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CONTENTS S.No Contents Page No. 1 Introduction 4 2 IT tools and there benefits 5 3 Company Profile 6 4 Technology and operation solutions 7 5 IT TOOL-Medinsight 7 6 Medinsight-Architecture 10 7 Key Features 13 8 Medinsight-Technical overview 15 9 Case study 21 10 Medinsight version 7.0 23 11 Solutions 24 12 Conclusion 28 13 Reference 28 1

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CONTENTS

S.No Contents Page No.

1 Introduction 4

2 IT tools and there benefits 5

3 Company Profile 6

4 Technology and operation solutions 7

5 IT TOOL-Medinsight 7

6 Medinsight-Architecture 10

7 Key Features 13

8 Medinsight-Technical overview 15

9 Case study 21

10 Medinsight version 7.0 23

11 Solutions 24

12 Conclusion 28

13 Reference 28

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DATABASE MANAGEMENT SOLUTION-A case study of Milliman

Medinsight”.

INTRODUCTION

Initially in insurance company and other organizations, internal reporting was made

manually and only periodically, as a by-product of the accounting system and with some

additional statistic(s), and gave limited and delayed information on management

performance. Previously, data had to be separated individually by the people as per the

requirement and necessity of the organization. Later, data was distinguished from

information, and so instead of the collection of mass of data, important and to the point

data that is needed by the organization was stored.

Earlier, business computers were mostly used for relatively simple operations such as

tracking sales or payroll data, often without much detail. Over time, these applications

became more complex and began to store increasing amount of information while also

interlinking with previously separate information systems. As more and more data was

stored and linked man began to analyze this information into further detail, creating entire

management reports from the raw, stored data. The term "MIS" arose to describe these

kinds of applications, which were developed to provide managers with information about

sales, claims, premium, inventories, and other data that would help in managing the

enterprise. Today, the term is used broadly in a number of contexts and includes (but is

not limited to): decision support systems, resource and people management

applications, enterprise resource planning (ERP), enterprise performance

management (EPM), supplychainmanagement(SCM), customerrelationshipmanagement

(CRM), project management and database retrieval applications.

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IT TOOLS AND THERE BENEFITS FOR HEALTH INSURANCE CO’S

Payers, employers, and third-party administrators (TPAs) operating in the current

business environment are facing some of the most difficult market conditions in decades.

From the recession and high unemployment to the uncertainty associated with the future

of this country’s healthcare policy, companies are under unprecedented pressure to

manage operating costs and improve margins. There are cases, however, of sophisticated

executives using the power of their own data to succeed in these difficult times. For more

than 10 years, the health insurance industry—from commercial payers, Blue Cross Blue

Shield organizations, and government-focused insurers to self-funded employers and

TPAs—has invested consistently in decision-support systems. These systems are made

up of business intelligence technology that organizes a variety of healthcare data into an

integrated warehouse and, through the application of various analytic tools, processes that

data into useful information. Reports are then generated to make that information usable

and easy to understand. Examples include simple cost and utilization reports that

illustrate in detail what specific components are driving the medical loss ratio for a

company, provider profiles that describe how your network providers are performing

relative to their peers and predictive modeling that projects which members of a health

plan are in need of proactive outreach and care. A variety of software vendors have

launched numerous analytic products during the past decade and investment in this type

of technology has been heavy. As the decision-support market within health insurance

has matured somewhat, there are fewer stories of success than one might have expected.

The economic value derived from these investments is not only difficult to measure, but

also in many cases it does not exist. Nearly half of all healthcare data warehousing

projects fail to meet their original objectives. There are many reasons for the lack of

return on investment (ROI). The biggest reason has less to do with the strength or

weakness of a specific product and more to do with the type of specific action a company

takes, or does not take, based on an undesirable metric or statistic that the product

produces. Organizations are busy with many priorities—just running the day to day

business is often a challenge in itself. Solving the underlying, difficult problems is often

swept under the rug for fear of how expensive or time-intensive such work may become.

