A playbook with 41 detailed analyses for a health payor
Each analysis includes:
- Goal of the analysis
- Data required
- Detailed step-by-step instruction on how to conduct the analysis
- Format of the output of analysis
- How to interpret results
- Steps a company can take to improve on the measure
In this guide you'll learn the following 41 analyses across eight categories:
Table of Contents
A. Financial Performance and Cost Management
- Medical Loss Ratio
- Premium Pricing Competitiveness and Rate Setting
- Cost-of-Care Reduction Initiatives
- Health Outcomes and Impact on Cost
- Risk Pool and Reinsurance Structure Evaluation
- Pharmacy Benefit Management Performance and Cost
- Specialty Drug Spend and Management Effectiveness
- High-Cost Claimant and Catastrophic Coverage
- Episode-Based Bundled Payments Performance
- End-of-Life Care Quality and Cost Management
B. Member Experience and Engagement
C. Care and Disease Management Programs
- Care Management Effectiveness and ROI
- Chronic Disease Management Program Effectiveness
- Chronic Care Incentive Program Effectiveness
- Preventive Care Utilization and Effectiveness
- Patient-Centered Medical Home Model Performance
- Preventable Hospital Admissions and Readmissions
- Ambulatory Care Sensitive Conditions Management
D. Provider Network and Contracting
E. Risk Assessment and Population Health
F. Claims Management and Compliance
G. Access to Care and Integration
H. Government Programs and Regulatory Performance