Data Mining: Opportunities for Healthcare Quality Improvement & Cost Control
|
|
- Beatrix Silvia Carr
- 6 years ago
- Views:
Transcription
1 Data Mining: Opportunities for Healthcare Quality Improvement & Cost Control Joseph A. Welfeld, FACHE Long Island University x 5410 Joe.welfeld@liu.edu March 7, 2005 The Health Information Technology Summit West
2 Data Mining: Opportunities for Healthcare Quality Improvement & Cost Control Speaker Profile Data Mining Quality Improvement Changing Behavior with Incentives Cost Control Targeting Key Areas Data Mining Software Practical Applications A Case Study Questions
3 Speaker Profile Joseph A. Welfeld Regional Operations Director: NY - RelayHealth Program Director: Graduate Program in Health Administration: LIU Rockland Graduate Campus 30 years of healthcare experience CEO - Ocean State Physicians Health Plan Regional VP United Healthcare 10 years in strategy consulting for IPAs, PHOs & Hospital Networks MBA Healthcare Administration CUNY/Mt. Sinai School of Medicine
4 Data Mining: Definition An information extraction activity whose goal is to discover hidden facts contained in databases. True data mining software doesn't just change the presentation, but actually discovers previously unknown relationships among the data.
5 The Healthcare Database Minefield Hospital claims data billing systems Medical claims data billing systems Pharmacy claims data PBMs Lab data systems Aggregators: Managed Care Organizations Third Part Administrators Medical Groups/IPAs None of the above
6 Data Mining: Obstacles in Healthcare Organizations Deer in the headlights look Data what? We don t have any more money to buy software We have all the software we need We just spent $ million on a new system Our IT staff can produce anything we want from our in-house data system Our data analysis could not be better
7 Quality Improvement The Challenge Finding acceptable standards Combining data from multiple sources Limited financial incentives to promote change Until recently, no financial incentives to change Goal physician behavior change
8 Quality Improvement The Opportunities HEDIS Standards Leapfrog Group Bridges to Excellence MCO Performance Incentives
9 Sample HEDIS Report Activity: Beta Blocker Treatment After Heart Attack Members age 35 and older who where discharged with an AMI and were prescribed beta-blockers within 7 days of discharge. Numerator: Members who received an ambulatory prescription for a beta-blocker within 7 days of discharge Denominator: Members with an AMI between Jan 1 and Dec 24 of the measurement year Problem Faced: Linking admission/discharge and prescribing data
10 Beta Blockers Prescribed after MI Diagnosis: ATENOLOL COREG INDERAL LABETOLOL SOTALOL BETAPACE PROPRANOLOL NORMODYNE
11 Use of Appropriate Medications: People with Asthma Numerator: Members age 5-56 who received a prescription for a long term control asthma medication such as inhaled cortico-steroids Denominator: Members age 5-56 are identified as having asthma using pharmaceuticals and diagnostic data during the year prior to the measurement year Four dispensing events One ER visit with a principle diagnosis of asthma One acute inpatient discharge with a principal diagnosis of asthma At least four outpatient visits with a diagnosis of asthma and two dispensing events
12 Cost Control The Challenge Payer Provider trust chasm The my patients are sicker debate Combining data from multiple sources into coherent and logical reports
13 Cost Control The Opportunities The ability to merge medical claims, hospital claims, drug claims, medical records and clinical outcomes data The ability to analyze episodes of care including drug utilization The ability to rapidly create contract models by user-defined resource and provider categories Ability to drill down into individual patient claims Ability to target high cost trends
14 Cost Control: Targeting High Cost Trends Puts up to 3 datasets side-by-side. Can compare performance against benchmarks. Unlimited number of resource categories and user-defined resource utilization models allowed Tracks in-patient, professional, lab, pharmacy and other cost categories automatically See example:
15
16 Cost Control: Drilling Down to Specifics Isolate a resource category and quickly find highest cost by any factor (disease risk group, age, sex, plan, doctor, etc.) Then drill down to get more information on those results Drill down further to see treatment line items for those specific patients Example on following screens shows disease groups with highest lab costs
17 ACRG2 Metastatic Category: 5 episodes with very high costs
18 Those 5 Patient Episodes in the ACRG2 Metastatic Group
19 Cost Control: Age/Sex Analysis Creates unlimited number of age distribution models to apply against data Select specific resource categories to view Cross-tab against specific values of any factor, i.e., disease group, specialty, etc. The following slide shows the utilization of selected resources by Age/Sex for patients in the Asthma-Diabetes-CHF CRG categories:
20
21 Cost Control: Physician Profiling Functions designed to monitor physician activity Monitor ICD9 and CPT code utilization patterns Cross-tab against specific values of any factor, i.e., disease group, specialty, etc. Summarizes all costs by provider and compares on one screen.
