Each day, payor executives face critical judgments involving physician quality and efficiency, provider and network management, benefit design, employer relations, regulatory and accreditation reporting, and other issues. A clear understanding of data is crucial for making choices that will positively affect the well-being of organizations and the quality of care delivered to members.

Claim Management Business Intelligence for Operations

Business professionals in payor organizations need more than access to traditional data. They need to interact with data and drive their own models to make important operational decisions. Interactive business intelligence (BI) not only enables payors to investigate specific data but also to analyze it, thereby uncovering business trends. Armed with this information, a payor can begin the key component of business intelligence—communicating results and effecting change. McKesson's business intelligence solutions for medical claims management operations, a combination of software and services, help organizations move from managing transactions to managing information.

• Payment Policy Diagnosis analyzes payors' claims data to determine the root causes of variances in claims results across platforms, regions or lines of business.
  
  
• Performance Analyzer provides real-time access to payors' key claims performance indicators.

Medical Management Business Intelligence and Reporting

Clinically based business intelligence tools from McKesson help organizations leverage their data to quickly and accurately gain insights into key trends, behaviors and events that affect quality and drive costs. When clinical and financial information combine, payors gain an integrated view of care delivery that helps them measure and then improve performance.

Communicating these insights internally and externally is the next critical step, and McKesson's care management business intelligence tools provide the ultimate reporting ease and flexibility. Payors can access a robust set of standardized reports or tailor reports to their specific audiences—their executives, quality team or network management staff, physicians, employers, or regulatory groups—ensuring that the information is easy to digest and act on.

McKesson's business intelligence tools benefit payors by:

• Identifying preferred network physicians and informing pay-for-performance programs
• Helping shape benefit packages that balance premium revenue with member risk
• Producing easy-to-understand, sophisticated reports along key dimensions: plan, physician, employer, product and physician group
• Identifying new business opportunities and ways to retain at-risk employer accounts
• Facilitating quality improvement activities by ensuring minimum standards of care and demonstrating best-practice guideline compliance
• Detecting deviations from consensus- and evidence-based physician practice patterns and minimizing inappropriate utilization
• Streamlining regulatory and accreditation reporting

CareEnhance Resource Management Software (CRMS)