TULSA, Okla. – Employers, consultants, brokers and payers work daily to control rising costs associated with employee health benefit plans. The key to controlling these costs is to identify and predict risk, both for the plan and for individual plan members.
Benefit Informatics, a Benefitfocus company, has integrated the Johns Hopkins Adjusted Clinical Groups (ACG®) System into the Web-based Data Analysis and Reporting platform.
The integration of the Johns Hopkins ACG System adds industry-leading clinical predictive modeling capabilities to Benefit Informatics’ proven data integration, analysis and plan modeling applications. Benefit Informatics customers now have greater access to actionable plan information. Capabilities and uses include:
• Identify high risk and high cost individuals early utilizing key diagnosis factors
• Identify members who would most benefit from case and disease management
• Identify “gaps in care” for key risk factors
• Forecast future medical utilization and costs based on risk stratification
• Evaluate effectiveness of health providers and wellness and disease management programs
Benefit Informatics integrates data from a number of sources to give employers and all stakeholders in the employee benefits process access to timely information. The Data Analysis and Reporting applications have a proven track record of providing access to claim, member eligibility, pharmacy and ancillary health utilization information. By integrating the Johns Hopkins ACG System predictive modeling engine and benchmark data set, the enriched Benefit Informatics platform provides the following capabilities:
• Patient Risk Stratification – Assess and stratify each patient for a wide variety of risk factors.
• Medical Care Episode Grouping – Measure healthcare utilization and expenditures (costs) for various chronic medical conditions.
• Analysis of Key Care Gaps – Identify specific patients with gaps in medical and pharmaceutical care utilizing specific and standard care patterns.