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Forward-thinking executives who have moved swiftly to deal with these problems

through not only sophisticated technology, but also with consulting guidance, are the

ones whose companies are winning the competitive battles in the marketplace. Making

the investment in decision-support systems on its own is insufficient. Supplementing that

with consulting advice from a partner who can make a difference is the most effective

way to drive meaningful value from your decision-support investment

COMPANY PROFILE

Milliman is among the world's largest independent actuarial and consulting firms, with

revenues of $676 million in 2010. Founded in Seattle in 1947, they currently have 53

offices in key locations worldwide .Staff of 2,500 people includes more than 1,300

qualified consultants and actuaries. They are owned and managed by approximately 350

principals—senior consultants whose selection is based on their technical, professional

and business achievements.

Through consulting practices in employee benefits, healthcare, investment, life insurance

and financial services, and property and casualty insurance, Milliman serves the full

spectrum of business, financial, government, union, education, and nonprofit

organizations. In addition to there consulting actuaries, Milliman's body of professionals

includes numerous other specialists, ranging from clinicians to economists.

Wide variety of products and services in all major insurance areas. Major IT based

products include MG Alfa (life), MUGs / Care Guidelines / MedInsight (health) and

ReservePro / Affinity (P&C)

Milliman team in Gurgaon comprises of 48 people, including actuarial, clinical and IT

professionals. The team has significant health data warehousing and data analysis

expertise, since 2006:

Extensive experience on health data analysis for Indian insurers over the past 4

years

Extensive experience in analysis of health insurance data from UK, USA and

China

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Continues to manage data loading, warehousing and MIS function remotely for

US clients, some for more than 3 years

A number of strategic consulting assignments including business & operations

planning and rural & social market strategies

Highly structured process, integration of clinicians in process is key strength, with

focus on providing business intelligence for strategic decisions

Technology and Operations Solutions

As an integral part of the Milliman organization, Milliman Technology and Operations

Solutions focuses on helping healthcare organizations meet the operational and

technological challenges that are the norm in this dynamic industry. A consulting firm is

defined, in large part, by the quality, experience, and skills of its professionals. There

entrepreneurial culture attracts independent men and women who seek out challenges and

are willing to take risks. Each of there consultants has significant experience in the

healthcare industry, in addition to sophisticated technological expertise in the design and

development of solutions to complex problems.

There consultants work closely with the actuaries, clinicians, academics, and other

healthcare experts from the Milliman team. The result of this collaborative consulting

approach is that there clients benefit from the most complete combination of healthcare

management expertise in the industry. In the healthcare industry, every client is unique.

There are no one-size-fits-all remedies to the challenges that face their client’s needs

IT TOOL-MEDINSIGHT

MedInsight is an established, integrated Management Information System (MIS),

Decision Support System (DSS) and data warehouse platform specifically developed for

health insurance. It is in its 12th year and version 7.MedInsight offers sophisticated data

cleaning, reconciliation, analysis, benchmarking and report generation function.

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Since 1997, MedInsight has been implemented across more than 35 clients. According to

a recent Gartner Group review, MedInsight was identified as the most popular business

intelligence tool in the healthcare insurer market.

Milliman maintains a cluster of about 70 servers in its data center; MedInsight currently

handles about 80 million lives and processes about 2 billion transactions. MedInsight is

extremely versatile and easily scalable as it currently manages client’s ranges from a

hundred gigabytes to a few terabytes. Significantly adapted to Indian health insurance

data. MedInsight is an established, successful data warehousing approach developed by

Milliman Inc.’s (Milliman) Technology and Operations Solutions (TOPS) specifically for

the healthcare marketplace. MedInsight can be deployed as a stand-alone data warehouse

or it can be integrated and layered with existing data warehousing systems and initiatives.

Implemented as a stand-alone system, MedInsight offers the advantage of rapid

deployment, open systems architecture, and proven healthcare oriented data structures.

MedInsight works with existing claims, enrollment, and medical management systems, so

it is not necessary to abandon current operational systems in order to add data

warehousing capability.

Integrated with existing data warehousing systems and initiatives, MedInsight helps

healthcare organizations harness and leverage the power of the industry’s most

comprehensive performance measurement and analysis product

Management information system (MIS) is a system that provides information needed to

manage organizations efficiently and effectively. Management information systems

involve three primary resources: technology, information, and people. It's important to

recognize that while all three resources are key components when studying management

information systems, the most important resource is people . Management information

systems are regarded as a subset of the overall internal controls procedures in a business,

which cover the application of people, documents, technologies, and procedures used

by management accountants to solve business problems such as costing a product, service

or a business-wide strategy.

