Prediction of Diseases
Cost and Use Analyses
Analysis for Restricted Network
Studies of "Bundles"
Modules that analyzes the Population
Portfolio Profile Analysis
It corresponds to the loss control analyses (revenue evolution and care expenses) and analyzes of the beneficiaries (distribution by age group and sex, and combination among them, beneficiary movement and individualized analysis of high cost patients and use, among others).
It corresponds to the epidemiologic profile analysis of the population, including some predictions of the portfolio based on history and profile of sex and age. In R&D.
Epidemiological Profile Analysis
They are analyses using Health Databases (BDS) generated from multiple databases sharing of clients and partners. These analyses allow several combinations of procedures, trend analysis, use, patient tracking from a given diagnosis or procedure, among numerous other possibilities.
P&D Tool will have as purpose the predictive analysis of a population group, taking into account the probability a priori using models from Bayesian networks. The focus of this work will be for disease prevention or high cost actions for the health system, such as pregnancy, chronic diseases, women's health, men’s health, among others.
Prediction of Disease
Full Economic Analyses
P&D Tool will allow Effective Cost Analyses of health programs applied in companies and health plans.
Modules that analyze the Network of Providers
Network Sufficiency Analysis
Using the population epidemiologic profile as basis, plus the data contained in DBS, reinforced by ordinances of the Ministry of Health of Brazil, it will be possible to identify the size of the need for the network of providers for OPS. From this analysis of needs, a comparative with the current network is made. This comparative will allow analyzing the network sufficiency, i.e. which required services that are not properly available and which services are available beyond the need.
Cost and use analysis of the entire network, comparing self-generated and uses that exceed an average market standard, always using the DBS as a reference, in addition to the risk-adjusted network utilization profile.
Cost and Use Analysis
They are rules used by ERP of the Health Insurance Operators when regulating benefits. Analyses containing thousands of rules are considered taking into account all the fees tables, ROL updates, technical parameters such as type of procedure, service regime, justification, main ICD, serial procedure, authorization level, medical expertise, audit levels, gender, minimum length and maximum age, maximum occurrence, quantity, interval time, maximum intervals, days of hospitalization, extension days, predecessor event, dependent event and incompatible codes. In addition, the parameters for the use of Orthoses, Prostheses and Special Materials and audit of the accounts are established.
The verticalization with outpatient structure, focused on primary care, is a strategy for many Health Insurance Operators. The model advocated by the 2iM® is called Value Based Network (RBV ©). In this systematized analysis, a study of the impact on budget and loss control ratio is made on the adoption of a RBV, which is the ideal design for the profile of the portfolio and epidemiological profile of this Health Insurance Operator; and the impact it may generate on the cost and use of this Health Insurance Operator. RBV comprehend the organization of a RES - Electronic Repository in Health and the implementation of payment models by performance and / or hybrid models of remuneration for Medical Center professionals.
Analysis for Restricted Network
Studies of “Bundles”
Remuneration models by bundles have been a trend in the US. It is a more evolved model of the traditional "packages" that exist in Brazil. In the model by "bundles", the entire cycle of care is measured after a certain procedure and it becomes part of all the value that will be negotiated with the provider, always with additional gains linked to the quality of the patient's health. It advocates greater accountability for the patient, in addition to the main procedure, taking into account the full cost and use of a given period after surgery. The GPS.2iM © model is used to evaluate the performance of the patient group to be serviced by the Bundle in addition to the responsible professionals and services.