Having years of experience
with the risks in the Medical Industry we understand the challenges health organizations
face to provide quality care to their members.
Having mostly slow and ineffective reporting processes they struggle to get
the information they require to make informed business decisions. With this in mind
RiskSecure have developed two interlinking tools that will allow them to know their
members and monitor their provider performance; putting the power in the user’s
hands to get the information they require as the need arise.
Member Risk Stratification
must shift to a more proactive attitude and the best way to do this is to know your
members and their health risks. MRS
is a solution that gathers all the information that you will need to identify these
members. We will provide you with a complete comprehensive view of a group of members
as well as each individual member within your group.
We will show you what
your members are claiming for. What
diseases your members have been diagnosed with, what medicine your members are taking
and what procedures your members had.
MRS also provide you with a complete summary of each ICD, Tariff, Nappi and CPT
so that you can understand what it is costing you and discover relationships between
possible health risks and treatments.
Manage clinical risk
by identifying your members with high cost diseases and taking the information provided
to you by the stratification, analyze it and transform it into critical business
Know if your
disease management plan is working
Everything needs a proof on concept therefore we keep a comprehensive history of
a stratification, which will allow you to analyze the member’s clinical performance
and monitor their movements within and between stratifications.
Get the data
that you require to make informed business decisions
With MRS we provide
you with a tool to use as your need arise.
With an easy to use wizard you can specify the criteria that will be used in a stratification
according to the kind of information you require to make solid business decisions.
The medical industry
is a changing environment, new things are discovered every day and therefore MRS
was developed with change in mind.
With an easy to use wizard and update log, changes to the definition of your stratification
are made easy and traceable.
You can improve your
relationship with your member, by knowing him/her. MRS provides you with a single
complete view of your member and his claim history and gives you the ability to
act on the derived knowledge
to suite the members needs
You want to provide your high risk patients with the needed medical care to avoid
future complications and increased costs.
With MRS you can monitor the costs of the different high risk health conditions
you’ve identified and compare the information against your benefit designs to make
sure that adequate funds are supplied in the areas where they are most needed.
With the two models
being interlinked, you can with a click of a button analyze the providers of your
high risk members against their peers to make sure that your users get quality and
You can specify a
stratification based on the following criteria
is a provider analysis solution that allows you to monitor the providers within
your scheme and review them against their peers based on your defined criteria. This module will provide you with a
powerful search function, forecasting capabilities and meaningful graphs to identify
the providers that act against the norm / trend.
standards of practice
Make sure that your
members are getting affordable quality of care by monitoring how your providers
are performing against the industry norm
Analyze your providers cost and use by a single comprehensive view of your provider
and his claim and member history.
Review Providers Based
Number of Claims
Total Claim Amount
Total Amount paid
Cost Per Patient
Cost per encounter
Encounters per patient
Number of chronic
Trends and Patterns
Powerful Search Function
High level summaries
as well as more detailed data
Improve your member’s
quality of care
Track providers by
specific diseases and medicines
RISKSECURE™ Managed Health Care