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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Hospital Costs Surge with Increased Opioid Abuse

Every day, headlines detail the casualties of the nation’s surge in heroin and prescription painkiller opioid drugsabuse: the funerals, the broken families and the patients cycling in and out of treatment. Now, a new study sheds light on another repercussion — how this public health problem is adding to the nation’s ballooning health care costs and who’s shouldering that burden.

The research comes as policymakers grapple with how to curb the increased abuse of these drugs, known as opioids. State legislators in New York,Connecticut, Alaska and Pennsylvania have tried to take action by adding new resources to boost prevention and treatment. In addition, President Barack Obama laid out strategies last month intended to improve how the health system deals with addiction.

Published Monday in the journal Health Affairs, the study measures how many people were hospitalized between 2002 and 2012 because they were abusing heroin or prescription painkillers, and how many of them got serious infections related to their drug use. It also tracks what hospitals charged to treat those patients and how the hospitals were paid.

(Kaiser Health NewsShefali Luthra, May 2, 2016)

Kaiser Health News

 

 

Health Premiums Growing Faster than Income

Single Employee Insurance Up 48% from 2005-2014

It’s no surprise to employers that health premiums continue to take a bigger spending bite every year. Single employee premiums jumped 48% from 2005 to 2014, reported the Congressional Budget Office (CBO) in February 2016.[i] Estimates at 5% annual growth mean that the cost of insuring employees will outpace average income per capita by two percentage points per year.

health expenses, healthcare costs, employer premiums

Source: CBO with data from 2015 Employer Health Benefits Survey (Kaiser Family Foundation) & Agency for Healthcare Research & Quality

The CBO projects average premiums for employer-based coverage at $10,000 for individuals and about $24,500 for family coverage in 2025—an almost 60% increase from 2016.

Costs for government subsidized health insurance will top $600 billion this year. And most Americans who receive subsidies are working full-time. The Affordable Care Act (ACA) will account for $110 billion in subsidies.

Looming over employers is the Cadillac tax on more expensive health care insurance. Currently the 40% tax is set to take effect in 2020 (see “Cadillac Tax Revisions” blog), but ACA requirements are impacting employer planning for health benefits.

Since an average 62% of American employees still get their health coverage at work, tracking health care spending remains a major concern for businesses.[i]health premiums, healthcare costs, employer health expenses

As health care laws continue to change, employers must work closely with consultants and benefits administrators who have expert knowledge to get the best performance from every health care dollar.

[i] “Update from 2015 Employer Health Benefits Survey,” Kaiser Family Foundation, February 5, 2016, http://kff.org/private-insurance/issue-brief/a-comparison-of-the-availability-and-cost-of-coverage-for-workers-in-small-firms-and-large-firms-update-from-the-2015-employer-health-benefits-survey/ (accessed April 28, 2016)

[i] “Private Health Insurance Premiums and Federal Policy,” Congressional Budget Office, February 11, 2016, https://www.cbo.gov/publication/51130 (accessed April 4, 2016).

 

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

Avoid These Common Data Mistakes

The United States wastes $275 billion annually on health care spending through inefficient record-keeping, duplicated files, fraud or abuse, according to Truven Health Analytics. Nearly $9,000 per second is lost on illegible writing, incomplete entries or inaccurate interpretations of data.[i]

Graph.iStock_000022706119XSmall

In this era of massive data generation, how can companies ensure accurate analyses of their employees’ population health? Here are four common data mistakes to avoid:

1. Making business decisions based on “uncleansed” data.

Electronic health records today overflow with complex treatments, prescriptions, lab results and other tests. Incorrect synthesis of these outcomes can obscure a 360-degree view of past medical history and future potential problems.

MedCost creates detailed reporting with Deerwalk software to help clients identify both medical and financial trends. Sophisticated analytics identify areas of data where misinterpretation may occur. When data is integrated and “scrubbed,” employers may then be assured of making accurate decisions based on those results.

 2. Assuming that claims are processed correctly.

Data integrity is key to avoiding skewed results. Were monthly premiums accidentally included in claim expenses? Have claims been duplicated? Were pharmacy costs integrated with the right patient’s claim?

No one would try to calibrate a car’s multiple computer systems without the right training and equipment. Not using standard query entries will produce data sets of unreliable results for financial and medical decisions. The company that manages your health plan benefits should do rigorous quality assurance audits before releasing “cleansed” data to you.

3. Failing to use technology to protect your group of covered members.

The operating rule of today’s digital health care is that if it can’t be measured, it can’t be managed. How can a company uncover excessive medical costs or emerging health issues for employees, unless clinical and claims data is tracked?

Smart businesses track profit and loss columns. Smart businesses also keep a close eye on cost trends to reduce medical spend and improve population health for employees. MedCost as a benefits administrator delivers monthly reports with specific cost analyses and recommendations to each of our clients.

4. Ignoring cost trends that are wasting your health care dollars.

Health care, despite the tsunami of data generated, is still about people. How can an employer know when an employee’s blood pressure is out of control? When blood glucose levels have gone sky-high? When prescribed meds are no longer being taken? Without careful
analysis of gaps in care, expensive treatments won’t be avoided. And employee health conditions may worsen that could also have been prevented.

Are these data mistakes costing your company thousands of dollars? Consider using quality analysis by a reputable benefits administrator to clarify complex data, while managing population health and more efficient health care spending.

For more information on benefit solutions, contact Jason at MedCost.

[i] “Claims Audit Solutions,” Truven Health Analytics™, http://truvenhealth.com/portals/0/assets/emp_12181_0113_auditsuiteoverviewbrochure.pdf (accessed November 9, 2015).