Risk Navigator Performance incorporates retrospective utilization profiling and risk information. Provider performance can be measured against national and regional benchmarks. Key information includes Case Mix Index, Efficiency Index and Episode evaluation of potential savings.

Features include:

• Episode-based analysis of individual providers and provider groups using both PCP assignment and responsible physician assignment (Symmetry™ logic).
• The ability to compare severity-adjusted cost and utilization performance statistics using internal, national or regional benchmarks. Comparisons can also be adjusted by provider specialty.
• National, Regional, Product and Specialty ETG level benchmarks derived from a database containing over 50 million members.
• Traditional Case Mix and Efficiency Index along with episode-level statistics such as admission rates, re-admission rates, ER visits, physician visits, radiology costs and laboratory costs.
• Physician Peer Group assignment through application data entry stored across deliverables.
• Three (3) Physician Roles of Responsibility related to episodic reporting: Member PCP, Episode Primary Responsible and Episode Secondary Responsible.  Indexes are adjusted to account for less responsibility in the Episode Secondary role.
• Efficiency Indexing on observed cost as well as treatment pattern using a normalized service level reimbursement dollar figure.
• 24 months of episode data available for profiling.
• Use of a single integrated database and extract for both retrospective and prospective analysis.

 

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For more information on this product and pricing contact us:
Phone: 800.446.3324 -or- email: sales@medai.com