The sales force has had to become more knowledgeable because theiraccounts have more data.
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Account group reporting (AGR), a crucial part of doing business for health plans, has become even more crucial nowadays. Just as healthcare costs have spiraled rapidly upward over the past few years, so too has demand on the part of plans' and third-party administrators' (TPAs) clients for more detailed data on just how effectively and efficiently their healthcare dollars are being spent and managed-and whether their employees' health and wellness (and, by extension, their productivity) is at an acceptable level as a result of that spending.
Such is the extent of this demand that many employers have begun licensing their own decision-support systems to feed their need for such information, while others are requiring improved reporting mechanisms from their brokers or plans.
The plan likely would provide the client with a report booklet summarizing various key areas of interest, such as enrollment counts, demographics, cost drivers, disease prevalence, disease management, medical and prescription-drug utilization summaries, stop-loss claims and detail reports.
While the data itself was somewhat limited, often these reports were presented in professional-quality, bound volumes replete with color charts and graphics and custom logos to visually represent to clients the professional-quality services they were getting for their money. Many plans still perform this kind of face-to-face account review, but many health plans and TPAs have begun to turn to Internet-accessible Web sites to provide their clients with secured access to the information they're increasingly craving.
USERS CREATE CUSTOM REPORTS
These account-group reporting Web sites offer employer groups and/or brokers access to information in an interactive, investigative environment. Some allow employers to "slice and dice" their information by standard business dimensions, such as plan and region, or offer advanced formatting, charting and ad hoc capabilities that let users create their own custom reports and analyses.
A few offer employers guided analytic paths, providing the end user logical steps by which to focus on specific concerns and highlighting areas that may be of interest. Some solutions even offer national, regional and industry-level benchmark comparisons that allow employers to better understand their relative position on a variety of cost, quality and utilization attributes.
Some sites offer the ability to support employer-specific security and customization requirements, since business-dimension definitions and needs vary significantly from one employer to another.
One plan that's gone from the traditional, face-to-face "annual meeting with colorful binders" reporting method to the more efficient-and far less costly-group-reporting Web site scenario is Blue Cross of Northeast Pennsylvania (BC-NEPA) The Wilkes-Barre-based organization serves more than 600,000 members in a service area that encompasses 13 counties.
CoNexus, a customized group-reporting Web site that BC-NEPA now offers its clients incorporates the features and content that meet their specific needs.
"Prior to CoNexus we used traditional paper-based reporting, which is very labor- and cost-intensive and only allowed us to report face-to-face with our clients once a year, in addition to a host of more frequent reports mailed throughout the year," says Mark Ungvarsky, Senior Director of Healthcare Informatics for BC-NEPA. "We responded to requests from our sales force, which was telling us their accounts wanted more information on a much more regular basis."