Deerwalk's latest release of Plan Analytics enables easy viewing of "all-in" costs for medical procedures along with reporting to help predict future claims expenses
This month’s release of Deerwalk Plan Analytics, the flagship population health analytics and reporting application, incorporates new features in version 9.2:
- New Data Type: Bundled Payments
- New Report: Medical IBNR Estimate
1. Bundled Payments Data Type
Deerwalk is proud to introduce Deerwalk Episodes, designed to help you assess the impact of bundled payments on the cost and utilization of services for your population and compare providers for certain procedures.
The first phase of Deerwalk Episodes makes a new data type, Bundled Payments, available in Plan Analytics. Using logic defined by CMS, this data type groups claims for acute procedures into "episodes of care" for over 50 episode types, such as knee/hip replacement, back surgery, diabetes, stroke, and cardiac conditions. These "episodes" include the cost for the specific procedure as well as the cost for related clinical services, such as lab workups and physical therapy sessions, as well as related pharmacy claims, such as medications and drug therapy.
Bundled Payments data can be used to conduct analysis and reporting with existing Plan Analytics tools such as SumIt and the "Create" module. For example, if you wanted to compare physicians performing back surgery, you could take a look at the total cost as well as a breakdown of what that cost entailed (such as number of follow-up visits, scans, etc.) to get a better understanding of the actual value of services being delivered. You could also use the information to aid in the development of a bundled pricing strategy.
2. New Report! Medical IBNR Estimate
This report helps organizations anticipate the financial impact of outstanding expenses for healthcare services that have been administered to members, but for which a claim has not yet been reported (incurred but not reported, or "IBNR" claims). With the ability to predict actual claims liability, stakeholders can be proactive and plan accordingly to prepare for "bills in the pipeline." IBNR estimation can produce early indicators that changes to pricing or benefit plan design may be needed at some point in the future. It can also shed light on a plan's loss ratio for an accounting period, which can sometimes appear more favorable than it really is due to delays in reporting time from claims processing backlogs caused by an increase in claims volume.
In this report, an estimate of the "IBNR" amounts are calculated based off the average incurred and paid claim costs per member per month (PMPM). This information is presented using a lag triangle, which groups claims by incurred month and paid lag month. You have the option to toggle between plan paid and allowed amounts as well as the option to run the report using either 12 months or 24 months of paid and incurred data.
Looking ahead: In future releases, we will be bringing in more functionality around Deerwalk Episodes, adding data elements to the Bundled Payments Data List (such as care alerts score outcomes, risk-adjusted paid amounts, more utilization types, and additional provider detail). We also plan to expand types of episodes to include chronic disease and high-cost pharmacy. Future releases will further utilize this data to produce standard reporting, including aggregate reporting and analysis.
Schedule a demo to learn more about how to use Deerwalk Plan Analytics and the latest features.
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