Program Evaluation

SCIOinspire's Program Evaluation provides the health plan with a structured, objective view of the opportunities and issues facing its various care management programs. We address the essential components of these complex, multidisciplinary programs and identify if and where improvements can be made for improved outcomes and reduced costs. Using existing utilization and medical loss ratio data and outcomes analyses, activity reports and program materials, SCIOinspire will address the following questions:

  • Is the health plan effectively targeting high-risk, high-cost members for prospective care management?
  • Are current processes sufficient for identifying and acting on high-cost individuals?
  • Are there untapped opportunities for reducing costs by enhancing or reengineering the care management programs?
  • Does the data management and integration capability adequately support the focusing and reporting of the care management programs?

SCIOinspire offers a three phase approach to evaluate care outcomes. Each of these phases are distinct from each other and can be purchased separately. The evaluation can address the various programs such as utilization management, case management, disease management and wellness and health education.

Phase 1 is an evaluation of the program's structure and function including program scope and design and the critical program functions.

Phase 2 is a focused cases audit, building on the work done in Phase 1. SCIOinspire will further identify specific opportunities for, and barriers to, effective care management.

Phase 3 is an assessment of the data management capability, the program focusing and targeting process and reporting of program outcomes.

Client Benefits

  • Independent evaluation of the adequacy of the care management programs to meet the needs of the health plan, members and regulators
  • Specific suggestions and recommendations on improvements to your programs that will increase cost savings through improved efficiencies and focus

Care Financial and Clinical Outcomes Analytics

With health plans and employers looking to optimize costs and bend healthcare trends, the use of care and wellness management as a key lever has become an integral component of their cost management strategy. This has led to stakeholders investing heavily in preventive care and chronic care management. With budgets tightening and decision makers rationalizing expenses, it’s become increasingly important for vendors and sponsors alike to evaluate and demonstrate both clinical and financial outcomes.

Industry Pain Points

  • Increasing demand for care management program results
  • Lack of knowledge about the real clinical and financial value of a program
  • Clear, transparent and auditable outcomes analysis
  • Demand for routine accurate and credible reports validating the program and investment

Our Value Proposition and Solution

SCIOinspire provides credible, auditable, and customizable outcomes analytics built on our deep expertise in retrospective outcomes analysis, proprietary software, flexible methodology, and extensive care analytics benchcark database.

SCIOinspire provides Outcomes Analytics to help program sponsors and vendors understand and demonstrate the value of their programs to help improve effectiveness and rationalize care management dollars.

Delivery Models

We provide flexible outcomes analytics to clients based on their needs. We work with clients to identify their analytics and reporting needs and can deliver impactful analytics that can drive decision making via Reporting Service Bureau Analytics, Software and Advisory Services.