How to Turn Health Care Data into Dollars

Is your company one of the growing numbers of US employers using health care data to manage expenses?

Just as employers keep a close watch on profit and loss columns, the same analysis is now available for companies’ health care costs. Big data is increasingly driving improved, better coordinated care to improve employee health while managing spiraling expenses.

We know this is a complicated topic (just like health care). That’s why we’re offering a free white paper examining the role of big data in health care and how employers can achieve true quality, cost-effective outcomes.

Between 1999 and 2015, employer-sponsored health premiums rose 203%.[i] Managing employee health costs is becoming more and more difficult every year.

Big data compiles massive amounts of data from multiple sources, yielding key metrics and predictive analytics for health care providers. Providers can then leverage this into interventions that provide high quality, cost-effective care. And employers who receive regular reports on trends can work with a benefits administrator to better manage those costs while supporting employee health outcomes.

Jane’s Story

diabetic, advanced analytics, big dataHere’s an example of how MedCost applies this analysis. Jane,* a 42-year old female member with moderately-controlled diabetes, has health benefits through her job. Jane’s biannual visit to her Primary Care Physician (PCP) documents her routine lab work, prescriptions and referrals for preventive screenings.

Between PCP visits, this diabetic member gets the flu, causing severe increases in blood glucose levels. When Jane goes to the Emergency Room, the ER doctor increases her medication dosage. After she goes home, Jane’s personal blood glucose meter shows an alarming drop in her blood sugar levels. Jane calls her PCP, who adjusts her dosage to prevent more complications. Jane’s next checkup is planned in six months.

Was all the data communicated from the hospital’s electronic records, the lab vendor’s system, payer claims and her home monitoring glucose meter? Will the PCP be able to verify that Jane actually obtained her preventive mammogram or flu vaccine prescribed before the ER visit?

At MedCost, Jane’s case would be carefully monitored by her nurse health coach. If there is an issue, her nurse health coach would follow up.

white paper

Chronic illnesses like Jane’s need expert support to prevent worse outcomes and resulting higher costs. And advanced analytics can now identify patients and populations at risk for developing certain conditions prior to the actual onset of illness.

 The white paper, Transforming Data into Dollars, offers an understanding of factors influencing the need for advanced analytics solutions, including an example using the MedCost Care Management programs.

Here are other insights from the white paper:

BENEFITS OF ADVANCED ANALYTICS  
   
1.     Accurate Reporting Normalized measures based on industry-accepted tools of evaluation yield best results for your employees.
2.     Maximized Outcomes Your company will rate higher on the Analytics Sophistication Scale and outperform industry peers.
3.     Healthier Employees Potential risk for developing conditions can be identified and prevented.
4.     Lower Costs Wise management of expenses creates a sustainable long-term cost trend.

  We’ve identified high-risk employees, improved health results and minimized costly hospital visits using precise data analysis in a sample case study that illustrates these key benefits. Download our white paper to learn how.

white paper

*Actual patient data not used.

[i] “Recent Trends in Employer-Sponsored Health Insurance Premiums,” Kaiser Family Foundation, January 5, 2016, http://kff.org/infographic/visualizing-health-policy-recent-trends-in-employer-sponsored-health-insurance-premiums/ (accessed June 16, 2016).

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Saving Health Costs: A Case Study

It is possible to save on health care costs. Here’s how.

savings hospital admissions health costs

Between 1999 and 2015, employer-sponsored health premiums rose 203%.i Deductibles for workers have mushroomed faster than both income and premiums. Businesses have struggled to find ways to contain these costs while providing for their employees.

This graph, “Health Plan Savings for One Employer,” is a real-life illustration of how wise management based on data analysis has saved millions of dollars for a MedCost client over the past five years.

When this client came to MedCost in 2010, hospital admissions were 87 per 1,000 covered lives. Without any changes in plan design or benefits, the MedCost clinical team ensured that patients received thorough follow-up care to avoid readmissions after joint replacements, cardiac and back surgeries and other procedures.

Skilled nurse managers helped schedule doctor visits and asked questions such as: “Are you taking all your meds? Is there anything you don’t understand about your care?”pregnancy, pregnancies, high risk pregnancy, health costs

Board-certified case managers and highly specialized obstetrical nurses focused on early identification of high-risk pregnancies, offering tips for prenatal care. Sometimes they interacted with doctors’ offices to help families get the answers they needed.

MedCost nurse health coaches worked with patients suffering chronic conditions such as high blood pressure, diabetes, migraines or congestive heart failure, helping them reduce symptoms, close gaps in care and comply with treatment plans.

The result? Better health for patients, and increasingly lower costs for employers. Since 2011, this employer has enjoyed five consecutive years under budget for health plan expenditures—as a result of data analysis and managing the right care at the right time through MedCost Care Management programs.

It is possible to save on health care expenses, using the right partner to manage employee health effectively. If you would like more information about this case study, please contact Jason Clarke at jclarke@medcost.com.

