Harvard Pilgrim

Question 1

How continuously evaluate & improve performance of your platform?

Answer 1

• Ongoing dialogue with customers
• Agile development methodology is an iterative development process allows us to continually refine product
• Inputs for new features come from a variety of sources: internal concepts and ideas, market trends, usage data, perpetual usability testing, and most of all, our valued clients.
• In 2015, we conducted four in-person focus groups with more than 50 participants for redesign

Question 2

Usability Testing

Answer 2

• Conduct weekly usability test

- Testing for UI, UX and language (health literacy)

Question 3

Incorporate Input in Product Roadmap

Answer 3

• Human Centered Design Approach
• most of our design enhancements are the result of consumer feedback gathered via the platform feedback loops, through customer support interactions, or focus groups.
• Change Healthcare also deploys a semi-annual User Satisfaction Survey

Question 4

Human Centered Design Approach

Answer 4

?

Question 5

Process by which you evaluate and update your product roadmap? What is your release schedule?

Answer 5

• We operate in an agile product development environment, allowing us to manipulate our product development roadmap to meet the demand of the market and our clients over time.
• We typically deploy new features to our products multiple times a month, allowing us to deliver features in a timely manner as we follow our roadmap over time.

Question 6

CHC’s product roadmap is informed by:

Answer 6

Market dynamics, macro trends, and feedback from clients and members.

Question 7

Next 2 Yr Focus (Product Roadmap)

Answer 7

Enhancing the capabilities of our transparency solution and adding new decision support features to help users make more informed choices throughout the benefits utilization process

Question 8

Envision Building (Product Roadmap)

Answer 8

Integrated engagement platform that utilizes advanced analytics and deep consumer insights to act as a vital decision support tool for users and communication hub for plan sponsors

Question 9

Focused on Bridging Gap

Answer 9

Between individuals’ intentions and actual behaviors around healthcare consumerism.

Question 10

Cost Information on How Many Services & Prescriptions:

Answer 10

More than 1,000 medical and dental services and over 4,000 prescription medications.

Question 11

Agile development methodology

Answer 11

Iterative development process allows us to continually refine product

Question 12

What is price shown representative of

Answer 12

the “allowed amount” or the total price paid to that provider for the service or prescription for their specific network(s)

Question 13

Shows Total Cost w/ a Breakout of:

Answer 13

user cost and plan cost, based upon the user’s benefit plan and deductible status.

Question 14

Can Sort By

Answer 14

Cost, Quality, Distance

Question 15

Describe your experience working with varying provider reimbursement methodologies (e.g., APR DRGs, MS DRGs, APCs, PAFs, bundled payments, fee schedule inflators).

Answer 15

The cost methodologies used at Change Healthcare are most often geared towards the primary CPT code associated with a service with reference Revenue and DRG codes included based upon our service specific rule sets

Question 16

Because we recognize that provider reimbursement methodologies may vary across providers and services

Answer 16

• Have built our algorithms to be flexible and support many different versions per service/client
• Allows us to very quickly modify our rule sets as new methodologies are identified through analysis or requirements

Question 17

What are your capabilities for using industry prices, such as all payer data, to fill gaps where Harvard Pilgrim specific prices are not available? What sources do you use to provide the information?

Answer 17

Change Healthcare uses claims data available through our Intelligent Health Network which includes $1.2T in claims across 200M members and 850k providers. The output of this data is local specific ranges/medians along with listings of the providers and facilities that perform those services.

Question 18

How are costs based on claims data calculated?

Answer 18

The primary data source utilized to develop pricing and savings opportunities are fully adjudicated medical, pharmacy, vision and dental claims delivered to Change Healthcare through the client’s respective carriers. In addition, we are able to leverage fee schedules and external cost services where available.

Question 19

The primary data source utilized to develop pricing and savings opportunities

Answer 19

Are fully adjudicated medical, pharmacy, vision and dental claims delivered to Change Healthcare through the client’s respective carriers.

Question 20

Can you leverage fee schedules and external cost services?

Answer 20

Yes

Question 21

Pricing low volume services

Answer 21

In cases where the volumes are not enough from the payer-supplied claims data, local range data is provided using the data available from our Intelligent Health Network claims set.

Question 22

c. What level of granularity (facility vs. non-facility, contracted vs. non-contracted, Commercial vs. Medicare, carrier distinction (fully vs. self insured), state, physician practice, product) is displayed for pricing?

Answer 22

When a member performs a search for a service, the pricing returned is specific to that member’s “network” as identified through rules established through the implementation process. The normal display includes the provider/facility information including demographics, specialty, facility type, and quality/review pointers. Non-participating providers are typically not shown.

Question 23

Are you able to show costs for a full episode of care vs. a single procedure or surgery? If so, how do you lay these out for the user?

Answer 23

We display costs at the micro-episode level, bundling the services, products, and fees of a given healthcare event, such as a surgery. Based on our research and experience, this unit of analysis is the most intuitive for consumers and true to their shopping behavior and typical journey.

Question 24

Can you display broader episodes of care?

Answer 24

We have the ability to integrate and display your episodic cost data to include elements of a broader episode or bundle of care at either the provider or geographic level, such as a pre-surgical consultation or physical therapy post-surgery

Question 25

How do you explain to the consumer what constitutes an episode? Are you able to disclose what services are included and excluded for the episode’s price?

Answer 25

Based on our definition of a mini-episode, we explain to the user what constitutes an episode by showing the user the total cost and member responsibility for a bundled service with an option to see details. Accessing the details for a bundled costs shows a breakdown of applicable costs that constitute the total. For example, a knee replacement might include anesthesia, facility, and provider costs, among other items. These will vary from service to service based on our bundling logic.