As we examine the variation in costs from one provider to another, it is good to keep in mind that there are at least three important components of cost variation:

1. Price per service
2. Number of services per person or per episode
3. Actual types of services performed

For example, let’s say identical twins with the exact same health problem enter two different hospitals (Hospitals A and B). These two people could face vastly different health care charges after leaving the hospital, but the difference could be due to any (or all) of the three components mentioned above:

1. Price per service: Hospital A might charge more for each individual service than Hospital B – say $1,500 for one MRI instead of $500 (e.g., the price variation discussed in the recent media articles).
2. Number of services per person or episode: Hospital A might perform more services while treating the patient than Hospital B would. The patient’s bill from Hospital A will be higher if he received three MRIs than it would be if only one MRI were performed.
3. Types of services performed: Hospital A might choose to perform different kinds of services while treating the patient than Hospital B would have performed. For example, Hospital A might decide an MRI is needed, but Hospital B might think a simpler X-ray would suffice.

Each of these components will drive differences in costs between one provider and another. As an extension of HCMS Group’s Human Capital Risk Index (HUI), our Value HUI (V|HUI) methodology (cost per unit of risk) helps us compare providers in a way that adjusts for much of the health risk differences that might exist between the patients who visit one provider and the patients who visit another. This allows us to compare the costs of two different providers as if the health problems faced by them were the same.

By drilling into these three components of cost difference and by utilizing the V|HUI, we help our employer partners understand where inefficiencies lie and provide them with the information and leverage needed as they work with health plans and providers.

For more information on hospital cost variance, please visit:

• Washington Post’s Wonkblog: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-hospital-charges-8000-another-38000/?hpid=z1
• Forbes: http://www.forbes.com/sites/rickungar/2013/05/08/the-great-american-hospital-pricing-scam-exposed-we-now-know-why-healthcare-costs-are-so-artificially-high/
• The Wall Street Journal: http://online.wsj.com/article/SB10001424127887324059704578471453118371838.html#articleTabs%3Darticle
• News Observer: http://www.newsobserver.com/2013/03/27/2783356/new-bill-in-nc-legislature-would.html

-For Immediate Release-

Cheyenne, Wyoming — March 27, 2013 – HCMS Group (Human Capital Management Services Group) celebrated its tenth anniversary this month. Grounded in behavioral economics, HCMS specializes in human capital data warehouse services that support the organization’s predictive data analytics, robust online reporting, and clinical prevention service. HCMS Group’s research reference database, with person-centric data on over 3.3 million de-identified individuals from over 100 employers (the most comprehensive in the marketplace), supports their services.

“As an independent private business, HCMS continues to develop “disruptive innovation” solutions in response to the nation’s need to protect health while eliminating the 30% waste in health benefit costs,” as stated by HCMS Group CEO, Dr. Harold Gardner.

HCMS Group’s information solutions continue to provide resolution to healthcare reform, health benefit design, and the overuse of medical services by the high-risk 5% population that incur over 50% of health benefit costs.

A Decade of Clinical Prevention Achievements

Since 2003, HCMS Group’s clinical prevention service, KnovaSolutions, has informed and empowered individuals and their family to take ownership of their own health. KnovaSolutions identifies and engages the 5% population that is driving over 50% of health benefit costs and encourages them to be better medical service consumers under the adage of, “Your health. Your decisions.”

Shawn Petrini, Senior Vice President and Chief Clinical Officer, had this to say about the evolvement and success of KnovaSolutions: “Over the past 10 years, KnovaSolutions has grown from a concept focused on improving the quality of care experienced by those who are using the most medical services, to an established service that serves over 10,000 members. Our members receive education and support from a team of expert nurses and pharmacists. We are making a difference in the lives of the families we work with and teaching them the real meaning of ‘Your Health. Your Decisions.’”

HCMS Group CEO Dr. Harold Gardner addressed “the 5% issue” by stating the following: “A major risk of the 5% high-risk population is the risk of too much of a good thing. There are too many medical specialists, too many medical procedures, too many prescription drugs, and too little information from an independent, expert source on the risks and benefits. It is no wonder that most of the cost increase in health care is happening in only 5% of an employee population.”

HCMS Group’s Human Capital Risk Index® (HUI) is the only leading risk score that predicts and measures human capital health and job performance risk (not just disease).

Built from our diverse research reference database of over 3.2 million individuals from over 100 distinct populations, the HUI takes various data types into account; it utilizes lost-time, medical, pharmacy, and compensation data in order to provide the best assessment of risk and predict high-risk/cost cases.

Our HUI is unique in the fact that it incorporates lost time data and enables our evaluation of a full spectrum of risk. Using lost time data allows us to predict progressive HUI scores before claims cost even come in. This foretelling risk index allows us to provide the right service at the right time without delaying cost-saving and risk-prevention opportunities due to a lag in claims data.

Learn more about HUI by watching the video below.

HCMS Group has published a piece in Sodexo’s 2013 Workplace Trends publication titled, “Data Reporting OUT; Predictive Modeling IN.” The piece is written by Dr. Harold (Hank) Gardner (CEO of HCMS Group) and Neil Sullivan (HCMS Senior Account Manager and Online Business Intelligence Service Manager).

Earlier videos have demonstrated how 5% of an employee population is driving over 50% of benefit costs. Hank Gardner’s fourth video focuses on the management opportunity of understanding that people migrate in and out of this 5% high-risk/cost group.

This video answers the following questions:

• How is “the 5%” population dynamic?
• How often is there turnover in this group?
• How is our healthcare system a reactive system?
• What does the migration in and out of the 5% group help indicate?

Have a question or comment? Leave a response below and Dr. Gardner will reply.

