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Milliman's Hospital Evaluation & Comparison System™ (HECS™) allows users to easily compare and benchmark hospital contracts on a patient-severity adjusted basis. The HECS software assigns our RBRVS for Hospitals™ RVUs to claims data and produces a number of analytic reports that facilitate contract negotiations, consumer cost comparisons, and high-performance network development. Our patient severity adjusted-cost comparisons are used by both insurers and hospitals.
Conceptually similar to Medicare's RBRVS Physician Fee Schedule, RBRVS for Hospitals is a comprehensive inpatient and outpatient hospital fee schedule. Dividing the contractually allowed dollars on a hospital contract by the RVUs of production allows us to estimate the patient severity adjusted cost per unit of care and compare very different hospitals (e.g., community versus teaching) and patient populations. This is similar to using RBRVS to compare the cost per RVU for different physician specialties (e.g., neurosurgeons versus family practice).
A large number of insurers and hospitals rely on Milliman's HECS and RBRVS for Hospitals. Insurance users have included 20 Blue Cross Blue Shield plans and several state Medicaid plans. Hospital clients have included academic, tertiary, and community hospitals nationwide.
A manager at one Blue Shield client reported she found the system's RVUs extremely valuable in understanding hospital contract performance relative to peers and benchmarks. The RVUs helped the plan identify target opportunities for contract negotiation. The client's analysis found RBRVS for Hospitals can contribute as much as 1% yield on contract-allowable payments. Results vary, of course, among our clients.
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