Our guest blog series, where we feature a few of our friends and partners on the blog to give readers the opportunity to hear from leaders across analytics, wellness and health industries is back this week with a post from Gran LeCompte. In his work as an employee benefits consultant at Sabal Insurance Group, LeCompte has a host of experience doing what Sabal does best – “developing innovative insurance solutions for clients,” – and this week, shares his first-hand experience integrating data and analytics into those solutions.
I recently read an article by Jeff Yaiga, Chief Revenue Officer at Maestro Health, titled “7 Signs You Need to Break Up with Your Benefits Vendor.” The seven reasons Jeff cites are all valid, but I wanted to focus on his fifth point – “Their Data is Not Smart.”
Big data and data analytics are not just for Fortune 500 firms anymore as several vendors have made this technology available to groups with 500 or more members.
At Sabal’s annual claims review, our third party administrator shared some data with us that showed our client’s emergency room (ER) usage was drastically higher than expected and the TPA encouraged us to increase the cost of ER visits to reduce their usage. While this could be the answer, it pays to look at the problem more closely and see if there is a more subtle and elegant solution, which is what we were ultimately able to do.
Using a leading data analytics tool, we were able to determine that there was one location (out of our client’s 37 locations) that was the issue; if we removed this location from the data, the client’s ER usage was much better, in fact, better than the TPA’s benchmark.
In this situation, had we followed our TPA’s advice, we would not have “fixed” the problem, we would have just penalized the employees living in this location (and any other employee who needed to utilize the ER). Instead, we were able to research the location and determine if the employees had better options.
In looking closer at the information, we were able to see that the ER visits driving the cost up were primarily driven by a child asthmatic and a diabetic, both of whom were not taking their medications routinely. With this information in hand, the health plan was able to reach out to the employees and has since enrolled them in our disease management program with the hopes that their illnesses can be better managed to reduce ER visits.
By utilizing big data, we were able to track a claims spike back to two individuals trying to cope with diseases they did not fully understand. With better resources to deal with these diseases, the client was not only making their employees’ lives better but also managing the plan in a more responsible manner.
If you aren’t accessing the power of data analytics (and your broker hasn’t brought it to you as a responsible and necessary way to manage your plan) then in Jeff’s words, “You might need to break up with you Benefits Broker.” Go big data!
DHS Group was able to assist LeCompte and Sabal in finding the real cause behind a spike in costs to enable creative solutions that better serves the health of the patients through its HealthSpective Analyze program. Analyze is a powerful application that can help you understand your population’s health and health spending as a whole, at the same time as you optimize your investment in your health and wellness solutions. Schedule a time to chat with our team on how to put Analyze to work for your group.