“Both our Data Analytics and Clinical Prevention Services require that our clients trust our capability to protect and secure their confidential data,” said HCMS Group CEO Hank Gardner, MD. “Becoming HITRUST CSF Certified is another important step in meeting the highest standards of data security in protecting ePHI.”

“By being CSF Certified,” as stated by HITRUST, “an organization is communicating to its business partners and other third-party entities (e.g., state or federal agencies) that sensitive information protection is both a necessity and priority, essential security controls are in place, and management is committed to information security.”

Coalfire, a HITRUST CSF Assessor, performed HCMS Group’s assessment for this certification. “HCMS Group has satisfied the requirements of the CSF through the implementation of a comprehensive IT security program that not only meets the objectives of the HITRUST CSF, but also meets the HIPAA Security Rule and IT security-related requirements of HITECH. This achievement demonstrates HCMS Group’s commitment to securing the confidentiality, integrity, and availability of the electronic protected health information that its customers entrust them with,” said Andrew Hicks, Director and Healthcare Practice Lead at Coalfire.

ABOUT HCMS GROUP

HCMS Group, as a privately-held independent business, is the only combined health information data analytics and clinical prevention services company which helps businesses reduce their health benefit costs and support those employees with the greatest health risks. HCMS provides services to employers of all sizes in various industries, health organizations, and government. HCMS’s Research Reference Database, the most comprehensive database of its kind in the marketplace, allows HCMS to provide proven human capital risk management solutions such as data warehousing, data analytics, and Software as a Service online reporting. Learn more at: www.hcmsgroup.com.

ABOUT HITRUST

The Health Information Trust Alliance (HITRUST) was born out of the belief that information security should be a core pillar of, rather than an obstacle to, the broad adoption of health information systems and exchanges. HITRUST, in collaboration with healthcare, business, technology and information security leaders, has established the Common Security Framework (CSF), a certifiable framework that can be used by any and all organizations that create, access, store, or exchange personal health and financial information. The CSF is an information security framework that harmonizes the requirements of existing standards and regulations,including federal (HIPAA, HITECH), third party (PCI, COBIT), and government (NIST, FTC). www.hitrustalliance.net.

ABOUT COALFIRE

Coalfire is a leading, independent information technology Governance, Risk, and Compliance (IT GRC) firm that provides IT audit, risk assessment, and compliance management solutions. Founded in 2001, Coalfire has offices across the U.S. and completes thousands of projects annually in retail, financial services, healthcare, government, and utilities. Coalfire’s solutions are adapted to requirements under emerging data privacy legislation such as the PCI DSS, GLBA, FFIEC, HIPAA/HITECH, NERC CIP, Sarbanes-Oxley, FISMA, and FedRAMP. Coalfire is a HITRUST CSF certified assessor, a Payment Card Industry Qualified Security Assessor (PCI QSA), and a Payment Application-Qualified Security Assessor (PA-QSA). For more information, visit: www.coalfire.com.

For the original version on PRWeb, click here.

Contact Information
Darcy Barnard
HCMS Group, LLC
www.hcmsgroup.com
(307) 996-4261

As we have presented in earlier videos, we know that 5% of employees drive over 50% of a company’s health benefit costs, but which benefits are driving the most cost and waste?

Watch the third video in Dr. Hank Gardner’s “New Thinking Paradigm” Series to hear his discussion on how lost time (short & long-term disability and workers’ compensation), prescription drug, and health plan policies are contributing to the waste.

Learn the answers to these questions:

• How does the design of benefits drive cost and waste in the different employee risk groups?
• What are the costs incurred by “the 5% group” broken down by benefit type?
• What behaviors are predictors for employee migration into “the 5%”?
• What is an integrated benefit management strategy and why is it important?

Dr. Harold (Hank) Gardner is the founder and CEO of HCMS Group. His 40+ years of experience in healthcare delivery, health economics, and health professions education coupled with the use of HCMS’s unmatched Research Reference Database (RRDb) fuels his “new thinking” disruptive solutions for the healthcare cost and quality problem.

Dr. Gardner’s second video of this new series addresses Population Risk Stratification as he discusses how employee risk groups differ in terms of benefit use. Just 5% of an employee population drives more than 50% of benefit costs.

Have a question or comment? Please leave your response below and Dr. Gardner will reply.

Dr. Harold (Hank) Gardner is the founder and CEO of HCMS Group. His 40+ years of experience in healthcare delivery, health economics, and health professions education coupled with the use of HCMS’s unmatched Research Reference Database (RRDb) fuels his “new thinking” disruptive solutions for the healthcare cost and quality problem.

Dr. Gardner’s first video of this new series addresses HCMS Group’s RRDb (with de-identified information on over 3.2 million individuals) and “Big Picture” Data Model as he discusses the importance of comprehensive person-centric data in human capital risk management.

Explanations for this pattern have included: “warm-up” or ergonomic effects, false classification of off-the-job weekend athletic injuries (facilitated by lack of health insurance, replacement rates, or union status), age/tenure-related responses independent of ergonomic differences, and psychological responses to Monday work. This study found more soft tissue claims filed for younger workers, union members, for workers with higher expected workers’ compensation benefits, and workers in non-exempt occupations, but did not find that these factors—nor the absence of health insurance—differentially increased soft tissue filings on Monday.  However, there is also no evidence that Monday claims are more ergonomic in nature.

Gardner and Butler will be presenting key findings from their paper, “Monday Work Injury Claims: Ergonomic, Economic, or Just Hard to Return to Work?” at the Conference to Celebrate the Centennial of the US Department of Labor. The conference will be held on Friday, November 9, 2012 in Washington, DC.