GREATER CERTAINTY.

RISK PREDICTION WITH

(AND MUCH FASTER)

We help clients better understand their potential risk before it occurs and then show them what to do about it.

Healthcare analytics have become very good at defining the clinical side of your plan, telling you what has happened and what is likely to happen next.  While these are important steps, clinical information is not the same as financial direction. And that is what distinguishes BST from other solutions – we provide prescriptive action.  It’s a significantly more complex calculation to recommend specific actions tailored to meet plan objectives – and only BST offers it.

THREE FAMILIAR STEPS PLUS

ONE FOUND NO WHERE ELSE

Data Warehousing

We gather data into a single, secure and elastic data warehouse. Data are normalized to create a database for in-depth analysis, and resides in an extremely secure encrypted environment.

 

 

 

Advanced automation that delivers your data with more accuracy and speed securely accessible through a cloud-based portal.

Descriptive Analytics

We define what has happened by identifying lag measures, providing high-level views of total block performance and drill down views of individuals by key metrics. We stratify risk down to the member level and what each member is likely to cost the plan over the next 12 months.

 

We deliver greater insights into the financial drivers of your plan by analyzing more of the data, looking at it more often and with more granularity.

Predictive Analytics

We define what is likely to happen next through advanced data analytics, predictive modeling and plan design optimization. Automation transforms a tedious manual process into a fast automated one to identify financial drivers of next year’s plan, down to the member level.

Advanced automation that delivers your data with more accuracy and speed securely accessible through a cloud-based portal.

Prescriptive Analytics

We prescribe specific actions by considering billions of scenarios, removing unforeseen inefficiencies and eliminating less favorable options. In a matter of minutes, BST’s Health Plan Optimizer designs plans that meet the specific needs of the members while respecting the budgetary constraints and goals of the employer.

 

 

 

We deliver greater insights into the financial drivers of your plan by analyzing more of the data, looking at it more often and with more granularity.

(Unique to BST)

WE UNCOVER INSIGHTS

THAT OTHERS CAN’T. 

Instead of the traditional cost containment strategies of cost shifting or reducing benefits, BST’s Plan Optimizer uses math and science to remove inefficiencies and design health plans optimized for both the plan sponsor and plan members.  It quickly and efficiently sorts massive data sets eliminating less favorable scenarios, moving to the next most likely solution. The system considers billions of scenarios, identifies the optimal plan design and prescribes specific actions in a matter of minutes. It’s a game changer – and only BST has it.

  "BST stands apart in our ability to report on the financial health of a plan, in minutes not weeks.  We transform a tedious manual process into a fast automated one. Insights are based not on projections, but on actual population experience, describing what has occurred, predicting what’s likely to occur next and prescribing specific action to meet the financial and quality objectives of the plan.  With BST plan managers gain a distinct advantage not previously available.

- Stephen Sofoul

CEO, Benefits Science Technologies

INSIGHTS APPLIED TO IMPROVE 

(NOT JUST COST SHIFT) 

BST’s Optimizer designs to a plan, a population or both utilizing actual population experience augmented with actuarial science. We help plan owners better understand their risks before they occur. This unprecedented control and visibility of data, allows us to identify optimal choices and recommend specific actions to meet plan objectives. Identifying emerging risk and eliminating misaligned incentives impacts the bottom line. 

IDENTIFY MORE COST DRIVERS FASTER AND WITH MORE ACCURACY

We process large data sets quickly constructing forecast models on actual data to uncover future clinical risks with greater certainty. 

We identify global risk factors within a population by finding patterns and relationships. Our predictive models are based on a granular understanding of each member health to the point of distribution of disease, understanding both the progression of disease and the treatment phase allows us to accurately predict the amount that member is likely to cost the plan over the next 12 months. 

WE IDENTIFY

High cost drivers

Lag measures

High-level views of total block performance

Drill down views of individuals by key metrics

DETAILED CLINICAL REPORTING

Chronic Conditions 

Other Chronic or Disabling Conditions 

Comorbidities 

HEDIS Measures (plan effectiveness/performance) 

Gaps in Care 

Evidence Based Medicine Compliance 

Risk Scores 

Distribution of Disease 

Patterns of Heart Attacks 

Optimal Intervention of Type II and Pre-Diabetes 

Drug Utilization 

Drugs Classifications and Most Common Use 

Drug-Drug Interactions 

Individual Dashboard, Table, and Progress Chart 

Cohort Dashboard, Table, and Progress Chart 

CLINICAL INSIGHTS

Fast, comprehensive explanation of plan performance

Detailed financial reporting 

An understanding of how their risk is stratified

Efficiencies from automated reporting tools

The ability to evaluate at granular level

OUR CLIENTS GAIN

WE LINK CLINICAL INSIGHTS

TO FINANCIAL ACTIONS

The BST process designs to a plan, a population or both utilizing actual population experience augmented with actuarial science. We help plan owners understand trends, patterns and risks before they occur. This unprecedented control and visibility of data, allows us to identify optimal choices and recommend specific actions to meet plan objectives. Identifying emerging risk and eliminating misaligned incentives impacts the bottom line 

ANNUAL PLAN DESIGN OPTIMIZATION

Optimizer considers millions of scenarios while

     preforming billions of calculations in determining

     optimal plan design for a given population.

