Analytics

From benchmarking, risk assessment and forecasting - to real-time plan monitoring and claims expense intervention, our analytic prowess is simply second to none

Information in the form of data analytics is at the core of our value proposition and provides structured insight into your plan and cost trends. It drives long-term strategies that will shape your health plan design and maximize program values.

Monitoring plan performance in relation to expected utilization levels and performing year-over-year analysis and comparisons to normative data is critically important. It enables us to quickly identify and report on emerging trends and manage high-dollar exposures effectively.  It also enables us to work with our clients in a collaborative fashion and address plan management issues as they arise.

Our analytics and proprietary models enable us to:

  • Identify and quantify discrete cost drivers of medical cost and utilization
  • Offer sophisticated plan modeling to help measure the impact and effectiveness of plan design changes
  • Provide benchmark of claims experience against nationally recognized norms
  • Provide complex information in an easy-to-use and understandable way

Our health plan utilization measurements include, but are not limited to:

  • Total Health Plan Costs
  • Health Plan Cost Trend by Month
  • Total Medical Claims Costs
  • Medical Claims Costs by Relationship and Place of Service
  • Major Diagnostic Categories
  • High Cost Claimants
  • Inpatient and Outpatient Claims
  • Inpatient and Outpatient Surgery Procedures
  • Emergency Room Visits
  • Office Visit Utilization
  • Chiropractic Care
  • Inpatient Behavioral Health Utilization
  • Outpatient Behavioral Health Utilization
  • Claims by Major Diagnostic Categories
  • Lifestyle-Related Claims
  • Wellness Visits
  • Disease Management

The JP Griffin Group also monitors Rx spending, covering topics such as paid summary, PMPM, total member cost share, retail vs. mail service, brand vs. generic utilization, high cost claimants and more.

Of course, the most important factor with analytics is the team reviewing and utilizing the data on behalf of our clients. By having a Medical Director, Underwriter, and Actuary/Financial Analyst advocating on behalf of our clients, the JP Griffin Group is able to deliver the best outcomes possible.

Large Claim Analysis

Managing and preventing large claims is critical to the success of any health plan. One key aspect that differentiates our organization is our ability to engage early at many levels of the claims process.  We maintain excellent working relationships with Medical Directors and Care Management staff of our carrier partners.  The ability to have early and open dialogue regarding claim status provides for unique insights that lend value to the overall management of large claims development.

It is impossible to stop a large claim once it has become a reality. However, it is possible to ensure that it is managed correctly and that the proper level of treatment is available.  Additionally, having such in depth knowledge of claimant status dramatically assists with the pricing of risk for future renewals.

The more proactive approach is to manage and identify risk factors in individuals and prevent them from becoming the next large claim.  Our analytic platform identifies Disease Burdens, Care Gaps, Comorbidities, and assigns risk scores based on predictive modeling to allow our Medical Director to hold the carriers accountable in managing disease states.

Identification of Key Cost Drivers

As part of our monthly data review process, we engage our data management group to identify key cost drivers. This process breaks out from general financial performance, network efficiency, health claims, Rx claims, quarterly trend and period-to-period analysis. In addition to claim data, we utilize data pertaining to disease states, comorbidities, gaps in care and predictive modeling.

This data is incredibly useful as it can be used to determine underlying health conditions within a given populations on individuals that have not yet surfaced in the form of actual claims. Utilization of this data in the development of outcomes-based wellness programs has shown to provide on average a 7 to 1 return on investment over behavioral-based programs. Additionally it also allows for the tracking of data markers to evaluate to overall effectiveness of wellness and disease management efforts over multiple time horizons.

Additionally, it also allows for the tracking of data markers to evaluate to overall effectiveness of wellness and disease management efforts over multiple time horizons.

Benchmarking

We utilize actuarially-derived national benchmarking data for commercial populations to measure plan performance and variations from norms. These databases include but are not limited to the Verisk DxCG methodology, The Kaiser Family Foundation Surveys, Truven, MarketScan and Johns Hopkins Adjusted Clinical Groups (ACG) system. We also utilize statistical rates and data from the CDC and CMS. Available benchmarks include comparisons by plan, size of group, region/state, and industry.

Our process begins with an in-depth analysis of current plans, plan designs and current utilization within your organization in order to determine what areas of the plan are functioning properly. We benchmark against a variety of databases in order to get a true baseline comparison. This report takes into consideration regional, industry and national data aspects.

Additionally, a full study is completed as to the effectiveness of the current network based upon true discounts, as well as actual clinical costs. The process described here gives us an accurate snapshot of the performance of your benefit plans and allows us to begin developing recommendations based upon actual utilization.