We reported on this topic in February 2013. It continues to be part of many conversations Milliman is having with current and prospective clients. Health plans are focusing on this topic as evidenced by the number of RFPs released the past few months seeking analytic software to support this use case. The MedInsight team will be focusing on employer group reporting in May by presenting a webinar on May 15th, as well as two white papers on best practices.
The remaining part of this article is from our February 22nd blog article.
Employer group reporting is a requirement for most health plans and third party administrators in today’s healthcare environment. Almost every large group employer seeking healthcare coverage has some requirement in their selection process related to reporting on membership and claim experience. These requirements can vary significantly depending on the analytic sophistication of the employer and or broker working with the group. The real question is, what do employer groups really want from employer group reporting and what do employers really do with these reports?
Milliman MedInsight has recently added to their portfolio of standard reports a new “storybook” employer group report that focuses on meeting the needs of employers looking to understand their healthcare spend. Additionally, the report can serve as the foundation for data-driven discussions with their broker or sales agent about how to better tailor their benefit design and healthcare investment to better serve their employees’ needs and the employer’s investment.
The report development process was a collaborative effort between several Milliman clients and MedInsight data analytics consultants. At the start of the project the development team identified two primary objectives for the new storybook employer group report:
- Enable the employer to understand and reconcile their historic healthcare spend.
- Provide the employer data-driven insight into how they might wish to change their benefit offerings in the future – identify action items
As the report specification evolved further, several secondary requirements emerged: the report had to be easy to read and understand, the report had to have meaningful comparative benchmarks to help an employer put its experience in context, and the report needed to be able to be modifiable at runtime by the sales group so they could add comments and adjust report output.
Some of the analytic tactics employed in the report to achieve the goals for Objective One are:
- Analysis of both paid and allowed amounts by Milliman’s Health Cost Guidelines categories.
- Trend analysis between a definable current time period and prior time period.
- Benchmark comparatives between a similar block of business for the health plan and/or a set of benchmarks derived from Milliman’s research database.
- Reconciliation analysis of claims by paid date.
- Membership analysis by demographic and benefit design dimensions.
- Concurrent risk scores to measure the illness burden of the population between time periods.
Tier Analysis – Current Year (Paid & Allowed)
Some of the analytic tactics employed in the report to achieve the goals for Objective Two are:
- Use of Milliman’s Chronic Condition Hierarchical Groupings (CCHGs) to identify medical condition prevalence when considering wellness program initiatives.
- Evidence based measures to identify gaps in preventive care that influence the long term health of the population.
- Predictive risk scores for the employer group and the other similar groups within the health plan to forecast how future health care expenditures might compare.
- Frequency of potentially avoidable emergency room use.
- Provider network utilization analysis.
- Pharmacy use analysis for mail order, generic use and specialty drug use.
Top 10 Medical CCHGs
Milliman’s design of the employer group report will continue to evolve as we present the report to more clients and get additional feedback from our user base. If you’re interested in learning more about this new feature or would like to contribute your ideas to future versions of the report, please contact your MedInsight consultant or add a comment to this posting. Also watch for announcements about our May 15th webinar.