New McKesson Benchmark Analytics Service Gives Payers Actionable Insights into Claims Performance
Quarterly comparative reports reveal outlier trends in provider billing, facility spend, and more
NEWTON, Mass.--(BUSINESS WIRE)--Today McKesson Health Solutions introduced McKesson Benchmark Analytics™, a new service that helps health plans compare their performance to industry peers and use outlier analysis to discover ways to optimize performance.
“The reality of today’s market is that plans need to save money everywhere they can”
Drawing on current data from over 960 million annual healthcare claims, Benchmark Analytics pairs custom reports with analysis and one-on-one consultations with McKesson experts to give health plans actionable insights into claims performance. This helps plans swiftly pinpoint potentially unnecessary or inappropriate medical spend and take appropriate action to address these issues.
Payers can see how their performance compares to peers with respect to provider outliers, facility-based spend and service cost. The breadth and reach of the data allows plans to discover insights beyond their own claims data that might otherwise be missed. For example, from 2012-2013, McKesson Benchmark Analytics revealed the average payment for the BRCA test (CPT 81211) rose from $1,160 to $1,4281. With the additional awareness that various labs charged anywhere from $900-$2,800 during that timeframe in different lines of business, payers may gain a much stronger negotiating position with laboratories.2 Apparently some payers were unaware of paying nearly double the average cost for the BRCA test3.
“Payers want to know how their paid claims compare side-by-side with a statistically significant sample of their peers,” said Ali Russo, director of business analytics at McKesson Health Solutions. “The discoveries often are eye openers that can drive actions that optimize plan performance. Now, thanks to McKesson Benchmark Analytics, payers can be armed with the crucial insights that help them improve their bottom line in sync with market dynamics.”
The McKesson Benchmark Analytics’ dataset is updated every quarter and is HIPAA and HITECH compliant. It includes multiple claim types (professional, outpatient and inpatient facility) and aggregates statistically significant data sampling distributions across all four regions of the United States, as well as across commercial, Medicare and Medicaid lines of business.
Payers can choose any one or all of three available benchmarking packages: Provider Outlier Analytics™, Facility Outlier Analytics™ and Service Outlier Analytics™. Every package includes analysis from McKesson experts and dashboard-style reports on a regular basis (quarterly or annual) as needed. McKesson Benchmark Analytics are available to all health plans regardless of whether or not they license McKesson payment integrity software solutions such as ClaimCheck® or ClaimsXten™.
“The reality of today’s market is that plans need to save money everywhere they can,” said Carolyn Wukitch, senior vice president and general manager for the Network and Financial Management at McKesson Health Solutions. “McKesson Benchmark Analytics is a great new way to help plans accomplish that goal and keep up with market financial trends.”
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McKesson Corporation, currently ranked 15th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit us at www.mckesson.com.
1 Co-pays and deductibles may not be considered in the paid claim line totals.
3 BRCA testing was only performed in a single laboratory prior to the Supreme Court patent ruling in June 2013, making this variation in pricing and payment amounts even more remarkable.