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Thought Leadership

Employers, are you ready to reduce medical costs & improve quality?

June 7, 2016
Analytics uses vast amounts of data, funneled into one model that can predict behavior and outcomes providing transparency into healthcare costs.
Chief Executive Officer, Retired

4 ways your firm will benefit from an analytics platform

Healthcare costs continue to escalate. Since 2010, employee healthcare deductibles have risen almost seven times as fast as wages and inflation, according to the Henry J. Kaiser Family Foundation. Nearly half of large employers say that if they don’t take additional measures to control costs, at least one of their health plans will reach the threshold that triggers the “Cadillac” excise tax in 2020 under the Affordable Care Act, according to the National Business Group on Health (NBGH). To control costs and prevent penalization under the Cadillac tax, employers first need a deep understanding of how healthcare value, facilitated through payer relationship management, can address and alleviate spiraling healthcare costs. Employers also need an understanding of how costs incurred compare to outcomes achieved.

Analytics uses vast amounts of data, funneled from many sources into one model that can predict behavior and outcomes and provide transparency into healthcare costs. For example, an analytics platform provides stakeholders with a view of a patient’s healthcare-related information across a continuum of care, including primary care, specialists, home healthcare nurses, pharmacies, medical equipment providers, and benefit providers. Insights gained from this knowledge will empower employers and employees to make better decisions about the care they receive. The result is that employees become better healthcare consumers, which in turn, helps employers rein in soaring healthcare costs.

Geneia’s Theon® Care Engager® is helping employers respond to this requirement. It is a powerful analytics engine that, while requiring little technical background to use, delivers employer-focused insight and healthcare engagement tools, integrating multi-sourced claims data, utilization data, clinical outcomes, and health and wellness information.

Here are four reasons why employers choose an analytics solution to help them better manage their healthcare benefits program and control costs:

1. It’s difficult to get a handle on how your employees use healthcare, what it costs, and if they are receiving value for the price.

For most employers, employee healthcare data is contained within a wide variety of systems and only available in different formats. This makes it impossible to see a complete, 360-degree view of an employee’s health situation. Some data—such as clinical notes—may be missing.

Instead of viewing costs over the continuum of care, employers are left to aggregate and analyze costs at the specialty or service department level for individual employees. For example, a medical condition such as diabetes or congestive heart failure requires highly skilled specialists coordinating treatment and ongoing medical management. Although employers have access to data, the data is useless without the tools to make sense of it.

Using an analytics platform, employers have visibility into costs, performance, and utilization across insurers, regions, and programs. This intelligence helps employers make better decisions about which health plans to offer and how to work with providers to influence product design and networks.

2. You need visibility into healthcare events to be proactive.

Employers recognize the need to be proactive in helping employees take better care of their health. Unfortunately, current healthcare systems do not provide employers visibility into real-time or near real-time events. For example, an employer may not be notified that an employee has been admitted to the hospital until a few days later.

A real-time or near real-time analytics platform informs the employer of a hospital admission almost immediately, which allows the employer to be proactive and assist with discharge planning, outreach and ongoing support after the employee leaves the hospital.

3. You recognize the importance of consumer-driven healthcare. 

In a recent NBGH survey, more than eight in 10 employers (81%) plan to offer nurse coaching for care and condition management while 73% will offer nurse coaching for lifestyle management. Nearly three in four respondents (73%) provide employees with self-service decision-making tools to help them become better healthcare consumers.(3)  In addition, employers can help employees utilizing high deductible plans understand the services that are available, how much they cost, the impact of participating in reward and incentive programs, and how to measure the value they get for their healthcare dollars. Helping employees become more involved in choosing high-value and cost-effective healthcare services, particularly for non-emergent care, is an important component of consumer-driven healthcare and will help control overall healthcare spend.

4. Making sense of healthcare data is complicated and time-consuming.

Employers struggle to make sense of complex employee healthcare data. At best, they receive a static report or a raw data feed. Often data is 30 to 60 days old.

Analytics platforms like Geneia’s Care Engager® can integrate and normalize structured and unstructured data from multiple sources in real time or near real time and present it in an easy-to-use and intuitive dashboard. The data is readily available and actionable, helping employers make important decisions about plan design, benefit levels, service offerings and more.

Getting to Analytics Quickly

The good news for employers is that, once they’ve implemented an analytics platform, they will gain immediate insights into their healthcare program. For example, in 20 minutes of using Care Engager®, a Fortune 500 company identified $500,000 in potential savings.

The ability to analyze performance, reduce costs and empower employees to make better healthcare decisions is available today. Are you ready?