© 2012 Zywave, Inc. All rights reserved.

Introduction to Claims Analysis

What is Decision Master Warehouse?

Step 1: Benchmark

Problem area identified:

Emergency room utilization is high

We find that the 4th most common reason for ER visits is ear/nose/throat claims, illnesses that probably shouldn’t need an ER visit.

Step 2: Dig Deeper

Continuing to dig, we find that employees are the highest utilizers of the ER for ear/nose/throat diagnoses.

Step 2: Dig Deeper

So we know that: •ER utilization is high•One of the top diagnoses is one that shouldn’t be seen at an ER•Employees are using the ER most

Consider options to address this problem:•Give employees flexible scheduling to see the doctor during business hours•Initiate a communication campaign to educate employees•Increase the Emergency Room Deductible

Step 3: Explore Solutions

To decide if flexible scheduling is a good strategy, let’s look at which days employees are going to the ER

Step 3: Explore Solutions

It looks like they are going on weekdays, so this sounds like a smart strategy

To see when a communication campaign would be most effective, let’s look at when the ER utilization was highest

Step 3: Explore Solutions

January and September were the most popular months for ER utilization for the diagnoses in question

We can model an increased ER deductible to demonstrate the financial and employee impact before you make any decisions

Step 3: Explore Solutions

• You can decide based on our analysis and modeling whether you want to implement one or more of the following:

– Flexible scheduling

– Communications campaign (targeted January and August, right before peak utilization)

– Increased ER deductible

Step 4: Implement Solutions

We’ll also provide the employee education materials for your communication campaign.

Step 4: Implement Solutions

ANY QUESTIONS??

Contact your [B_Officialname] representative to learn more or get started today!