CEBS GBA/RPA 3 - Module 7 - Analytics
and Vendor Management, Questions &
Answers. VERIFIED.
Define data analytics in the health care context. - ✔✔-Data analytics is the process of inspecting,
cleaning, transforming, interpreting and modeling data to discover trends, patterns, and other
information that can support benefit plan decisions and changes. The ultimate goal of this work is to (1)
reduce costs and (2) improve clinical outcomes and/or the participant experience.
Define predictive modeling in the health care context. - ✔✔-Predictive modeling is a statistical technique
commonly used to forecast future behavior. It involves analyzing historical and current data to generate a
model to forecast future outcomes. Predictive modeling can be used to quantify risk and costs for
individuals and groups of individuals enrolled in a health plan.
List the ways in which predictive modeling can be leveraged by health plans. - ✔✔-a. Review a plan's
disease burden (health status) and how this burden will change over time.
b. Stratify a plan's population by risk level to identify at-risk and catastrophic claimants for targeting
disease management and case management, respectively
c. Identify risk factors likely to generate future plan costs that should be targeted with more intensive
outreach, including finding at-risk individuals who - although they may be low-cost today - may generate
significant costs in the future
d. Compare relative resource consumption by groups for budgeting and underwriting forecasts.
Consumption refers to how intensively plans use physician visits hospital stays and other resources to
care for members.
e. Compare providers fairly, adjusting for differences in health risk among patient populations. Such
comparisons can be used to profile providers for utilization review and quality of care.
f. Analyze a medical management program to see what the true savings are, as opposed to those that are
regression to the mean. Regression to the mean involves outcomes that are at least partly due to
chance. It refers to the phenomenon of "averaging out" in statistics.
Explain how health plan sponsors can use data analytics and predictive modeling. - ✔✔-a. Identify claims
trends
, b. Target high-risk users
c. Identify gaps in care
d. Steer patients to the best providers
e. Measure vendor performance
f. Uncover cost-sharing strategies
g. Engage participants in their own care
h. Investigate waste, abuse, and fraud
Describe the five recommended steps that plan sponsors should take to implement data analytics and
predictive modeling tools. - ✔✔-a. Determine who will perform the data analytics. Only the very largest
plans have the capabilities to handle data analytics on their own. Most need to decide whether the
analytics offered by their existing health care vendors are sufficient or if they should outsource their data
analytics.
b. Use data analytics and predictive modeling to identify and map the most prevelant clinical
characteristics and associated costs in the plan population. Plan sponsors should then evaluate the
programs in place to address these risks
c. Establish a three-year health-management strategy. This strategy should have a budget, goals, and
performance targets that increase over time (e.g., improving wellness program participation from 10% in
year one to 50% in year two and 75% in year three).
d. Develop a formal participant communications strategy. While data analytics can reveal the cost
outliers to plan sponsors, effective communication have an immediate, direct and positive impact.
e. Identify how plan participants will react to change. It is important to remember that any changes a
plan sponsor implements affect people directly.
Identify three macro trends that present impact day-to-day operations of most HR teams. - ✔✔-1. Rising
health care costs. Health care costs consistently outpace inflation and make up one of the largest line
items in almost every company's budget.
2. Budgets are under stress. Budgets are under pressure, and HR departments are being asked to do
more with less. COVID-19 accelerated this trend for many industries - and even for unaffected industries,
the uncertainty surrounding future variants has often led companies to become more risk-averse and to
restrict spending.
3. Workforce shifts. Attracting and retaining the best talent is key to company growth and sustainability.
Economic changes surrounding COVID-19 have given employees more choice than ever, leading to the
largest upheaval in talent acquisition and retention in two decades.
and Vendor Management, Questions &
Answers. VERIFIED.
Define data analytics in the health care context. - ✔✔-Data analytics is the process of inspecting,
cleaning, transforming, interpreting and modeling data to discover trends, patterns, and other
information that can support benefit plan decisions and changes. The ultimate goal of this work is to (1)
reduce costs and (2) improve clinical outcomes and/or the participant experience.
Define predictive modeling in the health care context. - ✔✔-Predictive modeling is a statistical technique
commonly used to forecast future behavior. It involves analyzing historical and current data to generate a
model to forecast future outcomes. Predictive modeling can be used to quantify risk and costs for
individuals and groups of individuals enrolled in a health plan.
List the ways in which predictive modeling can be leveraged by health plans. - ✔✔-a. Review a plan's
disease burden (health status) and how this burden will change over time.
b. Stratify a plan's population by risk level to identify at-risk and catastrophic claimants for targeting
disease management and case management, respectively
c. Identify risk factors likely to generate future plan costs that should be targeted with more intensive
outreach, including finding at-risk individuals who - although they may be low-cost today - may generate
significant costs in the future
d. Compare relative resource consumption by groups for budgeting and underwriting forecasts.
Consumption refers to how intensively plans use physician visits hospital stays and other resources to
care for members.
e. Compare providers fairly, adjusting for differences in health risk among patient populations. Such
comparisons can be used to profile providers for utilization review and quality of care.
f. Analyze a medical management program to see what the true savings are, as opposed to those that are
regression to the mean. Regression to the mean involves outcomes that are at least partly due to
chance. It refers to the phenomenon of "averaging out" in statistics.
Explain how health plan sponsors can use data analytics and predictive modeling. - ✔✔-a. Identify claims
trends
, b. Target high-risk users
c. Identify gaps in care
d. Steer patients to the best providers
e. Measure vendor performance
f. Uncover cost-sharing strategies
g. Engage participants in their own care
h. Investigate waste, abuse, and fraud
Describe the five recommended steps that plan sponsors should take to implement data analytics and
predictive modeling tools. - ✔✔-a. Determine who will perform the data analytics. Only the very largest
plans have the capabilities to handle data analytics on their own. Most need to decide whether the
analytics offered by their existing health care vendors are sufficient or if they should outsource their data
analytics.
b. Use data analytics and predictive modeling to identify and map the most prevelant clinical
characteristics and associated costs in the plan population. Plan sponsors should then evaluate the
programs in place to address these risks
c. Establish a three-year health-management strategy. This strategy should have a budget, goals, and
performance targets that increase over time (e.g., improving wellness program participation from 10% in
year one to 50% in year two and 75% in year three).
d. Develop a formal participant communications strategy. While data analytics can reveal the cost
outliers to plan sponsors, effective communication have an immediate, direct and positive impact.
e. Identify how plan participants will react to change. It is important to remember that any changes a
plan sponsor implements affect people directly.
Identify three macro trends that present impact day-to-day operations of most HR teams. - ✔✔-1. Rising
health care costs. Health care costs consistently outpace inflation and make up one of the largest line
items in almost every company's budget.
2. Budgets are under stress. Budgets are under pressure, and HR departments are being asked to do
more with less. COVID-19 accelerated this trend for many industries - and even for unaffected industries,
the uncertainty surrounding future variants has often led companies to become more risk-averse and to
restrict spending.
3. Workforce shifts. Attracting and retaining the best talent is key to company growth and sustainability.
Economic changes surrounding COVID-19 have given employees more choice than ever, leading to the
largest upheaval in talent acquisition and retention in two decades.
