Publicly-Funded Programs

Healthcare Financing With a Business-Like Approach

Publicly-funded healthcare programs such as Medicaid, Medicare, Tribal Health, TRICARE / Veterans Administration (VA), etc. have all of the managerial challenges of health insurance, plus a set of complicating factors unique to the public space.

Salient’s Visual Data Mining approach allows managers, supervisors and analysts at all levels of an organization to easily query their beneficiary and claims records to help them see what is driving outcomes. Armed with this knowledge, they can improve efficiency, creating better outcomes, lower costs.

With Salient, managers, supervisors and analysts can control their own program sectors, and manage in a changing environment with greater knowledge, flexibility and speed. For the first time, senior managers and executives can utilize the same real-time analytical power previously available only to technical knowledge workers.

Take control of your program and manage preemptively rather than always catching up. With Salient, you’ll always have the answers necessary to adapt.

 

Policy Support


Easily use data (not guesswork) to drive development and revision of coverage and eligibility rules, as well as rates and fees

  • Understand who’s using and providing services, and at what level and cost
  • Have data available throughout your organization
  • “Turnaround time” changes from days to seconds
  • Report preparation is done with “clicks,” not programming
  • Easily share data within your organization

Cost Containment


Using data to manage program costs

  • Easily use data (not guesswork) to identify highest program cost centers
  • Monitor program changes easily, comparing time periods instantly
  • Quickly compare average cost per beneficiary, per claim, etc. by service type, provider, procedure, drug, or any other variable

Program Integrity


Manage program oversight and rule compliance with point and click data

  • Quickly identify utilization spikes, then dive into data to find providers or beneficiaries who are causing utilization changes
  • Spot chronic abuse and misuse and document problem providers and beneficiaries
  • Profile high cost beneficiaries and providers and examine their service use/provision
  • Easily share data with other control and oversight agencies
  • Foster regular communication among control and oversight agencies, as recommended by CMS
  • Go To Program Integrity Page

Patterns of Care Analysis


Monitor and evaluate care protocols for groups of beneficiaries

  • Easily look at utilization data over time, by groups of beneficiaries or providers
  • Dive into groups to examine outliers easily
  • Quickly identify utilization changes over time
  • Group beneficiaries easily, and examine the care they receive

Utilization Management


Monitor and control utilization limits and parameters

  • Monitor utilization on weekly, monthly quarterly basis
  • Use trend analyses and program monitoring to evaluate existing or potential edits and program limits
  • Evaluate utilization management techniques (co-payments, generic drug maximization programs, etc.) before and after implementation

Post Pay Retrospective Review


Review paid claims and identify outliers

  • Identify improperly paid claims and initiate recoupment
  • Find chronic abuse and misuse and document problem providers and beneficiaries

Healthcare Transformation Initiatives


Understand the program, monitor strategic initiatives, and revise program direction based on current performance

  • Track cost and utilization by service type over time
  • Drill into data for each service type all the way to procedure, rate, drug code, therapeutic code, practitioner type, etc. to spot broad trends
  • Produce “Executive Dashboard” reports quickly and easily for senior managers
  • Easily share data throughout the organization

Process of Care Management


Identify and Group Special Populations for Further Analysis

  • Quickly identify beneficiaries with chronic or special care needs
  • Group special populations (chronic care, behavioral health, etc.) to identify beneficiaries receiving too much or too little care
  • Identify providers who serve special populations and target communications directly to them