Makalu Healthcare Risk Analysis
Deerwalk’s Makalu product is an innovative reporting and analytics platform for healthcare management. It’s flexible and configurable architecture makes it an ideal candidate for integrating with other platforms and services to create a more robust analysis for customers. It was clear in the initial vision of Makalu that comprehensive risk profiling would be a key value for decision making by Third Party administrators, health plans, brokers, consultants, physician groups and Accountable Care Organizations (ACOs).
Risk Analysis Overview
Assessing risk is a common business practice in many industries including healthcare. By determining the level of risk of a health plan’s population you can identify those members at highest risk for adverse events, disease progression, and increased costs. It’s also common practice to identify the drivers of increased risk and focus programs such as disease management and wellness on those areas in an attempt to decrease overall risk in population.
Deerwalk has chosen the Milliman Advanced Risk Adjuster (MARA) as the initial suite of measurement tools to handle its predictive risk modeling. Milliman is an independent actuarial and consulting firm with over 60 years of experience. Their primary consulting business spans many industries and they offer a variety of professional services and products.
During the selection process Deerwalk was very impressed with Milliman and their MARA. The technology behind the package made it very easy to integrate and it was clear that MARA was designed to provide customers with the greatest level of accuracy and insight about individual health risk. It offers very flexible modeling options and the scoring is broken down in a manner that makes it easy to describe illness burden by service categories. MARA is perfectly suited to meet Makalu’s need to stratify and project risk, and adds tremendous value to the analytic reporting features.
Makalu and MARA Processing
Makalu processes member eligibility, medical claims, and pharmacy claims data in order to perform complex analytics. Similarly MARA takes in a subset of this information and in turn calculates the individual risk scoring for members. Integrating with MARA was a positive experience thanks to Milliman’s excellent documentation and examples. In addition their very responsive staff was able to assist with a number of data related intricacies specific to Makalu’s needs.
While Milliman offers a number of adjusters and models for Makalu’s initial implementation Deerwalk chose to use the Comprehensive Adjuster (CxAdjuster) to take full advantage of both the medical and pharmacy claims data. Makalu needs to present not only predicted costs but also the expected values for the comparison period against the actual costs. Because of this Deerwalk is using the CxAdjuster with both the concurrent and prospective models.
When Makalu processes a 12 month period of data we in turn calculate two sets of risk scores, one for the 12 month period and another for the following 12 months. By running this process, normalizing the scores, and storing the results Makalu can effectively track the risk scores for members on a regular basis (i.e. monthly, quarterly, etc.) and do further calculations to predict future costs.
Makalu Group Risk
Generating the risk scores is one thing but how do you summarize and report the information back to customers in the most concise and effective manner? Makalu exposes the information via the Risk Analysis module. The module consists of a series of reports and drilldowns to give a macro and micro view of risk. Additionally you can filter by risk score on the member search screens.
This first report breaks down the risk scoring by client. Customers can use this to see which employer groups have the highest risk as well as the overall risk for their company. By normalizing a client population’s scores we are able to calculate the expected and prospective PMPM costs.
Makalu Member Risk
By drilling down into an employee group clients can get a more detailed view of the population. They can order by risk score to find members at higher risk than the employer average and plan average scores.
Makalu Member Profile
Lastly you can drill down into the individual members themselves to get to their profile page. Here you can not only view the risk scores for the reporting period but also see all of the relevant data for that member and get a complete picture of their health history and status. The profile page also displays the top diagnosis and procedure data (not pictured).
Risk analysis is a key tool for healthcare management in the effort to provide better care at a lower cost. Deerwalk recognizes this need and the Makalu product delivers the capabilities that customers need to achieve their goal. The Milliman Advanced Risk Adjuster has been an incredibly powerful tool for Deerwalk and we are excited to make it accessible to all of our customers. We look forward to expanding upon our risk analysis offering in the future in order to continue providing the one of the most comprehensive and effective healthcare management tools in the market.