22 ER Utilization Costs by PCP: Outliers shown above dotted line on graph Highest outlier on graph highlighted on chart
23 CPT Codes for Gastroenterologists: Ranked by Frequency
24 PCP Utilization Cost Summary by Major Resource Category
25 Detailed 3M CRG (Clinical Risk Groups) Disease/Severity Cost Distribution
26 Detailed 3M CRG (Clinical Risk Groups) Disease/Severity Cost Distribution
27 Hudson IPA A Case Study Strategic Question How to deliver real value to managed care organizations? Replace capitated agreement with performancebased model Provide managed care organizations data analysis capabilities they don t really have Assist with HEDIS performance monitoring and communications a key MCO objective
28 Data Mining Software Bringing Value Gave IPA: Ability to merge medical claims, hospital claims, drug claims, medical records and clinical outcomes data Ability to analyze episodes of care including drug utilization to meet agreed-upon goals Ability to rapidly create contract models by userdefined resource and provider categories Ability to drill down into individual patient claims Ability to analyze HEDIS performance criteria including diabetes and cardiology care
29 Data Mining Software Characteristics Powerful disease state management and risk contract functionality Data warehouse designed to merge all types of healthcare data. Physician profiling and resource tracking features Drill down into individual patient claims from either financial or clinical perspectives and retrieve both types of information together
30 Data Mining Software Characteristics SmartCare Developed by VantagePoint Health Information Systems, Inc. Loads claims data at a rate of 100,000 claims/hr Links pharmacy (PBM), hospital & medical claims Automatically creates episodes of care Computes PM/PM ratios in less than five seconds Powerful graphing & statistical tools No programming/data analysis skills/staff needed Open database for addition of other clinical or administrative fields lab, blood pressure, etc.
31 Data Mining Applications Summary Gives Physician Organizations: Ability to develop quality indicators, performance improvement programs and incentive-based compensation programs. Ability to analyze HEDIS performance criteria including diabetes and cardiology care. Ability to analyze formulary compliance activity. Tool for additional revenue resources including comprehensive market research, clinical outcomes and pharmaco-economic studies. Ability to monitor risk-contract progress.
32 Data Mining Applications Summary Can Give Managed Care Organizations: A tool to develop true partnership relationships with provider organizations seeking incentive compensation or risk relationships Ability to develop comprehensive HEDIS analysis and performance reports Ability to combine multiple claims data bases into a single data reporting and analysis system at the contracting level Ability to do rapidly model the impact of fee schedule changes on provider costs and contract performance.
33 Questions??
Comprehensive Primary Care Payment Calculator User s Guide
1 Comprehensive Primary Care Payment Calculator User s Guide Prepared by Health Data Decisions August 2017 Disclaimer: Information provided in connection with this calculator by FMAHealth and its contributors
More informationData Analytics Solutions
Data Analytics Solutions Controlling health, measuring performance and assessing risk all start with data analytics. BenRx s comprehensive Data Analytics solutions give employers the advanced analytical
More informationHealth Information Technology and Management
Health Information Technology and Management CHAPTER 11 Health Statistics, Research, and Quality Improvement Pretest (True/False) Children s asthma care is an example of one of the core measure sets for
More informationStrategies for Assessing Health Plan Performance on Chronic Diseases: Selecting Performance Indicators and Applying Health-Based Risk Adjustment
Strategies for Assessing Health Plan Performance on Chronic Diseases: Selecting Performance Indicators and Applying Health-Based Risk Adjustment Appendix I Performance Results Overview In this section,
More informationFor the RRU Index Ratio, an EXC is displayed if the denominator is <200 for the condition or if the calculated indexed ratio is <0.33 or >3.00.
