In today’s ever-changing healthcare landscape, the ability to quantify the value that health plans deliver has become crucial. A recent study conducted by EY-Parthenon and KLAS Research highlights that more than 70 percent of payers are prioritizing cost optimization as a top strategic goal.1 As health plans face increasing pressure to manage costs and demonstrate their value, relying solely on raw data and surface-level reporting is no longer sufficient. What is truly needed are meaningful insights that drive effective decision-making and lead to optimal clinical and financial outcomes. These decisions must be both cost-justified and impactful, making deep employer group insights invaluable.
To help you maximize the value derived from employer group reporting, consider the following three best practices:
1. Uncover hidden insights through robust data storytelling
In an environment where every dollar spent on employee well-being is of utmost importance, organizations can leverage employer group reporting to uncover hidden insights. By diving deeper into the data, organizations can reveal patterns, trends, and correlations that may have otherwise gone unnoticed. These insights can empower informed decision-making, leading to targeted interventions, cost savings, improved health outcomes, and increased productivity.
Consider the topic of emergency department (ED) utilization and costs. Simply examining the top diagnoses of emergency cases provides some information but limited insights. To truly understand the situation, one must go beyond the surface and explore what happened before, after, and what alternative options could have been pursued.
A comprehensive narrative on ED utilization involves analyzing urgent care utilization alongside it. Plans could also assess primary care physician (PCP) utilization and explore telehealth as an alternative for non-emergency care needs. Additionally, it is crucial to evaluate the underlying conditions contributing to frequent ED visits and determine the extent of potentially avoidable utilization. Are there specific markets or regions where this issue is more prevalent? Is it a result of network limitations or accessibility challenges?
By constructing a comprehensive narrative, plans can identify populations lacking the necessary resources and support to make informed healthcare decisions. This understanding enables more effective resource allocation, ensuring individuals receive appropriate care that leads to improved health outcomes and more efficient utilization of healthcare resources.
2. Implement targeted strategies for improved outcomes
Data insights can provide valuable information about the unique needs and impacts of specific populations with similar clinical needs. Armed with these insights, health plans can develop targeted strategies and interventions to address areas for improvement. This may involve implementing wellness and disease management programs, negotiating better contracts with targeted healthcare providers, or offering tailored benefits to meet specific employee needs.
For example, analyzing office and telehealth data can help identify patterns and guide necessary actions. If uptake in telehealth utilization is below the market average, launching an education campaign to promote its benefits and ensure employee awareness may be beneficial. Additionally, assessing the availability and usage of urgent care providers for members with complex needs is crucial. Increasing payer and provider collaboration can help address any gaps in access to urgent care, reducing unnecessary emergency room visits. A corresponding targeted communication to members living with chronic conditions about the optimal way to utilize urgent care is a win for all. By leveraging data insights, health plans can strategically collaborate with their healthcare partners and communicate effectively with members to optimize access to care and promote efficient utilization of resources.
3. Utilize employer group reporting to assess book of business performance
Employer group reporting does not begin and end at the individual employer group level. Rolling multiple employer groups into meaningful segmentations (markets, line of business, top performers) enables health plans to conduct book of business performance analyses on specific topics, enriching the overall narrative of their plan performance and identifying enterprise-wide opportunity for change. This type of analysis provides detailed insights into critical clinical cohorts and a deeper understanding of specific healthcare demographics and their impact on outcomes – but at a such a macro level that it could credibly inform change for the entire organization. Additionally, they present an opportunity to address current industry topics of interest, offering timely analysis and insights, for broad based consultative communication to client groups.
Depending on a health plan’s strategic focus and the flexibility of its employer group reporting application, special projects can focus on various areas. A health plans strengths or market value proposition is a great place to start. For example, a health plan who has effective methods for steering generic pharmacy utilization should be demonstrating that through data to their current clients and expressing their vast success to prospects. A robust pharmacy analysis which includes a comparison generic utilization by therapeutic classes with norms and benchmarks would highlight that strength.
Leveraging MedInsight’s Employer Group Insights (EGI)
The MedInsight Employer Group Insights (EGI) application is designed to help health plans unlock valuable information about their employer group population and enable more informed decision making around targeted strategies that can positively impact your business. Built as a cloud-native application on the Azure Cloud and Databricks platform, EGI offers comprehensive narratives, benchmarks, dynamic filtering, polished reports, and account provisioning capabilities. These features empower health plans to deliver deeper cuts of information, easily accessible and scalable, meeting the diverse needs of employer groups.
Watch the webinar
To learn more about EGI and how it can help your plan uncover additional insights, watch the webinar titled “Navigating Change: A Roadmap for Advanced Employer Insights.” This webinar focuses on the significance of providing timely and actionable insights to employer groups amidst the dynamic healthcare landscape.