AHP MARS involves a sequence of data manipulations (using SAS software), that summarizes detailed healthcare claims data into homogenous service categories, and then calculates various metrics such as utilization rates, PMPM costs, provider discounts, actuarial value, medical loss ratio, and risk score. The reporting interface is developed in Excel, and using Visual Basic for Application (VBA) programming, gives the user the ability to mass produce reports for various time periods, lines of business, market segments, healthcare providers (including PCP attribution), and clinical condition categories.
In addition to producing user-friendly reports, AHP MARS gives health plans (and hospital systems) the information needed to make strategic business decisions. Some of these decisions include (but are not limited to) the following:
- Initiatives to reduce emergency room visits, inpatient admissions, and inpatient length-of-stay
- Design and evaluation of provider contracts (including risk contracts, value-based payments, and PCP attribution)
- Design and evaluation of medical management programs
- Evaluation of risk appetite and decisions regarding market exposure and reinsurance
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