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Decision-support systems (DSS) are computer program applications used by middle

management to compile information from a wide range of sources to solve problems and

make decisions

Database management system (DBMS) Software to create a computerized database; add,

delete and manipulate data and create forms and reports

Example of Database Management System

1. MS Access2. Oracle3. Sybase4. Adabas5. Paradox6. Visual Fox Pro

 Data warehouse (DW) is a database used for reporting and analysis. The data stored in

the warehouse is uploaded from the operational systems. The data may pass through an

operational data store for additional operations before it is used in the DW for reporting.

A data warehouse maintains its functions in three layers: staging, integration, and

access. Staging is used to store raw data for use by developers. The integration layer is

used to integrate data and to have a level of abstraction from users. The access layer is for

getting data out for users.

This definition of the data warehouse focuses on data storage. The main source of the

data is cleaned, transformed, catalogued and made available for use by managers and

other business professionals for data mining, online analytical processing, market

research and decision support. However, the means to retrieve and analyze data,

to extract, transform and load data, and to manage the data dictionary are also considered

essential components of a data warehousing system. Many references to data

warehousing use this broader context. Thus, an expanded definition for data warehousing

includes business intelligence tools, tools to extract, transform and load data into the

repository, and tools to manage and retrieve metadata

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MedInsight-Architecture

MedInsight was developed on the foundation of Milliman’s 50 plus years of healthcare data analysis and experience. Its architecture specifically addresses an organization’s need to retain data accuracy and integrity over time

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Acquire, Transform, LoadData can be loaded into MedInsight from any number of client data sources by one of two

primary methods:

o Database specific loading tools, such as SQL Server DTS or

o Ardent, a third-party ETL tool that is provided and supported by Milliman.

Both types of tools have the ability to move data from virtually any source or source

format into MedInsight. Raw source data is moved into the Staging (or source) Area of

the MedInsight data model. It is moved completely in an unchanged form so that

downstream results can always be audited and reconciled against the raw data. Data

loading procedures move data from the Staging Area to MedInsight’s Base Area. The

purpose of this area is to hold all cleaned, standardized and scrubbed data for analysis and

reporting. The base table data model seldom changes and is therefore a consistent

repository of good, accurate information. All standard MedInsight analyses obtain data

from the Base Tables. MedInsight contains a user customizable region called the User

Area. This region is the repository for any custom data tables, stored procedures or

analyses. The User Area may access data structures from the Base Tables or Staging Area

but may not modify the data structures in those areas (modified structures and views can,

however, be stored in the User Area).

AggregateMedInsight contains a collection of data analysis procedures and routines that summarize

base table data utilizing MedInsight Performance Measures and Benchmarks. These

summarizations update information in MedInsight’s Analysis Data Marts.

DistributeMedInsight contains a collection of data analysis procedures and routines that summarize

base table data against MedInsight Performance Measures and Benchmarks. These

summarizations update information in MedInsight’s Analysis Data Marts. These data

marts provide OLAP-optimized, reconcilable, multi-dimensional views of the medical,

financial, operational, marketing, and administrative information in a client’s data

repository.

The data analysis data marts can be categorized as follows:

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o Claim Payment Audit

o Disease Identification

o HCG Utilization

o Medical Cost

o Operational Performance

o Profit and Loss

o Provider Profiling

o Risk and Severity Adjustment

Executive Information SystemThe MedInsight Executive Information System includes a comprehensive suite of

standard performance measurement and analysis reports. These reports were developed

with and display utilizing Crystal Decisions’ Crystal Reports functionality and are

accessible through an Internet browser. Because this system is optimized from summary

tables and analyses, parameterized reports can be regenerated nearly instantaneously. The

Executive Information System contains approximately 50 standard reports that can be run

through user-input parameters to generate well over 5,000 different views of the data.

Decision Support SystemMedInsight is integrated with an analysis and decision support system that provides

multidimensional data visualization, analysis, and reporting capabilities to our clients.

