Medical Cost Trend Management

Identify trends to improve outcomes

A coordinated, ongoing trend management process can lower costs and maintain or improve outcome. We can show you where the dollars are going. Though the actual emphasis differs from health plan to health plan and region to region, we can isolate the biggest areas of concern in medical cost trend.

Three pillars of effective trend management:

• Changing consumer behavior through creative benefit designs, consumer information and participation in focused, proven forms of disease management.
• Changing provider behavior through value-based reimbursement and medical management programs that truly motivate providers to adhere closely to high quality, evidence-based medicine.
• Having rich data and sophisticated analytics that support the benefit designs, the medical management and the contractual arrangements, as well as proactive underwriting and operational efficiency.

Strategic trend management

Using these pillars as a touchstone for their efforts, a few health plans are creating successful, strategically-driven trend management processes. These health plans have shaved a few percentage points off their trend and saved millions of dollars in the short term, while creating lean and sophisticated infrastructures positioned to consistently meet cost and quality goals.

An integrated effort yields the best results

Of course, nearly all health plans have some cost control efforts in place, but the most successful health plans integrate trend management across the various business units, rather than having the efforts emerge from individual business units working with limited reporting capability and only a vague awareness of what the other units are doing. That’s because a lack of integration undercuts efforts to decrease medical cost trend.