Planwatch gains a major addition today with Risk Analysis - fast, accurate disclosure and reporting for partially funded health plans and their stop loss carriers / MGUs.

Nearly all stop loss carriers now require an employer disclosure before offering a new or renewal quote. Don’t let the growing demand for more detailed and timely disclosure information put a strain on staff - meet new disclosure challenges head-on. An efficient disclosure process means better quotes and creates choice for the sponsor, while an unorganized process can result in higher premiums and can potentially lead to future claim denials.

Immediately Understandable

The Disclosure Listing has great depth and accuracy, is beautifully presented, and can be run in as little as one minute. Included in the list are all known participants who have exceeded a customizable dollar threshold, received certain diagnoses, are known high-risk / complex care cases, have incurred disability related claims or who are currently involved with case management … all in a detailed yet intuitive format:

The Disclosure List is based heavily on the SIIA and SPBA endorsed standard stop-loss disclosure form and ICD codes set. A 2006 Ernie Clevenger / MyHealthGuide Newletter article reported that 70% of the self-funding stop-loss market (representing over $2.3 billion in stop-loss premium) had adopted the standard form. In 2005, SIIA conducted a survey of 112 members of the self-funded community that resulted in 86% favoring adoption of the standard.

You’re In Control With Drill Down

Striking a balance between providing too much and not enough information is key to an effective disclosure process. That’s why we included advanced Drill Down capabilities in the design from day one. Click on any participant or trigger and receive detailed claims activity:

Without enough information, the underwriter is forced to assume the worst about the group’s potential future experience, leading to higher attachment points and premiums. With too much information, the underwriter is overwhelmed with irrelevant data, making it impossible to establish the most important contributions to the overall experience. Drill Down provides the best of both worlds and the worst of neither: a relevant and timely disclosure list and the ability to selectively control additional detail.

Plays Well With Others

Give underwriters, actuaries, and even nursing staff secure access over the web with a variety of collaboration controls, like limiting a user’s access to specific groups, or configuring Create and View vs View Only access to certain types of reports.

And That’s Only The Beginning

Of course, every aspect of Risk Analysis supports exporting to Excel so you can still pass files around in email or print a hard-copy when required. You can even export a multiple-worksheet version that includes each of the Risk Analysis reports in a single file for easy offline analysis.

In additional to the Disclosure Listing and Drill Down capabilities, Risk Analysis also includes other reports commonly requested by underwriters and MGUs:

• Active Member Census: Provides detail on each currently active participant, including the member’s date of birth, age, gender, enrollment date and geographic location.

• Age Banded Census: Shows the number of participants by age band and gender that are active in each of the following types of plans: Single, Single and Spouse, Single and Other, and Family.

• Historical Claims and Active Lives Report: An account of the number of participants enrolled in Single, Family and Dental plans along with the total amount paid in Medical, Dental, Vision, and Rx coverage each month over a three-year period.

For more information on Planwatch Risk Analysis or the standardized disclosure form, please consult the following resources:

• Planwatch Risk Analysis Help and Documentation - includes screenshots and detailed descriptions of various data items.

• Standard Stop-Loss Disclosure Form (Ernest Clevenger et al.) - general information and resources related to the disclosure form and ICD-9 codes set, including downloadable PDF and Word templates.

• SIIA Endorses Standardized Stop-Loss Disclosure Form and Codes - The Self-Insurance Institute of America endorses the proposed standardized stop-loss disclosure form and ICD-9 codes set.

• Society of Professional Benefit Administrators (SPBA) - downloadable copies of the form and codes set along with other great information.

Planwatch Risk Analysis is immediately available for all new and existing customers.

You know how you’re always telling clients that more than 80% of spending will go to less than 20% of the covered population? That one of the most important goals a self-funded group can take on is keeping well / moderate risk members out of the high risk / complex care tier? Now you can show the exact impact of the 80/20 rule to a program’s bottom line with Paid Claims Distribution for Claims Review:

Claimants are grouped into one of fifteen expense bands ranging from $250 to $1 million. The chart then plots the percentage of members in each expense band against the percentage of plan expenditure for the same. Cumulative values make it easy to establish how closely the plan is following the 80/20 rule and whether action is required to help control spending.

Please see the Planwatch Documentation for additional information. Paid Claims Distribution is immediately available to all new and existing users.

