Budgeting health plans

The HealthPlan Operations utility allows your organization to calculate revenues and expenses based on Membership Per Member Per Month (PMPM)Membership Per Member Per Month (PMPM) calculations, which you can then use to determine the profitability of each health plan and/or insurance product.

TIP: The ability to determine profitability depends on the data provided by your organization. The more revenue and expense data you enter into the system, the closer you can get to a true margin ratio.

This utility is primarily for Axiom Budgeting administrators and/or finance liaisons of health plan companies and their key stakeholders.

The following list and image describe the different areas and functions of the utility:

  1. Key Results Summary - Summarizes the results of all the health plans included in the utility.
  2. Insurance Plans - Displays a list of all the health plans and their key metrics for members as well as the PMPM rates for revenue and expenses. The system calculates historical PMPM values for historical periods such as Last Year Actual and Year-to-Date. Projection and monthly budget values are calculated based on members multiplied by the PMPM rate for revenues and expenses. The header bar for each entity/department displays the entity and department number, the insurance plan product, and the location. For each entity/department, the system shows the number of covered members, the revenue, and the expenses.
  3. Annual Comparison and Budget - The first half of the sheet displays the Annual Comparison section, which shows values for the current year, including the current fiscal year budget, YTD actuals, and projected actuals and next year budget. The other half of the sheet is the Budget section, which shows the monthly and total budgeted values for the next fiscal year.
  4. Expand/Contract entity/department rows - By default, the list of entities/departments is expanded, but you can double-click to expand or double-click to contract it. After you save your changes, the system remembers this setting the next time you open the driver.

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IMPORTANT: The utility does not allow your organization to enter any health plan data containing patient identifying information.

To budget health and insurance plans:

  1. In the Bud Admin task pane, in the Budget Files Administration section, double-click Open HealthPlan Utility.

  2. In the Refresh Variables dialog, do any of the following to filter the list of records that display in the utility, and click OK:
    • In the Filter by ENTITY field, enter or select one or more entities.
    • In the Filter by DEPT.KHABgtMap field, enter or select one or more departments.
    • To include all entities and departments, leave the fields blank.
  3. To enter details for a line item, in the Comments column, type information in the blue cells for the appropriate line item.

NOTE: The information in the HealthPlan Operations utility is controlled by a series of dimension tables and drivers. See the Managing utility information section below on how to update information and calculations in the utility.

Using different views

The system provides several different ways to view the sheet information. In the Main ribbon tab, click Change View.

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The following table provides a description of the different options.

Column views

View Description
Select All Show all Annual Comparison, Comments, and Budget columns
Deselect All Hide all Annual Comparison, Comments, and Budget columns
Show Section - Annual Comparison Hide or show the Annual Comparison columns
Show Comments Hide or show only the Comments column
Show Section - Budget Hide or show only the Budget columns

Row views

View Description
Select All Show both the HealthPlan Operations title and Key Results Summary Area
Deselect All Hide both the HealthPlan Operations title and Key Results Summary area
Show Title Hide or show the HealthPlan Operations title
Show Section - Key Results Summary Hide or show the Key Results Summary area

Sheet views

View Description
Default Show both the Annual Comparison, Comments, and Budget rows and columns
Annual Show only the Annual Comparison and Comments rows and columns
Monthly Show only the Comments and Budget row and columns

Managing utility information

The information that displays in the utility comes from several different sources. The following table lists where to update information, as needed:

NOTE: To update dimensions specific for health plan budgeting, see Updating dimensions for health plan budgeting. To update dimensions specific for health plan budgeting, see "Updating dimensions for health plan budgeting" in the online help.

Location Description
LOCATION dimension Add or edit department locations.
INSCODE dimension Add or edit healthcare or insurance plans.
DATATYPE dimension Assign budget types to plan revenue and expense streams.
ACT_HP_20XX table Add or edit plans and the corresponding actual account data.
Membership Enrollment Trend driver Enter enrollment percentages for each health plan or insurance product offered by your organization. The purpose of this driver is to determine the membership trend of each product. The trend percentages are then used in the Membership Per Member Per Month (PMPM) driver to adjust the membership statistics.
Membership Per Member Per Month driver Review member lives, revenue PMPM, and expense PMPM for each health plan.

Printing the HealthPlan Operations utility

Axiom Budgeting allows you to save the Annual or Monthly version of the HealthPlan Operations utility as a PDF.

To print the HealthPlan Operations utility:

  1. Open the HealthPlan Operations Utility.
  2. In the Main ribbon tab, click Publish > Print > Print This Sheet.
  3. In the Print Sheet dialog, do any of the following:
    • Print Details - Click the View/Edit link to edit print view options, scaling, and header/footer information.
    • Print Preview - Click the Print Preview link to view a preview of the report.
  4. Next to the sheet name, click the check box for the report to print, and click Print.