Payers of healthcare are faced with tight budgets, declining revenues, growing economic pressures and a wide array of risks. At the same time medical costs continue to rise and present a continued challenge. By 2030, the number of people aged 65 years or older in the United States is projected to double to 72 million adults representing 20% of the total U.S. population. Research predictions indicate that medical costs will rise steadily due to increased aging of the population, increases in co-morbidity, obesity, and injury severity.
FACTORS DRIVING MEDICAL COSTS RISK
• Medical Services Utilization
• Aging Population
• Increase Fraud and Abuse
• Increased Injury Severity
• Increased Co-morbidity
• Narcotics Drug Utilization Addiction
• Medication Utilization
• Ancillary Service Utilization
• Increased DME Utilization
• Increased Technologically Driven Service
ENTERPRISE WIDE MEDICAL COST RISK MANAGEMENT SOLUTIONS
HCRG specializes in Medical Cost Data Analytics and formulation and implementation of real time solutions to manage and monitor the medical cost of claims. Through our Data Analytics capabilities, we utilize information to proactively and predictively assist our clients to develop solutions to proactively manage and control medical cost exposure risks.
PROACTIVE MEDICAL COST EXPOSURE RISK MANAGEMENT
HCRG deliberately and intentionally studies critical medical cost junctions both at the claims and clinical levels of the medical file. We can predict the areas that would result in high costs. We work seamlessly with our clients to:
• Identify Medical Cost Risks
• Evaluate Risk
• Develop Real-time focused risk management strategies at different junctions
This approach has assisted our clients to prevent a lot of complexities.
PREDICTIVE MEDICAL COST RISK MANAGEMENT
Our expertise not only address proactive analysis and solutions development but also predictive.
We work with our clients and their unique needs. We utilize each specific client data analytics to:
• Identify risk populations
• Capture complexity of each claim population and forecast medical cost
Categorize medical cost drivers into:
· Claim Characteristics
· Medical Conditions
· Medical Service Utilization
· Pain Management Utilization
· Over-utilization of Services
· Fraud, abuse and Wastage
· Identify diagnosis of anxiety, depression, sleep problems Study the characteristics and patterns that differentiate low costs and high cost claims to formulate predictive solutions intervention.
FUTURE MEDICAL COST RISK MANAGEMENT
Future medical costs carrying high risk exposure although sometimes hidden it is important to predict and manage future medical cost.
We work with our clients to:
• Identify and estimate future high cost claims
• Identify and quantify cost drivers of claims
• Create focused intervention medical management solutions to address the exposure