Gain an understanding of what you can review, analyze, and track with the reports in HealthAnalytIQ's Opportunity Discovery Module.
Below is a list of the reports, analyses, and groups that can be tracked using the Opportunity Discovery Module of HealthAnalytIQ.
- Executive Summary – The Executive Summary report highlights findings and insights from other more detailed reports in the HealthAnalytIQ® platform. Some of these reports and dashboards focus on inefficient and wasteful spending and provide insights on potential savings opportunities for the health plan. It is intended as a way for senior leaders and members of an executive team to quickly become familiar with the current status of the health plan across several disciplines without having to review all of the individual reports. The focus areas of the Executive Summary report are Medical Claims Inefficiencies, and Prescription Drugs. Opportunities in each of these areas are ranked and highlighted at a high level.
- Medical Opportunity – Most medical services are best thought of as commodities. There is little to no difference in quality for these services, so there shouldn’t be much justification for significant price variations between where these services are rendered. Significant price variations for these services is a strong indicator of wasteful spending and inefficiencies within a health plan. These Place of Service inefficiencies occur largely due to legacy billing systems and questionable reimbursement practices. They also occur because of intentional efforts by some providers to take advantage of billing loopholes that allow for higher reimbursement for the same service if it is billed as an outpatient facility claim as opposed to a professional office claim. The reports in this module shine a light on these types of inefficiencies, analyzing medical claims for wasteful, avoidable spending in these service areas.
- Pharmacy Opportunity – This set of drug cost opportunity reports provide findings in several areas of prescription drug use. These inefficiencies occur within pharmacy spending as a whole and include practices such as prescribing branded generic drugs when generic equivalents are available, prescribing branded generic drugs when generic therapeutic alternatives are available, prescribing higher-cost generics manufactured by owners of the equivalent brand name drugs, and prescribing higher cost generic drugs instead of clinically effective low-cost generic drugs. The information presented on these reports acts as an Executive Summary of findings for pharmacy spend within your formulary.