General Questions What changes were made for HEDIS 2016? RRU specification changes: - We removed the Use of Appropriate Medications for People With Asthma (ASM) measure from the Relative Resource Use for
More informationRRU Frequently Asked Questions
RRU Frequently Asked Questions General Questions What changes were made for HEDIS 2015? RRU specification changes: We removed the Cholesterol Management for Patients With Cardiovascular Conditions (CMC)
More informationImportant benefits information inside >>
Dear Medical House Staff Member, Each year, Emory University offers you the opportunity to review your benefit elections during the benefits annual enrollment period and make changes for the upcoming plan
More informationPayment Reform in Support of Population Health Management
Payment Reform in Support of Population Health Management Aligning Forces for Quality Employers - Providers Summit October 25, 2011 Charles Chodroff, MD, MBA, FACP Senior Vice President, Chief Clinical
More informationExhibit A EXAMPLE I: PERFORMANCE TARGETS. The Financial Target will affect 50% of the interest payable under the terms of the Bonds.
Exhibit A EXAMPLE I: PERFORMANCE TARGETS There will be a Financial Target and three Non-Financial Targets, as described below. The Financial Target will affect 50% of the interest payable under the terms
More informationANNUAL NOTICE OF CHANGES FOR 2017
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2017 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be
More informationSECTION II PATIENT CENTERED MEDICAL HOME (PCMH) CONTENTS 200.000 DEFINITIONS 210.000 ENROLLMENT AND CASELOAD MANAGEMENT 211.000 Enrollment Eligibility 212.000 Practice Enrollment 213.000 Enrollment Schedule
More informationINFORMATION ABOUT YOUR OXFORD COVERAGE
OXFORD HEALTH PLANS (CT), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I. REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
More informationMN DEPARTMENT OF HEALTH PROVIDER PEER GROUPING (PPG) ADVISORY GROUP DEFINING PARAMETERS ANN ROBINOW
MN DEPARTMENT OF HEALTH PROVIDER PEER GROUPING (PPG) ADVISORY GROUP DEFINING PARAMETERS ANN ROBINOW MEETING 2: JUNE 26, 2009 Introduction Comments and changes to meeting summary? Review of questions or
More informationHealth Plans Dashboard
Health Plans Dashboard Q2 2015 Dashboard Summary Report A review of Inpatient, Outpatient and RX trends January 14, 2016 Prepared by HSS and Aon Hewitt Introduction This report completes the first phase
More informationANNUAL NOTICE OF CHANGES FOR 2017
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2017 You are currently enrolled as a member of Cigna-HealthSpring Premier (HMO-POS). Next year, there will
More informationANNUAL NOTICE OF CHANGES FOR 2017
Cigna-HealthSpring Premier (HMO-POS) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2017 You are currently enrolled as a member of Cigna-HealthSpring Premier (HMO-POS). Next year, there will
More informationHealth Benefits Simplified
Health Benefits Simplified What you need to do: What s inside: Review this benefit overview Benefit Highlights 3. 4. Turn in all completed paper forms to your Human Resources Department. Complete the HealthEZpay
More informationGlossary of Terms (Terms are listed in Alphabetical Order)
Glossary of Terms (Terms are listed in Alphabetical Order) Access Access refers to the availability and location of pharmacies that participate in the network that serves your pharmacy benefit plan. Acute
More informationAPPENDIX. Methodology COST AND UTILIZATION 2018 REPORT MN Community Measurement. All Rights Reserved.
