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MedMetrics®,LLC
Workers Compensation Medical Knowledge Management
Linking Business Intelligence to Operations

The Industry Problem

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

Similarly, the costs for providing or purchasing managed care services continue to climb, without proof of value. Medical Case Management, Utilization Review, Peer Review, Bill Review programs, and medical provider networks all cost more to purchase or maintain, yet their contributed value is unknown.

The MedMetrics Solution-Linking Business Intelligence to Operations

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 data-inspired business 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 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 data. With MedMetrics, the resulting information is reformatted into electronic tools that are easily accessed for decision support and informed action. Advances in technology and the ways we can access and share information have made such knowledge management feasible and affordable, especially for Workers Compensation medical management.

MedMetrics uniquely creates a medical knowledge management platform, tooled to immediately and positively impact claim outcomes, managed care operations and organizational profitability. MedMetrics medical knowledge management tools include Predictive Intelligence Profiling, Provider Performance Analysis, and "Ask-the-Data" Query Library.

  1. Predictive Intelligence Profiling

    MedMetrics continually scrutinizes its customers' current and historical data. 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 action 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 and profitability is optimized.

  2. Provider Performance Analysis

    Provider Performance Analysis evaluates medical treatment processes in context with outcomes. Individual provider performance and costs for treating specific injuries are peer-compared in the data. MedMetrics combines multiple 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.

  3. "Ask the Data"-Query Library

    "Ask-the-Data" Query Library is a medical information and performance dashboard whereby clearly defined, easy-to-understand decision support information based on current and historical 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's 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.

Additional MedMetrics Features and Services

Drill-down features

MedMetrics amplifies the results of medical data analysis with drill-down features that leap-frog users through further study. Outlier claims for a set of conditions are listed so users can investigate further. Claim summaries clarify provider involvement, the treatment process and other variables. Drill-downs are short-cuts to deeper analysis, better understanding and decision support.

Affiliations feature

MedMetrics customers' clients and accounts are called Affiliates. They are segmented hierarchically so that one client or account's performance can be carved out and compared to the book of business. Moreover, the hierarchy is multi-layered, providing configurations appropriate to each account. Affiliates in the data can also be authorized via password to view their unique information results.

Consultation

MedMetrics offers subject matter and IT consulting services. As subject matter experts, we assist our clients in creating their unique and comprehensive Predictive Intelligence Profiles and action benchmarks. We also design analyses and studies that address and interpret specific information needs. Moreover, we assist in applying business knowledge gained through analytics to operations to achieve efficiency, support management decisions and determine how to sustain or satisfy client accounts' and management's demands for measured results.

MedMetrics experts will also consult with IT personnel regarding data transfer and security from current, legacy or vendor systems to MedMetrics. We validate, integrate, normalize and map the data, freeing MedMetrics customers' IT personnel of those tasks.

MedMetrics ROI Calculator

MedMetrics brings its users an array of analytics application tools that result in administrative savings. ROI Calculator, found on the MedMetrics HOME page and accessible to anyone, is another tool provided to assist in measuring value-the value of using MedMetrics! Use of the MedMetrics ROI Calculator tool is free!

Fill in the blanks in the ROI Calculator estimating your monetary return gained from using MedMetrics. Simply contact MedMetrics to obtain estimated annual license fee based on claim volume or organizational size to complete the calculation. The ROI calculator will determine your return on investment.

Custom queries, studies, and data services

MedMetrics will develop custom queries and studies upon request. MedMetrics designs custom analyses to elicit new business knowledge or present results differently. MedMetrics will develop electronic claim summaries, audits of claims, programs, and contract compliance, for example.

MedMetrics WC medical data warehouse

MedMetrics imports, validates, integrates and maps your medical billing data and select claims level data on a continuous basis. Initially, we import and integrate current and historical data. Subsequently, we invite data from additional, related systems such as vendor systems, legacy systems or other sources in order to gather the most comprehensive and appropriate data set and insights needed. The data are stored separately for each MedMetrics customer in their confidential and secure sector of our Workers Compensation medical data warehouse. Confidentiality and security are imperative for all data. For instance, MedMetrics does not transfer claimant personally-identifiable data, thereby insuring strict confidentiality.

MedMetrics makes transferring data easy and secure. We will accept data in nearly any form and format, accompanied by a data dictionary, usually transferred via secure FTP. To keep data current and results most powerful and actionable for medical management business units, MedMetrics suggests data be refreshed frequently, optimally, on a daily basis.


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