Budget health and insurance plan products

Why use this feature

Axiom Budgeting and Performance Reporting now includes a health and insurance plan solution that helps your organization forecast a projection and annual budget using planning methodologies centric to the structure of health plan insurance products. This allows you to work with an industry specific model that is common to the health plan business. You can track and plan the profitability of each insurance product, all while viewing real time results in Axiom Budgeting.

How this feature works

There are several key features in the new health and insurance plan product:

NOTE: This is a separately licensed product available for purchase.

1. HealthPlan Operations utility

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

Key Results Summary - This area summarizes the results of all the health plans included in the utility.
Insurance Plans - The utility 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.
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.

Where: The utility is located in the Bud Admin task pane, in the Budget Files Administration section.

Who: Axiom Budgeting administrators and/or finance liaisons of health plan companies and their key stakeholders.

How: Most of the utility is devoted to displaying calculated revenues and expenses derived from Membership Per Member Per Month (PMPM) and Membership Enrollment Trend driver. The list of insurance plans is maintained in the new INSCODE dimension table and the actual data used for the calculations is stored in the new ACT_HP_20XX data table.

Click here to watch a video demonstration

2. ACT_HP_20XX data table

This table stores the actual data used by the HealthPlan Operations utility to budget for your organization's health and insurance plans across entities and departments. This information is used primarily by the Membership Per Member Per Month (PMPM) driver to calculate actual and budget amounts by period by the number of members in a particular period. 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.

Where: The table is located in the Library > Management Reporting > Actuals > Health Plan folder of the System Browser.

Who: Axiom Budgeting administrators and/or finance liaisons of health plan companies and their key stakeholders (assigned the proper security permissions.

How: You can enter the data in this table manually or as part of an import. Your Syntellis Implementation Consultant will help you set up the table for your organization. There is no pre-defined import available to import health plan data at this time, but you can work with your Syntellis Implementation Consultant to create a custom import. You will need to maintain this table as plans, revenue streams, and expense streams are added or changed.

NOTE: The Health Plan product relies on data identified in this table for refresh variables and blocks of data. Without the data, refresh variable picklist(s) will display blank.

IMPORTANT: Your organization cannot enter any health plan data containing patient identifying information into the system. Please do not send any transmission of data in any form to Syntellis related to this feature containing any patient identifying information.

3. Membership Enrollment driver

This driver allows you to 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 insurance product. The trend percentages are then used in the Membership Per Member Per Month (PMPM) driver to adjust the membership statistics. The driver displays the list of insurance plans by clearly grouping them together by entity.

Where: The driver is located in the Bud Admin task pane, in the Budget Assumptions section. The driver is located both in the Access NY Budget Assumptions and Access CY Budget Assumptions drop-downs.

Who: Only users assigned the GlobalDriverMgmt role profile have access to this driver.

How: When you open the driver, you can use the Refresh Variables option to filter the entities to view in the driver. In the actuals columns for each period, enter the actual percentage of growth or reduction of membership that the plan experienced or expect to experience. By default, and upon initial use, all Projected Actuals and Budget columns display 100% for all plans. The configured growth or reduction of membership percentages provides the basis for budgeting plan membership for the next budget year. You can change this number, if needed. In the budget columns for each period, enter the percentage of growth or reduction of membership that you expect the plan to experience. If a plan is removed from the INSCODE dimension table (i.e., a plan is retired or discontinued), an Unmatched Records area displays at the bottom of the driver page.

Click here to watch a video demonstration

4. Membership Per Member Per Month (PMPM) driver

This driver provides the basis for several important planning activities needed for your organization to budget health plans and insurance products, which is then used by the system to populate the HealthPlan Operation utility. This driver provides a central location to review member lives, revenue PMPM, and expense PMPM for each health plan and specifically within each entity (or department). The enrollment percentages from the Membership Enrollment Trend driver updates the planned member lives, which also flows to the HealthPlan Operation utility. This driver does the following:

Depending on the level of detailed records loaded by your organization in the ACT_HP_20XX data table, the driver can bring in actual data for members, revenues, and expenses by entity, department, insurance code, location, and data type. The driver calculation methods then calculate historical PMPM values based on available history.
The historical PMPM rates carry forward to any non-actual period. For example, if six months of actual is used, then month seven of the current year in the driver refers to the month six PMPM rate. The rates in all non-actual months can be edited.
The PMPM rates in the projection and monthly budget columns are then used to calculate the projection and monthly budget for revenues and expenses in the HealthPlan Operations utility.

NOTE: If the Membership Enrollment Trend driver is not configured, the Membership PMPM driver will default to 100%.

Who: Only users assigned the GlobalDriverMgmt role profile have access to this driver.

How: When you open the driver, you can use the Refresh Variables option to filter the entities or departments that display in the driver. In the actuals and budget columns for the different data types, you can use the default values derived from the Membership Trend Enrollment driver or enter the values manually. You can also add and remove data types.

Click here to watch a video demonstration

5. INSCODE dimension table

The INSCODE dimension stores information for the insurance/health product plans offered by your organization. This information is used to manage and configure the plans included in related driver tables and in the Health Plan Operations utility. Similar to other dimension tables like ACCT, there are column structures to control what insurance plans will be allowed to interface to the HealthPlan tab and at what level of rollup, if any.

Where: The dimension is accessible from the Dimension Maintenance Utility, located in the Bud Admin task pane, in the Budget System Maintenance section.

Who: Users assigned the GlobalDriverMgmt role profile and Budget Admins or Budget Local Admins have access.

How: When you open the dimension, enter the insurance code, description, InsCode.BgtCode (used to group the insurance/health plan products together), and KHAInt (specify whether to include the insurance product in the list of available plans in the Health Plan Operations utility).

Where to find more information

The following topics include new information and instructions for using this feature: