Public Sector

Medical Expense Benchmarking & Analysis

With margins razor thin in the increasingly competitive health care market, it is important for health plans, insurers, and at-risk providers to understand how their experience compares to realistic and achievable industry benchmarks.

A medical expense benchmarking analysis will empower you to understand the areas with the greatest return on investment or potential savings.

Create realistic, achievable, and sustainable medical expense targets

The Reden & Anders medical expense benchmarking analysis relies on the Reden & Anders Utilization Rate Estimates. This detailed, longitudinal database represents the experience of more than five million managed care members. Reden & Anders Utilization Rate Estimates is one of the largest databases in the U.S. of actual Health Maintenance Organizations (HMOs) and other Managed Care Organizations (MCOs) and is updated regularly. Our  access to this database helps us deliver a superior level of analysis.

Value

  • Compare against current benchmarks
  • Identify areas where there are significant duplicate claims
  • Recover significant claim overpayments

Summarize your experience with proprietary methodology

Compare your experience to Reden & Anders’ benchmarks by major service category (i.e.; inpatient hospital, outpatient hospital, physician, prescription drugs, and other) to Reden & Anders benchmarks. We drill down into greater and deeper levels of detail including: inpatient by type of day and by DRG; outpatient hospital by service categories; physician by service category and by physician specialty; and prescription drugs by therapeutic class.

Adjustable benchmarks

The benchmarks are adjusted for your block of business/population (commercial, Medicare+Choice, Medicaid – TANF, Medicaid – CHIP, Medicaid – SSI, etc.); product design (co-pays, limitations, etc.); demographics (age and gender); geographic location; and medical management level (loose, moderate, and well).