Cost and Utilization Management
Clinical Performance Analytic
Cost and Utilization Management
Clinical Performance Analytic
Align level of care from each category to service to identify treatment anomalies and appropriate utilization from both a cost and quality of care perspective for a population.
Today, data lag and access to limited data sets lead to stale recommendations for consumer care leading to duplicated services and unnecessary procedures being performed across each consumer population.
Analytic programs can be difficult to manage as data sets are too disconnected, they require technology that is too complex and expensive to administer, insights have a long lag time and they do not have a consistent definition of utilization.
HealthPointe’s Cost and Utilization Management analytic identifies trends associated with medical costs and utilization within your organization. Our predictive analytics help to identify treatment patterns and the appropriateness of services performed for over 2,500+ conditions. These insights can help you align the right care at the right time and gain a better understanding of where your utilization and cost drivers truly are located across your network.
Cost and Utilization Management Analytic Process
1. Harvest Critical Financial, Clinical, Claim and Provider Roster Data
- Centralize and organize data from across the organization
- Cleanse, standardize, enrich and prepare data for analytic processing
2. Assign and Evaluate Service Categories
- Evaluate care for appropriateness and align to service categories
- Create events, episodes and bundles across the care spectrum from utilization level to units of service provided
3. Continuous Monitoring of Performance Against Utilization Targets
Heat maps for each service category with drillable insights highlighting avoidable and appropriateness of care delivered
