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Case Study

Custom Healthcare Payer Data Analytics Solution Improves Analysis of Health Management Data

Client Profile

  • Location: Southeast
  • Industry: Health Insurance
  • Number of covered lives: + 1,000,000

Key Program Highlights

Through their collaboration with HDMS, the insurer is now able to:

  • Unite market and product data in one platform
  • Standardize reporting processes
  • Produce reports relevant to diverse audiences
  • Enhance visibility into datasets
  • Complete an accurate analysis of program costs
  • Demonstrate value of health management programs
  • Save users valuable time and resources from manual reporting

As the number of programs designed to promote health and wellness continues to grow, so does the need to collect, normalize and analyze increasing volumes of health management data. This was certainly the case for a large Southeastern health insurance company, representing nearly one million participants.

Like other health care organizations, clinical reporting at the organization had become more complex and detailed over time. The lack of a cohesive and uniform platform paired with the growing need to integrate health management program data with other types of clinical and cost/use information increased demands on already limited resources. The use of multiple reporting tools across different business units also resulted in frequent data reconciliation issues, making accurate reporting a costly and time-consuming endeavor.

In addition, the insurer needed an effective method for evaluating the costs of the health management programs it offered to members. Together, the insurer and HDMS established a plan for leveraging current analytic solutions to gain additional insights, better meet the needs of its employer clients and address an increasing complex set of reporting needs.

The Situation

As a longstanding HDMS customer, the insurer successfully used HDMS’s flagship data analysis and reporting tool for more than 10 years. As part of the expanded collaboration, the insurer worked with HDMS to fully integrate the data from several ancillary services into the tool. The organization also expanded its collaboration with HDMS to include Population Health Management analytics which deliver presentation-ready management reports for its employer groups.

To build on these investments, enhance visibility into its datasets, better evaluate costs and demonstrate program value, the next step was to implement a more comprehensive – yet flexible – way to analyze and review health management program data. By placing data into one unified platform, the insurer sought to increase efficiencies, save valuable staff time and preserve resources that could be devoted to other mission-critical tasks.

The Need

At the outset of the project, the insurer identified a number of specific needs and requirements the new clinical health management reporting platform would need to meet, such as the ability to input new data from diverse sources and apply standardized codes and formats. The platform would also need to allow intuitive, easy access for users, including case managers, company leadership, health managers and account managers.

Recognizing the development of such a solution would require tight collaboration and flexibility between both organizations, HDMS worked closely with the insurer to meet these needs by:

  • Incorporating new data sources as they were identified
  • Establishing a uniform, underlying file architecture
  • Formulating diverse enrollment, engagement terminology and access codes between health management, case management and complex care
  • Reaching consensus on data methodology and reporting objectives

The Solution

The collaboration between HDMS and the insurer resulted in a highly flexible, customized and user-friendly system. Building on the existing data analytics platform, the new solution allowed data input from many more sources – including disease management, case management, lifestyle management and wellness program data – all of which were vital to assess the effectiveness and utilization of health management programs.

The new platform also unified codes, standardized processes and provided customized templates, tables and dimensions that took the needs of all health data end users into consideration.

Ultimately, more than 30 customized clinical eligibility dimensions – a collection of reference information used to determine whether a member may or may not be considered to have a condition or be allowed to enter a care management program – were added to the platform to facilitate greater data analysis and reporting. These included both participant and risk dimensions as well as customized data tables for a range of wellness-specific initiatives.

The Results

As a result of this collaboration, HDMS’ customized reporting solution has delivered a wealth of benefits for members and staff. One of the biggest advantages so far has been the ability to combine data, analysis and reporting in one platform. In conjunction with the predictive modeling tool, users can quickly and easily analyze enrollment, participation and cost data for a wide range of health management programs.

“The biggest value from the HDMS platform is the customization of the data base based on customer’s specific needs. The  platform allows us to send and pull data independently of other areas. Now we can add indicators to HCC reports to identify participants and see if they’re in disease management, case management or maternity management.” – Medical Director

Additional benefits include:

Reduced wait times for reports

“Without the need to aggregate multiple platforms, reports that once took staff all day to produce can now be generated in as little as an hour. Beyond dramatically accelerating report delivery times to clients and staff, these new efficiencies have freed up valuable resources that can now be devoted to other projects and initiatives.”

Higher Client Satisfaction

Whether clients want to better understand what’s happening related to admissions, out-of-network claims or emergency department (ED) visits, users are empowered to quickly and efficiently produce customized, high cost claimant reports, and conduct drill down analysis by claimant, facility type or service.

 “The new reports and deliverables have been very well-received by clients. In fact, with the level of customization and detail the reports now provide, we have secured a competitive edge in the local marketplace.”

 Improved Ease of Use

While previous HCC reporting processes required a great deal of manual intervention, the new platform dramatically streamlines workflow and eliminates the need for the many hands-on, cumbersome steps that caused a drain on productivity. Clinical teams find the participation-to-utilization linkage to be especially useful.

 “Health management data is now better organized and presented in a more intuitive format.”

 “Our clinical leaders and staff, including health coaches, appreciate the fact they don’t need to have a programming background to capture the information and reports they need.”

 Enhanced decision support

The combination of timelier reporting and episode data enable more accurate recommendations for program and benefits plan design going forward. For example, predictive modeling information, such as risk scores, also enables nurses to prioritize outreach efforts. Using this information, the organization was able to increase program enrollment by more than 650% in the span of two quarters.

Increased data visibility

The platform allows users to identify HCCs and see how risk levels shift and change over time based on a variety of factors like age or recent diagnoses. For opt-in programs like maternity management, having the ability to rapidly identify members that could benefit from these programs but are not yet enrolled can help drive more effective outreach and engagement.


HDMS Health Plan Case Study