APPENDIX Methodology COST AND UTILIZATION 2018 REPORT mncm.org mnhealthscores.org METHODOLOGY Calculation of Total Cost of Care, Relative Resources and Price Index The total cost of care metric is allowed
More informationControlling Healthcare Costs through Innovative Methods - Analytics
Controlling Healthcare Costs through Innovative Methods - Analytics 2 What are we seeing? Trend is improving, but still significantly above general inflation 10% 8% 6% 9.0% 9.0% 8.5% 7.5% 6.5% 6.8% 6.2%
More informationPharmacy Benefit Managers Overview
Pharmacy Benefit Managers Overview A Presentation to the House Health Innovation Subcommittee Mary Alice Nye, Ph.D. Health and Human Services Staff Director, OPPAGA December 6, 2017 Pharmacy Benefit Managers
More informationInformation About Your Oxford Coverage
Information About Your Oxford Coverage Overview of provider reimbursement methodologies Generally, we pay participating providers ("network providers") on a fee-for-service basis. Feefor-service based
More informationERM , Getzen Economics and Financing (Sec. 5.4, 5.5)
ERM 512-13, Getzen (Sec. 5.4, 5.5) 1/17 Key Points Types of Managed Care Plans Ways to Reduce Costs Features of Managed Care Utilization Review 2/17 Managed Care Plans Why Managed Care? Primary reason
More informationPredictive Analytics and Technology Session
Predictive Analytics and Technology Session Eric Widen, CEO HBI Solutions Population Health Colloquium March 28 th, 2017 HBI Solutions Session Agenda Introductions and Overview Eric Widen Session 1: Michael
More informationE-PRESCRIBING SERVICES TERMS
E-PRESCRIBING SERVICES TERMS Certain software licensed by Allscripts Healthcare, LLC ( Allscripts ) may allow Client to access E- Prescribing Services (as defined below) to route prescriptions, access
More information2018 Quality Rewards Program
2018 Quality Rewards Program UnitedHealthcare Community Plan of Pennsylvania Quality Rewards Program Overview We created the UnitedHealthcare Community Plan of Pennsylvania Quality Rewards Program to:
More information2018 Quality Rewards Program
2018 Quality Rewards Program Agenda Quality Rewards Program Overview New for 2018 Quality Benchmarks: Primary Care Providers (PCPs) Quality Benchmark: Federally Qualified Health Centers (FQHCs) With Dental
More informationBending The Healthcare Trend
Bending The Healthcare Trend Mark Rosenberg & Greg Alonzo May 2018 High Performance Employer Summit Today s Discussion More than just cost-shifting What we are seeing Keys to successful cost containment
More informationMEASURING THE IMPACT OF POINT OF SALE REBATES IN COLORADO S COMMERCIAL MARKET
MEASURING THE IMPACT OF POINT OF SALE REBATES IN COLORADO S COMMERCIAL MARKET FEBRUARY 2019 Anna Bunger, FSA, MAAA Jason Gomberg, FSA, MAAA Jason Petroske, FSA, MAAA Sharing Pharmacy May Lower Patient
More informationAnnual Notice of Changes for 2018
Dean Advantage Balance (HMO) offered by Dean Health Plan Annual Notice of Changes for 2018 You are currently enrolled as a member of Dean Advantage Balance. Next year, there will be some changes to the
More informationAnnual Notice of Changes for 2017
HAP Senior Plus Option 2 (PPO) offered by Alliance Health and Life Insurance Co. Annual Notice of Changes for 2017 You are currently enrolled as a member of Alliance Medicare PPO. Next year, there will
More informationAnnual Notice of Changes for 2017
HAP Senior Plus Henry Ford Tiered Access (HMO) offered by Health Alliance Plan of Michigan Annual Notice of Changes for 2017 You are currently enrolled as a member of HAP Senior Plus - Henry Ford (HMO).
