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
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
- Identify the number(s) of injury types treated by each medical
- 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
- Statistical flags for providers performing outside of the norm
for costs and return to work timelines.