DATA ANALYSIS & REPORTING Select Sample Reports

Transcription

1 DATA ANALYSIS & REPORTING Select Sample Reports Integrated Charts and Graphing Drill-Down to Individual Transaction/EOB Benchmark Performance Normative Comparison Summary Key Utilization Indicators Claim Analysis Overview Cost by Age Group Utilization Benchmark Summary Preventable Conditions Top Ranked Procedures, Providers, Drugs Benefit Informatics, Inc INFO (4636) Data Integration & Warehousing Data Analysis & Reporting Modeling & Forecasting Member & Provider Communication

2 Normative Comparison Summary Output Generated: 5/6/2010 Date Range: Check Date 4/1/2009 through 3/31/2010 Enrollments, Payments & Savings Total Health Contracts 236 Total Health 576 per Contract 2.44 Average Member Age Average Age Inpatient Facility $228, Outpatient Facility $434, Inpatient Professional $4, Outpatient Professional $574, Dental $156, Total Payment $1,398, Total $3,238, Total Payment $1,398, Responsibility $212, Other Insurance COB $18, Not Covered $849, Overall N/W Savings $759, Overall N/W Savings Percent 23.44% Utilization Statistics % Claim Type Statistics Group Norm Difference All Medical Claims Inpatient Facility Outpatient Facility Services/ ,113 Norm Category Payment/Member $2, $5, $8, % National, Overall* $5, $9, % 200 or More EEs* $5, $8, % Midwest Region* $5, $8, % Agriculture/Mining/Construction* Services/1000 Payment/Member Admissions/1000 Average Length of Stay (Days) Days/1000 Services/1000 2,267 $ $ ,641 Payment/Member $ $1, Inpatient Professional Services/1000 Payment/Member 30 $7.74 $18.88 Outpatient Professional Services/1000 Payment/Member 10,238 $ $2, * Derived from: Employer Health Benefits 2009 Annual Survey (#7936), The Henry J. Kaiser Family Foundation and HRET, September 2009, This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.

3 Per-Network Savings PPO Exclusions Discount % Savings ABCPPO $2,336, $0.00 $745, % DEFPPO $41, $0.00 $ % Other $860, $0.00 $13, % Total $3,238, $0.00 $759, % In-Network Statistics Number of Services (70.97%) Payment $878, (62.85%) Claim Type % Services Payment InpatientFacility 11.72% 24.35% Outpatient Facility 38.91% 40.41% Inpatient Professional 0.15% 0.46% Outpatient Professional 49.16% 34.55% Top Five Payees by Payment Payee Payments Payments ASSOCIATED ASSOC 26.85% $375, ASSISTANCE INC 14.82% $207, ASSOCIATED HOSPITAL 6.96% $97, ENDOCR ASSOC 3.31% $46, ASSISTANCE MEDICAL CENTER 3.18% $44, All Other Payees 44.88% $627,500.09

4 Key Utilization Indicators Date Range 1: Check Date 1/1/2009 through 4/30/2009 (120 days) Date Range 2: Check Date 1/1/2010 through 4/30/2010 (120 days) Check Date Check Date 1/1/2009-4/30/2009 1/1/2010-4/30/2010 % Difference Enrollment Average Member Age % Average Age % Number of Enrollment Contracts % Total % per Contract % Payments Inpatient Facility $8, $71, % Outpatient Facility $68, $143, % Inpatient Professional $36, $ % Outpatient Professional $251, $175, % Dental $52, $50, % Total Payments $418, $440, % Unit Cost Payment per Enrollment Contract $1, $1, % Payment per Member $ $ % Inpatient Facility Admissions/ % Average Length of Stay(Days) % Days/ % Services/ , ,578.05% Payment/Service $ $ % Payment/Member $15.18 $ % $37.06 $ % Outpatient Facility Services/ , % Payment/Service $ $ % Payment/Member $ $ % $ $ % Inpatient Professional Services/ % Payment/Service $ $ % Payment/Member $63.87 $ % $ $ % Outpatient Professional Services/1000 4, , % Payment/Service $99.44 $ % Payment/Member $ $ % $1, $ % This report provides an overview of your group s medical cost and utilization. Key indicators can help identify both where positive changes have occurred and where potential problems exist.

