The product
The launch of the risk structure compensation based on morbidity risk has been a decisive step in the statutory health insurance market. The change from competition in contributions to competition in performance that is currently taking place also requires new approaches in cross-sectoral data analysis. The objective is to achieve a valid basis for decision making, based on which a balance can be created between the topics securing of revenues and expense control. With the innovas suite for morbidity and risk management we support the statutory health insurance companies in living up to the new type of competition.
Components
Besides the BVA-Grouper, the innovas suite for morbidity and risk management comprises the following products: innoAnalyzer, innovas Morbi-RSA Grouper, ReGrouper, KOLUMBUS Morbi-RSA, 106-Check (software product of our partner Global Side), and innovas HM. So the innovas suite encompasses the entire range of anticipated analyses, shows operative options for action according to both formal and competition-relevant criteria, and, with its closely intertwined modules, represents a complete functional value creation chain.
Background
In the field of securing revenues we have placed the focus on excluding structural errors, inaccurate or incomplete data, and thus to avoid the resulting disadvantages in allocations from the Health Fund in a prospective manner. By means of retrospective data analysis as to data quality we foster aspects of strategic orientation of health insurance companies. In doing so, we pursue the objective to create optimum options for the health insurance company in compliance with rules and legal foundations. innovas expressly dissociates itself from all aspects of retroactive "up- or rightcoding".
In the field of expense control our focus is on the improvement of the relative state of health of the insured in the medium and long term. In the field of health care management we support case managers from the health insurance company by targeted control measures in order to reduce the risks of inappropriate care, overprovision and underprovision that particularly occur at the sector transition points. We foster cooperative approaches with care providers, topics like registration of vital parameters for pursuing successes in prevention and the function integration with the billing audit.
Technology
The operative systems (KOLUMBUS Morbi-RSA, innovas HM) of the innovas suite for morbidity and risk management are based on a state-of-the-art service-oriented architecture (SOA), the technological basis of which is Java. In the field of anticipated analysis (innoAnalyzer) the product is based on IBM Cognos. The groupers it is based on (innovas Morbi-Grouper und ReGrouper) are Java applications, which, besides of functional concepts of the analysis tool, can also build on other BI solutions.
Market
The innovas suite for morbidity and risk management addresses insurance companies, associations, service providers and consulting companies in the market of the statutory health insurance. Dependent on the size of the respective clients and the technologies already in use at their premises, the individual products can be used as a complete solution or alternatively as a pattern and modular system. We elaborate the most efficient integration solution jointly with our clients in tangible client projects.
Scenario
With certain insured persons, analysis with the innoAnalyzer indicates non-encrypted allocation-relevant diagnoses. The set of rules and standards delivered with the innoAnalyzer (here: "Reverse Engineering Pharma") serves as a reference source. Part of the insured is inscribed in the DMP program and may be contacted. This measure results in a voluntary participation in a health care program (controlled by innovas HM). The program enables future care in compliance with the guidelines (expense control) for insured persons showing suspicious courses of treatment, and, thanks to its diagnosis-specific intervention, ensures adequate allocation by means of correct encryption by the care providers in a prospective manner.
