M7: Flashcards
Process of data handling to determine benefit trends and patterns
Data Analytics
Statistical technique used to forecast future behavior
Predictive Modeling
To quantify risk/costs for individuals and groups in health plans
Uses of predictive modeling
Involves outcomes that are partly due to chance
Regression to the mean
How intensively plans use physician visits and hospitals
Consumption
What plan sponsors in a self-funded arrangement contract, often either with a TPA or insurance carrier
Administrative Services Only (ASO)
Health plan trends show there has been increased enrollment and
savings in this type of account
Health Savings Accounts (HSAs)
Health plan trends show there has been increased participation in this type of health plan
High Deductible Health Plans (HDHPs)
Visualization Layer
Analytics solutions
Data collected in spreadsheets and databases
White space data
The number of levels in the Healthcare Analytics Adoption Model
Eight
Level 3 of the Healthcare Analytics Adoption Model
Automated Internal Reporting
This ensures a plan has been set up properly
Transitional audit
Audit procedures associated with plan enrollments
Operational Plan Audits
Suggested frequency of administrative plan audits
Every 3 to 4 years if it is the same plan sponsor