The system has a simple easy-to-use client interface for non-technical users. Decision

makers across all functional areas of a corporation can access MedInsight data quickly

and intuitively.

Platform Independence, Scalable Architecture, HIPAA CompliantMedInsight is an open system designed for portability and scalability. The system has

been implemented on Microsoft SQL-Server, Oracle, and DB2. MedInsight functions

within a client’s Microsoft Windows 2000 and NT computing environments MedInsight

is engineered to conform to HIPAA standards and can be used to ease an organization’s

HIPAA compliance efforts.

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MetaData Tool

The MetaData tool is designed to assist in the management of the metadata during a MedInsight implementation. It provides a single source to view stored procedures, views, tables, fields, notes, and other details about the current implementation database environment.

Data Auditing, Data Reconciliation, and Data Editing Tools

Data auditing, process logging, and data reconciliation are supported both within the

MedInsight environment and through the use of electronic workbooks.

Flexible Scheduling

Data loading and data analysis procedures can be scheduled and run over any user-

defined period. Since MedInsight analysis procedures are modular Transact-SQL

routines, they will integrate with virtually any job/batch-scheduling engine

Key Features

Performance Measurement

The Performance Measurement component of MedInsight provides a comprehensive

performance measurement tool for health plans, insurers and TPAs. It contains more than

145 financial, medical management, and operational measures covering every department

and aspect of the organization. Nearly 70% of the performance measures contain

associated Milliman benchmarks that describe the Worst, Median and Best performance

in the industry for that measure.

Medical Cost Analysis

The Medical Cost Analysis component of MedInsight creates summaries of medical

utilization and reserve information from the underlying detailed repository data. These

summaries provide intelligent views of utilization measures by Product, Line of Business,

Group and PCP for:

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o Admits/1,000

o Days/1,000

o LOS

o Utilization/1,000

o PMPM

o Average Cost Per Service

Risk and Severity Adjustment

The MedInsight Risk and Severity Adjustment (RSA) engine utilizes age/sex and

condition/episode profiling techniques to determine retrospective and prospective

medical risk factors. The risk factors are used as primary input into rating, underwriting

and provider profiling processes.The RSA engine is unique in the industry in that it

develops risk factors, for 13 different utilization and cost measures, for each member for

each month of eligibility. The risk factors, themselves, are presented as a multiplier of the

total population for each of the utilization categories (defined as a risk factor of 1.0).

Because the RSA engine develops factors for each patient for 13 utilization categories,

the user is able to risk adjust not only total costs, but more specifically measures like drug

utilization and cost, inpatient days and costs, etc. This is invaluable in that each risk

category inherently produces distinct utilization profiles.

Milliman Health Cost Guidelines (HCG) Grouping and Utilization

The HCG Grouper categorizes health care claims data into Milliman’s Health Cost

Guidelines categories (which are groupings of similar types of services). The ability to

categorize health care claims data into the groupings is useful for many purposes

including:

o Benchmarking

o Utilization tracking

o Inpatient days / 1,000

o Office visits / 1,000

o Prescription drug scripts / 1,000

o Average charge tracking

o Analyzing the claim cost dollar

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Disease Identification

MedInsight’s Disease Identification module facilitates the development and maintenance

of algorithms for identifying specific diseases and conditions. In addition, the module

automates the process of interrogating MedInsight’s claims data against the algorithms

and returning a resultant data mart of applicable information.

In addition the Disease Identification module:

o Provides a flexible way to define and maintain complex disease (and disease state)

criteria.

o Identifies patients who meet criteria.

o Can be used in a variety of analyses or studies to create data marts of individuals

meeting selected criteria

.

MedInsight -Technical Overview

MedInsight® is modeled on the data warehouse design principle known as Star Schema.