More informationThe U.S. Healthcare System: How Pharmacy Benefit Managers Impact Prescription Drug Use. Presented by Daniel Tomaszewski Pharmd, PhD
The U.S. Healthcare System: How Pharmacy Benefit Managers Impact Prescription Drug Use Presented by Daniel Tomaszewski Pharmd, PhD 1 Medical Vs. Pharmacy Coverage Medical Insurance Managed by an Insurance
More informationGLOSSARY OF USEFUL HEALTH INSURANCE TERMS
Data Decisions Delivery Directing Comprehensive TA: From Systems to Sustainability GLOSSARY OF USEFUL HEALTH INSURANCE TERMS This glossary is adapted from an array of resources to improve the health insurance
More informationTranslating Health Data into Community Change
Translating Health Data into Community Change Ricky C. Brathwaite, PhD Director, Health Economics 11th Caribbean Conference on Health Financing Bonaire, 2016 Topics The Need for Claims Analysis Select
More informationTouchScript Medication Management System. Financial Impact Analysis on Pharmacy Risk Pools
TouchScript Medication Management System Financial Impact Analysis on Pharmacy Risk Pools October 2000 Table of Contents Introduction 3 Executive Summary.. 4-5 Quantitative Analysis 6-10 TouchScript Impact
More informationANNUAL NOTICE OF CHANGES FOR 2018
Cigna HealthSpring Preferred (HMO) offered by Cigna HealthSpring ANNUAL NOTICE OF CHANGES FOR 2018 You are currently enrolled as a member of Cigna HealthSpring Preferred (HMO). Next year, there will be
More informationHealth Service System Board
Health Service System Board Q2 2013 Dashboard Summary Report A Review of City Plan Inpatient, Outpatient, and Rx Trends November 14, 2013 Prepared by Aon Hewitt Health and Benefits Introduction This report
More informationRecent data (lag time is less than 6 months)
Centricity 2 GE Centricity is an electronic health record system that enables ambulatory care physicians and clinical staff to document patient encounters and exchange clinical data with other providers
More informationC H A R T B O O K. Members Dually Eligible for MaineCare and Medicare Benefits MaineCare and Medicare Expenditures and Utilization
C H A R T B O O K Members Dually Eligible for and Benefits and Expenditures and Utilization State Fiscal Year 2010 Muskie School of Public Service Analysis of Members Dually Eligible for and and Expenditures
More informationExhibit 1. Availability of Public Information
Exhibit 1. Availability of Public Information In your view, how important do you think it is to have information about each of the following available to the public? Clinical quality health outcomes (e.g.,
More informationSutter Medical Network
Sutter Medical Network Sutter Care Pattern Analyzer making the case for affordability Fifth National Pay for Performance Summit March 9, 2010 Michael van Duren, M.D., CMO Sutter Physician Services Colleen
More informationSubject: Pharmacy Services & Formulary Management (Page 1 of 5)
Subject: Pharmacy Services & Formulary Management (Page 1 of 5) Objective: I. To ensure the clinically appropriate prescription and use of pharmaceuticals by Tuality Health Alliance (THA) providers and
More informationANNUAL NOTICE OF CHANGES FOR 2017
Cigna-HealthSpring Primary (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2017 You are currently enrolled as a member of Cigna-HealthSpring Primary (HMO). Next year, there will be some
More informationCity of Los Angeles Periodic Utilization Report 3rd Quarter 2017 (10/1/2016 9/30/2017)
Dr. Craig Collins, MD, MBA, FACS General and Minimally Invasive Surgery Physician Marketing Leader, Los Angeles Metro Area Associate Clinical Professor, UCLA Geffen School of Medicine City of Los Angeles
More information2009 UBS Healthcare Services Conference
2009 UBS Healthcare Services Conference February 10, 2009 John H. Hammergren Chairman and Chief Executive Officer Safe Harbor Clause Some of the information in this presentation may constitute forwardlooking
More informationMinnesota Health Care Claims Reporting System. Stakeholder Meeting 1/29/09, 1-4 p.m. Presented by: Maine Health Information Center
Minnesota Health Care Claims Reporting System Stakeholder Meeting 1/29/09, 1-4 p.m. Presented by: Maine Health Information Center 1 Meeting Agenda About Maine Health Information Center Introduction to
More informationAnnual Notice of Changes for 2017
WellCare Value (HMO-POS) offered by Harmony Health Plan, Inc. Annual Notice of Changes for 2017 You are currently enrolled as a member of WellCare Value (HMO). Next year, there will be some changes to
More information2018 RETIREE ANNUAL ENROLLMENT PERIOD 11/15/17 11/29/17
RETIREE WELL BEING FAIR PRESENTATION November 15, 2017 2018 RETIREE ANNUAL ENROLLMENT PERIOD 11/15/17 11/29/17 PLAN DESIGN CHANGES FOR FY19 PLAN YEAR (Effective 03/01/18) TOTAL MEDICAL PLAN COST What was
More informationProvider Manual. ChoiceBenefits. BayCare Health System Medical Plan
2019 Provider Manual ChoiceBenefits BayCare Health System Medical Plan 1 Table of Contents BayCare... 2 BayCare Exclusive Network... 2 Rules unique to Cigna BayCare Members... 2 Provider Relations Representative...
