WALTHAM, Mass., June 14, 2012 — Verisk Health announced the release of its DxCG Risk Solutions Medicaid models designed to help health plans and state agencies manage the clinical and financial needs of this complex population. The enhanced DxCG® Medicaid product suite includes a full line of models that support payers with accurate forecasting of costs, effective care coordination and delivery, and risk-adjusted provider performance evaluation. Additionally, state agencies will have the ability to distribute capitation dollars based on fair and balanced population risk assessment.
“Changes in healthcare policy will dramatically affect Managed Care Organizations (MCOs), as an influx of new beneficiaries will soon be entering the system through the Medicare and Medicaid programs. MCOs will have a greater need to drive network performance and manage associated cost, quality, and utilization metrics,” said Nathan Gunn, MD, chief operating officer at Verisk Health. “The DxCG models support these initiatives by providing an accurate measurement of network performance, identifying inefficiencies, and delivering the analytical insight necessary to guide the performance measurement process.”
The DxCG Medicaid product line provides the ability to quantify risk on less than 12 months of data and predict costs and utilization needs for beneficiaries with fluctuating Medicaid eligibility. This knowledge will support state agencies in monitoring risk changes from year to year and driving seamless integration between public programs and health insurance exchanges. The suite also includes performance assessment models that inform network management initiatives by delivering accurate measurements of provider efficiency. Payers can evaluate performance by quantifying the expected medical services needed to treat a population — based on demographics and clinical factors affecting those patients — and compare those results to actual outcomes.
“Our Likelihood of Hospitalization and Emergency Department prediction models for Medicaid will be another integral toolset in helping our payer clients drive appropriate and cost-effective care,” added Dr. Gunn. “The identification of patients at high risk for return trips to the hospital is a first and crucial step to informing effective, proactive clinical interventions that will help target avoidable and expensive utilization patterns.”
First developed in the mid-1990s and used as the basis for assessing risk by the Centers for Medicare and Medicaid Services, DxCG science is used worldwide to inform healthcare budgeting and financial resource allocation.
About Verisk Health
Verisk Health, a subsidiary of Verisk Analytics (Nasdaq:VRSK), helps organizations identify, manage, and mitigate healthcare risk to improve quality, reduce costs, and maximize profitability. Our data-driven risk assessment technologies and business decision analytics enable clients to proactively seize opportunities for improving clinical, financial, and performance results. Our solutions optimize the efficiency of key business objectives, including care management; risk identification and stratification; HEDIS compliance; benefit program measurement; fraud, waste, and abuse prevention; payment accuracy; and revenue cycle management.