MedInsight consists of five parts databases, reports, OLAP (online analytical processing),

backups (optional), and client computers.The dimension and fact tables make up the

OLAP cubes. The cubes are a part of objects logically defined as Data Marts. Data Marts

contain specialized data derived from the Data warehouse and are meant to be tactical to

meet specific requirements. MedInsight has data marts for Enrollment, Claims, Medical

costs etc .MedInsight contains approximately 80 standard reports that can be run through

user-input parameters to generate well over 5,000 different views of the data

Components of portalDashboard Report Library Analytic tools Reference libraryEnrollment MedInsight Reports Cubes DocumentationClaims Custom Reports Extract Builder User ManualClinicalFinancial

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FIG: Infrastructure setup for a single installation

Solution Architecture

MedInsight will include:

1. An ETL tool/interface

2. OLAP engine

3. Analysis tools (cubes and reports)

4. Other applications/utilities/tools to gather and deliver data

Methodology facilitates modeling and integrating a large volume of operational data and

sources. The data will be represented in multidimensional format to enable highly precise

visualization of data by summarizing, aggregating, drilling down, slicing and dicing.

MedInsight will provide the Users with intuitive and secure browser-based interface to

conveniently search , combine and analyze this data repository that enables data

visualization at varying granularity and allows for data import in various formats.

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Solution Architecture

Centralized 2-tier solution

For a comprehensive, enterprise-wide solution based on centralization of data as also

with a projected significant growth in enrollments and claims, they propose implementing

a centralized 2-tier data warehouse solution for Client

Solution Architecture

2 - Tier

Components:

Source Data: Client database consisting of consolidated Enrollment and Claims data

from various sources.

 

Firewall: Monitor, control and restrict all inward connections to the server. Will have a

Router to connect to the warehouse servers

 

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Source Database: In a single Tier architecture this server contains the data as well as the

application for querying and analyzing. It contains the data warehouse and data marts

depending upon overall data size and functionality.

 

In case of two-tier, this would contain the source (operational or legacy) data (historical,

pre-processed) and the ETL tool. This is the back-end server. This will also be the FTP

server for source data transfer. In this case the data is simply stored in 2-dimensional

format within the RDBMS.

 

Data warehouse/Cubes/Reporting server: In case of two-tier architecture, this server

would contain Data marts and cubes which are objects in data warehousing that hold

processed, specialized, aggregated, summarized and multi dimensional data for querying.

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Scalability to N-Tier

Additional application/middleware layer(s), containing business rules, is segregated .

This is a scalability related approach and can be implemented based on issues such as

surge in data, data load balancing, increased analytics, performance issues etc. A scenario

for this could be an unusually increasing demand on the underlying data warehouse

system.

Implementation steps

Project Scoping and Planning Infrastructure Setup Base MedInsight Installation Data Procurement Data Mapping Run Benchmarks Run Analytics and Setup Reports Run Cubes Portal Set -up and Deployment User Acceptance Testing Training Move to Production

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CASE STUDY

{1}A member attrition mysteryAn 85,000-member health plan was experiencing rapid membership attrition. Anecdotal

evidence from sales suggested uncompetitive premium rates. However, providers claimed

the plan offered low reimbursement compared to competitors.

MedInsight analysis

To analyze several potential root causes for the client's membership decline,

MedInsight was used to:

Benchmark utilization against competitors.

Audit the claims payment process.

Examine capitation and reimbursement levels.

Results

MedInsight showed that physician costs were 34.8% higher than median commercial

levels and pinpointed specific contributors to cost increases:

Utilization: 8.0%

Overpaid claims: 4.5%

Above-market capitation: 10.5%

Above-market fee schedule: 11.8%

The client implemented several corrective actions to eliminate cost variances: It

improved claims processing procedures, worked to reduce claim over-payments, adjusted

capitation rates, implemented a new fee schedule, created a maximum allowable fee

schedule for out-of-network claims, and began to actively drive care into the network.

{2}Medical management savings

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A 600,000-member health plan was concerned about the effectiveness of its medical

management initiatives, and was looking for ways to further reduce costs.

MedInsight analysis

The client used MedInsight® to benchmark performance, conduct trend analysis, identify

high-cost and high-risk populations, and analyze disease categories. These analyses

revealed startling findings:

Surgical admissions exceeded the benchmark by 20%.

Emergency room costs per member per month were twice the benchmark—over-

utilization was the main driver.

Physician office services were twice the benchmark—cost per visit was the main

driver.

Radiology was four times the benchmark—one delivery system was responsible.

