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Overview

Insight Templates are built from Insight Models.  An Insight Model is a collection of fields relevant to a specific set of data such as Enrollment, Medical or Member.

To access an Insight Model:

Go to the navigation bar > Insight > Insight Models.

Model Fields

There are 2 types of model fields: Dimensions and Measures.

  • Dimensions are descriptive fields that categorize the data (e.g., diagnosis code, drug product name, provider name, etc.) 
  • Measures are numeric fields that can be aggregated (e.g., total amount paid, total provider allowed amount, prescribed days supplied, etc.)

Model Types

Benchmark Year

The data represents de-identified, national medical and pharmacy claims data sourced from Truven Health Analytics for the years 2015 – 2016.

This model includes dimensions for state, demographics, plan funding status, and industry classification. There are over 100 financial, utilization, and enrollment measures.

Common Uses

Create a benchmark to compare with an organization's data. For example, you can answer the following questions:

  • How much are companies spending on Rx in my industry? 
  • How much are companies spending on medical in my state? 
  • How much are companies spending on opioids in CA, OR, and WA? 

Biometric

This model contains biometric screening data such as Blood Glucose (mg/dL), Diastolic BP (mm Hg), Systolic Blood Pressure (mm Hg) and Total Cholesterol (mg/dL) to name a few. These measures can be reported at the member, group, plan, or organizational level.

Common Uses

  • Assess the overall health of the client.
  • Evaluate the performance of your health and wellness initiatives.
  • Review member specific biometric screening results.

Enrollment

Sourced from the client's Third Party Administrator (TPA), this model includes enrolled member demographic and detailed plan information.

Common Uses

  • Identify the total number of members and subscribers enrolled by plan.
  • Identify the characteristics of the plan benefit design.
  • Analyze member and subscriber demographics over time.

Financial Ledger

This model contains aggregated medical, prescription, enrollment, and worker's compensation financial data.

Common Uses

  • Create robust financial reports on an incurred or paid basis.

Member

This model integrates medical, prescription, enrollment, biometric, and workers' compensation data to provide a holistic view of a member.

Common Uses

  • Identify cost and utilization drivers at the member level
  • Analyze medical, Rx, and workers' compensation costs for specific members.

Medical Claim

The medical model provides a detailed view of the medical claim information submitted and processed by the TPA.

Common Uses

  • Generate a comprehensive view of medical, financial, and hospital/professional utilization trends by member, provider, diagnosis, or procedure.
  • Identify medical cost drivers.

Rx Claim

This model contains prescription drug claim information. The claim data received from the TPA is enhanced with Innovu Drug Indicators and other third party data sources such as AHFS, Medispan, and REDBOOK.

Common Uses

  • Evaluate prescription drug utilization and cost trends by member, drug, therapeutic category, prescribing provider, or dispensing pharmacy.
  • Identify Rx cost drivers.

Workers Compensation

This model contains workers' compensation claim information sourced from the TPA.

Common Uses

  • Evaluate cost and age of the claim by member, nature of the injury, and diagnosis.
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