From claims come informed decisions

Questions your plan’s own data can answer.

A total spend number is a starting point. MSK Benefit Analytics examines how care begins, what happens next, and where plan resources go.

1. Where does care begin?

See the first MSK encounters and the paths participants take after them.

2. What care was delivered?

Connect diagnoses to visits, therapy, imaging, injections, procedures, and follow-up care where the data permits.

​3. Where does cost accumulate?

Identify spending patterns by joint, service, provider, and sequence of care.

 

Data access & stewardship - A useful analysis starts with a usable claims file from the administrator.

Under the Consolidated Appropriations Act of 2021, certain contract terms may not restrict a group health plan’s electronic access, upon request and consistent with applicable privacy rules, to de-identified claims and encounter data. The covered information includes per-claim financial information, provider information, and service codes. Federal guidance: DOL FAQ Part 57 and FAQ Part 69. 

 

Start with four checks

Requested years✓

Diagnosis details✓

Service / procedure codes✓

Provider and financial fields✓

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​How MSKBA works - A baseline you can use to make decisions.

We begin with the plan’s actual claims experience, report what the available data supports, and establish a foundation for later measurement.

1. Review the file

   Assess the years, fields, and service-level detail delivered for analysis.

2. Map the care

   Analyze MSK utilization and spending across diagnoses, services, and participant pathways.

3. Present findings

   Give decision-makers a focused report with the patterns that merit attention.

4. Measure change

   Use comparable later data to evaluate changes in care pathways and cost.

 

Start the conversation and see what a plan-specific MSK analysis can reveal.

Request a sample report and discuss the claims information available from your administrator.