STOP-LOSS REPORTING
Stop-Loss and MGU Reporting
HRM predictive modeling system provides stop-loss carriers and managing general underwriters (MGUs) with key information about probable shock losses and overall aggregate spending.
It also provides information on high-cost, high-risk patients for the next 12 months. This includes predicted total cost, the estimated amount to be spent on pharmacy, major clinical risk drivers and specialty pharmaceuticals for renewals. Custom underwriting reports can be created to summarize group clinical and cost risks, report on the presence of specific medical conditions and specialty drugs and infusions, and isolate probable shock-loss cases.
Stop-loss carriers can generate fast, accurate quotes for renewals. Monthly updates to HRM plus our Daily Dashboard identify new plan members likely to hit the spec deductible within the policy period. Additionally, with monthly reporting, the carriers can monitor plan performance and identify new shock losses before claims are incurred. This allows them to manage their clinical and financial risk effectively.
THE HRM RISK MEASURES
The HCRM model accurately predicts cost by clinical risk drivers, pharmacy costs, emergency room visits, and inpatient days. The predictive modeling software provides measures of relative risk compared to the national norm for each member. It also provides member risks for 1) being in an acute care environment (ER or inpatient care) 2) the long term impact of multiple co-morbid chronic conditions and poor compliance with standards of care and, 3) the member’s motivation to maintain or improve healthy behaviors.