Congestive heart failure patients accounted for more than $11 million per year,

and cost per case was increasing nearly 20% annually.

Results

The client identified more than $38 per member per month in potential savings. It

refocused existing medical management activities and implemented new initiatives to

target problem areas identified by MedInsight. The system also gave the client credible

information to use in modifying emergency room benefits and renegotiating provider

contracts.

{3}Inpatient costs: A sudden increase

A 250,000-member health plan started experiencing upward reserve adjustment on a

monthly basis. It could not get a handle on its liabilities even though there did not appear

to be any substantial changes in their claims processing area or reimbursement rates.

MedInsight analysis

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MedInsight's completion-based trend analysis showed a sudden and dramatic increase in

inpatient costs due largely to an increasing average cost per day on inpatient care.

Using MedInsight, the client discovered that a recently implemented contract clause that

reverts to percent of billed reimbursement when billed charges exceeded $30,000, has

resulted in a substantially higher number of claims being billed in excess of $30,000.

This new clause was on its way to costing the company $20 million per year. MedInsight

further identified $8 million in overpaid claims. ($2.67 per member per month in savings

for 250,000 members).

Results

The client immediately began the process of renegotiating hospital contracts and

recovering the overpaid claims. Cost trends were eventually brought back down to more

competitive levels, saving the client in excess of $15 million per year and stabilizing its

reserves.

MedInsight version 7.0With the launch of MedInsight 7.0, Milliman now offers an even stronger solution to the

healthcare industry. This significant upgrade provides many additional benefits,

including:

Tighter integration of Milliman Health Cost Guidelines   ™  (HCGs) with improved

drill-down paths

Improved provider attribution capabilities to support medical home initiatives

New Medicare regulatory reporting capabilities

New clinical trend analysis and population management capabilities (CCHGs)

that pinpoint clinical drivers of trend

Enhanced benchmarking with adjustment factors and full alignment with HCGs

Integration of Milliman's new risk-adjustment models (MARA), providing the

industry's most powerful predictive models

Greatly expanded employer group reports to support your clients' reporting needs

The release of Version 7.0 builds upon MedInsight's existing capabilities and provides

your organization with a way to achieve even more value from the industry's most

comprehensive performance measurement and analysis solution

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SOLUTIONS

All-payer Claims Database Program

For years, health plans have explored ways to reduce costs and improve quality of care

delivered to patients. Many states are evaluating ways to accomplish these same goals.

With healthcare reform in full swing, state governments are willing to invest in strategies

that support quality improvement and cost containment.

An example of an increasingly popular strategy is the All-payer Claims Database

(APCD), which aims to promote transparency by making healthcare information

available to consumers and patients. Because the idea has been embraced by many—

including employers, healthcare providers, health plans, consumers, and state agencies—

APCDs will likely continue to sprout up for years to come.

Data collection

Level 1 validation

Level 2 validation

.

Standardized prices

Clinical data integration

Analytics/metrics

Data access/portals

Public use datasets and applications: Standard and customized datasets

Public policy: Support/data analysis

Project/account management

Ongoing support

.

Community Health Exchange Program

Community-based quality collaboratives, now active in many areas of the United States,

are demonstrating that it is possible to use health data from multiple sources to improve

healthcare quality and transparency.These organizations provide reporting based on

quality measurements (usually tied to providers or facilities) in order to establish a

baseline for improvement and for measuring the impact of other initiatives. They are an

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important component of the nation's evolving healthcare delivery system. However,

building, developing, and managing a viable community health exchange presents

significant challenges related to infrastructure and technological standardization.

Chronic Conditions Hierarchical Groups (CCHGs)

Chronic Conditions Hierarchical Groups (CCHGs) is a unique clinical-care-based

identification methodology for patients and chronic conditions designed to more

accurately identify cost trend drivers and effectively allocate disease and care

management resources. Coupled with traditional actuarial analyses, this new and highly

effective patient-centric model produces an information-driven management process that

results in more effective care and lower administrative costs.

CCHGs was developed at Milliman in collaboration with David Mirkin, MD. Before

CCHGs, analytical tools were unable to capture 100% of a patient's hospital experience.