 

[1] “Recent Trends in Employer-Sponsored Health Insurance Premiums,” Kaiser Family Foundation, January 5, 2016, http://kff.org/infographic/visualizing-health-policy-recent-trends-in-employer-sponsored-health-insurance-premiums/ (accessed June 16, 2016).

 

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Reducing Health Costs with Data

Analysis Reveals Better Care Options, Less Cost 
reducing health costs with data

(Source: Kaiser Family Foundation)

In the past six years, health premiums have increased by 203%, reported a recent Kaiser Family Foundation study.[1] But workers’ earnings grew an average 56% during that period. How can employers better manage health care dollars?

The surge of sophisticated technology for big data analysis gives providers and employers unprecedented opportunities to target potentially unnecessary costs, while better caring for covered members.

Consider this example: Jane,* a 42-year old female member with moderately-controlled diabetes, has health benefits through her job. Jane’s biannual visit to her Primary Care Physician (PCP) documents her routine lab work, prescriptions and referrals for preventive screenings.

Between PCP visits, this diabetic member gets the flu, causing severe increases in blood glucose levels. When Jane goes to the Emergency Room, the ER doctor increases her medication dosage. After she goes home, Jane’s personal blood glucose meter shows an alarming drop in her blood sugar levels. Jane calls her PCP, who adjusts her dosage to prevent more complications. Jane’s next checkup is planned in six months.

Was all the data communicated from the hospital’s electronic records, the lab vendor’s system, payer claims and her home monitoring glucose meter? Will the PCP be able to verify that Janreduce health expensese actually obtained her preventive mammogram or flu vaccine prescribed before the ER visit?

At MedCost, Jane’s case would be carefully monitored by her nurse health coach. If there is an issue, her nurse health coach would follow up.

Big data equips providers to accurately analyze key metrics to do more than explain past diagnoses and trends in a group of employees. Advanced analytics can now identify patients and populations at risk for developing certain conditions prior to the actual onset of illness.

It is possible for employers to save on health expenses. Harness the power of accurate data analysis to preserve medical costs, while benefiting your employees’ health.

 

*Actual patient data not used.

[1]Journal of American Medical Association, 2016; 315(1);18, doi:10.1001/jama.2015.17349, http://bit.ly/1TSOFho (accessed Feb. 15, 2016)

 

2015 MedCost Care Management Outcomes (Infographic)

save health care plans, cut costs, health insurance

How Big Data Directs Smart Benefits Plans

Result: Lower Medical Costs

Analytics imageEmployers and consultants are hearing a lot of buzz about how “big data” saves money on company health care plans. The revolution in analyzing mounds of big data is now providing unprecedented opportunities for employers to drive cost efficiency while improving employee health.

A January 2014 study by the nonprofit Milken Institute projected that avoidable expenses for chronic conditions such as diabetes, heart disease and certain cancers could reach $8 billion in North Carolina and $5 billion in Virginia by 2023.[1] A 2015 Centers for Disease Control report lists this alarming fact—most of the risk factors for chronic diseases are preventable.[2]

Risk stratification of employee populations can prevent unnecessary spending for costly services. Predictive modeling based on big data can help calculate emerging risks that otherwise could go undetected until the full onset of illness.

Definition of Risk Stratification

In April, MedCost announced a new partnership with Deerwalk Inc. to provide more extensive analytics for our Care Management programs. In-depth reporting identifies gaps in preventive care for particular employee populations that could save thousands of dollars each year in excessive costs. This innovative technology gives employers robust analysis of cost trends. Health screenings and individual nurse coaching are impacting negative patterns of risk and spending, while optimizing care.

Employee hospitalizations affect insurance rates as well as health outcomes. The chart below demonstrates how MedCost has consistently outperformed the benchmark Milliman Care Guidelines (MCG) through reducing hospital readmission rates.

Readmission rate mc vs MCG2

Comparison between MedCost and Milliman Care Guidelines

Lower hospital readmissions mean healthier employees and significant savings to employers. Deerwalk’s national average of inpatient hospital costs is $24,000 per admission.[3] MedCost employers saved over $21 million in 2014 just on inpatient hospital costs alone.

Total population health (managing your employees’ health overall) is the key to controlling medical spend. Benefit plans that strategically evaluate trends with predictive modeling can optimize employee care while conserving valuable health care dollars.

Contact Jason Clarke at (336) 774-4283 or your benefits consultant for more resources.

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[1] Anusuya Chatterjee, “Checkup Time: Chronic Disease and Wellness in America,” Milken Institute, January 2014, http://www.chronicdiseaseimpact.com/

[2] “Four Domains of Chronic Disease Prevention,” Centers for Disease Control Fact Sheet 2015, http://www.cdc.gov/chronicdisease/pdf/four-domains-factsheet-2015.pdf

[3] Based on Deerwalk Inc. Utilization Metrics Report FA144, accessed October 16, 2015