ClaimsDX Inpatient
The Skein Health ClaimsDx Inpatient Product is designed to address the real-world data and operations concerns of your clinicians and executives. We take your inpatient claims and use them to power a data solution that resides within your IT infrastructure. Our products allow staff at all levels see and understand drivers of utilization management performance — from high end KPIs down to individual member claims. If the inability to gather and categorize data into meaningful, actionable classifications is familiar to your organization, and you are looking for a solution that works on day one, contact us! We’ll be happy to discuss your needs and provide you with a demonstration of how we can make a difference for you and your members.
inpatient utilization module
In order to effectively manage inpatient utilization, one must dig much deeper than high-level KPIs. You need to understand what is driving variances and design interventions specific to those opportunities. The ClaimsDX Inpatient Utilization module offers unprecedented ability to drill across clinical episodes, providers, geography, benefit types, or just about any other variable your data will support. Coupled with benchmarks and/or your targets, variances can be denominated into dollars to allow you to choose high impact interventions.
Intended for use by Medical Directors, concurrent review leaders, and network operations.
For your custom cohort, can lead to answers to these types of questions:
What are my key opportunities for level of care conversion in my market?
Which facilities are admitting candidates for observation and what are the specific opportunities?
Are there length of stay challenges that are increasing risk for outlier/stop-loss payments?
readmission module
Often improvements in readmission rates can be attributed to implementing solutions to specific problems at a particular facility. The readmissions module allows total visibility into what is driving your readmissions. When benchmarked, insights can be gained down to the DRG level. Expect to see more than just rates — the readmission module allows visibility into the reasons for readmission, and how that varies across different providers.
Intended for use by Medical Directors, quality/STARs leaders, and medical management leaders.
For your custom cohort, can lead to answers to these types of questions:
For our top readmitting facilities, exactly what is driving their variance? Are there one or two readmission reasons or episode types that are driving the variance?
For our key variant episode types, which facilities are doing well and may be a better option?
Inpatient financial module
Inpatient spend is more than just utilization. The other key variable is what is paid per admission — and this information is not always readily available. The ClaimsDX Inpatient Financial module allows you to track spending in the same way that other modules track utilization.
Intended for use by CMOs, network operations, and finance.
For your custom cohort, can lead to answers to these types of questions:
How are surgical rates changing and how does this affect network strategy going forward?
Are facilities with a reputation for high value still delivering?
er module
Emergency Room usage is difficult to manage and is a key driver of inpatient utilization. Is there sufficient network access to ER alternatives? Is your ER providers’ coding appropriate? Are a few members driving your utilization? Are your PCPs sending your members to the ER too frequently? The ER module helps you answer these questions and many more.
Intended for use by Medical Directors, network operations, and concurrent review leaders.
For your custom cohort, can lead to answers to these types of questions:
For your key diagnoses, what are the ER conversion (admission) rates and how does that compare to benchmark and competitors?
Who are the top ER utilizing members?
For key ER-inappropriate diagnoses, who are the top attributed PCPs or PCP groups/Pods/IPAs?
observation module
If you are tasked with managing inpatient utilization, you cannot excel without a robust view of its counterpart, observation level of care. Being able to compare inpatient and observation levels of care by geography, facility, clinical episode type, etc. allows you to see more than just admissions or observations per thousand. Coupled with benchmarks, the ClaimsDX Inpatient Observation module shows you exactly where your opportunities lie.
Intended for use by Medical Directors, medical management leaders, and concurrent review leaders.
For your custom cohort, can lead to answers to these types of questions:
What episodes have the highest opportunity (in dollars) for conversion to a lower level of care when factoring in the cost difference?
Which facilities should I focus on, and what specific episode types (even down to the individual cases) should I discuss when we meet?
member module
Member demographics change over time. The ClaimsDX Inpatient Member module gives you all the details you need. You can understand all the key information about your total membership or countless different member cohorts of your choosing. Once you get down to the individual member level, you can see detailed information about eligibility, problems lists, utilization at all levels, prescription drugs, or even professional claims.
Intended for use by medical management leaders, case management personnel.
For your custom cohort, can lead to answers to these types of questions:
What does my fully insured membership look like in each market?
What health challenges does a specific member referred to disease management have? Are they visiting their PCP? Are they filling their prescriptions?
You have the team in place. You know there are opportunities out there to improve quality and reduce medical expense. You just need the data, and you don’t need to take a year to develop a report to get the data.
You need Skein Health ClaimsDX Inpatient. It delivers real value, not just charts, out of the box. Contact us to learn more about how we can help, or to arrange a demo.