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Our approach to meeting your needs: Decision Master® Warehouse
Years of experience and extensive research into the needs of our clients led to the development of Decision Master Warehouse — a medical claim decision support system that significantly impacts the way traditional healthcare claims information is viewed and utilized.
What is Decision Master® Warehouse?
Decision Master® Warehouse (DMW) is an Internet-based decision support system for managing group medical plans. DMW lets us detect problems with medical utilization or plan cost, isolate the root causes of utilization problems, and create money-saving solutions.
What can Decision Master® Warehouse do for You?
• Help determine the root causes of medical cost and utilization problems
• Offer a sophisticated modeling or “what if” tool to help measure the impact and effectiveness of plan design changes
• Compare your claims experience to benchmarks
• Provide complex information in an easy-to-use and understandable format
• Help you make faster and more effective decisions
Components of Decision Master® Warehouse
Thanks in part to technological and operational advances, claims administrators are typically able to capture and report on volumes of claims data. Claims data can be provided in numerous ways but are typically cumbersome, lack a meaningful benchmarking process, and are difficult to extract valuable information from without considerable additional effort and analysis. Benefits managers are challenged to easily derive value from a vast and complex array of reports, and find it difficult to use the information to help their companies positively impact benefits costs.
Unorganized data from too many different sources makes it impossible to clearly focus on areas of high utilization and cost. The Decision Master® Warehouse system lets us take the opposite approach. One of the primary goals of the DMW system is to simplify the typical reporting process and focus on the meaningful facets of claims experience.
Before looking at the details, DMW lets us see the big picture. For example, the DMW process allows us to see if your office visit utilization is high by first comparing your data to a norm. After this high level observation is made, we can then determine why the situation exists and begin formulating solutions.
With the help of Decision Master® Warehouse, the quality of information you need to refine your medical benefits plan design strategies and decisions increases. With information at its core, DMW provides a structured insight into your plan, and drives long-term strategies that will shape your health plan design and employee communication efforts.
Health Plan Management Reports
DMW is based on a philosophy of structured information and normative analysis. The Health Plan Management Report is designed to provide your company with printed information we can use to develop broad observations and cost-saving strategies. Regional and state normative measures of health plan utilization are important components of the report. Plan utilization benchmarks identify where plan use is higher than average, and offers the platform from which productive plan design alternatives can be examined.
Each DMW Health Plan Management Report contains over sixty easy-to-read and comprehensive exhibits geared toward the executive level reader. Nearly every exhibit contains brilliant charts to make the data easier to understand, as well as benchmark comparisons, advice for comprehending the data, and suggestions on where to look for more detail.
The Health Plan Management Report exhibits include:
• Total Health Plan Cost by Month
• Total Claims by Age Category
• Total Claims by Relationship
• Total Claims by Network/PPO Affiliation
• Total Claims by Inpatient/Outpatient Status
• Place of Service
• High Cost Claimants
• Top Hospitals
• Top Doctors and Clinics
• Inpatient Hospital Utilization
• Top Inpatient Surgery Procedures
• Top Outpatient Surgery Procedures
• Office Visit Utilization
• Inpatient Mental Health Utilization
• Outpatient Mental Health Utilization
• Claims by Major Diagnostic Categories
• Lifestyle-Related Claims
• Disease Management
DMW uses state-of-the-art online analytical processing known as OLAP. This powerful querying engine formulates your data into robust “cubes” that allow it to be viewed in limitless variations. DMW's Drill-Down can answer nearly any question you have about claims experience, including:
• Why are my office visits so high? Who's going to the doctor? Why are they going? Are they using in-network or out-of-network providers?
• Do my high-cost claimants represent long-term chronic care problems? Or were they caused by accidents?
• Why are my members using the emergency room so frequently? Who's using the ER the most — employees, spouses, or dependents? Are they using it appropriately?
• What does my group's experience show about disease management? What types of diseases should our communication pieces focus on?
The Capitol Group uses Drill-Down to analyze the following categories:
• Claims History
• High-Cost Claimants
• Inpatient and Outpatient Hospital
• Inpatient and Outpatient Surgery
• Inpatient and Outpatient Mental Health
• Chiropractic Care
• Emergency Room
• Lifestyle Claims
• Major Diagnostic Categories
• Place of Service
• Disease Management
• And more!
The Decision Master® Warehouse claims analysis process is designed to help clients save benefit dollars by making plan design decisions that are based on observable claims experience. You should expect that any plan design changes you make will have a desirable financial outcome.
Our goal is to clearly present plan savings projections in a realistic format, based on the client's actual claims experience. DMW's Plan Design Modeling feature lets us do just that.
Once we isolate problem areas using Drill-Down, Plan Design Modeling lets us focus on solutions. DMW's modeling feature lets us experiment with plan design alternatives and see if plan changes can save you money. The advanced modeling capabilities even show how plan members would be affected by a particular plan change.
DMW allows us to model your plan based on a variety of plan elements, including:
• Calendar year deductibles, coinsurance, and out-of-pocket maximums for both in-network and out-of-network claims
• Office visit co-pay, deductible, and coinsurance
• Inpatient hospital co-pay, deductible, and coinsurance
• Outpatient hospital co-pay, deductible, and coinsurance
• Inpatient surgery co-pay, deductible, and coinsurance
• Outpatient surgery co-pay, deductible, and coinsurance
• Inpatient mental health co-pay, deductible, maximum visits, and coinsurance
• Outpatient mental health co-pay, deductible, maximum visits, and coinsurance
• Chiropractic co-pay, deductible, visits, and coinsurance
• Emergency room co-pay, deductible, visits, and coinsurance
We believe that the best decisions regarding your groups health plan design will be based on careful observations of trends, utilization patterns, and normative comparisons over multiple years. We are confident that our claims data analysis services will help us produce the results necessary to consistently meet your employee medical benefits objectives.