Total Outcomes Management Solution (“TOMS”) – design, development and implementation of proprietary data mart, data warehousing, and Ad-hoc & executive reporting solution (Total Outcomes Management Solution – “TOMS”) with outcomes focused measurement, benchmarking and vendor performance and assessment capabilities. This non-intrusive, low-cost solution has a built-in processing engine that integrates information across lines of insurance, business units, data elements and geographical areas. This application design has been deployed by insurance carriers, third party administrators, medical management entities, bill review processors, corporations, brokers, industry consultants and state funds. TOMS is also available under a Private Label Program.
TOMS is a multi-faceted data warehouse delivering integrated information across:

• Lines of insurance (e.g. workers’ compensation, STD, LTD and general liability)
• Vendors (e.g. carriers, TPAs, case management, bill review, provider networks)
• Data elements (e.g. reporting, claim processing, file notes, financials, medical management, bill review and risk management)
• Geographical areas (e.g. states, distinct jurisdictional areas and different countries).

TOMS integrates all information, helps reduce costs and effectively measures performance.

• Complete integration and data integrity – TOMS integrates data, both from internal and external vendor sources, to provide a true normalized database of information with complete data purification, ensuring information integrity and consistency.
• Performance management – TOMS enables intelligent analysis and evaluation of vendors and their services: claims handling, medical case management, return to work activity, provider profiling, network coverage and overall risk reporting. TOMS also enables forecasting “what-if” scenarios across business entities and clients to help continuously enhance overall performance: profitability by client, geographical area, business unit and even employee.
• Outcomes Measurement and Benchmarking – by measuring and benchmarking results against industry standards (NCCI, WCRI, PRDP, URAC), competitive or “best in class” performance, opportunities for operational efficiencies to improve risk programs and decision-making can be identified throughout the organization.
• Independence – since all data is delivered into the warehouse, information independence is maintained including complete vendor flexibility without data conversion or data integrity concerns.
• Proactive services – Customizing the edits within TOMS processing engine to specific requirements help identify potential trouble areas before they occur. Both vendors and clients can be proactively managed and internal resources shifted accordingly.
• Non-intrusive ASP Delivery – working from standard EDI transaction sets and proprietary feeds, TOMS does not disrupt or force changes to systems or established workflows. The low-cost ASP delivery minimizes the typical expenses for hardware, software, communication lines, technical infrastructure and on-going support.
• Universal sharing of information – by reducing the need for investment in new or additional tools, TOMS accessibility of data promotes the sharing of information across the entire organization at minimal cost with maximum insight.

First, TOMS removes the technical barriers to accessing complete and accurate data from multiple systems. Second, TOMS identifies opportunities for improvement by providing critical benchmarking information, productivity dimensions and performance measurement, all within an intelligent environment. Third, TOMS generates a rapid return on investment through its low-cost, non-intrusive delivery (ASP).

With TOMS, professionals, management and support personnel are empowered with the information they need to make both strategic and tactical business decisions to:

• Focus on the quality of service to clients and demonstrate value
• Manage total service costs effectively and increase profitability
• Improve overall market position and manage long-term success.