Population Risk Management for Payers

Health plans and payers face pressure to control costs, manage risk and improve quality of care. Today, new value-based healthcare models such as Accountable Care Organizations (ACOs) are increasing the need for payers to measure provider performance and manage population health.

McKesson Risk Manager™ for payers is a cloud-hosted population risk management and healthcare analytics solution that helps drive efficiency and better healthcare outcomes. Its analytics helps payers to collaborate with provider networks in improving care quality, reducing unnecessary medical spend, managing population risk and supporting population health management.

Payers get visibility into the effectiveness of healthcare spend at the member, employer group, provider and provider group level – across one or multiple lines of business. Efficiency metrics help payers to quickly understand which networks are performing well — and which are not. McKesson Risk Manager is a population risk management solution that helps you engage and reward providers for delivering excellent care and contributing to your plan's goals.

Using predictive modeling, McKesson Risk Manager stratifies members based on their associated risk factors. This helps you identify members for clinical care intervention, aiding in the delivery of better health outcomes at a lower cost.

McKesson Risk Manager can also help you uncover costly healthcare patterns, such as members seeking primary care in high-cost settings or physicians prescribing expensive drugs despite the availability of less-expensive alternatives.

Actionable Insight into Your Populations

McKesson Risk Manager brings together healthcare data from many sources – such as paid medical claims and pharmacy – in a single, comprehensive data warehouse. The analytics engine helps you to gain actionable insight from the data in many ways, including:

  • Population risk management reports that support population health management
  • Quality metrics, including HEDIS and ACO measures
  • Provider performance profiling, including episodic-based analysis and risk-adjusted primary care provider (PCP) efficiency comparisons
  • Pay-for-performance (P4P) modeling and adjudication
  • Pharmacy usage, formulary compliance and intervention
  • Ad-hoc reports for innovative, in-depth analysis via access to the data mart

Monitor Your Networks Effectively

McKesson Risk Manager is a population risk management solution that provides the intelligent healthcare analytics to monitor your networks effectively:

Insight for better quality management

Use our population risk management solution to engage physicians and drive improvements in care. Accountable Care Organization (ACO) and HEDIS measures help you profile guideline compliance for your physicians and networks throughout the year. Embedded workflows help to proactively engage physicians and members to improve timely screenings. Provider staff can see members' gaps in care when scheduling appointments, and customized letters and call lists let you take action to alert physicians and members about gaps in care.

Scorecards for Primary Care Physicians (PCPs)

Population-based, risk-adjusted determinations of efficiency provide comparison at an overall level and for high-volume or cost areas.

Episodic Analysis for Specialists

Gain insight into how providers differ in their performance compared to their specialty peers, as well as to national and regional cost benchmarks.

Manage Incentives

Population risk management scorecards and provider profiling help you manage physician incentives. Based on evidence-based care guidelines and claims data, PCP profiles are risk-adjusted, using diagnostic and medical episode groupings to deliver insight into provider and specialist efficiency patterns and case mixes.

Track High-Risk Members

Monitor inpatient admission, emergency room and outpatient utilization to identify members (and their physicians) for care management and education.

Pay-for-Performance Program Management

Get the data you need to change provider behavior. System-generated metrics with customizable P4P criteria help you identify improvement opportunities. McKesson Risk Manager includes P4P adjudication, reporting, trend tracking and payment calculation. Multiple P4P programs can be managed at once, and what-if functionality can help you design new incentive programs.

Manage Pharmacy Costs

Mine opportunities to reduce pharmacy spend. Pharmacy-related metrics supply provider and member detail, as well as high-level dashboards, to help you to understand drug usage. You can easily identify which members have costly drug regimens, recommend substitutions, and alert the prescribing physician to the opportunity to switch to a cost-effective therapy.

Streamline HEDIS Reporting

McKesson Risk Manager™ Compliance Reporter, a National Committee for Quality Assurance (NCQA)-certified HEDIS reporting and workflow tool, can be used with McKesson Risk Manager to streamline HEDIS reporting for accreditation, including all administrative measures.

Want more information?
Let McKesson be the cornerstone of your clinical integration program. We'll help you find the right tools. Call 781.290.2500 or request more information.