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).
Planwatch is a Datamart. Fully adjudicated claims data is extracted from claims processing systems (e.g., GBAS, Eldorado, 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 72 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.
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.
Planwatch recognizes the key of an effective disclosure process is finding the balance between too much and not enough claim information. Risk Analysis generates a detailed disclosure listing in minutes to include all participants who have exceeded a customizable dollar threshold, received a "trigger" diagnosis, are known high-risk / complex care cases and have incurred disability related claims. By streaming the approach, it allows for the most up-to-date, accurate disclosure and provides detailed reporting with drill down capabilities, to help identify the diagnosis/prognosis of large claimants.
Month End Reporting
Month End reports provide a detailed monthly and year to date summaries of enrollment, paid claim information by group, division and coverage type. These reports chart Network Utilization and Savings, provide a Lag and Adverse Claim report to provide estimates of unpaid claims and illustrate top claimants recent claim activity. This module features the ability to attach and share securely any internal reports or additional documentation.