Knowledge 3-23-16

Question 1

How and What of Cost Calculations

Answer 1

Claims-based and derived from an ongoing analysis of client-specific claims. The process begins with 12 months of data,

Question 2

All pricing data is derived from

Answer 2

Change Healthcare’s proprietary algorithms, which leverage allowed amounts and put historical and ongoing claims imports through a custom ETL (extract, transfer, load) process that looks for voids, adjustments and other inaccurate data points for removal.

Question 3

How Specific? And what happens after Savings Engine mines the data?

Answer 3

Once the data has been scrubbed, our Savings Engine mines the data to identify a specific price (by plan and network), at a specific provider, for a specific service.

Question 4

Price shown is the _________ amount?

Answer 4

Allowed

Question 5

Allowed Amount

Answer 5

The total price paid to that provider for the service or prescription, for the member’s (user’s) specific network(s).

Question 6

The Price or Costs are specific to?

Answer 6

Plan & Network

Question 7

How Does Platform Display Price?

Answer 7

Platform shows the total cost for the service or prescription, with a break out of user’s cost and plan cost, based upon the user’s benefit plan and deductible status.

Question 8

When network-specific pricing is unavailable?

Answer 8

Data from the surrounding region is used to determine an average expected cost.

Question 9

From Internal Audits

Answer 9

95% within 5%

Question 10

User or member cost is based on?

Answer 10

Users benefit plan & deductible status

Question 11

How often is data refreshed?

Answer 11

Agreed upon frequencies

Question 12

Accumulator files for benefit status

Answer 12

Typically provided on a weekly basis. But, for many health plan clients, we utilize EDI 270/271 transactions for real time accumulator information.

Question 13

Cost data for Rx-where from?

Answer 13

claims, PBM supplied pricing lists, and generic saving program lists from pharmacy chains.

Question 14

Pharmacy–area of differentiation

Answer 14

The frequency with which we intake claims data from the PBM. Claims are received and processed every other week to ensure the most accurate cost information, rather than monthly or bi-annually as is true of other transparency companies.

Question 15

Pharmacy

Answer 15

We have the most experience in the transparency industry in managing pharmacy claims and in algorithms to identify opportunities for savings.

Question 16

Reporting Frequency

Answer 16

Tied to the stage of the customer in the implementation process

Question 17

1st 4 Weeks Reporting

Answer 17

During the first four weeks after implementation, reports are sent weekly and will be presented by your Account Executive.

Question 18

Reporting post 1st Month

Answer 18

After the first month, we will move to monthly reporting.

Question 19

Quarterly basis Reporting

Answer 19

We present a reporting package which incorporates consultative commentary around user engagement, as well as a roadmap view.

Question 20

Comprehensive Annual Review

Answer 20

Includes our Claims-Verified SavingsTM, is held to compare results with stated goals.

Question 21

Tableau

Answer 21

Deliver a monthly snapshot of your program metrics, including member search preferences, number of sign-ins, in addition to service, provider and prescription search statistics. You can even set-up your reports to deliver to your inbox every month.

Question 22

Well Alerts Based On:

Answer 22

Client need and data analysis (using demographic data, claims history, member search data or data from client sponsored health and wellness programs).

Question 23

Types of Well Alerts:

Answer 23

Preventive Services - founded on evidence-based medicineprotocols
Point of Care Utilization - to help members choose the best providers based on condition acuity and severity
Benefit Program Alerts - to help drive awareness of and engagement in disease management and wellness services
On-site Clinics - to drive utilization of clients’ on-site clinics and pharmacies; working with clients and listening to the challenges they face promoting healthcare consumerism has helped us understand that many of our customers struggle to educate their members on basic benefits

Question 24

Provider Finder Overview

Answer 24

Enables members that are shopping for a health plan or are a current health plan member to easily search and compare: DSHIS

• doctors,
• specialists,
• hospitals,
• imaging centers,
• surgery centers and more in a user-friendly interface.

Question 25

Provider Finder Search & FIlters

Answer 25

on quality, distance, gender, language and more.

Question 26

Members can compare provider-specific detail such as

Answer 26

In- and out- of network flags (for multi carriers), locations, facility affiliation, quality ratings, credentials and special recognitions.

Question 27

3 Primary Differentiators:

Answer 27

Data
Engagement
Integration

Question 28

Data Differentiator

Answer 28

we have access to the single largest financial and administrative healthcare network in the U.S.

Question 29

The Extensive Data allows us to:

Answer 29

provide highly accurate pricing information and more deeply personalize the way we present it to users to encourage their engagement.

Question 30

With dataset, can leverage both:

Answer 30

commercial AND Medicare claims data to provide the most comprehensive view of provider procedure volumes, a key driver in provider quality and patient outcomes.

Question 31

From Engagement Perspective

Answer 31

our ability to present data to the user in a highly personalized fashion, combined with our proactive approach to communication, drives market leading engagement rates averaging 60% across our book of business

Question 32

Integration Flexibility

Answer 32

APIs, Partnerships, etc…

Question 33

Where are the cost estimates are derived from?

Answer 33

recent claims data

Question 34

Our proprietary algorithm factors in

Answer 34

a number of detailed plan, provider and timing elements to support accuracy of system estimates

Question 35

More detailed quality metrics, such as

Answer 35

patient experience, credentialing, outcomes and efficiency measures.

Question 36

How Often does Change Review Quality Data?

Answer 36

Each quarter, Change Healthcare does a thorough review of existing quality data sources and is continually evaluating additional quality data and data provider sources that meet evolving market needs.

Question 37

Who Provides Quality Data?

Answer 37

Provider Ratings (physicians, dentists and chiropractors) are provided by Strenuus, HHS and Health Plan credentialing. Facility Ratings are provided by HHS, AHRQ, HCAHPS and The Joint Commission.

Question 38

Data Sources 1

Answer 38

Member eligibility data: Typically sourced from an eligibility feed.
• Accumulator data: Typically sourced via a real-time EDI 270/271 (eligibility) call routed to the medical carrier.
• Benefit data: Typically sourced from a 270/271 transaction with supplemental information provided by the plan as business rules dictate.
• Provider data: Used when business rules dictate special processes at the provider level. Typically provided in a file on an agreed upon frequency.

Question 39

Data Sources 2

Answer 39

Formulary: Typically provided by a PBM or plan on a monthly basis.
• Service Cost: Sourced primarily from client claims and supplemented with contract rates and/or book of business claims where available.

Question 40

Provider Quality Includes data from:

Answer 40

The largest group of annual studies of hospital quality, physician information and patient experiences available in the U.S., including nationally aggregated ratings for providers and hospitals, and patient care interaction data across 5,000 hospitals and 2 million healthcare professionals.

Question 41

What % of Providers on platform have quality data?

Answer 41

Change Healthcare’s quality data covers 75% of providers available in our database, including facilities, doctors and dentists.