Tom’s Take: In a fully insured health plan, employers will generally receive some basic, cumulative data at the end of the year. This often coincides with renewal time, so other than getting a quick recap of what’s happened over the last 12 months, employers don’t really have an opportunity to do much with those numbers.
In self-funding, data is a big deal … for good reason. It allows employers to see where care dollars are going, identify new or emerging health trends within their work population and, most importantly, take action.
If a large number of plan participants were dealing with the same medical condition, for example, perhaps you’d want to add specific coverage for testing and treatment. Or maybe your data shows a series of high-cost claims related to diagnostic imaging and you feel it’s time to implement an advocacy program that gives members guidance on where to have procedures done to be more cost-efficient. Another way employers put data to use is by monitoring prescription expenses. Have costs been going up because of an increasing shift from generic to specialty drugs? How can you get these expenses under control?
On top of all that, data can be used for predictive plan modeling. This allows employers to go through past and current claims data to analyze risks and forecast future expenses, and identify any gaps in care or waste in health spending, too.
What good is your health plan data if you’re not able to access it on a regular basis and use it to adapt your employee benefits accordingly?
With self-funding, you get more data, more often and always have the opportunity to act on it and make plan adjustments. Read more about the topic in this article.