5 Claim Analysis Overview Output Generated: 5/6/2010 Date Range: Check Date 1/1/2010 through 3/31/2010 Total Total % Total Dependent % Dependent Total Total Number of Claims Processed 1, ,057 Total Number of Services 3,940 1,501 2,439 Total $731, $297, % $433, % Total Provider Reductions $340, % $121, % 40.63% $219, % 50.62% Total Responsibility $52, % $16, % 5.59% $36, % 8.36% Total Exclusions $ % $0.00 N/A 0.00% $0.00 N/A 0.00% Total Other Insurance $6, % $ % 0.21% $5, % 1.37% Total Payment $331, % $159, % 53.56% $172, % 39.66% This report provides an overview of claim expenditures, provider reductions and employee responsibility. These costs are broken out by employee and dependent for further analysis.

6 Cost by Age Group Output Generated: 5/7/2010 Date Range: Check Date 1/1/2010 through 4/30/2010 Age Group Clmnts Empl Clmnts Dep Clmnts Svcs Claim Discount Discount Resp Resp Payment Payment $42, $10, % $5, % $19, % $111, $19, % $9, % $57, % $112, $27, % $11, % $39, % $200, $47, % $14, % $90, % ,378 $211, $51, % $21, % $83, % ,737 $330, $50, % $27, % $188, % $101, $21, % $11, % $58, % $26, $2, % $3, % $6, % $0.00 $0.00 N/A $0.00 N/A $0.00 N/A Total ,999 $1,137, $229, % $105, % $544, % 65 & Over $40, $5, % $4, % $13, % This report can be used to monitor claim amounts and network discounts by age bands for your plan.

7 Utilization Benchmark Summary Output Generated: 5/6/2010 Date Range: Check Date 1/31/2010 through 3/31/2010 Benchmark Type Value For Group Percent National Variance Benchmark from Value Benchmark Medical Encounters % persons having at least one office visit, home visit or ER visit % % 149% ER Services % persons under 18 who had at least one ER visit % % -21% % persons under 6 who had at least one ER visit N/A N/A N/A % persons between 6 and 17 who had at least one ER visit % % -11% % persons between 18 and 64 who had at least one ER visit % % -29% % persons 65 and older who had at least one ER visit % % -100% Dental Services % persons under 18 who had at least one dental visit % % 299% % persons between 18 and 64 who had at least one dental visit % % 141% Mammography Services % women age 40 and over who received a mammogram % % 57% % women age 40 to 49 who received a mammogram % % 97% % women age 50 to 64 who received a mammogram % % 58% % women age 65 and over who received a mammogram % % -100% Infectious Diseases % persons presenting Hepatitis cases % % 31,807% % persons presenting Tuberculosis cases % % -100% % persons presenting STD cases (Syphilis, Chlamydia, Gonorrhea) % % -100% % persons presenting Symptomatic HIV cases % % 7,537% Cancers % persons presenting Cancer cases (All Types) % % 609% % persons presenting Lung Cancer cases % % -100% % persons presenting Colon and Rectum Cancer cases % % -100% % persons presenting Prostate Cancer cases % % 563% % persons presenting Breast Cancer cases % % 773% % persons presenting Leukemia cases % % -100% Diabetes % persons having services associated with physician-diagnosed, nonpregnancy diabetes % % 74% This application displays a summary of your group's utilization versus selected benchmark values. The benchmark values were derived from information supplied through the United States Department of Health and Human Services, Centers for Disease Control and Prevention. Note that if a particular service is not available through your plan, this application will show little or no utilization for that service category.

