Our client is a global, multi-billion dollar, multi-industry company with over 30,000 employees. Its network of businesses produces advanced aviation, defense and industrial products.
Being a self-insured health plan, our client takes on the financial risk of providing certain healthcare benefits for its employee and dependent population. In order to support the costs that are associated with being a self-funded employer, the company was looking to expand its analytical capabilities to:
- Project healthcare expenditures for its employees to ensure appropriate funds are earmarked
- Propose ideal healthcare benefit structures that accommodate employee needs and Affordable Care Act (ACA) standards
- Determine appropriate employee payroll contributions and suggest modifications based on expected future cost increase
- Identify appropriate medical management programs or intervention strategies that help ensure a healthy productive workforce while reducing total cost of care
- Develop strategies to reduce overall cost of healthcare
In summary, the company was looking for an integrated data warehouse, as well as a reporting and analytics platform solution with self-service capabilities to assist its Finance and HR Benefit teams.
In order to be able to conduct such analytical studies, the company needed to overcome a number of challenges.
- Acquiring and aggregating data from its carriers
- Creating a fully integrated clinical data warehouse across all of its business units
- Enriching its data warehouse with clinical and predictive analytics
- Providing its benefit analysts the ability to access this enriched data warehouse and supplying them with pre-defined reports on its member population
- Finding a partner with the knowledge and expertise required to enrich its data from a clinical and analytical perspective
EXL Health Solution Approach/Methodology
EXL Health designed a three-pronged approach to addressing the client’s needs and challenges.
Our team will work with the client’s third-party vendors and coordinate the file layouts, file feeds, testing, and approvals between and among the client, its data vendors and EXL Health.
We will provide data integration and warehousing services for initial implementation in coordination with the client.
Access to and use of the SCIOVantage® Analytics and Reporting Platform
Our web-hosted analytics platform, deployed for client, will include the following features:
- Clinical Definition Module: includes our Disease Identification, Facts, Measures and Indication modules implemented with our standard definitions.
- Member Analytics Module: provides client users the ability to search for members using various parameters, as well as a Member 360 degree view.
- Predictive Models: includes Financial Risk Models and Impactability Models.
- Standard Reporting Package: featuring multiple user-friendly dashboards, the following report types are included:
- Population Reporting: includes a series of standard population reports, including HEDIS measures reporting.
- Financial Reporting: includes financial trend and analytics reports that provide users with a line of sight on key cost centers.
- Outcome Reporting: includes a standard set of outcome reports, as well as an advanced outcome reporting module with the ability to upload program participation data to generate self-service reports.
The EXL Health solution also includes the following:
POWER USER ACCESS LICENSE
A specific access license for SCIOVantage® and the reporting base. This license includes the ability for “power users” todevelop and deploy custom reporting packages, as well as perform ad-hoc analysis. This analysis is enabled through access to the client’s data warehouse using our report building tool and SQL database access. In addition, these users will have access to our SSH File Transfer Protocol (SFTP) to transfer data as required.
ACCESS TO EXL HEALTH’S BENCHMARK DATABASE
Enables comparative analysis relative to populations external to the client. This commercial benchmark dataset is provided via the SCIOVantage® platform as part of our standard reports, as well as a separate member month level extract for the client’s ad-hoc analysis.
We will provide a monthly ongoing production refresh subject to data receipt before a mutually agreed upon cut-off date from each eligibility, medical and pharmacy data source, per agreed upon schedules with each data source.
We will build out a Basic Benefit model that will allow the client’s users, with Standard access to the SCIOVantage application, to tweak the input parameters (e.g., benefit structure, payrolls, medical trends, etc.) and to generate a pre-defined set of standard reports. Additionally the client’s users, with Power User access, will also be able to access the underlying data that is generated from the model run if required for additional ad-hoc analysis.
The client chose our data aggregation, warehousing, analytics and reporting solutions to recognize the following anticipated outcomes.
- Identify highly prevalent conditions and choose appropriate Medical management programs for its employee and dependency population
- Close gaps in member care, thereby improving overall health quality and potentially increasing productivity
- Develop strategies to help reduce costs generated by typical High Cost Claimants
- Identify potentially avoidable ED usage, and educate members about usage of Urgent Care centers
- Negotiate payment contracts for services utilized by members
- Evaluate the effectiveness of the Medical management programs the client has chosen to implement by measuring the population who participated
- in the program (participants) in contrast to members who did not participant in a program (non-participants) and assess cost, utilization, quality, and eventual ROI of the program
- Project necessary financial reserves required to cover incurred claims
- Project cost budgets for upcoming year in order to evaluate benefit design
- Evaluate financial impact of different plan designs before choosing one
- Report on monthly, quarterly and annual financial metrics required by management
- Provide a single source of truth – its aggregated and warehoused data – for analyst groups within finance and HR benefit management, enabled by a single partner in handling data aggregation, data management and analytics.