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Healthcare cost modelling

Health Cost Guidelines – Grouper

Analyse and benchmark utilisation and costs using the Health Cost Guidelines—Grouper, which sorts medical and pharmacy claims data into hospital, surgical, medical, and other benefit service categories using Health Cost Guidelines (HCG) definitions.

Use HCG Grouper software to:

  • Analyse and benchmark cost and utilisation for many different types of population data, such as product lines, lines of business, employer groups, primary care panels, disease populations, incurred service periods, and member state.
  • Track utilisation—inpatient days per 1000, office visits per 1000, prescription drug scripts per 1000, average charge tracking, and analysing the claim cost dollar.
  • Run granular reports leveraging more than 100 HCG categories.
  • Mitigate the expense of annual CMS Plan Benefit Package (PBP) definition compliance.
  • Perform financial and utilisation analysis of your organisation's claims data and overall data quality using the optional HCG Cost and Validation Model.

The HCG Grouper is a platform-independent standalone application that can be quickly installed and run on a standard Windows PC. Import claims in flat file format and receive results output in formats that lend themselves to a flexible integration model with the vast majority of commercially available databases or analytical applications.

The HCG Grouper:

  • Assigns each line of claim detail an HCG service cost category for use in commercial, Medicare, or Medicaid analysis.
  • Uses the most current medical code sets and Health Cost Guidelines methodology to assign service categories.
  • Permits integration into an existing data warehouse or data mart solution using a Windows application design.
  • Aligns your regular data loads with Milliman HCG benchmarks.
  • Aligns performance monitoring with product creation and rate structure.
  • Maintains the CMS methodology for defining preventive services.
  • Is fully integrated with the MedInsight Analytic Platform, Milliman’s powerful software for data warehousing, decision support and reporting.

The products we sell are the tools we use

As the premier health management consulting firm, the Health Cost Guidelines are used daily by our own in-house actuarial consultants for insight into the key drivers of healthcare costs and utilization.

The Health Cost Guidelines Suite includes the following products:

  • Ages 65 and Over
  • Commercial
  • Dental
  • Grouper
  • Prescription Drug Rating Manual
  • Reinsurance

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Milliman Health Cost Guidelines - Grouper resources

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