ikaUA
Robust Utilization Analytics for Financial, Underwriting and Clinical Performance
Decision-Making
ikaUA delivers comprehensive Web-based analytics and reporting for executive management, actuarial, underwriting, finance, quality and medical management decision-making. Incorporating generally accepted utilization metrics and clinical criteria, ikaUA takes command of health plan data, analyzing virtually all plan-level utilization metrics — for example, most common and most expensive diseases, CPT codes and procedures.
The system automatically generates over 60 standard reports in the following categories:
- Administrative/Actuarial/Statistical Analyses
- Catastrophic Case Listings and Analyses
- Utilization Analyses (Plan)
- Commercial Group Utilization Data
- Hospital Utilization Analysis
- Membership Information
In each report, data can be accessed at the most granular level and rolled up into larger units of analysis.
Plans have access to the foundational data elements to generate ad hoc reports with SQL queries or with any off-the-shelf reporting application. The new reports are always returned to the data repository and can easily be combined to create endless report variations.
Sample ikaUA Reports
| REPORT NAME |
REPORT DESCRIPTION |
| PMPM Expenses Age/Sex Utilization |
Age/Sex Utilization (Utilization Amount) No Exclusions (Note Capabilities for Graphical Analyses) |
| Catastrophic Case Analysis >$20K (Liability) |
Detailed Listed by Member, Group, PCP, Age, Sex, Charges and Diagnosis (Liability) = >$20K |
| PRG Events >$20K |
Member-Specific Data for PRGs >20K |
| Expense Summary 250 Highest Cost CPT Codes |
Highest 250 CPT codes used: Billed, Liability, Utilization, FFS Equivalent, Unit, Unit Cost and Frequency |
| Expense Summary 250 Highest Cost ICD9 Codes |
Highest 250 ICD9 Codes Used: Billed, Liability, Utilization, FFS Equivalent, Unit, Unit Cost and Frequency |
| Group Relative Performance (Liability Amount) |
Group Relative Performance Adjusted by Age and Sex Liability Amount |
| In-Patient Analysis Age/Sex Categories (Liability) |
Age/Sex Hospital Utilization Analysis: Member Months, YTD Admits, YTD Days, LOS, Costs and Rates Utilization |
| Performance Index by Procedure Site (Utilization) |
Performance Index by Procedure Site, PRG Index (Utilization) |
| Monthly PCP Membership Statistics by Age/Sex |
Monthly PCP Membership Statistics by Age and Sex |
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