Standard models like the NCQA HEDIS measures often failed to identify and separate

the incremental cost and trends for individuals with multiple conditions.

Benefits

The CCHG software application assigns all patients, including healthy individuals, to one

of 36 unique and mutually exclusive categories, using a clinically relevant hierarchy

based on the way physicians make treatment decisions. By focusing care management

interventions on factors that are most affected by clinical decisions, the user can make

smart and informed disease management decisions.

HCG Grouper

The Milliman MedInsight HCG Grouper software application categorizes medical and

pharmacy claims data into healthcare categories that can be used to analyze and

benchmark medical utilization and cost. It is integrated into the MedInsight Analytic

Platform, but is also offered as a standalone application. HCG Grouper leverages

Milliman's Health Cost Guidelines™ (HCGs), the industry standard for tracking claim

costs by hospital, surgical, medical, and other benefit service categories. HCG research

employs multiple sources of data, more than 30 million patients, and more than 2 billion

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claim records across data sets from both the public and private sector. HCGs can be used

to adjust national average healthcare costs for specific geographic areas, benefits,

reimbursement structures, and plan characteristics. Traditional health insurers, managed

care organizations, and third-party administrators find them valuable for product

evaluation and pricing. The HCG Grouper application utilizes HCGs to assign detailed

information to claims. Each line of claim detail is assigned an HCG service cost category,

number of admits or cases, number of days or procedures, and procedure grouped

families, as well as identification of continuous stay claims.

Benefits

The HCG Grouper application helps quantify your organization's performance and can be

used to analyze cost and utilization for many different types of population data, such as

product lines, line of business, employer groups, primary care panels, disease

populations, and many others.

MedInsight Benchmarks

The combination of looming healthcare reform and trying economic times is driving

health plans to create new strategies to improve financial and clinical performance. A

crucial piece of every strategy is the use of benchmarks for setting goals and

communicating objectives to a wide range of staff. Often, health plans perform one-time

benchmark studies using external bodies and their static benchmarks. This use of external

data is no longer adequate for today’s fiercely competitive marketplace.

Common issues with the use of external benchmarks include:

Benchmarks that are based on limited sample sizes

Aggregated empirical data devoid of local market adjustments and unable to

provide a realistic picture of the marketplace

Lack of drill-down capabilities that facilitate a greater depth of understanding

Impractical benchmarking methods that require significant data integration efforts

in addition to in-depth analytic review

Difficulty tracking external benchmarks over time

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The MedInsight Benchmarks application integrates vast empirical data, intimate local

market knowledge, and a wide number of plan and provider agreement variables. These

adjustments turn normative data into valuable, meaningful benchmarks. The MedInsight

Benchmark tool is accessed as a standalone web application, but is also part of the

MedInsight Analytic Platform.

Benefits

MedInsight Benchmarks offers the ability to generate custom benchmarks with deep

drill-downs of insight for any commercial or Medicare population, geographic region,

and benefit plan(s).

The vast Milliman empirical database, rigorous organizational methods, and advanced

adjustment factors let you effectively use your data to:

Measure cost and rating development.

Review procedural efficiency.

Create custom methods or combine your desired methods with Milliman's

advanced local market-adjustment factors.

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CONCLUSION

Medinsight maintains a copy of information from the source transaction systems. This

architectural complexity provides the opportunity to: Maintain data history, even if the

source transaction systems do not. Integrate data from multiple source systems, enabling

a central view across the enterprise. This benefit is always valuable, but particularly so

when the organization has grown by merger. Improve data, by providing consistent codes

and descriptions, flagging or even fixing bad data. Present the organization's information

consistently. Provide a single common data model for all data of interest regardless of the

data's source. Restructure the data so that it makes sense to the business users.

Restructure the data so that it delivers excellent query performance, even for complex

analytic queries, without impacting the operational systems. Add value to operational

business applications. Integrated with existing data warehousing systems and initiatives,

MedInsight helps healthcare organizations harness and leverage the power of the

industry’s most comprehensive performance measurement and analysis product

REFERENCE:

http://www.medinsight.milliman.com

http://www.mi60 systemoverview.com

http://www.medinsight.com/solutions/enterprise-solutions/medinsight-analytic-platform/

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