Why Are My Medical Costs Going Up?

Population provides the financial perspective to answer why medical costs are going up. Population –based reports show you where the organization is headed financially. Financial performance is measured in terms of volume, mix, and cost of services provided to a covered population.

The software’s financial and actuarial reporting conforms to your business rules, enabling you to produce not only standard monthly and quarterly management reports in seconds, but also create reports on issues such as PMPM trends by line of business, provider group, employer group or anything else that make sense for your organization.

By putting utilization data into a clinical context, showing the medical conditions that drive utilization and accounting for changing disease burden within populations and sub-groups, ProfSoft Population™ helps you understand why your costs are rising and identify clinical areas on which to concentrate your efforts .

• Traditional type reporting with a clinical context.
• PMPMs, unit costs, and utilization rates.
• Medical cost and epidemiological trends.
• Clinical efficiency trends for subpopulations.
• Risk-adjusted trend studies.
• Pharmacy cost and utilization reports.
• Benefit and expense category analysis.
• Enrollment trends.
• Claim lag reports.
• High cost patient distributions.
• Commercial group reporting.

Types of Reports:

• Cost and Utilization Trends
• Risk-adjusted cost analysis
• Period-to-period cost comparison
• Pharmacy cost and use
• High cost members
• Enrollment