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Custom Databases & Reporting

HCRM's processing of medical, pharmacy and other data for predictive modeling results in the creation of several databases.  These may be used for additional purposes.

Many of our clients maintain data warehouses for analytical and reporting purposes.  Because HCRM normalizes all data into a common structure, we can generate the data in a set of standard layouts suitable for database use - these are known as "Standard Extracts."  Even when the customer uses multiple carriers or TPAs or Pharmacy vendors, the data are standardized.  Since HCRM collects 24 months of data prior to commencing predictive modeling, the company can provide that two years plus any data collected after that time, generally with monthly updates for the predictive modeling process.  Several groups have over eight years of history in our system. 

As noted earlier, HCRM also generates three files of member level data for each monthly prediction run.  These files are:

  • Member File: contains nearly 300 fields for each person including total cost, forecast cost, inpatient admits, length of stay, ER visits, forecast days inpatient, forecast ER visits, actual costs by diagnosis category, forecast costs by clinical risk driver, primary care physician and other key components.  These values are for the 12 months prior  to the processing date and 12 months after that date.  Thus, a rolling 12 month average for a specific plan is easily generated for each month of processing.
  • Compliance File:  contains compliance with specific standards of care (the system tracks 19 illnesses and four preventive categories) at the time of processing.
  • Therapeutic Class File:  prescription level detail is available in the pharmacy file within the standard claims extracts.  This file contains member level information by therapeutic class of drug.

Both the Standard Extracts and the predictive modeling results files use common member, group and provider IDs so they can be combined in a single query.  Extracts are generally provided in tab delimited text files, but can also be provided to clients in an Access database.

Using these underlying databases gives HCRM the ability to create custom and ad-hoc reports for its clients.  These reports can be one-time to satisfy a particular project or they can be created monthly. 

Through the years HCRM has learned that every business has unique needs.  Though most of your operational requirements are met with Health Risk Monitor and Stop-Loss Claims solutions, we understand that every organization prefers or requires different types of databases or reporting.