Commercial
Our commercial cost model logic used to map detailed medical claims into over 100 granular service categories
Dimension
Our Part C pricing tool that projects Part C claims at detailed type of service category level in order to populate the Part C BPTs
Element
Summary of reported financial information on entity and company level. The tool provides data tables and graphs to summarize and compare company data.
Domain
Our clinical cost model logic is used to group service categories from a provider lens and also determines important metrics such as readmission rates and avoidable ER admits
Pyramid
economic utility model that captures the flow of individuals across various markets and coverage options based on their economic purchasing decisions and is integrated with actuarial modeling designed to assess the impact various reforms are expected to have on the health insurance markets. This model is a leading-edge tool for analyzing the impact of various healthcare reforms or proposed legislation.
Simulate
Our competitive analysis template that provides a comprehensive, carrier-level financial view of the individual and small group markets
Degree
Seriatim model that projects and re-adjudicates Part D claims data in order to populate Part D BPTs, as well as facilitate customized analyses
Sequence
Quarterly newsletter providing insights of the current financial experience, profitability and capitalization trends within the health insurance market.
Pulse
Determines future facility needs based on projected utilization, demographics, efficiency, etc. of the population
Volume
Our Medicare reimbursement tool that adjudicates commercial claims at 100% of Medicare for contract evaluation and comparison
Scale
Calculates historical experience trends by major service category utilizing a regression model; flexibility to normalize for several key variables
Slope
Proprietary process for calculating CMS HCC risk scores relying on various diagnoses data
Strata
Evaluating hospital expenses to deliver inpatient and outpatient care for a system. Under the same efficacy and outcomes, identifying drivers of unnecessary cost and utilization variation from supplies, labs, pharmacy, imaging, or length of stay associated with an inpatient stay or outpatient visit
Variance
Rate development model that projects single risk pool experience at detailed type of service category levels in order to develop ACA rates for individual and small group products
Matrix
Our managed care benchmark tool that shows a comparison of client utilization across cost categories vs. a benchmark population adjusted to match client demographics and/or morbidity
Congruence
Generates Part C, Part D, and combined income statement by PBP on an incurred basis
Intercept
Our managed care benchmark tool that shows a comparison of client utilization across cost categories vs. a benchmark population adjusted to match client demographics and/or morbidity
Congruence
Summary of key MMR data and Rx Claim data by liability type by product, as well as processing and summarization of bene level file summaries
Helix
Our high-cost claimant model that predicts the probability of shock claimants in a future period
Extrema
Logic to map detailed medical claims into over 100 granular service categories
Dimension
Our Medicare reimbursement tool that adjudicates commercial claims at 100% of Medicare for contract evaluation and comparison
Scale