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Data’s Role in Reducing Costly Health Claims

Data’s Role in Reducing Costly Health Claims

Everyone is a patient at one point or another, and we all want great medical care. When going to a doctor to receive a treatment or diagnosis, we enter with the presumption that he/she is an expert, and there is medical research backing their decisions. Unfortunately, this is not always the case. In this installment of CenterStage, Danielle Koenig, a Market Analyst at ClearPath Benefits, talks about the increased use of data in the healthcare industry, and how this is good news for doctors and patients alike.

Data Delivers Better Medical Outcomes

Physicians are smart, well-trained and do their best to stay up-to-date with the most accurate research in the medical industry. However, they cannot commit to memory all the knowledge they need to know for any given situation and likely cannot turn to a colleague or superior doctor and expect them to be a trove of information. Even if they did have access to massive amounts of data needed to compare possible treatment outcomes for a patient’s condition, it would require large amounts of time and expertise to make information comprehensible and allow for integration into a patient’s medical profile.

This type of work is simply out of a physician’s line of work, and thus, they are turning to data analytic vendors to supply this information in a complete and consumable format. Using software such as predictive analytics (PA), these vendors use technology and statistical methods to search through massive amounts of information, analyzing and predicting outcomes for individual patients.

Information given to doctors plays an important role in providing better medical outcomes for patients/employees. For example, data can be pulled to identify trends within an employee population, such as where they go for medical treatment and how much they pay out of pocket for said treatment. In addition, statistics about a population can reveal increases and decreases in certain areas, such as emergency room visits and pharmacy spending, as well as various risk factors that may be prevalent in certain times and cases, which provides valuable insight for employee wellness packages. Through the identification of risk factors, such as low blood sugar and high cholesterol levels, physicians can identify who has received annual check-ups and physicals, as well as if one or many employees are suffering from a chronic condition (blood pressure problems, diabetes, etc.). If so, the data can show whether they are scheduling regular visits to monitor their conditions.

Utilizing data offering an in-depth look into the current state of a patient’s well-being is not only timely and efficient to doctors but cost-effective and sensible to employers. Danielle notes, “When it comes to employee benefits, data offers insight into where your money is going, and how those dollars are being utilized.” She continued, “Employers are either self-funded or fully-insured” and the differences are noticeable. Danielle says for employers who are self-funded, “you are paying claims as you go, and data accurately shows where your money is going, so there are no surprises”. An option that allows for more control and increased transparency, a self-funded program offers flexibility and rewards employers who have employees in better health by incurring lower monthly costs, taking statistics gathered from data vendors more to heart and mind. On the other hand, fully-insured programs offer a flat rate premium each month regardless of medical spend. Danielle says, by adding a data analytics solution to a fully-insured program, “There is a window to better direct employees.” With either plan, employers can have a better and more accurate view of the utilization and expenses of their plan offerings.

How Can Employers Gather This Information?

For employers interested in having a detailed look at how employees are utilizing their healthcare dollars, ClearPath Benefits offers solutions that focus on data. This is performed by connecting employers to a data analytics vendor who enters your claims into their system for records and referrals. Often used in tandem with a medical management service, a data analytics vendor provides a deep dive into the medical spend of your business and can help target key areas where patients/employees can take on more responsibility for their own care, if they are to make use of information derived. From the acquiring and utilization of healthcare data, there may be a drop in hospitalizations, yet admissions will be more meaningful and worth insurance dollars.

Not to be confused with benchmarking, which also provides informative feedback on employees in the form of analytics, data analytics is focused strictly on how employees are spending healthcare dollars and how employers can gain a better understanding of the current healthcare market and trends to offer more cost-effective options and plans to save themselves and employees dollars. Ready to begin placing the power of analytics on your side? Speak with Danielle at ClearPath to learn more about having a data analytics vendor on your side. You can contact her at 614.857.6444 or dkoenig@clearpathbenefits.com.

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