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Analytics-Informed Medical Management

The Industry Problem

Managed Care programs in Workers' Compensation have been in place for well over twenty years, yet medical costs have relentlessly increased. According to the NCCI, medical costs now amount to 60% of claim costs and that portion is increasing. Still, most continue to do business as usual.

The MedMetrics Solution

Analytics-Informed online apps link business intelligence to operations making it actionable

Reinventing Managed Care programs is not an option. Huge sunk costs and thriving businesses resist major change. However, a better answer is to refine, invigorate and empower existing medical management programs by operationalizing analytics-informed intelligence. MedMetrics offers insurers, self-insured/administered employers, third party administrators, and managed care organizations the means to gain and operationalize their business intelligence easily and affordably. MedMetrics collects, validates, integrates and analyses an organization's data, then uniquely converts the information results to electronic tools (online apps) that optimize efficiency, effectiveness and profitability.

Business Intelligence is a concept widely implemented in other industries where an organization intentionally gathers, organizes, and analyses its own data. With MedMetrics, the resulting information is reformatted into electronic tools (online apps) that are easily accessed for decision support and informed action.

MedMetrics uniquely creates a medical knowledge management platform, tooled to immediately and positively impact claim course and outcomes, managed care operations, and organizational profitability. MedMetrics' medical knowledge management apps link analytics to operations and include Medical Loss Reserve Watch, Predictive Intelligence Profiles, Provider Performance Analysis, Diagnostic Risk Score, and "Ask-the-Data" Query Library.

  1. Medical Loss Reserve Watch New!

    An analytics-informed knowledge assistant
    for claim reps to accurately and efficiently
    manage medical reserving

    MedMetrics analyzes claim and medical data to identify common cost drivers in claims that may result in elevated medical spend. MedMetrics monitors claims data and sends alerts to claims reps when conditions or events in claims indicate a change that may impact the medical reserves. The alert contains predicted ultimate cost based on the aggregated data.

    Further, alerts are customized for medical case management interventions that may drive operational consistency and loss mitigation. The system provides insight at the claims level while offering management-customized operational and reserving tools.

  2. Predictive Intelligence Profiling

    MedMetrics continually scrutinizes its customers' data and creates checklists containing data elements that portend risk and cost. Electronic alerts are sent to appropriate persons when data elements in a claim match those in a Predictive Intelligence Profile. The recipient gains early insight into claims that may be high risk or have reached a critical benchmark. As a result, medical management expertise is focused on claims needing the most attention while MedMetrics continues to electronically monitor the rest.

    Moreover, as a result of Predictive Intelligence Profiling, processes are standardized and streamlined, thereby increasing efficiency, and productivity. Outcomes are improved, savings can be objectively calculated, and profitability is optimized.

  3. Provider Performance Analysis

    Provider Performance Analysis evaluates actual medical treatment in context with outcomes. Individual provider performance and costs for treating specific injuries are peer-compared in the data. MedMetrics analyzes over 50 Key Performance Indicators in the data to rate and rank providers. Users "quick-search" best practice providers in a geo-zip region to create, restructure and monitor networks. Fraudulent provider activity is exposed! Moreover, identified underperforming providers are automatically transferred to the MedMetrics Predictive Intelligence system to alert appropriate persons when they are involved in a claim.

  4. Diagnostic Risk Score

    MedMetrics has scored individual ICD-9's and ICD-10's for how serious they are medically. As bills are submitted, ICD's accrue in claims. MedMetrics recalibrates the ICD scores continually, thereby re-tallying the total diagnostic risk score for the claim. Alerts are sent to users when a pre-defined set-point is reached. Migrating claims cannot go unnoticed.

  5. "Ask the Data"-Query Library

    Ask-the-Data Query Library is a dashboard whereby pre-defined, easy-to-understand decision support information data is readily available to authorized users. A menu offering defined queries can be quickly executed from live data on the Internet any time. Select Criteria options enable users to hone their queries to gain the precise information needed.

    MedMetrics Query Library compares performance for organizations and their clients or accounts. Individual account performance are carved out and compared to the organization's book of business. Management evaluates how interventions and business initiatives affect outcomes. Users distinguish trends and conduct "before and after" studies. Importantly, cost savings reports validate medical management initiatives.

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