Client Analytics & Consulting

Panel Members

• Rocky Henisey– Director, Client Analytics & Consulting – BCBS Texas (HCSC)

• Darren Taylor– President, Cobalt Talon (Subsidiary of BCBS Kansas City)

• Recently VP, Enterprise Analytics & Data Management – BCBSKC

• Maureen Lowe– Director, Client Reporting & Analytics – BCBS Tennessee

• Sally Marier– Senior Director, Payer Solutions - MedeAnalytics

• Recently Director, Employer Reporting & Analytics – BCBS Minnesota

Panel Objectives

Client Analytics

• Client Consulting Overview – Providing Trusted Information and Actionable Insight.

• Medical Home – Answering client questions about ACO / PCMH growth and value.

• Prospect Analytics – Leveraging analytics to demonstrate differentiating value and win new business.

• Cost Savings Ideas – A few examples of creative solutions targeting the client’s specific trends.

Panel ObjectivesAnalytics & Information Management provides Client Analytics services to assist clients with their important and difficult employee health benefit plan decisions.

As an addition to the internal analysis, AIM also provides Client Consulting services which allow us to partner as benefit consultants with our clients helping them to identify their most valued opportunities, while addressing their critical healthcare challenges.

Analytics for the Health Care Industry

ConsultationAnnual Plan ReviewComprehensive Utilization AnalysisRecommendations & Actionable InsightsBlue Care Connection Analysis

Actuarial ServicesTrend AnalysisForecasting/Predictive ModelingRisk AssessmentActuarial Studies

CollaborationAccount ManagementMedical ManagementNetwork ManagementConsultants/Brokers

Research & AnalysisProject Based Reporting on Key DiseasesHigh Impact ClaimantsPopulation AnalyticsIndustry & Segment Trend Analysis

Client

What do Clients want?

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Reporting

Degree of Business Intelligence

Business Intelligence & Analytics

Information Insight

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Statistical Analysis / Benchmarking

Data Extracts

Standardized Reporting

Ad-hoc Reporting / Drilldowns

Discovery / Custom Reporting

Alerts / Responses

Forecasting / Predictive Modeling

Plan Optimization / Recommendations

Actionable Insight: ABC’s Condition Comparisons of Perinatal Conditions, Musculoskeletal, ESRD, MH/SA and Pregnancy Complications have higher PMPM’s than the BCBSTX’s Book of Business (PPO, ASO 500+).

Recommendations on Next Page:Perinatal ConditionsMusculoskeletalESRDMH/SA

Client Analytics

Cost Savings Ideas

• Current Trends for demonstrating value to clients• Population Health – integration of third party data

(biometrics, HAS, Medical Registry, EMR) to fully assess member health and value of programs

• Predictive work: risk adjustments, extrapolation, statistical modeling, trending (rocky, can we tag team here a bit?)

• More details and drill downs: account structures, high claims analysis, code level analysis, procedure analysis

• BHI Usage / Large Benchmark datasets• Account Histograms• SIC Reporting• Regression Analyses

• Client Specific Analysis – growing importance of adhoc support• Example: ER Frequent Fliers

Pre-Sale Consultation

• Empowerment of the account management team• Provides meaningful, actionable information to integrate into

proposals and presentations• Enables immediate collaboration capabilities with

prospective client

What value does Pre-Sale Analytics bring to the account team and to the prospective client?

Core Pre-Sale Package

• Use of standard proposal data files• Mapping based on diagnosis and procedure code • Provides insight into appropriate program opportunities

Pre-Sale Consultation

Enhanced Pre-Sale Package

• Allows for in-depth view of population health• Provides insight into opportunities for optimizing decisions and management • Enables projected impact based on prevalence and behaviors

What information can you derive from a Pre-Sale Analysis?

Information DerivedWhat information can you derive from a Pre-Sale Analysis, cont…

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Non-Preventive Visit Wellness Visit

87.0%

13.0%

89.6%

10.4%

Wellness Visits and Other Office Visits

Percentage of Total Members Book of Business Percentage of Members

Insight into Wellness and Preventive Care behaviors

55.0%

10.0%

17.0%

25.0%

28.0%

65.0%

Percentage of Members Percentage of Total Cost

Distribution of Health Status

Healthy Acute Chronic

Identification of Health Status

and associated costs15.0%

5.0%

3.0%

20.0%

30.0%

10.0%

7.0%

5.0%

15.0%

25.0%

Cardiac Surgery

Hip Replacement

Hysterectomy

Knee Replacement

Lumbar/Back Surgery

Percentage of Members by Type of Surgery

Percentage of Members Having Had Surgery

Book of Business Percentage of Members Having Had Surgery

Opportunities for Optimizing Decisions

0.1%

2.5%

3.0%

0.8%

0.4%

0.6%

0.2%

0.1%

2.4%

1.6%

1.1%

0.2%

0.4%

0.3%

Obesity and Overweight

Diabetes

Hypertension

Coronary Artery Disease

COPD

Asthma

Congestive Heart Failure

Targeted Chronic ConditionPrevalence Rate

Prevalence Rate Book of Business Prevalence Rate

Targeting appropriate chronic conditions

Questions• What value does Pre-Sale Analytics bring to the account team and to the

prospective client? • What information can you derive from a Pre-Sale Analysis?

Questions