8 Preventable Conditions Output Generated: 10/29/2010 Date Range: Check Date 1/1/2009 through 9/30/2010 This table displays your group's experience with certain illnesses that may be modifiable using disease prevention and health promotion initiatives. Diseases and injuries are categorized as preventable when there is a modifiable factor that influences the development or severity of the condition. For example, hypertension, dietary fat, cholesterol, tobacco use, inadequate exercise and obesity are all modifiable factors that influence the risk of heart disease and stroke. Genetic predisposition and age also influence the risk of heart disease and stroke, but these factors cannot be modified. Diagnosis Category Admissions Avg Length of Stay Avg Payment per day Services Patients Avg Payment per patient Total Total Payment Diagnosis Prefixes Considered Cerebrovascular Disease - Cerebral Hemorrhage $53.00 $15, $ Occlusion Cerebral Artery $ $ $ Trans-ischemic Attack $ $1, $ Stroke $ $2, $1, Other Cerebrovascular Disease $0.00 $0.00 $ Heart Disease - Heart Attack $9, $39, $19, & Other Acute Heart Disease $1, $35, $18, & & Chronic Heart Disease $5, $96, $47, Congestive Heart Failure $0.00 $0.00 $ Manageable - Diabetes & Related , $1, $57, $31, & & & & Asthma $ $12, $6, Vascular Disease - Arteriosclerosis $0.00 $0.00 $ Aneurysm $0.00 $0.00 $ Peripheral Vascular Disease $ $1, $ Weight-Related Disease - Obesity/Hyperalimentation $ $ $ Phlebitis $ $ $ Varicose Veins $1, $12, $3, Totals: $1, $278, $130,886.50

9 Top 30 Procedure Codes by Payment A1 Analysis - Group ID: DEMO3 Output Generated: 10/29/2010 Date Range: Check Date 1/1/2010 through 9/30/2010 (Paid Data) Comparisons: Procedure Code <> '' Procedure Code Number of Claims Number of Services Total Charge Discount Responsibility Other Payment OFFICE/OUTPATIENT VISIT, EST $56, $27, $5, $77.00 $23, D DENTAL PROPHYLAXIS ADULT $26, $3, $0.00 $ $22, D PERIODIC ORAL EVALUATION $15, $2, $0.00 $ $12, OFFICE/OUTPATIENT VISIT, EST $26, $11, $2, $0.00 $12, J ZOLEDRONIC ACID 8 8 $10, $1, $ $0.00 $9, S HIT ANTIBIOTIC TOTAL DIEM 2 2 $10, $3, $0.00 $0.00 $7, TISSUE EXAM BY PATHOLOGIST $10, $3, $ $0.00 $6, LOW BACK DISK SURGERY 3 6 $82, $76, $0.00 $0.00 $6, DECOMPRESS SPINAL CORD 2 2 $7, $0.00 $ $0.00 $6, PREV VISIT, EST, AGE $10, $4, $ $0.00 $5, OBSTETRICAL CARE 4 4 $13, $6, $ $0.00 $5, OFFICE/OUTPATIENT VISIT, EST $10, $4, $ $0.00 $5, D DENTAL PROPHYLAXIS CHILD $6, $ $0.00 $0.00 $5, THERAPEUTIC EXERCISES $15, $10, $ $0.00 $5, D DENTAL BITEWINGS FOUR FILMS $6, $ $0.00 $44.00 $5, OFFICE CONSULTATION $8, $3, $ $0.00 $4, D PERIODONTAL SCALING & ROOT $7, $1, $1, $0.00 $4, CESAREAN DELIVERY 2 2 $8, $3, $1, $0.00 $4, D CROWN PORCELAIN W/ H NOBLE M $9, $ $4, $0.00 $4, HEART IMAGE (3D), MULTIPLE $8, $3, $ $0.00 $4, ANESTH, SURG LOWER ABDOMEN 2 2 $4, $0.00 $ $0.00 $4, D POST 1 SRFC RESINBASED CMPST $7, $1, $1, $0.00 $3, OFFICE/OUTPATIENT VISIT, NEW $8, $3, $ $0.00 $3, J OXACILLIN SODIUM INJECITON 4 5 $5, $1, $0.00 $0.00 $3, CHIROPRACTIC MANIPULATION $9, $5, $ $0.00 $3, D POST 2 SRFC RESINBASED CMPST $7, $2, $1, $0.00 $3, OFFICE/OUTPATIENT VISIT, EST $10, $5, $1, $24.60 $3, DENTAL SURGERY PROCEDURE 5 8 $8, $4, $ $0.00 $3, ANESTH, SPINE, CORD SURGERY 2 2 $3, $ $ $0.00 $3, DIAGNOSTIC COLONOSCOPY $9, $4, $1, $0.00 $3, Total in Top 30 2,999 $424, $198, $27, $ $198, All Other 6,607 $940, $511, $86, $2, $339, Grand Total 4,491 9,606 $1,364, $709, $113, $3, $537,688.55

