Passing along medical plan costs to employees is nothing new. In fact, this traditional approach has been used for decades as employers scramble to find ways to afford the escalating costs of group benefit plans. Unfortunately, the status quo has many negative, albeit unintended, consequences. Passing along additional costs or making sweeping plan design changes simply to control costs is like using a sledgehammer to drive a nail into a piece of woodwork. The nail is in place but the surrounding surface sustains significant damage.
Oswald is working with clients to help them understand that simply passing along costs year after year is not a sustainable business model. It does nothing to change behaviors, manage chronic conditions or provide earlier interventions.
- A Better Way
It’s time to relegate the sledgehammer to the shed. Data-driven solutions will address waste and improve the ways participants utilize medical services with precision. Sophisticated analytics allow us to pinpoint the drivers of escalating costs and take action.
Let’s look at ways data-driven interventions can help reduce two of the largest drivers of escalating healthcare costs.
Let’s assume these stats mirror those of an employee population. Using data built from geo-mapping, demographics, psychographics and claims history, the risk manager can help the employer identify and reach out to those who are unaware of additional medical access points and hours. It could be as simple as mailing a postcard with locations and hours of alternative medical care. Or a personalized phone call to offer alternative suggestions to ER treatment. While these types of outreach have been around for a while, the ability to pinpoint the actions to those with the most applicable situations results in better chances of behavior change. In other words, only those who need the information receive it.
Most employers offering group medical benefits know that the largest plan costs are most often the result of a small percentage of the participant population. In many cases this is due to the costs associated with chronic condition management. According to AARP, four out of five adults age 50 or older suffer from at least one chronic condition. The same study reports that those with chronic conditions have higher rates of hospitalization, more ER visits, and greater healthcare spend than the general population. Using sophisticated data tools allows risk managers to reach those in need sooner, with more regularity and using channels that drive action for this chronically ill population. In many cases, assigning a medical professional for regular intervention is helpful. For others, providing information on services may keep protocol adherence at acceptable levels.
For both groups, and for others as well, the ability to gather information, analyze data, make data-driven recommendations, personalize interventions, validate solutions and measure progress are the keys to success.
- Sophisticated Partnerships for Success
Discovering the power of data is magical. At first glance, the solutions seem simple. And indeed, first-blush, low-hanging fruit is tasty. In our experience, data is more – it drives discovery, awareness and partnerships. When those come together, the result is viable, exciting and sustainable data-driven solutions that benefit organizations and their employees.
Enabling change and building viable benefits programs and controlling costs requires expertise and a history of proven success. You need a partner who knows the market, technology, analytics and best practices. We have helped many organizations lose the sledgehammer and with our help, assign key measurements, understand their unique populations, track progress of improving health and ultimately, control plan costs.
Note: This communication is for informational purposes only. Although every reasonable effort is made to present current and accurate information, Oswald makes no guarantees of any kind and cannot be held liable for any outdated or incorrect information. View our communications policy.