CASE STUDY: The Power of A Flexible, Turnkey Software System:

Prairie States empowers customers by putting data into their hands --showing them what works, what doesn’t work -- and helping to slash
costs and measure health plan performance

 

By Michou Reichelsdorfer

President

Prairie States Enterprises, Inc.

 

Background

Prairie States Enterprises, Inc.  (www.prairieontheweb.com), with locations in Chicago, Ill. and Sheboygan, Wis., was founded in 1989 by nurses and other medical professionals with a commitment to managing health benefits in order to deliver quality, affordable healthcare. As a third party administrator (TPA) Prairie States draws on the experience and expertise of its staff to provide a complete range of services while controlling costs for clients in the simplest way possible. The company uses live operators – no service call is automated.  Underneath the high touch service runs a sophisticated technologically advanced company offering a comprehensive range of products and services in health benefits.

 

Strategic Challenges: 

As a TPA, we live or die by the data and analysis we provide our customers. Our challenge was to expand our data analysis capabilities in order to get a view of not only where a health plan has been but where it is going. We needed to be able to give our clients a clear view inside a patient population in order to help those populations. If we were looking at a thousand employees with 167 diabetics in a particular population, we wanted to know how many were in compliance with medical and pharmaceutical care; how many had a hemoglobin A1c test that year; how many had a urinalysis; and so on.

 

Because of our need to apply business management control principles and performance measures, we began to look for a technology partner that could get us up to speed and help us integrate healthcare analytics.

 

Our objective was clear: a cost-effective technology solution to provide our customer base, broker/consultant partners, plus internal staff, with the ability to collect, integrate, and organize healthcare data to optimize value-based health plan designs and generate the information needed for initiating interventions that incent individual behavior changes, improve member health, increase workforce productivity, and lower healthcare cost trends. Primarily, we needed data and analysis tools, executive reporting, benefit modeling capabilities, and flexibility.

 

Data Management Solution

Initially, we considered four data solution providers. One company offered a powerful tool, but it was a one-size-fits-all and could not be customized, which is critical in the TPA industry. Another company offered great annualized reports with benchmarking, but wasn’t strong in spontaneous analysis or benefit modeling. It also failed to provide any kind of flexibility. The third company didn’t offer the level of analytics and modeling that we needed.

 

The fourth company, NavigatorMD, Inc. (www.navigatormd.com), stood out as our clear vendor of choice. Navigator’s Design180™ technology collects, integrates, and organizes healthcare data into a single repository. Their price was very competitive, and they offered an easy-to-use solution adoption that could be fitted to our corporate culture, which was an enormous advantage. We also liked the power of Navigator’s analytics and benefit modeling, along with the continuous evolution and clinical foundation. The biggest advantage of using Navigator, however, was that it could be customized to meet specific organizational needs.

 

Implementation

We started with Navigator as their second customer using version 1.0.  The implementation and training went very smoothly.  With each new version, we receive updated information on what the version changes are, as well as training for new features.  The IT support is outstanding. NavigatorMD processing turnaround is usually within a day of data transmission.

 

Currently, we use Navigator’s Design180™ with the beta version data dashboards, which have been in place since February of 2009.  Installed and running in one month, Navigator allows our clients to identify health risks and their causes, arming plans with information to introduce appropriate health practices and incentives for behavior modification.  As a result, they can track member progress and calculate the return-on-investment for interventions and wellness activities.

Navigator’s Design180™ technology has become our best ally in helping our clients control costs and revitalize employee productivity lost as a result of poor health. As a data repository with a global filtering system, it allows users to look at different levels of compliance and identify trends within patient populations to determine potential problem areas. If members are out of compliance, then it becomes a matter of looking at potential factors that are influencing the lack of compliance within that population, be it plan design, education, or any number of variables.

 

Results

Across our book of business, we have been able to achieve cost savings that have held our customers to below the national average annually.  This is due in part to the power of the Navigator tools, and the integration with our health services and claims management processes.

 

Navigator exceeded our expectations. They have been highly instrumental in helping us step up our customer and broker data and analysis needs.  Because Navigator promotes more effective health plan modeling and empowers plans to align their investments with incentives that advance behavior modification, we have been able to generate results for our clients, who are empowered with information to reduce individual health risks and favorably impact health cost trends.

 

For example, our BOB (book or business) claims cost increases have been below the national average.  From 07 – 08, our BOB cost increase was 5.4% versus the national average 7.3%.   So far in 09, we are trending at 4.6% BOB versus national projections of 6%.  Part of this can definitely be attributed to Navigator giving us the ability to model benefits, and analyze data to give targeted direction to “value-based” plan design changes.  NavigatorMD’s  powerful filtering system allows us to “slice and dice” data in practically any way we can imagine, giving us the ability to measure, monitor and track plan utilization and cost in many different ways. 

 

We are also using Navigator’s tools in our health management program so nurses and clinicians can use Navigator to provide data support and analysis of patients to reach objectives for customers. We don’t just look at diabetes but at a patient’s entire health status, to flesh out the whole picture and provide lifestyle support.

 

Navigator’s turnkey software solution is more than just a tool. It is one system that does it all through data integration – and thus gives us a competitive edge by helping our clients make correlations between cost and behaviors. For example, the system allows users to compare data on average claims for patients within a population group who are compliant with medical and pharmacy treatment standards and those who are not. If the average claims cost is $3,000 per year for a particular disease state for those who are in compliance versus an annual cost of $12,000 for those who are not, alarms are raised and programs can be tailored to address this disparity. 

 

Navigator looks at de-identified, aggregated groups of data to pinpoint trends. Take, for instance, hypertension. One thing this powerful tool can look at is blood pressure medication. Let’s say a patient is supposed to get 30-day refills every month but has only gotten six refills in the past 12 months. That would indicate the person is only getting refills 50 percent of the time. Perhaps they are pill splitting or getting samples, but the data shows at least a probability that they are not getting their refills.

 

Simply put, Navigator provides the endless flexibility to modify data analysis and view a population from every angle imaginable.

 

It’s also possible with Navigator to look at issues such as income levels, education, communication, and other access barriers. With this breadth of information, plan design decisions can be made for positive utilization, which is the actual cost of meeting the treatment standards for a particular disease stage. Bottom line: Navigator helps us help our clients by using this information to intelligently reframe or redesign a benefits program, drive positive utilization, and achieve appropriate behaviors.

 

Additionally, Navigator offers outstanding customer service at every step of the way, facilitating new versions of the solution and helping us with customer and broker partner training. This has been a tremendous improvement in terms of implementation success. The Navigator staff is wonderful to work with. In fact, we feel a close affinity with them as if we are part of the same company or an extension of one another. They bring to the table competence and technical focus wrapped up in a visionary approach.

 

Navigator allows us to put the power of data into our client’s hands, which is so important, especially during fiscal uncertainty when knowing where the dollars are and measuring a health plan’s performance are so critical.

 

Before we began utilizing Navigator our data analysis ability was comparable to a black hole. Navigator opened the aperture wide and eliminated our greatest challenge: providing flexible, customizable data and analysis. With this technology we have the ability to determine a client’s needs and fulfill it no matter what level of sophistication required, with absolute flexibility across various industry partners.

 

Before Navigator, I would sometime spend weeks analyzing data. Now when a change in parameters occurs and the data must be re-analyzed, it usually takes me no more than a half hour. It’s by far a more streamlined, accurate, and efficient process.

 

And they company’s upgrades are frequent and much added value to what already is there.  They are indeed a great organization with a unique superior turnkey system that is leading edge, a game changer for healthcare.