider allocation, and network utilization.
How do paid dollars break down between facilities and physicians? Who is the most heavily utilized care provider? Are the top ten providers in network? These are just some of the questions answered by Planwatch's provider related analysis.
The high level allocation break-down shows how paid dollars fall between facilities and physicians combined with whether the claims were paid in or out of network. The Top 30 Provider report lists the most heavily utilized providers based on amount paid by the plan. Physician and Facility analysis reports illuminate opportunities for network steerage and employee education.
Employee / Member Demographic Analysis
Understanding the demographic makeup of the covered population is a good way to approximate how costs are likely to trend in the future. A plan with a high 50+ population has completely different needs when compared to a plan full of 20 year-old males. Planwatch includes three top level reports that break paid dollars down by various combination of member age, gender, and relationship (employee, spouse, child) providing a wealth of knowledge about the makeup of the covered population.
Benefit programs are designed around the concept of individual benefit types: Injections, Chiropractic, Lab Work, ER Visits, Doctor's Office Visits. Much of the appeal of the self-funded system comes with the ability to tailor coverage at the benefit level to the needs of the employee population. Self-funded employers are free to tweak the plan for their specific circumstance instead of adopting a generic plan.
Planwatch provides a multi-layered benefit analysis. Individual charge types are grouped into categories for higher level analysis. Categories are fully customizable and may include any number of individual charge types. Top level reports provide a breakdown of paid dollars by category, including percentages of total charge and total paid dollars. Determining which benefit categories are most costly and by what percentage is a snap.
When you drill down into a benefit category, you can view how cost is distributed between individual charge types or break charges down by any other aspect of the program, such as Provider, Network, or Lifestyle Category.
A detailed diagnostic analysis is one of the best ways to determine whether a disease management or wellness program might be a good fit for a plan. Planwatch includes two top level reports based on diagnostic information: Diagnosis Analysis and Lifestyle Analysis. The Diagnosis Analysis report groups charges by major diagnosis category as defined by the International Classification of Diseases and Injuries (ICD) while the Lifestyle Analysis report breaks down expense by categories designed to help assess the lifestyle characteristics (e.g., Type 2 Diabetes, Alcohol, High Cholesterol).
The categories used in both diagnostic related reports can be customizable by ICD code range and support drill down for detailed claims analysis.
Nearly all self-funded programs contract with one or more Preferred Provider Organizations (PPO) as well as multiple third party repricers. Planwatch shows how network usage and savings breaks down between each of the contracted organizations. This is especially useful in determining what percentage of claims are being paid in-network vs. out of network. In most cases, plans showing less than 80% of paid dollars going through in network providers can be optimized for additional savings.
You can drill down into a specific network or contract to see how provider usage is distributed as well.