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Prime Metrics

Managed care programs are designed to assist in controlling the costs associated with workers' compensation injuries. That is the primary purpose. Yet most programs in place today lack the tools to capture, quantify and aggregate relevant data in order to evaluate the true success of a program in meeting this basic requirement, or inaccurately comparing one managed care program to another. The industry has traditionally relied on somewhat nebulous and crude savings and outcome reports. At Prime Health, we believe that empirical evidence is always superior to anecdotal evidence.

Prime Metrics uses intelligent design, a technology that allows us to "pull data" from our clients to normalize and analyze, while simultaneously "pushing data" back to our client, providing them with descriptive and predictive metrics.

The "push" information provides alerts when any of the pre-set statistical norms have been exceeded. This creates a "window" into the medical life of the claim, giving claims handlers' access to an unprecedented amount of outcome impacting information and allowing them the opportunity to take immediate and appropriate action. Additionally, by pairing Prime Metrics with Prime Health Services PPO, we consult with our network providers to help them understand their performance as it relates to our client, their peers, geographic area, injury type, etc. in order to achieve optimum outcomes. Prime Metrics can be integrated within the existing claims system or accessible via our secure web portal.

Prime Metrics tracks, evaluates and compares literally thousands of data sets to quantify and report on hundreds of client customizable metrics.

Some examples:

  • Identify the number(s) of injury types treated by each medical provider.
  • Breakdown of all charges, fee schedule, PPO, and allowed amounts spent in a given month/year on an individual injured worker or by a treating provider.
  • Identify recurring or multiple surgeries by medical provider and also by injured worker.
  • Number of days from date of Injury to first date of service for treatment
  • Statistical flags for providers performing outside of the norm for costs and return to work timelines.