MedInsight and Hayes Create Industry’s First Evidence-Based Claims Analytics Solution
June 18, 2019
Milliman’s MedInsight® and Hayes, a division of TractManager, announced the MedInsight Hayes Grouper™, a powerful new decision-making tool that integrates Hayes’ clinical criteria with Milliman’s industry leading claims analytics to create a robust data set of evidence-based claims analytics™.
David Mirkin, MD, Chief Medical Officer at MedInsight, explains, “This solution is the first of its kind to combine traditional analytics with evidence-based metrics to provide a new depth of insight into unique populations. It is the only product healthcare insurers can use retrospectively to understand where spending without proven benefits exists, and to prepare proactively for the impact emerging and disruptive technologies may have in the future.”
Trace Devanny, CEO of TractManager, added, “The MedInsight Hayes Grouper is an exciting new solution that is going to support healthcare professionals in making better, more defensible clinical and policy choices. The Grouper’s unique decision support analytics will help insurers manage the enormous challenges that are raised by emerging and disruptive technologies. And it is consistent with our mission to help providers and insurers make smarter decisions with data, research, and services as they continue to advance a smarter, more integrated healthcare system.”
The MedInsight Hayes Grouper uses Milliman’s powerful claims analytics and pairs it with Hayes Ratings™, the gold standard for evidence-based analysis trusted by insurers and providers for more than 30 years. The Grouper features two evidence-based analytics calculators that analyze the impact of emerging and disruptive technologies, such as new therapies, medical devices, and diagnostic testing. The Disruptive Technology Impact Calculator™ determines the potential financial impact that emerging and disruptive technologies may have on an insurer’s population over time. The Hayes Rating Impact Calculator™ runs the client’s MedInsight claims analytics against Hayes’ evidence-based criteria to identify and determine the real cost of technologies that lack clinical evidence to support their use for specific clinical applications.
Maura Connor, Chief Operating Officer of TractManager’s Hayes division, noted, “The MedInsight Hayes Grouper offers clients a new way to mine claims data and identify procedures and technology utilization not backed by evidence. The results are consistent with TractManager’s and MedInsight’s goals of positively impacting our healthcare system through improved decision-making, patient outcomes, and sound financial results.”
Purchasing blood has become more challenging than ever, due to supplier consolidations and shortages of platelets and rare blood types. As a result, skillful negotiation of blood service...
In November 2019, the Centers for Medicare and Medicaid Services (CMS) published Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule (the Final Rule,...
Better start making your list and checking it twice. No, we’re not suggesting you become Santa Claus. We’re referring to checking your Medicare Provider Enrollment, Chain, and Ownership System...
Top 10 Negotiating Strategies
Skilled negotiators are like musical virtuosos. They have an extensive repertoire of tactics from which to draw, and they know when and how to make them a part of their performance. But negotiating healthcare contracts for capital, purchased services, and IT services can test the artistry of even the most masterful negotiator.