How to Read Healthcare Reports: Analyze Employer Claims Data

This Video Describes a Way to Read an Employer Claims Cost Report to Find Actionable Information and to NOT Get Distracted by Less Important Data.
1) Don't Look at the Report First... Rather Start with What Questions You Would Like to Answer and Then Find Those Answers Within the Report.
2) Review the High-Cost Claimants by Quarter or by Year. Not Claims... Claimants. Claimants with Greater Than $100K in Spend are Likely Too Embroiled in the Healthcare System and Their Doctors to be Intervenable, But Claimants with $20K - $100K in Spend Offer a Better Opportunity for Intervention.
3) For Each High-Cost Claimant (I.e. Each Individual Person), Review the Paid Amount by Diagnosis Code and Procedure Code Because the Spend by Diagnosis and Procedure Will Tell the Clinical Story of What is Going on with That Person.
4) Review the Paid Amount and Number of Claims by Facility (i.e. Hospital, Surgery Center, etc.) to Identify Facilities that Have Very High Spend with only a Very FEW Claims (e.g. Out-of-Network Dialysis Facility).
Reviewing Healthcare Claims Reports in This Manner Allows an Employer Group to Identify What Types of Plan Design Changes, Network Changes or Targeted Program Changes Will Be Helpful to Reduce Waste in the Future.
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[@patricklong6931]

Very helpful (again)! We try to get Employers and Advisors to “look at claims like your underwriter” - just like you articulate so well... when it happens, we have true alignment... better care and lower costs are not mutually exclusive as many employees and employers assume! The best providers are actually the most willing to work directly with Plans to lower their costs... thanks for shedding more light on the “numbers behind the numbers.”

[@ahealthcarez]

Thank you for watching and for your comment.

[@justice6551]

Sir u are amazing

[@ahealthcarez]

Hardly, but thank you for your nice comment.

[@bigb2littleb]

Does those reports tell the employer the actual employee who is costing the most?

[@ahealthcarez]

Great question. No.
Thank you for watching!

[@middleclasshealthcare]

Most often the WHEAT is unobtainable in the carrier reports.....amazing manipulation.

[@ahealthcarez]

#True. Thank you for watching and leaving a comment.