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Clinical Concept Benchmarking

Uncovering evidence-based hot spots

Healthcare insurers need to sift through an enormous amount of utilization data to uncover optimization initiatives and high-value opportunities. To do that, payers need a powerful analysis tool that can pinpoint the areas with the highest potential impact.

Clinical Concept Benchmarking designs initiatives that ensure high-quality care and safety by ingesting an organization’s medical- and pharmacy-utilization data, comparing it with external benchmarks, and highlighting evidence-based hot spots.

~5K

potential risk-adjusted code groupings depending on desired granularity

>65M

lives covered in our third-party data

~5K

clinical concepts covering 106,000 detailed medical codes at a clinically-relevant level of granularity

Our approach

Clinical Concept Benchmarking allows organizations to compare specific member groups and medical-cost categories with those of peers by using external market data. The platform leverages internal data to highlight the specific geographies and populations that hold the greatest potential for utilization optimization.

Intelligent categorization

Our benchmarking insights allow the categorization of all diagnoses, procedures, and pharmacy codes into clinically relevant groups that reflect how patients and providers think about medical care. This allows users of the platform to address common pain points with utilization-management-analytics products and identify interventions to capture identified value.

Simple, powerful, and fast benchmarking

The tool acts as an integrated hub with an intuitive interface that provides automated insights within hours. Users can find answers fast by cutting data based on needs, obtaining information on specific groups, and performing top-down analyses through a variety of visuals.

Equivalent comparisons

Our sophisticated risk-adjustment method allows users to choose a risk-adjustment model that fits their situation by including data on member demographics and chronic conditions and ensuring that the comparison populations are equivalent.

Key features

Utilization granularity

An interactive comparison dashboard provides utilization variance at different levels of granularity, from high-level classifications of service to individual procedure codes, and real-time filtering across various dimensions.

Utilization variance

Interactive visuals show utilization variance at multiple levels. Our proprietary grouping method provides users various views of their data and helps uncover opportunities—at both the highly aggregated and highly disaggregated levels—that aren’t apparent.

Featured expert

Mahi Rayasam
Partner, Ohio - Cleveland
Brings deep experience in advanced analytics, product development, P&L management, performance transformations, and executive...

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