In 20 Minutes, Curt Identified $500,000 in Savings on Employee Medical Costs*

April 12, 2016
Mark A. Caron, CHCIO, FACHE / Chief Executive Officer, Geneia


Shortly after I returned from speaking at the National Business Coalition on Health Annual Conference, I wrote a blog about how the explosion of health data is creating unprecedented opportunities to improve and personalize employee healthcare.

It’s an exciting time for a company like Geneia – whose flagship product integrates consumer, clinical, provider, and health plan data – and for our employer, physician, hospital, and health plan clients on whose behalf we translate all of this data into an easy-to-use, actionable format.

  • Throughout this year, we’ve been writing about the people at the heart of healthcare transformation who’ve been using Geneia’s Theon® advanced analytics platform to meet their quality and cost goals. People like Val who trimmed claims costs by two percent and Jody who reduced out-of-network referrals five percent.
  • Today I want to introduce you to Curt. He is the vice president of human resources for a Fortune 500 company with more than $10 billion in sales, 150,000 customers, and 15,000 employees. He has been in this role for seven years. Prior to joining his current employer, Curt spent the past decade in similar roles for smaller companies.  He holds a B.A. in political science and an M.B.A with a concentration in organizational behavior.

Like most human resources leaders, Curt is focused on controlling health costs for his company and its employees while simultaneously improving employee health and productivity and preserving a competitive benefits package. His company self-funds its health plan, and offers employees a choice from four plan options. Employees pay 20% of the premium on the mid-level option.

In just 20 minutes on our Theon platform, Curt identified opportunities for $500,000 in savings on employee medical costs. He found a range of cost drivers along with potential remedies that can reduce medical costs while simultaneously improving the quality of employee healthcare.

His Findings Include:

  • Over $500,000 in out-of-network utilization prime for possible redirection to in-network services and/or network expansion opportunities,
  • 68 employees who visited the emergency department in the past year but not their primary care physician,
  • 200+ employees with high-risk conditions who had not seen their primary care physician in the past 12 months for follow up and case management
  • More than $39,000 in retail prescription refill costs that could be redirected to lower-cost, mail-order channels,
  • 240+ employees taking brand name prescriptions that could switch to a generic and reduce medication costs,
  • More than 500 employees who are pre-diabetic, and
  • More than 10,000 employees with open care opportunities such as mammograms and colonoscopies – essential preventive services that may help prevent future high-cost conditions

Together, these findings can translate into more than $500,000 in savings on employee medical costs for Curt’s company. Many of these findings also point to opportunities to improve the quality of employee healthcare.

For example, let’s combine #2 and #3 and look more closely at the 268 employees potentially in need of outreach and engagement by their physician and care team as well as care coordination services. Armed with this information, Curt can initiate a conversation with the four health plans his company uses about how they identify higher risk employees, encourage and incent them to engage with their physicians and care team, and enroll them in care coordination programs. Similarly, he can discuss the programs his health plans have for working with his more than 500 pre-diabetic employees to prevent them from becoming diabetic.

Curt’s story is another example of how Geneia’s technology with a heart is helping to transform healthcare. For the first time, advanced analytics platforms like the Theon application are able to meet the needs of employers like Curt who need comprehensive, aggregated, real-time data to improve the quality and cost of employee healthcare.

 

*Curt’s experience is an illustrative example based upon the actual experience of a Geneia client. This information is provided for illustrative purposes only. Curt is fictional and not intended to represent any specific person. Any direct similarities to any real person are purely coincidental and unintentional.


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