Analytics & Outcomes | KWS

Measurement:

Data Analytics, Impact, Reportable Outcomes

As an account manager and marketing expert whose advising and consulting clients,

showing demonstrated value is crucial.

Project | 01

Hospital Adjustment Category Trending Report for Health Plan/Hospital Discussions

As an Account Manager for Equian for 2.4 years, a key component of my job was the preparation for potentially adversarial health insurer/hospital reimbursement discussions. I'd summarize individual hospitals' top expenditures that require additional information in order for the hospital to receive reimbursement.

First I'd shared the key findings with our internal team

(VP of Clinical, Medical Director and Resolution Specialist (lawyer)). Next, we'd share the content and strategize with the corporate client and plan-level representatives (VP of Contracting, Provider Relations Representative, Medical Director). At this time we'd provide recommendations on how to best approach the hospital representatives during the upcoming conference call and/or in-person meeting.

In the attached illustration, the four individual hospital's billing activities would be reflected in tabs 2-4. Using Excel pivot tables,

top-line-item expenditure was listed and categorized. Key findings are summarized on tab one.

Also, during monthly meetings with state-specific health plan Provider Relation teams, I'd highlight significant billing practice trends associated with assigned hospitals. The intention of these standing meetings was to prevent staff from being caught

off guard should a hospital representative contact them.

Project | 02

Project | 03

Reporting Migration to Tableau /

Report Dashboard Product Launch

While at Equian, a key component of my role was presenting desired shifts in programming. Creating operational efficiencies was critical due to explosive growth. My enterprise client was the first large client and having been served for eight years, transitions need to be managed delicately.

One corporate initiative involved migrating client

reporting from Pentaho to Tableau. Responsible

for development oversight of 15 unique enterprise reports, I provided thorough written specifications,

led phone discussions with the development team member, and conducted QA.

It was a seamless transition, and I had the

opportunity to highlight enhancements

when sharing the package with the client.

One year later, internally, I began collaboration

on developing a client-facing reporting dashboard. The purpose was two-fold:

1. To increase client reporting accessibility

with real-time data and

2. To reduce the amount of time required of me

to complete reporting activities.

As the subject matter expert, working with a

Report Dashboard Development Committee, over

the course of four months we successfully released

the Dashboard provided a training guide and

held several live desktop-sharing presentations

with the client representatives.

Attached is a reflection of the Dashboard Guide.

Project | 04

Care Management: year over year metic improvements

For the McKesson Care Management program, it was Program Communications' responsibility to reinforce the education taking place between the member and nurse advisor. Our organization's ultimate goal was to produce improved patient outcomes and generate health plan savings.

For these high-cost high-risk target groups, direct mail and interactive voice response (IVR) were often leveraged. Messaging would provide a specific call to action to increase metrics associated with an activity such as:

Establishing a medical home
Taking medications consistently
Getting influenza vaccination each year
Diabetics getting an A1C test biannually

IVR technology captured member responses so we could quantify items like:

A. The member already received a flu shot this season

B. The member has an appointment to get their flu

shot, or

C. The member is choosing not to get a flu shot.

For those members with associated PCP, reports would be supplied to ensure all parties were abreast of care plan activities.

Reflected in the PDF are sample metrics.

Project | 05

Flu Vaccine Randomized Control Trial published in the American Journal of Managed Care

Partnering with a McKesson statistician, a study was conducted to measure if medical services utilization changes and return on investment from a health plan's direct mailings that either encouraged members to receive influenza vaccinations or encouraged members to call a nurse advice service.

The health plan's Medicare-primary population (all members were over 65) was placed into a randomized control trial with two intervention groups and one control group.

Group 1 received a mailer recommending they get a flu vaccination
Group 2 received a mailer recommending they call the nurse line
Group 3 was the control group thus, no one received a communication piece.

The results suggested that members respond to health plan mailings. By mailing information to their members, health plans can affect rates of medical service utilization and generate cost savings.

Group 1 experienced a 2.87% fewer condition-related inpatient bed days at a hospital and 7.25% fewer condition-related emergency department visits.

Group 2 experienced a 7.65% fewer condition-related inpatient bed days at a hospital and 6.75% fewer condition-related emergency department visits.

The return on investment was estimated to be $2.51 for the influenza mailing and $24.24 for the nurse advice mailing intervention.

The conclusion, based on administrative claims data, suggests that members respond to health plan mailings. By mailing information to their members, health plans can affect rates of medical service utilization and generate cost savings.

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