3.8 Data Exploration and Drill Down

Many report sections within Claims Review include the ability to drill down for more detail and then to explore various aspects of activity.

What is "Drill Down"?

In its simplest form, "drill down" means nothing more than "give more detail."

High level reports condense large amounts of claims activity into easily digestible summaries. While these reports tell you a lot about your overall plan performance, they often lead to additional questions that require a more detailed look at specific activity. Drill down lets you instantly drop down a to get a slightly more detailed view of activity. If the question is still unanswered, you can drill down further still, in small or large increments, until the answer is apparent.

Drill Down Starts at The Report

The following is a sample benefit analysis report covering an entire plan year for a group with 262 active employees (758 total members). The purpose of this report is to provide a general idea of which benefit categories are most (or least) costly and is often a good starting point for potential optimization:

Benefit analysis full

Suppose the Outpatient Surgery category jumps out as being somewhat high (in this case it's 16% of total plan expense). Clicking Outpatient Surgery drills down into that specific category where, among other things, we can get a better feel for how cost is distributed between members and providers and see how well network contracts are being utilized.

Narrowing the Analysis

The Outpatient Surgery link takes you to a simple but highly functional data exploration screen:

Drilldown employees full

At this point, we are exploring Outpatient Surgery related activity and can slice and dice the view based on what we need to know. There are a number of things worth pointing out here:

  1. The table includes one row per employee and displays the aggregate number of claims, amount paid by the member, amount of savings generated by network contracts, and the amount paid by the plan. Clicking the employee drills down further.

  2. All Personal Health Information (PHI) is blinded but can be "unblinded" selectively by clicking the show PHI link.

  3. The top level reports are always only click away, making it easy to find your way back to the higher level analysis.

  4. The View box determines what is displayed in the table. We'll take a closer look at this in the next section.

Changing The View

Drilldown views

When we initially drilled into the Outpatient Surgery category we were taken to a list of employees but you can change the view by selecting between Employees, Members, Plans, Divisions, Places of Service, Network Contracts, Providers, Charge Types, and Claims. The result list is instantly updated with aggregate values for the selected item:

Drilldown networks full

Here we've selected the Network view and are now able to see how our Outpatient Surgery related activity breaks down across contracts. As you can see, network usage is very high with only a small amount of activity occurring in secondary (less savings) and non network providers.

Putting It All Together

Now that we've seen how to drill down for more detail as well as how to change the view, let's combine the two to show how powerful this form of interactive analysis can be. We'll first narrow the analysis further by clicking PPO 250 and switch the view to Providers:

Drilldown providers full

From here, we continue to narrow activity to include only claims that were generated by Facility11701 and switch to the employee view:

Drilldown employees in provider full

Now we see the employees that incurred claims at Facility11701 and were discounted by PPO 250. Let's go even further and take a look at the individual claims by clicking on the DEMO004:54186 employee:

Drilldown claims full

We've arrived at a listing of claims generated by employee DEMO004:54186, incurred at Facility11701, and discounted by PPO 250. We've also left a convenient trail of breadcrumbs at the top of the page, allowing us to return to any previous context quickly.

Drilldown eob level

Changing the view to Claim and clicking on claim 'CLAIM:12345' will bring you to an EOB type level showing a much more detailed version of the claim.