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More data means better solutions.


The DataSmart CST

The DataSmart CST (Client Solutions Tool) is an online computer software service which delivers medical advisory, scientific, and actuarial services and information to insurance companies, actuaries, and healthcare professionals. The CST enables professionals to predict healthcare costs, control losses in insurance plans, and discern and identify people who are at greatest risk of medical illnesses based on their bio-metric and other data. Results include benchmarking and comparisons to other populations of data.

Standard CST reports include plan level evaluations, member level analysis by risk and disease cohort, plan analysis and recommendations, concurrent and prospective member risk scoring, care density analysis, and a detailed analysis of key cost drivers. Priced on a formulaic, per employee per month basis (PEPM), the DSS CST provides you with everything you need to manage down your annual healthcare spend or that of your customers.


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All Source Risk Score

All Source Risk Scores are the most powerful predictive modeling tool available to actuaries, insurance, and healthcare professionals. All Source Risk Scores combine claims data, biometrics, and self-reported health data to help users manage existing and future health challenges.

The DataSmart All Source Risk Score is a feature of the CST (Client Solution Tool) and consists of an optional online computer software service which delivers highly-amplified medical advisory, scientific, and actuarial services and information to insurance companies, actuaries, and healthcare professionals. Using the All Source Risk Score, users may discern with greater accuracy the individuals who are at greatest risk of medical illnesses based on their bio-metric and other data. Users also use the All Source Risk Score to help predict healthcare costs, and control losses in insurance plans. Results include benchmarking and comparisons to other populations of data.

The DataSmart DAGR (Data Analytics Group Report)

DAGRs (pronounced, “Daggers”, for “Data Analytics Group Reports”), cut straight to the heart of DSS risk modeling and provide a complete picture of a plan’s activity and risk. Using predictive and descriptive metrics, DAGRs illuminate all areas affecting a plan’s bottom line and can identify areas ripe for improvement.

DAGRs are generated by special computer software and consist of electronically-delivered summaries of an individual employee benefit plan’s financial and clinical performance. The DAGR includes itemized clinical gaps-in-care, analyses of providers, provider facilities, trends in medical and Rx spends, and attribution analyses which pinpoint sources of cost increases and decreases. The purpose of the DAGR is to advise and assist medical and insurance professionals as well as actuaries, to predictively model healthcare costs, provide loss control advice, and ultimately improve the quality of healthcare enjoyed by plan participants.

DataSmart Health Solutions

DataSmart Health Solutions (DSHS) gives companies a smarter way to provide healthcare coverage through technology. Employers spend $1.2 trillion on health benefits for over 155 million workers, making them the best partner in the pursuit of better healthcare.

With the only platform that can connect and administer an entire health benefits ecosystem — health plans, benefits programs, spending accounts, member services — DSHS enables employer sponsored health plans to optimize their healthcare investment while giving employees the best coverage possible.

DataSmart Health Solutions utilizes the largest independent administrator of self-funded health benefits in the country.


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The DataHOQ

DataHOQ (pronounced, “Data Hawk”, for Health Online Questionnaire) provides the most accurate health risk-scoring available in cases where medical and pharmacy claims data are scant or absent. Using a well-tested panel of questions, the self-reporting survey gives a first glimpse into the existing and future risk of a plan and each plan participant, enabling risk managers, payers, and care coordinators to begin interventions earlier.

DataHOQ is a computer program, fed with a specific questionnaire (completed on paper or as an online service) which delivers analyzed results to actuaries and insurance and healthcare professionals for the explicit purpose of evaluating the current and prospective health risk of individuals and by accurately predicting which individuals are most likely to experience rising healthcare costs and at what cost. DataHOQ simplifies loss management and control within the plan.

The DataSmart Provider Efficiency Tool®(PET)

The new PET utilizes claims information to evaluate provider efficiency on an outcome-adjusted basis and includes care density analyses to capture and report network efficiency as well.

Also priced on a PEPM basis, the DSS PET enables financial and risk managers to optimize network formation.

DataSmart Consultative Projects

DataSmart Solutions deploys skilled teams of experts to meet client needs in data-dependent projects with the analysis and control of near-term healthcare costs as objectives.

Typical projects consist of the following:

  • Ad hoc reports, custom reporting capabilities
  • Supporting ACOs and other Carrier-Network shared-risk contracts with population risk scoring
  • Strengthening the product offerings of claims administrators and ASOs with predictive analytics
  • Design of ACA-compliant employee benefit plans
  • Pharmacy benefit plan optimization and design
  • Evaluation of initiative and program effectiveness (e.g. on-site clinics or wellness programs)
  • Network and provider efficiency evaluations
  • Special State, local, and Federal Government healthcare projects