Pendulum offers an opportunity for employers and members of coalitions to improve their ability to predict care utilization and cost while improving quality of care for their workforce.
How is this done?
Pendulum accomplishes this through an in-depth analysis of claims data; benefit and health services cost information for employees in your specific community. This goes beyond standard claims payment analysis. This analysis uncovers very specific trends for specific hospitals, specific doctors, and specific pharmacy use so as to get a clear picture of your panel of providers used by your employees.
What makes this unique?
Pendulum has access to claims data for insurers and health plans in your region to determine benchmarks of actual performance. By measuring variations and establishing best practices, patterns of practice emerge that identify physicians and hospitals with the best record of quality outcomes and the most reasonable cost.
These care and cost factors are measured on an outcome basis. In other words Pendulum can assign a value to a specific network of health services, which enables the purchaser or health plan to predict costs in advance of service.
How is this different from what you're doing now?
Most employee benefit contracts and insurance arrangements have reported units of care and a price of units. The strategy being to cut the volume of services used through preauthorizations and benefit elimination or by increasing employee co-payments. The other strategy has been to reduce the price through discounts and repricing agreements with third parties or fee schedule limitations such as maximum allowable fee schedules.
We learned 20 years ago in building community health plans and instituting care management principles that when health plans opt for discounts they see a surge in utilization and when they try to limit utilization the price goes up. In addition, when insurers separate the inpatient from the outpatient services it is impossible to tell which doctors are doing the best job or which hospital has the best services for a certain diagnosis. In short, old-fashioned accounting approaches to medical economics do not work and in fact can actually impede access to quality care.
Pendulum Health has been working with episodes of care and prospective payment issues designed to predict care since the early 1990’s. Our focus on developing contemporary medical management strategies for both community based health plans and employer purchasers gives us a broad knowledge of reimbursement issues, underwriting options, provider contract negotiations, and general management experience in creating, managing and monitoring multi-specialty panels of providers as well as single specialty arrangements.
Some employers use our information for plan design changes, wellness monitoring, network evaluation and find us particularly valuable as mergers or consolidations occur and change the workforce utilization pattern.
Pendulum Health represents a team of management executives, clinical specialists, database analysts, biostatistics resource and support staff. All of these individuals have 20 plus years in a variety of settings and are senior leaders in their respective specialities. Their specialties include claims and underwriting operations, credentialing and benchmarking, actuarial science, and employer and physician networking.
Our clients regularly comment upon the unusual insight and practical recommendations made by our team.
In an era of health reform we are seeing the self funding mechanisms change and new opportunities for employers to build thier own networks.