PMPM Module
Once the raw data has been transformed into a “study” in SmartCare®, i.e. data organized into episodes-of-care with a wide range of internal relationships created and statistics computed for data mining, you have all of the analysis modules at the top of the main toolbar at your disposal.

The sequence of buttons on the main toolbar is based on the “Drill down” concept fundamental to data mining. We start at the 20,000-foot level in the PMPM Module, looking at the aggregate utilization figures for every resource category, with grand totals of total number of treatments and costs. The highlight of this module is its automatic computation of the PMPM for the dataset. This usually takes an actuary a week to do. In the PMPM, when you select the study you want to view, it gives you the PMPM instantly.

One of the strengths of this module is its ability to display up to 3 studies on the screen at the same time, so that you can compare last year’s data to this year’s, and those against a benchmark for example. Other highlights of the module are:

• the Capitation and Utilization calculators (the Capitation Calculator is shown on the screen, after carving out the Ambulatory Surgery category) which let you quickly see the impact of various carve-out or threshold strategies.
• the Risk Pool window which lets you create a new study of episodes based on any combination of selection criteria, such as those in a common disease group, or being seen by a particular medical group or working for a certain employer. This risk pool can be saved and then accessed directly as another study throughout the rest of the system.