Healthcare Analytics

Leveraging Healthcare Analytics to Revolutionize Your Benefits

04/16/2024 Written by: AP Employee Benefits

The enhanced use of healthcare analytics is revolutionizing how employers are able to interpret data about their population that can aid in the successful evaluation and development of their employee benefits plans. Healthcare analytics can enable employers to better understand the needs of their population, identify high-cost drivers and trends in conditions, and ultimately determine what solutions may be best performing or missing in their overall benefits offering. According to a recent report from Management and Business Review, approximately 153 million Americans rely on employer-sponsored health plans. Accounting for nearly half of the U.S. population, this leaves a large majority of healthcare spending and care management leaning on employer-sponsored health plans, making it essential for employers to understand the healthcare spend of their employees, as costs associated with employee healthcare spend are the second largest operating expense of most companies.

Insight to Your Unique Population

Healthcare analytics tools and platforms allow employers to gain insight into the specific drivers of their healthcare spend. These programs can provide great detail down to the member level on plan cost drivers on things such as condition-specific costs, pharmacy spend and identify gaps in care. According to a recent report from Health Advocate, employees who received target communications on how to improve their health experienced a 13% decrease in healthcare spending. While the fine detail can help employers support individual employees, the overarching benefits to having insight to healthcare analytics is that employers are able to identify common chronic conditions that may be impacting a large number of employees such as hypertension or diabetes and begin to promote condition-specific programming for their organization. These tools are also able to break down population demographics such as age and gender, allowing employers to determine if there is a need to explore and implement generation-specific benefits in their program. By analyzing previous claims history of the total population employers can begin to plan communications that will have a greater impact to their unique population.

Healthcare Analytics and the Bottom Line

Healthcare analytics is a great tool for employers to leverage when working through predictive analysis and estimating future plan spend for the upcoming year. Many healthcare analytics models have incorporated predictive analysis into their core offerings. These reports can help determine and plan for future estimated costs associated with healthcare spending. By taking previous years of claims history of both medical and pharmacy spending and combining that with risk assessments done on the unique population, the platforms are able to predict an estimated future cost of expenses associated with their health plan offerings. While these predications cannot be taken as a guarantee, they do offer some guidance based on the previous performance of the healthcare plan in previous years. Risk scores are often assigned to members based on their previous usage and claims history to assign them into a category based on their financial contributions to the organization's overall healthcare spend. These reports can become extremely valuable when an organization is evaluating where certain costs originate from and assist them with budget allocations for future year planning. By understanding the specific conditions, treatments or medications that high-cost claimants may be receiving, analysts are able to determine if a certain condition is associated with a one-off catastrophic claim, or if the increase in spend if likely to continue as a result of a long-term of chronic condition.

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An additional feature of many of these platforms which can have significant value to employers are plan optimization reports. These reports and interactive tools enable employers to input different scenarios and values to see the potential impact on their benefits programs. These scenario planning tools can give some additional data and financial backing to how the changing of premiums, copays, deductibles or other variables may impact the future financial performance. These tools can be especially helpful when an organization is considering deductible increases or the potential implementation of a new plan option to the organization.

Hitting the Mark and Identifying Gaps

For employers, utilization of healthcare plans has typically been measured by participation and enrollments in their plan offerings. With healthcare analytics, that analysis can be taken a step further by identifying areas that may not be optimal for the employer and help them make informed decisions that can ultimately lead to cost savings by either removing or implementing an offering. These can also help identify if additional communication around the use of certain offerings is needed. For example, if an organization is seeing an increase in emergency room utilization for services that could have been seen at an urgent care, an organization can begin to communicate proactively with employees on the use-cases for each of these care centers. These tools are able to help determine an ROI of an offering, such as a mental health program, by reviewing the overall costs saved by employees leveraging the program in a proactive manner. These platforms can also demonstrate to an employer if they should be evaluating other unique offerings based on the characteristics of their population. For example, if a large number of plan participants are receiving care for musculoskeletal conditions, the employer can ask if themselves if there are programs such as regenerative therapies that could help improve patient outcomes by taking a more proactive approach in condition management. These platforms also can provide detail on the compliance rates of certain conditions, such as diabetic patient screening and testing compliance, and preventive screenings measures such as mammography and colonoscopy completion, giving employers additional data to use to influence communication plans to their organization.

By leveraging data analytics employers can be best prepared to evaluate the specific conditions impacting their overall healthcare spend and equip themselves with the data necessary to implement solutions tailored to their unique population. By doing this, employers can better understand the impact to their bottom line and make data-driven decisions while creating an impactful employee benefits program that meets their employee's needs.

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