Test

1. © 2012 Zywave, Inc. All rights reserved.
Introduction to Claims Analysis

2. What is Decision Master Warehouse?

3. Step 1: Benchmark
Problem area
identified:
Emergency room
utilization is high

4. We find that the 4th
most common reason
for ER visits is
ear/nose/throat
claims, illnesses that
probably shouldn’t
need an ER visit.
Step 2: Dig Deeper

5. Continuing to dig, we find that
employees are the highest
utilizers of the ER for
ear/nose/throat diagnoses.
Step 2: Dig Deeper

6. So we know that:
•ER utilization is high
•One of the top diagnoses is one that shouldn’t be seen at
an ER
•Employees are using the ER most
Consider options to address this problem:
•Give employees flexible scheduling to see the doctor
during business hours
•Initiate a communication campaign to educate employees
•Increase the Emergency Room Deductible
Step 3: Explore Solutions

7. To decide if flexible scheduling is a good strategy, let’s
look at which days employees are going to the ER
Step 3: Explore Solutions
It looks like
they are going
on weekdays,
so this sounds
like a smart
strategy

8. To see when a communication campaign would be
most effective, let’s look at when the ER utilization
was highest
Step 3: Explore Solutions
January and
September
were the most
popular
months for ER
utilization for
the diagnoses
in question

9. We can model an increased ER deductible to demonstrate
the financial and employee impact before you make any
decisions
Step 3: Explore Solutions

10. • You can decide based on our analysis and
modeling whether you want to implement
one or more of the following:
– Flexible scheduling
– Communications campaign (targeted January
and August, right before peak utilization)
– Increased ER deductible
Step 4: Implement Solutions

11. We’ll also provide the
employee education
materials for your
communication
campaign.
Step 4: Implement Solutions

12. ANY QUESTIONS??
Contact your [B_Officialname] representative to
learn more or get started today!