1.1 What is Planwatch?

Planwatch is a web-based analysis and reporting tool used to examine the current and historical performance of employer provided health benefit programs. Its use is optimized for, but not limited to, self-funded insurance scenarios involving the co-operation of one or more Health Providers, PPO Networks, Sponsor Companies (Employers), and TPAs (Third Party Administrators).

Datamart

Planwatch is a Datamart. Fully adjudicated claims data is extracted from claims processing systems (e.g., GBAS, Eldorada, RIMS, WLT, etc.), scrubbed, and transformed into a structure optimized for analysis. This restructuring of data makes it possible to perform intensive queries efficiently and allows historic activity to be correctly analyzed.

In most cases, new claims data is fed into the system on a weekly basis and is available for analysis within 24 hours of being received.

Analysis and Reporting

Planwatch takes a report oriented approach to analysis. Claims Review and Trend Analysis provide a set of powerful top level reports with summary and trend information on Network, Benefit, Provider, Diagnostic, Member Demographic, and Overall plan performance. These reports provide a starting point for deeper analysis using the drill-down capabilities built into every report. With drill-down, it is possible to pin-point the exact source (or sources) of specific activity displayed on higher level reports.

Plan Modeling

In addition to analysis and reporting, Planwatch provides the ability to simulate changes to a plan's benefit structure by re-adjudicating claims with modified benefit parameters. The result of the simulation is then compared with the actual claims to determine the impact of proposed changes in benefit structure.