More informationAnnual Notice of Changes for 2017
Blue Shield 65 Plus (HMO) offered by Blue Shield of California Annual Notice of Changes for 2017 You are currently enrolled as a member of Blue Shield 65 Plus. Next year, there will be some changes to
More informationInnovation Health At-A-Glance
Innovation Health At-A-Glance A quick reference guide for health care professionals 71.02.801.1 (8/13) innovation-health.com A guide for doing business with Innovation Health Getting started with Innovation
More informationUsing Analytics To Transform Your ACO
Using Analytics To Transform Your ACO How to Develop Effective Cost Reduction Strategies Presented July 2016 Agenda and Presenter External Forces and Market Response Critical Success Factors Analytics
More informationBuilding Actuarial Cost Models from Health Care Claims Data for Strategic Decision-Making. Introduction. William Bednar, FSA, FCA, MAAA
Building Actuarial Cost Models from Health Care Claims Data for Strategic Decision-Making William Bednar, FSA, FCA, MAAA Introduction Health care spending across the country generates billions of claim
More informationAnnual Notice of Changes for 2017
WellCare Value (HMO-POS) offered by WellCare Health Insurance Company of Kentucky, Inc. Annual Notice of Changes for 2017 You are currently enrolled as a member of WellCare Value (HMO-POS). Next year,
More informationHealth Information Technology and Management
Health Information Technology and Management CHAPTER 9 Healthcare Coding and Reimbursement Pretest (True/False) CPT-4 codes are used to bill for disease and illness. Medicare Part B provides medical insurance
More informationPredictive Analytics in the People s Republic of China
Predictive Analytics in the People s Republic of China Rong Yi, PhD Senior Consultant Rong.Yi@milliman.com Tel: 781.213.6200 4 th National Predictive Modeling Summit Arlington, VA September 15-16, 2010
More informationGlossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid.
Glossary Acute inpatient: A subservice category of the inpatient facility clams that have excluded skilled nursing facilities (SNF), hospice, and ungroupable claims. This subcategory was previously known
More informationPhysician Office Solutions
Physician Office Solutions In the ever-changing world of healthcare, you can rely on us to help you improve your practice to face the challenges to come. Commitment That Extends Far Beyond Products We
More informationAn Introduction to Medicare
An Introduction to Medicare Medicare can be confusing, but we re here to help you and your employees make sense of it all. This Medicare overview is a great place to start. It goes over the Medicare basics
More informationGlossary of Terms. Adjudication: The way a health plan decides how much it will pay for certain expenses.
Page 1 Glossary of Terms Adjudication: The way a health plan decides how much it will pay for certain expenses. Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.
More informationAccess to medically necessary healthcare is critical for successful patient outcomes, yet access
ISSUE BRIEF 2 February 2019 Access to Prescription Medications Under Medicare Part D The Patient Access Network Foundation believes that out-of-pocket costs should not prevent individuals with life-threatening,
More informationAnnual Notice of Changes for 2019
Preferred Gold with Part D (HMO-POS) offered by MVP Health Plan, Inc. Annual Notice of Changes for 2019 You are currently enrolled as a member of Preferred Gold with Part D. Next year, there will be some
More information2018 Medicare Advantage Quality Incentive Program
2018 Medicare Advantage Quality Incentive Program 72.07.800.1 Table of Contents General Program Details and Requirements Duties of Group Payment Arrangements Termination Obligations Dispute Resolution
More informationANNUAL NOTICE OF CHANGES FOR 2018
Cigna HealthSpring Preferred (HMO) offered by Cigna HealthSpring ANNUAL NOTICE OF CHANGES FOR 2018 You are currently enrolled as a member of Cigna HealthSpring Preferred (HMO). Next year, there will be
More information1199SEIU NATIONAL BENEFIT FUND FOR ROCHESTER AREA MEMBERS OVERVIEW OF YOUR BENEFITS
1199SEIU NATIONAL BENEFIT FUND FOR ROCHESTER AREA MEMBERS OVERVIEW OF YOUR BENEFITS Medical Benefits are provided through MVP Health Care. Dental Benefits are provided through Excellus BlueCross BlueShield.
