RETROSPECTIVE CLAIMS ANALYSIS (RCA)

Gordian's 3-part Retrospective Claims Analysis (RCA) engine is the most powerful in the market today. It is a singularly proactive approach to population health management.

Is your health management program operating on only one gear?

Most healthcare companies conduct retrospective claims analyses based only on ICD-9 codes for disease categories. By only counting disease states, you are looking at only a fraction of your population. Gordian has found such data to be inadequate in fully understanding and evaluating health seeking behaviors and healthcare utilization across the health continuum.

Integrated health management

Gordian's proprietary Self-Care and Lifestyle analysis engines help clients address early warning signs of illness - for early intervention and upstream cost savings. Our Disease analysis engine identifies individuals living with chronic illnesses.

  • Self-Care Analysis - includes over 700 self-care related ICD-9 codes for minor or uncomplicated illnesses and injuries that can be treated safely without a visit to the doctor. The fact that they may be showing up in higher rates in your population could identify specific wellness areas and programs to promote in your organization before they become harder-to-treat health risks.
  • Lifestyle Analysis - includes over 1600 ICD-9 codes for which a known health risk factor has been identified. The Lifestyle analysis sums scientifically attributable risk cost from those diagnosed claims. For example, smoking is responsible for several kinds of malignancies, heart disease and emphysema, among others conditions. Summing proportions of these costs scientifically linked to smoking helps us estimate smoking related costs for specified groups.
  • Disease Analysis - includes 21 disease categories for which a cost effective treatment pathway has been developed.

Gordian's 3-part RCA engine is the perfect tool to help organizations determine specific risks, focus resources, and cost-justify the implementation of health management programs. Using the RCA from year to year allows organizations to pinpoint need-specific interventions, plan programs, and prepare a realistic budget.