Health data should be used for more than just keeping score...

1. 22 Smart Business Pittsburgh | February 2018
Data analytics
Health data should be used for
more than just keeping score
B
enefits consultants use data as a part
of the consulting services provided
to employers. The consulting
strategy includes looking at health claims
throughout the benefits year, creating
reports and reviewing the reports with the
benefits administration team.
“But this approach of simply ‘keeping
score’ of data doesn’t accomplish the goals
of every employer, which is to drive down
the costs of a health insurance program,”
says Michael Galardini, director of sales
at JRG Advisors. “The next generation
benefits consultant uses predictive
modeling and data analytics to lower the
largest cost of a health insurance program:
emerging claims.”
Smart Business spoke with Galardini
about how employers can get better results
with emerging claims to lower the costs of
a health insurance program.
How can predictive modeling and data
analytics software identify risks and
improve a health insurance program?
Predictive modeling and data analytics
software is a population health
management service that can identify the
high-risk members of a health insurance
program.
Once identified, these members are
ranked by severity and gaps in care. A
web-based reporting system will provide
access to the actionable information
to target these high-cost and high-
risk members. The system reveals the
members who are noncompliant with
preventive care — and members who
require disease management, prescription
drug maintenance or health coaching
intervention.
Managing this data properly can ensure
that these high-risk members don’t fall
through the cracks.
Once properly identified, the next
step in the risk management strategy is
to evaluate the actual cost and forecast
the cost in the next 12 months for each
member. These include things like the
number of emergency room and inpatient
stays for each member in the next year. By
identifying and evaluating these emerging
claims, consultants can now get ahead of
the costs that are driving the increases in
premiums.
What’s the benefit for employers?
Identifying and managing these claims
helps stabilize or lower the premium costs.
The old process of reviewing claims data
after the claim already occurs doesn’t
allow the benefits consultant to provide
a strategy to mitigate the costs to the
employer.
Using predictive modeling and data
analytics to identify high-risk members
gives time to develop a population health
management strategy to better manage the
emerging claims.
What is population health management?
A significant component of reducing
the identified health risk is using care
managers to work with high-cost and
high-risk members. Benefits consultants
partner with care managers to review the
data provided by the predictive modeling
and data analytics software to motivate
these members to manage their health
care. Care managers can work directly
and confidentially with the members
to ensure the proper medical care is
being provided for their specific medical
conditions. These members will be guided
through actions, such as timely preventive
care, prescription drug adherence and
coordination of care.
How do employees benefit?
The goal of the care managers is to teach
the high-cost and high-risk members to
self-manage their health care, comply
with care instructions and pursue ways
to improve their health status. Care
managers can also use cost transparency
tools to guide the member to find the best
price for medical services. This not only
keeps the claims costs lower for the health
insurance plan, but also can help lower
out-of-pocket costs the member has in the
form of a deductible or co-insurance.
Incorporating predictive modeling and
data analytics with a population health
management strategy can produce the
result that every employer expects from
a benefits consultant — disrupting the
current distribution model to move the
needle of the emerging claims to lower the
costs of a health insurance program. ●
MICHAEL GALARDINI
Director,Sales
JRGAdvisors
(412) 456-7000
michael.galardini@jrgadvisors.net
Insights Employee Benefits is brought to you by JRG Advisors
WEBSITE: To learn more about JRG Advisors, visit
www.jrgadvisors.net.
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