Claim analysis looks at a client’s claims experience and compares it to existing premiums or benchmarks. It helps clients review the performance of their health portfolio in comparison to expected results.
Milliman has been regularly helping clients analyze variances from expected results. We do a detailed study of the portfolio to understand variances in performance metrics and conduct deep dives to find out the root causes. The metrics to be studied are decided by the portfolio risk managers and the deep dives are done on the basis of the relevance of a finding and the availability of data.
This analysis enables a timely flow of information in the feedback loop and also helps clients to grow in profitable segments and limit the volumes in unprofitable ones. It helps them understand whether to change premium rates and plan benefit structures or introduce new approaches to achieve utilization targets to reach established profit goals. After careful consideration, we recommend action to help the client accomplish its objectives.
Group health insurance
Group health insurance (or Group Mediclaim) claim analysis looks at an employer’s health insurance claims experience and compares it to the premiums or experience benchmarks. This analysis helps employers to find out the claim pattern of the covered members, which helps them make decisions related to changes in product features, wellness programs, and more.
We provide an independent opinion about the coverage that should be bought for employees and dependents. We can also help employers decide which coverage option gives the best value for the premium paid to the insurer.
Employer group claim experience analysis
We have worked with various group health insurance brokers and companies to analyze their data (or their clients’ data) to provide insight into trends and prepare customized experience reports for employer groups. Our reports contained insightful comparisons with market benchmarks, what-if analyses, and comments on possible benefit design modifications.
Our analysis helped the brokers and companies make an informed decision on buying a cover and also provided a half-yearly report on claims experience. This in turn helped employers answer questions like:
- How much insurance is adequate?
- How much corporate buffer is required?
- What is the impact on per-member claim cost and premium in case of a particular benefit design change?
Analyze insurance cost and utilization trends
We worked with a large US health insurance plan to analyze the variance in their year-on-year insurance cost and utilization trends for a number of their insurance policies. Their data was already in our health insurance database and business intelligence system. We extracted several data slices to identify the trends and determine the reasons for the variances.
We helped the client identify what caused costs and utilization levels to rise over the years, and also helped them relate these to their plan benefit structure. In addition, we helped the client to identify their more profitable plans and determine what made these segments profitable.
For more information, please contact us.