SmartCare® Executive Summary

SmartCare® enables both payor and provider health care organizations to design and monitor managed care contracts, disease and case management programs, and then control resource utilization with ease, accuracy and speed. It offers decision makers a significant competitive edge by taking the guesswork out of contract negotiations and providing a powerful tool for quickly identifying outliers and other important issues.

It is unique in its ability to merge all kinds of data, from hospital and physician claims to drug prescriptions and lab tests, membership and eligibility files, and even medical record and outcome data into a single integrated database.

SmartCare® automatically transforms claims data into episodes of care, assigns user-defined diagnostic groups, and produces a massive amount of useful information across hundreds of demographic factors and resource categories. Users can explore the data as much as they like in their own way, confident that the results will arrive in seconds and be displayed with striking graphs. As a result, an analyst can prepare reports and deliver important answers in hours rather than in weeks.

You don’t have to be a statistician, or computer scientist to use it. We designed SmartCare® for you, the healthcare professional.

Functions:

• Merges inpatient, ambulatory, professional, lab, outcome and pharmacy data.
• Imports membership data to analyze eligibility and report on utilization measures.
• Automatically rolls-up data into episode-of-care based on user-defined rules.
• Forecast PMPM and utilization levels for up to 3 studies at the same time.
• Create severity-adjusted risk pools out of larger populations and show the PMPM.
• View the Age/Sex cost patterns for up to 20 resources at a time.
• Drill down into the episodes-of-care and see actual sequences of treatment codes.
• Integration of 3M Health Information Systems’ CRG (Clinical Risk Groups) software available.

Features:

• Import data at a rate of 100,000 claims per hour, with data validation.
• Creates episodes-of-care at a rate of 100,000 claims per hour.
• Allows you to test various carve outs or cost reductions, immediately see the impact on the PMPM, and compare various scenarios on the screen at the same time.
• Intelligible graphs displayed with every query result, along with a graphing toolkit.
• Lets you query resource usage by any combination of demographic, provider, and diagnostic factors, and then see such statistics as standard deviation, mean, best fit.
• Cross-tab diagnostic groups by any set of factors for disease management.
• Simple sliders let you pinpoint the outliers for excessive resource use.Internal security architecture makes it entirely HIPAA-compliant.
• Track patients longitudinally over time to see disease and cost progressions.

Benefits:

• Dramatically increases analyst productivity.
• Find answers in minutes rather than hours.
• Save custom queries to rerun against other datasets.
• Know what the case rate or PMPM should be before you sign the contract.
• Allows you to control and reduce costs over the life of the contract.
• Easily identify and then monitor patients for disease and case management programs.