Plans designs are based on predictive models from

     actual medical and Rx claims data augmented with

     actuarial science as needed. 

PLANS CAN BE DESIGNED BASED ON

FINANCIAL ACTIONS

Plan sponsor’s budget 

Changing funding arrangements 

Cost sharing % between employer and members 

Multiple types of plans 

Adding or removing HDHPs, PPOs or HMO 

Both prospective and retrospective plan modeling 

Stop-loss modeling 

Tax efficiency modeling 

NOT JUST INFORMATION, ACTIONS. 

MONTHLY REPORTING

PACKAGES YOU CAN USE

Automated customized reporting about your plan today. The business intelligence you need in time to actually use it. 

Automated customized reports provide overview and detail of your health plan faster than ever before – 24 to 48 hours after carrier feed. This unprecedented visibility and control of healthcare data is made possible through its elastic data warehouse, which connects disparate silos, significantly expanding the access and speed to information. 

Roll-over for more detail

DROP THE TEDIOUS MANUAL PROCESS. GET MORE IN LESS TIME. 

Over 150 customizable clinical and financial reports and dashboards from a secure cloud-based platform. 

Automated customized reports provide overview and detail of your health plan faster than ever before – 24 to 48 hours after carrier feed. This unprecedented visibility and control of healthcare data is made possible through its elastic data warehouse, which connects disparate silos, significantly expanding the access and speed to information. We work closely with clients to customize reports to fit their needs and highlight our findings. 

  • Timely Monthly data feeds and updates 

  • AccessibleCloud-based platform 

  • AccountableMeasures of actual-to-planned 

  • Compliant HIPAA/ERISA 

  • CustomizedEnterprise or client-level platforms 

  • SecureSOCII/SAAE16 

  • TargetedFinancial and clinical cost-drivers 

- Stephen Sofoul

CEO, Benefits Science Technologies

Monthly Financial Reporting Package 
  • Automated customized monthly financial reporting     

  • One page overview of how the plan preformed the previous month     

  • Aggregate MLR for all plans, recalculated every 30 days     

  • Cost sharing between company and members broken down by plan     

  • P&L statements for each plan for the previous month and YTD     

  • Tracking of all high cost claimants via a summary report listing:      

  • Each member who has exceeded a predetermined $ threshold 

  • Employment status, Member, Spouse or Child   

  • Primary diagnosis including ICD-10   

  • Medical and Rx claims YTD     

  • Percentage of total and Cumulative % of total for reported members

  • Each high cost claimant receives a de-identified report showing:

  • Member status, Active, Termed or on COBRA   

  • If COBRA, date coming off plan     

  • Cost drivers for individual members     

  • ICD-10s along with diagnostic groupers     

  • Drugs and NDCs   

  • Historical perspective of up to 3 years of employee cost to plan

  • Stop-Loss contract performance including: 

  • Reimbursements due for both ISL and ASL   

  • Ability to track multiple specs and Ag-specs   

  • Ability to track lasers     

  • MLR for stop-loss policy     

  • Ongoing monthly risk stratification for every covered member 

Monthly Clinical Reporting Package 
  • Automated clinical reporting on population health includes:   

  • Eligibility and Enrollment   

  • Utilization 

  • Facilities 

  • Medical Claims 

  • Rx Claims 

  • Chronic Conditions 

  • Co-morbidities 

  • Evidence-Based Care Results, (Gaps in care) 

  • Population Risk (Disease and Case Management triage) 

  • Global Risk Factors (Emerging risk within the population) 

Semi-Annual ROI Studies on Cost Containment Strategies 

BST’s platform can evaluate Wellness Programs and provide the return on investment for the program. 

Annual Plan Design Optimization 
  • The optimizer considers millions of scenarios while performing billions of calculations in determining optimal plan design for a given population 

  • Plans designs are based on predictive models from actual medical  and Rx claims data augmented with actuarial science as needed 

  • Plans can be designed, and sensitivity testing provided around: 

  • Plan sponsor’s budget 

  • Changing funding arrangements 

  • Cost sharing % between employer and members 

  • Multiple types of plans 

  • Adding or removing HDHPs, PPOs or HMO 

  • Both prospective and retrospective plan modeling 

  • Stop-loss modeling 

  • Tax efficiency modeling 

Home Screen Dashboard provides for custom display of plan metrics. Data is updated monthly, weekly, or daily. 

Chronic Condition algorithm enables tracking of 27 chronic diseases over time. 

Eligibility Dashboards enable relative view of enrollment in current month, average over last year or over all years 

Med Possession Ratio

measured for recurring drug fills. 

Classification of large claimants 

by ICD Chapter. 

Summary of activity for user selected Individual Large Claimant. 

Emergency Room Review allows user to explore population utilization of the ER. 

ER Utilization

and reasons for visit are tracked. 

Drugs Review allows user to explore population utilization of the prescription drug plan. 

Large claimant summary table enables building of cohorts based on plan year and claims threshold.