10 Top 25 Provider Names by Payment A1 Analysis - Group ID: DEMO3 Output Generated: 10/29/2010 Date Range: Check Date 1/1/2010 through 9/30/2010 (Paid Data) Provider Name Number of Claims Number of Services Total Charge Discount Responsibility Other Payment ASSOCIATED ASSOC 1,199 2,734 $639, $323, $47, $ $268, ASSISTANCE INC $158, $0.00 $ $0.00 $158, ASSOCIATED HOSPITAL $218, $118, $9, $7, $83, ENDOCR ASSOC $96, $48, $12, $88.31 $34, ASSISTANCE HEALTHCARE $49, $12, $4, $1, $32, ASSISTANCE ASSOC $53, $23, $2, $0.00 $27, ASSISTANCE MEDICAL CENTER $54, $26, $3, $24.60 $25, GREEN SURGERY $47, $21, $3, $0.00 $23, ASSOCIATED LAB $47, $22, $2, $0.00 $22, SURGERY $39, $16, $3, $ $18, ASSOCIATED SURGERY $36, $18, $ $1, $16, ASSOCIATED MEDICAL GROUP $105, $87, $1, $0.00 $16, ASSOCIATED DENTAL $40, $17, $5, $ $16, ASSOCIATED MEDICAL CENTER $21, $6, $80.59 $0.00 $15, ASSOCIATED MED CTR 6 9 $28, $16, $1, $0.00 $11, ASSOCIATED BONE & JOINT $30, $17, $ $0.00 $11, ASSOCIATED RADIOLOGY $19, $8, $ $0.00 $10, CREATIVE HOSPITAL $65, $53, $2, $0.00 $9, ASSOCIATED UNIV $28, $17, $ $0.00 $9, ASSOCIATED HOSP $20, $10, $1, $ $8, CREATIVE MED CTR $53, $43, $1, $0.00 $7, ENDOCR ENDOCR $16, $5, $2, $1, $7, ENDOCR SURGERY $10, $2, $1, $0.00 $6, CREATIVE ASSOC $12, $5, $1, $0.00 $6, ASSOCIATED MEDICINE $16, $9, $1, $0.00 $6, Total in Top 25 7,225 $1,912, $934, $112, $12, $853, All Other 4,117 $463, $216, $56, $ $190, Grand Total 5,023 11,342 $2,376, $1,151, $169, $12, $1,043,492.75

11 Top 15 Drug Names by Payment A1 Analysis - Group ID: DEMO3 Output Generated: 10/29/2010 Date Range: Check Date 1/1/2010 through 9/30/2010 (Paid Data) Drug Name Number of Claims Number of Services Total Charge Discount Responsibility Other Payment LIPITOR TABLETS $21, $2, $5, $0.00 $12, AVONEX ADMIN PACK 30MCG S 3 3 $12, $3, $ $0.00 $9, NEXIUM CAPSULES DELAYED RELEASED $11, $2, $1, $0.00 $7, PREVACID CAPSULES DELAYED RELEASE $6, $ $1, $0.00 $4, ACIPHEX TABLETS $4, $ $ $0.00 $3, ZOLOFT TABLETS $5, $ $1, $0.00 $2, ZYRTEC TABLETS $5, $1, $2, $0.00 $2, HUMALOG INJECTION $4, $ $1, $0.00 $2, ZOCOR TABLETS $3, $ $ $0.00 $2, BEXTRA TABLETS $3, $ $ $0.00 $2, CELEBREX CAPSULES $3, $ $ $0.00 $2, PRAVACHOL TABLETS $3, $ $ $0.00 $2, RYTHMOL SR 425MG CAPSULE 3 3 $2, $ $ $0.00 $2, ALLEGRA TABLETS $3, $ $1, $0.00 $1, OXYCONTIN TABLETS CONTROLLED RELEASE 7 7 $2, $ $ $0.00 $1, Total in Top $94, $14, $18, $0.00 $60, All Other 14,505 $2,584, $1,189, $232, $12, $1,149, Grand Total 8,738 15,057 $2,678, $1,204, $251, $12, $1,209,476.94