SCIOinspire Corp. has released what it calls a Value Based Benefit Design decision support application for its care management and analytics software suite, designed to help health plans improve member engagement through a combination of plan design and financial incentives.
The SCIOinspire VBBD application includes what the vendor characterizes as innovative features and functionality that enable users to determine key drivers of an employer’s healthcare cost; identify which conditions require greatest attention; demonstrate estimated cost increases and savings; and create a proactive monthly report to assess impact of value-based programs.
A SCIOinspire statement says that the VBBD solution is proprietary framework of clinical and actuarially sound logic, algorithms and data, and can be customized for health plans to: improve overall health while controlling costs by increasing the availability of high-value services such as preventative services and early-stage disease management; improve the health plan’s medical loss ratio (MLR) by reducing hospitalizations and emergency room visits; identify and curtail the use of low-value services, such as repeat MRI and CT scans, which often are over-utilized and expensive; and identify the appropriate incentives to drive positive behavior changes at the member level.
SCIOinspire calls the VBBD application a flexible modeling solution that allows health plans to develop products and plan designs while identifying additional services –- such as disease management, wellness programs, targeted communications and web portals –- to engage members more effectively. Health plans can take advantage of the VBBD application in three distinct ways:
-As an advisory and evaluation application through which they submit variables and data for remote analysis via the SCIOinspire application;
-As a hosted application that allows the health plan to run the software separately for each of their employers based on their own claims, demographics, industry code, risk factors, income and co-morbid conditions; and
-As a customized solution that can be tailored to each plan based on the unique medical policies, physician practice patterns, employer demographics and other regional differences.