Employer Solutions
Claims Data Analytics & Medical Management
Claims Data Analytics & Medical Management is a comprehensive program that begins with capturing medical claims data while it provides over two dozen web-based reports (plus ad hoc reports) each month. Claims data is used to provide personalized nurse advocacy, to supply medical care management, and to identify ill patients and those predicted to incur high costs (predictive model with 87% accuracy). By identifying and contacting these members, patient outcomes are improved and health care costs are reduced.
Employees and dependents receive personalized nurse assistance and advocacy in the health care system as well as coordination of care among various providers and comprehensive medical management. These benefits result in better outcomes and lower costs. The employer receives lower health plan costs, improved employee productivity, and reduced employee absenteeism.