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HEALTH PLAN DATA ANALYTICS

Carrier Utilization
Data Services

LHD was founded in 1999 and we could see even in those early days as we approached the new Millennium that the “information age” of the late twentieth century was going to become even more driven by access to and analysis of data. We began investing major amounts of time into developing deep expertise in data analytics, and those efforts have been rewarded time and again as we stay on the cutting edge of data-driven design, implementation, and ongoing evaluation of health benefit plans for businesses across the nation. One area rich for revealing actionable insights from data analytics comes through the LHD health plan carrier utilization data analysis service.

Why Focus on Health Plan Carrier Utilization Data?

Studying the way employees utilize the health care they can access through their employer’s health benefits plan is a critical source of data that can provide a wide range of insights to inform better business decisions about health benefits. The overall goal of such constant data mining and allowing it to inform health benefits offerings is to help a business find the optimal mix of better health outcomes for employees while at the same time achieving cost savings in the face of ever-rising healthcare costs.

When the right data analysis tools and methods are used, utilization data can lead to an effective prediction of future utilization, reveal less than optimal care from providers, allow for the prediction of total costs for a group of people for a year, and evaluate the effectiveness of one type of health plan compared to another. All these thematic insights can become important factors in making better decisions around health benefits for a business and its employees.

Rx Utilization Data

Historical Rx utilization data is traditionally used to predict Rx costs for the next year, although it’s always important to account for known upcoming increases in specific medications when known. For the many other medications for which you don’t have firm anticipatory price data, use the latest consumer price index published by the U.S. Department of Labor as one way to account for prescription drug price inflation. It’s also worth anticipating new high-cost drugs in the development pipeline.

By analyzing your company’s population health data to identify what chronic conditions currently exist and the likely cost of the prescription drugs and medications to treat those conditions, a fairly accurate prediction of the overall Rx spend through the company pharmacy benefit is possible. From there it’s a matter of then identifying what changes can be made if costs need to be further contained. In one case, LHD carved out Rx from the insurance company plan and negotiated a direct PMB contract for a savings of $250,000 over the course of a three-year contract.

Provider Efficiency Data

Healthcare providers run the gamut in terms of whether efficiency is a priority. Some hospitals and other healthcare facilities emphasize efficiency too much at the expense of effective care while others don’t emphasize it enough. Inefficient providers end up costing an employer-provided health benefits plan significantly more over time. The healthcare industry, in general, is notorious for being inefficient and wasteful, with enormous administrative costs, and fragmented care. In other cases, there are far more costly specialists than good general primary care providers who could provide a lot of care to avoid people using emergency room visits to get what they need. LHD has the expertise needed to help companies navigate the inefficiencies of healthcare providers and networks to get better results for their employees and the bottom line of the business.

Health Plan Adequacy Assessment

A company’s health plan must be regularly assessed for adequacy, which includes more than just plan cost analytics, though that aspect is always important. The provider network, however, plays a big role in the adequacy of the health plan. Unfortunately, many networks don’t do well at keeping provider data up-to-date, which creates all kinds of headaches. And when those updates are made, they don’t always end up getting integrated into the plan, which in turn creates hassles when employees are trying to schedule appointments with health care providers. Because of how intertwined plan adequacy is with network adequacy, both need to be incorporated into an integrated analysis. While many employers have chosen to narrow their network in order to control costs, a better option might be switching networks.

Inpatient/Outpatient/Physician

Another area to investigate are comparing different types of care claims, such as inpatient and outpatient surgical claims. It’s not always an apples-to-apples comparison since once you reach a certain level of complexity in surgical procedures, then they must take place in the inpatient setting. Still, there is a surprising number of procedures that can and do take place in both settings, making comparisons not only possible but useful and even predictive for the purposes of optimizing your company’s health benefits plan.

Quite a few such comparison studies have been conducted, and the general trends indicate there while various problems that arise with surgical services are nearly identical in both settings, both the severity and volume of issues is almost always worse in the inpatient setting. Analyses like this are critical to strategically shaping the health benefits an employer offers to its employees and can have important ramifications for costs incurred.

Additional Health Plan Data Analytics

Other fruitful areas for health plan data analytics expertise include overall utilization and spend, high claimant analysis, top Rx by user and cost, identifying gaps in care, and case management, just to name a few.

LHD: Superior Health Plan Analytics for Your Benefit

Since our founding in 1999, LHD has invested heavily in developing both the expertise and resources needed to make the best use of health plan data analytics to get better results on behalf of our clients. Data-driven approaches to health benefits plan design, implementation, and ongoing evaluation make a huge difference by generating actionable insights that lead to better business decisions and more effective health outcomes for participating employees. Any company that wants to take full advantage of powerful data analytics to be more strategic about health benefits to create not only a high-performing plan but also vastly improve workforce population health is welcome to get in touch with LHD through the Contact page of our website, by calling us directly at 371.751.7049, or by sending an email to lhdbenefits@lhdbenefits.com. We’re here to help!

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