Mapping the holistic medical cost and care delivery opportunity space

Healthcare organizations face significant challenges in identifying opportunities to improve value in medical spending and close gaps in care. Organizations often deploy myriad medical-cost-management initiatives originating from various parts of the organization without fully understanding the opportunity space. Benchmarking to Value is an analytics engine that provides a holistic view of opportunities to improve medical-cost value and bridge population-care gaps based on patterns of variation in price, care-setting mix, and planned utilization versus potentially avoidable exacerbation. It allows for internal and external benchmarking of the total cost of care, with the abilities to disaggregate key drivers at multiple levels of granularity and aggregate potential savings based on performance improvement.

Our approach

Benchmarking to Value can be easily configured for most claim-analytics use cases, such as year-over-year medical-spending trends, rapid initial diagnostic of medical-cost-transformation opportunities, member cohort/service-specific care model design, provider performance monitoring, benchmarking to internal or party dataset, and more. Moreover, the engine can shed light on care-quality outcome and identify care gaps.

Comprehensive source-of-value framework

The analytics engine intuitively disaggregates healthcare-spending variation by mutually exclusive cost drivers, including the following:

• unit price
• site-of-care
• preventable exacerbations and complications
• utilization efficiency

Flexible segmentation methodologies

Companies can examine improvement opportunities based on various performance elements, including the following:

• plan, product, and market geography
• attributed provider
• member cohort

Granular analysis pathways

Users can deepen the analysis to various levels of granularity, including by the following groups, while maintaining fidelity:

• care type
• clinical-service line
• detailed clinical concepts

Multiple benchmarking approaches to inform opportunity sizing

The analytics engine compares performance by spending category and by sources of value against multiple benchmarks, including the following:

• year-over-year trend
• provider metrics (versus market peers)
• plan metrics (versus market peers)

Key features

Comprehensive performance overview

Rapidly compare performance at the total cost-of-care level and separate performance and spending variation by independent cost driver.

Hierarchical analysis to highly granular opportunity areas

Dynamic and customizable pathways help users navigate, screen, and prioritize tens of thousands of potential opportunity areas.

Addressable opportunity sizing by market and source of value

Prioritized granular opportunities are aggregated and organized into a unified view using a source-of-value framework.