ProServe Health Informatics will be an exhibitor at the Self-Insurance Institute of America’s (SIIA) 27th Annual National Educational Conference & Expo in Chicago from October 29 – November 1, 2007. Stop by Booth 343 for a demonstration of the full range of Planwatch capabilities, including a new set of Risk Analysis Reports providing fast, accurate disclosure and reporting for underwriters and MGUs.

About Planwatch.

Planwatch is a powerful web-based tool providing a dynamic suite of analysis and reporting capabilities in a user-friendly format. Customized data and analysis is retrievable on demand – down to the basic charge level – in more than 20 categories. Reports include easily interpreted information for use in assessing what is being done right and where health plan modifications may be needed. With its ability to maximize performance and minimize the cost of employer-sponsored health plans, Planwatch improves benefit management efficiency and delivers results to the bottom line.

About the SIIA conference.

The SIIA Conference and Expo takes place at the Sheraton Chicago Hotel & Towers from October 29 – November 1, 2007. It is the world’s largest event dedicated exclusively to the self-insurance/alternative risk transfer industry and offers a cutting-edge educational program combined with unique networking opportunities and a large tradeshow of products and services.

Planwatch. Booth 343.

Over the past year, we’ve seen a huge increase in the amount of quality health care related content being published on the web. After trying a variety of desktop and web based news aggregators, we found that a simple River of News had the most impact in enabling and encouraging our team to keep up with the wider industry. This was so successful as an internal experiment that we decided to see if the site might be useful to a wider audience.

While our primary goal is to provide a low barrier tool that makes it easy to find and keep up with the health blogosphere, we also plan on providing resources to assist individuals and organizations in publishing for the web. In the future we will be adding links to publishing tools, articles covering best practices for syndication, and information on content licensing.

Please contact Ryan Tomayko if you would like to be syndicated; we are especially interested in individuals and organizations publishing content related to providing, processing, or managing health benefit plans (e.g., TPAs, Brokers, Insurers, HR personnel, and Technology Vendors).

For more information on the history, technology, and goals behind the project, see About The Health News River.

Proserve Health Informatics upgrades the design of Planwatch with enhancements in: high resolution printed reports, a la cart printing features and processing speed.

A focus on user centered design led to upgrades on the look and feel of Planwatch. You utilize the precision and simplicity of the graphical report convey complex analytical information, and we have improved the quality of those reports. The reports now feature a variety of graph styles and maintain high resolution both online and in print.

We also took your time into consideration and added a la cart printing and increased the processing speed of the Plan Modeler. You can now completely re-adjudicate claims 20x faster than before and print specific graphs rather than the entire report.

Planwatch provides the platform that allows TPAs to offer analytics as a service. You have complete control over user access as well as the ability to blind data when necessary. Specific access parameters are automatically set when users are designated as:Administrator, Broker, Sponsor, or Account/Sales Representative.

Take a moment to view Planwatch and see how simple it would be to add powerful analytics as a service.

The Plan Modeler allows for the optimization of benefit plans with the complete re-adjudication of historical claim sets. Create various plan structure combinations in just a few clicks. Generate corresponding reports to view the financial impact of each plan dimension against the current plan. Show plan sponsors how and where changes to their plan will save them money.

Using the Plan Modeler, administrators are able to design hypothetical, or “what if,” benefit programs and completely readjudicate historical claim sets in order to better gauge the impact of specific modifications.

After a plan model’s claims are readjudicated, the simulated claims activity is analyzed and compared with historical claims activity to produce three reports:

• Overall Comparison Analysis - provides a high level overview of change between the actual claims activity and modeled claims activity. This includes deductible, copay, coinsurance, ineligible charges, and plan contributions.

• Benefit Comparison Analysis - shows the amount of change between actual and modeled plan broken down by benefit category.

• Member Disruption Analysis - determine which members are likely to be impacted by the simulated changes and by how much.

Information gleaned from these reports can be used as evidence for (or against) proposed plan changes. The TPA or broker is able to present complex analytical findings using intuitive interactive reports. Plan sponsors can use reports to eliminate apprehension and ensure the new plan is utilized effectively.

Proserve Health Informatics begins website demonstrations detailing their claims analysis software, Planwatch, for Third Party Administrators (TPAs) and the self funded market.

We are pleased to now offer live website demonstrations. If you have been reluctant to contact us with questions due to time constraints, you can now contact us and schedule a convenient time to have a website demonstration and a Q&A session. Please allow for approximately 30 minutes.