Asking the right questions is key to improving performance and defining success. Only Thomson Healthcare can provide vital insights across all these dimensions of your organization:

• Which service lines are expected to grow fastest?
• Where are our best opportunities to improve labor, supply and utilization?
• Which opportunities are best for improving costs, charges, length of stay, outcomes and delivery of care?
• Who are the real competitors in the outpatient market?
• Where and why are medical errors occurring?
• How should we invest to capture profitable growth?
• How does our clinical performance compare to that of our peers and national leaders?

For example:

• How can you identify and effectively manage high-risk patients?
• How can you build physician and staff resources to create profitable services?
• How can you accurately measure product line profit and loss?
• How can you identify claim underpayments?

How can you identify and effectively manage high-risk patients?

Through data mining and conducting analyses to determine why a health utilization pattern is occurring, you can:

• Examine historic utilization and treatment episodes along with health status, disease propensity, risk factors, and lifestyle traits to develop a comprehensive patient-by-patient risk profile.
• Determine opportunities for increased compliance with recommended treatment plans. Design education, outreach, and medical management programs that engage patients based on their needs and preferences.

How can you build physician and staff resources to create profitable services?

By using cost-benefit modeling to provide alternatives and reveal the right solution, you can:

• Determine historic and projected service utilization patterns in the market.
• Review the existing complement of practitioners within a targeted service – including specialization, productivity rates, practice location, network affiliations, and facility credentials.
• Evaluate growth opportunities by pinpointing current market gaps and revealing potential solutions.

How can you accurately measure product line profit and loss?

By using tracking, trend analysis, and benchmark comparisons to evaluate your solution, you can:

• Trend year-to-year product line charges, costs, and reimbursement by patient case. You can also evaluate these results against current market share.
• Link inpatient, outpatient, and other ancillary charges for a full analysis, then derive actual profit or loss.
• Measure cost savings against forecasted program returns based on best-case scenario calculations.

How can you identify claim underpayments?

By using system event triggers, quick problem analysis, and contract reimbursement calculations that uncover what’s happening, you can:

• Review daily patient work lists to match services delivered with contractual allowances to reveal appropriate treatment that isn’t being reimbursed.
• Calculate expected reimbursement by payer and contract. Compare payments received from payers against allowable contract terms to identify variances.