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Health Insurance Company: my Direct Blue Major Events EPO 7350
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Blue Cross Blue Shield: Major Events Blue PPO 7350 a Community
More information**BEGINNING OF EXAMINATION** HEALTH, GROUP LIFE & MANAGED CARE MORNING SESSION
**BEGINNING OF EXAMINATION** HEALTH, GROUP LIFE & MANAGED CARE MORNING SESSION 1. (4 points) You are an actuary for a reinsurance company. A business school professor at a local university has invited
More informationMemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT. Specialty Drug Management
MemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT SPECIALTY DRUG MANAGEMENT 1 1% Prescriptions Written in 2012 99% 25% Prescription Drug Spending in 2012 75%
More informationGateway to Practitioner Excellence (GPE)
Gateway to Practitioner Excellence (GPE) 2018 Medicaid Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members Practice Eligibility (see PCMH slide #15 for separate eligibility
More informationControlling Health Care Spending Growth. Michael Chernew Oct 11, 2012
Controlling Health Care Spending Growth Are new payment strategies the solution Michael Chernew Oct 11, 2012 Definitional issues matter Definition of spending Cost per service [i.e. Price] Spending per
More informationPHARMACY BENEFIT MANAGER (PBM)
PHARMACY BENEFIT MANAGER (PBM) Presentation by: Pantea Ghasemi, USC Pharm.D. Candidate of 2015 Mentor: Dr. Craig Stern, Pro Pharma Consultants Inc. April 3, 2015 OBJECTIVES 1. Define PBM 2. Discuss Service
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/ /31/2019
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Highmark West Virginia: my Blue Access WV EPO Silver 3500-2 Free PCP Visits
More informationImportant Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://eoc.anthem.com/eocdps/fi or by calling (855) 333-5735.
More informationPresented by: Steven Flores. Prepared for: The Predictive Modeling Summit
Presented by: Steven Flores Prepared for: The Predictive Modeling Summit November 13, 2014 Disease Management Introduction A multidisciplinary, systematic approach to health care delivery that: Includes
More informationFrequently Asked Questions (FY 2018)
Frequently Asked Questions (FY 2018) As of January 2017 On February 17, 2017, all Massachusetts specialists were sent details of their Clinical Performance Improvement Initiative tiering designations.
More informationPay For Performance Summit Ann Robinow March 10, 2009
Pay For Performance Summit Ann Robinow March 10, 2009 1 Force providers to manage cost and improve quality Give consumers incentives and tools to migrate to better performing providers Do this without
More information$200 individual/$400 family combined network and out-of-network.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 New Castle County Government : Blue Choice PPO Coverage for: Individual/Family
More information2.05 Predictive Modeling P4P and Physician Engagement. Pay for Performance Summit February 7, 2006
2.05 Predictive Modeling P4P and Physician Engagement Pay for Performance Summit February 7, 2006 1 Agenda Three Key Healthcare Trends About Predictive Modeling About Reporting Business and Clinical Outcomes
More informationHealth Benefits Simplified. CopperSands Inc. Medical Benefits Overview. Effective 10/1/
Health Benefits Simplified CopperSands Inc. Medical Benefits Overview Welcome! HealthEZ is a national benefit administrator that specializes in helping companies like CopperSands Inc. provide affordable,
More informationANNUAL NOTICE OF CHANGES FOR 2019
Cigna HealthSpring Advantage (HMO) offered by Cigna HealthSpring ANNUAL NOTICE OF CHANGES FOR 2019 You are currently enrolled as a member of Cigna HealthSpring Advantage (HMO). Next year, there will be
More information10 Best Practices For Payer Contracting: A Roadmap for Successful Negotiations
10 Best Practices For Payer Contracting: A Roadmap for Successful Negotiations Steve Selbst Healthcents, Inc. Speaker Disclosures Steve Selbst is employed by a business firm that provides services related
More informationA Path to Accountable Care Organizations: How Do We Get From There to Here? Financial Considerations for Accountable
A Path to Accountable Care Organizations: How Do We Get From There to Here? Financial Considerations for Accountable Care Entity Engagement Presented by Milliman, Inc. San Francisco, CA susan.pantely@milliman.com
More information10 Best Practices For Payer Contracting:
10 Best Practices For Payer Contracting: A Roadmap for Successful Negotiations Steve Selbst Healthcents, Inc. 2016 NHIA Annual Conference & Exposition 1 Speaker Disclosures Steve Selbst is employed by
More informationAnnual Notice of Changes for 2019
Stride SM Value Rx (HMO) offered by Harvard Pilgrim Health Care, Inc. Annual Notice of Changes for 2019 You are currently enrolled as a member of Stride SM Value Rx (HMO). Next year, there will be some
More informationWPS HealthyChoices Group Guide. Effective January 1, Be Happy. Live Healthy.
