The PSIMedica Clinical Knowledge Manager (CKM) system offers
Managed Health Plans a wide range of standard reporting in
addition to its broad ad hoc query capabilities. This web
enabled default content can be invoked at the user’s
option and is cataloged in the “Standard Reports”
module of the CKM user interface for easy access and customization.
We divide the standard reporting content into three general
content areas of interest:
population health, health benefits, and quality
management. The following is a brief
description of each of the content areas and report types:
Content Areas
Population Health
– reports in this area describe trends in the health
of covered population. The population may be stratified and
analyzed by whatever categories are most meaningful –
i.e. by employer group, by benefit plan, by disease/condition,
by procedure, by provider, by age/sex demographics, by location/geography,
by active vs. retired, and so on.
Health Benefits –
reports in this area describe trends in the utilization of
health benefits, the medical expenditures associated with
them and the accuracy of benefits adjudication and payment.
Benefits/services may be defined and analyzed at whatever
level of granularity best meets requirements. Utilization
and cost patterns are assessed by plan and product types,
benefit packages, demographic groupings, locations, diseases
and conditions, procedure types, and so on.
Quality Management –
reports in this area describe trends and profiles in the quality
of the healthcare services purchased and delivered under benefit
plans. Quality is defined and analyzed both in terms of process
and outcome standards. Report content covers preventive care,
chronic care, and acute/emergent care including place of service,
service provider, type of service, and so on.
Report Types
Status Monitoring
– reports of this type provide basic descriptive statistics
over time, including trend analysis and oversight evaluation.
Variance / Comparative Analysis
– reports of this type identify problems and opportunities
for improvement by arraying current status against peer benchmarks
and performance targets.
Intervention Modeling
– reports of this type provide forward forecasting and
predictive modeling based upon management intervention assumptions,
allowing more accurate forecasting of future financials.
Figure 2 illustrates the nine-part framework of CKM standard
reporting. Within each of the cells of this framework, CKM
offers a variety of report sets. For example, within the status
monitoring section of Health Benefits, we offer report sets
on cost and utilization rates by service (including worker’s
comp and disability), on large claims, and on adjudication
and payment of claims. These reports, which are provided as
“seed” content, may be “drilled” into
and supplemented by an unlimited number of user-generated
analyses.
