The Power & ROI of
Actionable Information
Problem
Increasing Health Cost Trends
Large retail food supplier had experienced progressively increasing trends for a
number of years. Company management was having a difficult time understanding the
drivers of their healthcare spend and trend and wanted to:
- Continuously monitor their health plan expenditures
- Understand potential problems and opportunities within the plan
- Measure the impact of various actions taken to determine their effectiveness
Approach
Analysis of Plan Performance
This company clearly had a need for data integration and analytic services. We suggested
an initial analysis of their past three years of medical and pharmacy plan performance
measures to determine the best course of action.
Action
Implement Tools and Evaluate Benchmarks
Conduent Care and Quality Solutions implemented our Health Plan Tools
web-based software to facilitate the data analysis. We warehoused historical claims
in our standardized format and established ongoing monthly data feeds with the company’s
TPA & PBM. The company’s HR executives, Finance staff, and benefit consultant
all accessed the online analytic reports to fuel their benefit strategies.
In seconds (rather than months), we created detailed benchmarking studies vs. nationally
recognized norms that were customized based on the company’s specific demographic
mix. The company was able to quickly determine their overall cost, price, and healthcare
utilization patterns. Also, since claims were mapped back to the de-identified patient
and provider, valuable analyses of their provider networks and employee disease
risk profiles were easily developed.
Company used the analyses derived from Health Plan Tools to take
the following actions:
- Chose narrow network option offered by their TPA
- Modeled new plan designs by re-processing claims using their actual data
to estimate the financial impact from both the company’s and employee’s
perspectives
- Evaluated the members being managed by their care management vendor
- Automated monthly reports to monitor their strategies on a go-forward basis
Result
Reduced Trends, Increased Management
Reduced Trend – Trends dropped from 25% annually prior to
the implementation of Health Plan Tools to 6% annually in the 2
years afterward! Much of this was directly attributable to actions driven by the
information.
Actionable Information – Company identified 60 high risk
members in Health Plan Tools and asked existing care management
vendor how many members they currently had under management. After learning only
3 of the 60 were under management, the company switched vendors.
Vendor Management – After reviewing a Health Plan Tools
report, company’s benefit consultant caught a $230,000+ error in the provider
discounts that their TPA was administering.
Company was now able to respond to executive leadership with clear answers in a
timely fashion to reinforce their strategic decisions.