WPS HealthyChoices Group Guide Effective January 1, 2015 Be Happy. Live Healthy. Table of Contents: Introduction 2 Choose 4 Save 5 Control 6 Covered Benefits 7 2 With high-quality coverage, affordable
More informationIMPACT OF TELADOC USE ON AVERAGE PER BENEFICIARY PER MONTH RESOURCE UTILIZATION AND HEALTH SPENDING
IMPACT OF TELADOC USE ON AVERAGE PER BENEFICIARY PER MONTH RESOURCE UTILIZATION AND HEALTH SPENDING Prepared by: Niteesh K. Choudhry, MD, PhD Arnie Milstein, MD, MPH Joshua Gagne, PharmD, ScD on behalf
More informationAnnual Notice of Changes for 2019
Gold PPO with Part D (PPO) offered by MVP Health Plan, Inc. Annual Notice of Changes for 2019 You are currently enrolled as a member of Gold PPO with Part D. Next year, there will be some changes to the
More information83% 29% employees. 90% US businesses offer HDHP $6, M. 110M pay out of pocket 25% HEALTHCARE CONSUMERISM LANDSCAPE.
HEALTHCARE CONSUMERISM LANDSCAPE High deductible health plans (HDHP) will grow at double digit year-over-year rates for the foreseeable future. 29% employees are on HDHP 17.4M Americans on HDHP 90% US
More informationMANAGED CARE : THEN, NOW AND TOMORROW
MANAGED CARE : THEN, NOW AND TOMORROW Craig Stern, RPh, PharmD, MBA Pro Pharma Pharmaceutical Consultants, Inc. USC School of Pharmacy, Level III, Managed Care Elective November 9, 2015 Current Situation
More information2017 Health Plan Comparison Chart
207 Health Plan Comparison Chart Tenet Network: Tenet-employed physicians, Tenet-owned facilities, Tenet ACO/CIO physicians In-Network: Physician or facility within carrier network Out-of-Network: Physician
More informationAnnual Notice of Changes for 2019
Network PlatinumSelect (PPO) offered by Network Health Insurance Corporation Annual Notice of Changes for 2019 You are currently enrolled as a member of Network PlatinumSelect. Next year, there will be
More informationService Participating Providers: Non-participating Providers:
Bend Chamber of Commerce Provider Network: SmartChoice Medical Benefit Summary SmartChoice 3000+25-50_30 S2 Annual Deductible Per Person, Per Calendar Year Per Family, Per Calendar Year All Providers $3,000
More informationAnnual Notice of Changes
Annual Notice of Changes January 1 December 31, 2018 Generations State of Oklahoma Group Retirees (HMO) GlobalHealth is an HMO plan with a Medicare contract. Enrollment in GlobalHealth depends on contract
More informationManage your Prescriptions Online Through the Express Scripts Pharmacy
Manage your Prescriptions Online Through the Express Scripts Pharmacy www.express-scripts.com Customer service specialists are also available 24 hours a day/7 days a week at 1-800-711-0917. Get a 90-day
More informationSummary of Benefits and Coverage: What This Plan Covers & What You Pay For Covered Services Coverage Period: Beginning On or After 01/01/2018
Summary of Benefits and Coverage: What This Plan Covers & What You Pay For Covered Services Coverage Period: Beginning On or After 01/01/2018 California Association of Professional Employees Custom POS
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Blue Cross Blue Shield: my Direct Blue Conemaugh EPO 6950B Coverage
More informationAnthem Blue Cross Your Plan: Classic PPO 1000/35/20 (Essential Formulary $5/$20/$30/$50/30%) Your Network: Prudent Buyer PPO
Anthem Blue Cross Your Plan: Classic PPO 1000/35/20 (Essential Formulary $5/$20/$30/$50/30%) Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you
More informationAnnual Notice of Changes for 2019
Network Health Medicare Anywhere PPO offered by Network Health Insurance Corporation Annual Notice of Changes for 2019 You are currently enrolled as a member of Network Health Medicare Anywhere. Next year,
More information