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Health plan uses risk data to explain medical trends, manage employee health

Purchasers frequently ask health plans about the principal drivers of their PMPM trends-information that is equally valuable to capitated provider organizations. Pittsburgh-based Highmark, Inc., uses risk data developed by DxCG, Inc., of Boston to develop sophisticated reports that identify the drivers of PMPM trends, enabling the plan to promote specific medical management opportunities to mitigate employee healthcare costs. Highmark, an independent licensee of the Blue Cross and Blue Shield Association, has more than 28 million members enrolled across all product lines and markets in Pennsylvania and West Virginia, accounting for about $10 billion in annual revenues, according to Kristen L. O'Donnell, MBA, MHA, the health plan's practice leader of personalized health management.