Evolving Your Benefits Strategy with the Power of ... · 3/8/2019 · © 2019 Benefitfocus.com,...

© 2019 Benefitfocus.com, Inc. All Rights Reserved 1© 2019 Benefitfocus.com, Inc. All rights reserved.

Evolving Your Benefits Strategy with the Power of Technology and Analytics

March 8, 2019

© 2019 Benefitfocus.com, Inc. All Rights Reserved 2

Overview

• Introductions

• Organizational cost of benefits

• Data integration and management

• Analytics technology

• Plan modeling

• Putting it all together – benefit plan management


Your Presenters


Supporting each phase of the Benefits Lifecycle

• Help employees make the right choice

• Benefits strategies that address the entire benefit life cycle

• Short term wins + long-term sustainability of value

• Strategies and insights driven by data

• Do more with your investment


Benefit Analytics Components

• Data Integration: Consolidate medical, Rx, dental claims, member eligibility, financial and other health data in single data warehouse

• Reporting and Analysis: Visibility into book, group, individual data

• Plan Performance: Analyze member health, identify cost drivers, monitor plan utilization

• Plan Design Modeling: Evaluate changes to co-pay, coinsurance, deductible, OOP using actual data


ORGANIZATIONAL COST OF BENEFITS


Rising Healthcare Costs are the Problem of Our Lifetime

U.S. annual health costs1

$3.5 trillion

employers pay 20% of all health costs1

$700 billion

1CMS, National Health Expenditure Accounts


Warren Buffett

“Medical costs are the tapeworm of American economic competitiveness.”

1Yahoo! Finance, May 6, 2017


Employer Health Costs

Projected per-employee health costs to increase2

Medical cost trend up3

Average per-employee cost for large employers1

Rise in health costs

Health spending per-person for commercially insured in U.S.5

Specialty drug prices up4

Specific cost challenges

$14k+

4.0%

6%

14.3%

$5,400

Employee premium+deductibleamount of median income6 12%


Minnesota Employer Health Costs

Employee premium trend increase

Specialty drug costs percentageof drug spend

Total employer + employee costs increase

Rise in health costs

7.4%

5.7%

36%


Solution

• Comprehensive analysis of ER claims data; procedure codes, diagnoses, locations –determined back injuries from specific employee population at specific location

Results

• Workplace analysis conducted by ergonomics experts. Simple solution of coaching and rubber mats placed on floors

• More than $1M reduction in ER utilization by workplace employees over next two years

Problem

• Manufacturer with 3,000 employees

• Increase in ER utilization and costs

• Significant increase in back injuries

Real World Example: ER / Workplace Ergonomics


*NIHCM Foundation Data Brief: The Concentration of Health Care Spending

Workforce

of your healthcare costs

50%

of your employees drive

5%


Chronic Conditions in US

• 58% of US population has 1 chronic condition; 42% has 2 or more2

• 90% of the nation’s $3.5 Trillion in health costs related to chronic conditions1

• People with 5 or more chronic conditions represent 12% of population but total more than 40% of overall national health costs2

1Center for Medicare & Medicaid Services. National Health Expenditure Data for 2016 2Multiple Chronic Conditions in the United States, RAND Corp


Diabetes Prevalence in US

Americans have diabetes1

30 million

Americans are pre-diabetic1

84 million

U.S. Diabetes Rates - County Level

1National Diabetes Statistics Report, 2017, Centers for Disease Control and Prevention


Diabetes Prevalence in MN – County-Level


Solution

• In-depth analysis performed to determine potential cost savings

• Specific procedure codes, places of service, diagnoses evaluated

Results

• Implemented onsite clinic with data-based view of cost and impact

• Employer used analysis to establish performance guarantees for clinic

• Negotiated pricing, volumes and evidence-based care criteria to assure ROI

Problem

• Manufacturer with 2,500 employees

• Extensive utilization across several chronic conditions

• Onsite health coaching in place for three years

• Implementing an onsite clinic for employees

Real World Example: Onsite Clinic Evaluation


DATA INTEGRATION AND MANAGEMENT


Health & Wellness

Voluntary Benefits

Human Capital Mgmt.

Compliance & Admin.

Technology Approach to Data Integration


Analytics Platform

Data Warehouse

Online Access


Solution

• In less than 20 minutes, using an analytics solution, benefits manager discovers $30,000 in claims paid incorrectly

Results

• Employer contacted insurance carrier to correct process and prevent future occurrences

• Discovery of this problem and correction became an important component of union negotiation

Problem

• Employer with 12,000 employees. Offers multiple plans, including affiliated union population

• Employee brought a claim to benefits manager

• Benefitfocus Analytics technology being used by employer

Real World Example: Incorrect Payment of Claims


PLAN MODELING THROUGH TECHNOLOGY


Plan Modeling – Claims & Experience Based

• Remove guesswork from plan design evaluation by re-adjudicating actual claims experience

• Review, save and retrieve plan design types

• Gain visibility into employee and member populations affected by plan design changes


Plan Modeling – Real Time

• Quickly model “what if” changes to:

o Deductible

o Out of pocket maximum

o Number of services maximum

o Copay

o Coinsurance

o Service type

o Inflation


Solution

• In-depth analysis of plan and utilization including modeling and forecasting

Results

• Plan design changes made, increased co-pays for outpatient procedures, ER

• Over-utilization of outpatient procedures reduced 14% the following year

Problem

• Health system with 6,000 employees

• Increasing utilization, ER and outpatient procedures

• Generous health plan design. Small or no co-pay for certain procedures, diagnostic imaging

Real World Example: Plan Design


PUTTING IT ALL TOGETHER


Vendor Management

• Broker/Consultant

• Carrier/TPA/PBM

• Wellness

• Disease Management

• Healthcare Providers

• Onsite Clinic

• Technology

Employee Engagement

• Communication

• Technology

• Mobile

• Share costs

• Options

Plan Design

• Funding• Self-funded

• Fully-insured

• Structure• PPO – HMO – POS - HDHP

• Employee Contributions• Premium

• Co-pay

• Coinsurance

• OOP maximums

Three Primary Health Plan Management Tools

© 2019 Benefitfocus.com, Inc. All Rights Reserved 27© 2019 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary | Internal Use Only 27

Benefit Plan Design

• Plan Types and Offerings

• Spousal Surcharge

• Dependent Verification Audit

• Wellness Incentives

• Deductibles, Co-Pays, Co-Insurance

• HSA Contribution

What actions can I take?Validate your Plan Design Decision Making

Performance metrics should show you that your benefit strategy is working; health plans are optimized and member behaviors and outcomes are improving


Administrative Management Services

• TPA/ASO Claims Processing

• Broker Consultant

• Pharmacy Benefits Management

• Stop Loss Insurance

What actions can I take?Evaluate Vendors and Partners

Performance metrics should show you that your partners that assist with plan management are effectively containing costs


Decision support

• Enable access for all employees

• Provide access to utilization

• Provide cost transparency

• Single platform experience

What actions can I take?Empower employees with their own information

Employees with access to their utilization and cost information will make a more informed decision about their health plan


Evolving Your Benefits: Key Takeaways

1 Data integration is a must.

2 Ease of use and access to analytics technology.

3 Challenge the status quo – providers, vendors, employees.


Your Presenters

Evolving Your Benefits Strategy with the Power of ... · 3/8/2019 · © 2019 Benefitfocus.com,...

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