By David Hom, Chief Evangelist, SCIO Health Analytics
Twitter: @SCIOanalytics
Brokers and consultants often are left to rely on the same set of data (over and over again) when trying to enable clients to improve members’ health as their own financial health. As a result, consultants often find themselves frustrated when they can’t move the needle toward better results.
By looking beyond traditional data sources such as medical and pharmacy claims, consultants can work with employers to create a more comprehensive view of population and financial performance. Adding employee and member data such as workers compensation, disability, and social determinants of health into the mix makes it possible to gain a holistic view of employees and to understand key trends. Indeed, by combining members’ clinical history (conditions, gaps, interactions with the healthcare system), with a view into key social determinants of health that are potentially affecting access and attitudes toward care, you can clearly identify formerly hidden opportunities to truly improve health and financial outcomes.
By leveraging robust data and advanced analytics brokers and consultants are able to:
1: Identify, manage and reduce employee/member health risks. More specifically, you can understand root causes behind rising costs, over or under utilization, leading clinical risk drivers (maternity, pharmacy utilization, etc.) and identify areas of opportunities for action.
2: Proactively and effectively identify and close care gaps. When you know the conditions and/or cohorts with greatest non-compliance, it’s easier to take the action that will close care gaps. More robust insights can also help to hone in on employees’/members’ preferred communication method, making it possible to more effectively engage with employees.
3: Drive better outcomes by focusing on impactability. It is possible to quickly and effectively focus time and resources by identifying employee populations and conditions that will have the greatest improvement on health and financial outcomes.
4: Proactively manage healthcare spend. You can help employers mitigate financial risk by proactively tracking and managing healthcare costs trends, including medical loss ratio; impact and value derived from insuring high cost claimants; necessary reserves required to cover obligations; value benefits on the stop loss coverage; and ROI & outcomes of specific plan design.
5: Manage employee absenteeism. Predict which segments of the employee population are at risk for a workers compensation, short term disability, long term disability or Family Medical Leave Act (FMLA) claim; target at risk employees for prevention and/or population health programs; manage employees/members on leave in an attempt to improve quality outcomes and reduce costs; and promote proper utilization of resources and minimize time away from work.
These are just a sampling of the ways that more comprehensive data can help improve outcomes. Can you think of any others?
This article was originally published on SCIO Health Analytics and is republished here with permission.