The Benefits of Data
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Transcript of The Benefits of Data
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Vickie Rice, GBASolutions Manager, Data & Analytics
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All Your Benefits. One Place.• Founded in 2000• NASDAQ: BNFT• Headquartered in Charleston, SC• Offices in Greenville, Tulsa and
San Francisco• Over 23 million consumers
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Transforming the Way Benefits Are Managed
Voluntary Benefits
Financial
Third PartyAdministrator
Broker Consultant
Government Reporting
Health Insurance
LEGACY ERP/HR
The Old Way The Benefitfocus Way
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7-15% 70% 4%Percent of healthcare costs are
rising on average per yearPercent of all healthcare costs caused by unhealthy behavior
Percent of companies can perform predictive analytics
about their workforce
The Facts about Healthcare Data
Strategic benefit administration is only as good as the data that drives it
Aggregating enormous amounts of data will be essential
Make data useful and actionable to drive decision making
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Employer vs Benchmark: Cost Per Employee
National, Ove
rall*
200 or More EEs*
South Region*
State/Lo
cal G
overnment
$0.00
$2,000.00
$4,000.00
$6,000.00
$8,000.00
$10,000.00
$12,000.00
$14,000.00
GroupBenchmark
2014
National, Ove
rall*
200 or More EEs*
South Region*
State/Lo
cal G
overnment
$0.00
$2,000.00
$4,000.00
$6,000.00
$8,000.00
$10,000.00
$12,000.00
$14,000.00
GroupBenchmark
2013
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National My Size My Region My Industry My Group$8,000.00
$8,500.00
$9,000.00
$9,500.00
$10,000.00
$10,500.00
$11,000.00
$11,500.00
$12,000.00
$12,500.00
$13,000.00
20132014
Employer vs Benchmark: Cost Per Employee
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© 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 9BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary
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+ + +
Tailoring Benefits Plan Design
What have we been spending on healthcare?
Who’s on our plan? What will be spending in the future?
How can we lower expected costs?
= Custom Benefit Plan Design
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First Things First – Get Access to your Data
Benchmark Data Case ManagementWorkers comp Premiums
Claims Member Eligibility Misc. FinancialHRA/BiometricsPBM/Rx
Secure UI
DATA WAREHOUSE Episode Grouping Engine
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Learn About The Past
Jan Feb Mar Apr May
$1,046
$663
$1,118
$897
$1,249
$441 $286
$482 $387
$540
PEPM PMPM
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Who’s on your plan?
940
66Employee Gender Member Gender
1,508
1143
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Employee
Dependents
$2,933,767
$2,148,982
And how do they affect your cost?
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If you don’t make any changes, what can you expect to spend in the future?
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• Multiply your current expenses by – National Trend (7-15%)– Your group’s trend (4%)
• Hire an Help– Consultant– Actuary
• Know and understand the health of your population and how that impacts your plan’s financial risk
How Do You Determine What the Future Will Cost?
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• Hierarchical Condition Categories (HCCs): Part of the Medicare Advantage Program for CMS, HCC contains 70 condition categories selected from ICD codes and includes expected health expenditures.
• Adjusted Clinical Groups (ACG): Developed at Johns Hopkins University, ACG uses both inpatient and outpatient diagnoses to classify each patient into one of 93 ACG categories. It is commonly used to predict hospital utilization.
• Elder Risk Assessment (ERA): For adults over 60, ERA uses age, gender, marital status, number of hospital days over the prior two years, and selected comorbid medical illness to assign an index score to each patient.
• Chronic Comorbidity Count (CCC): Based on the publicly available information from Agency for Healthcare Research and Quality (AHRQ)’s Clinical Classification Software, CCC is the total sum of selected comorbid conditions grouped into six categories.
• Minnesota Tiering (MN): Based on Major Extended Diagnostic Groups (MEDCs), MN Tiering groups patients into one of five tiers from Tier 0 (Low: 0 Conditions), Tier 1 (Basic: 1 to 3), Tier 2 (Intermediate: 4 to 6), Tier 3 (Extended: 7 to 9), to Tier 4 (Complex: 10+ Conditions).
Member Risk Scores
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Member Risk Scores
Prescription Compliance
Frailty
Pregnancy
At-risk Births
Emergency Room Utilization Patterns
Non-Chronic, Expensive Treatments
Likelihood of Hospitalization
Chronic Conditions
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No Conditions 1 Condition 2 Conditions 3 Conditions 4 Conditions 5 or More Conditions0
100
200
300
400
500
600
700
615
20198 65 24 11
What are your plan’s Comorbidity Rates?
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Individual Predicted Risk
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Enrollments, Payments & SavingsHealth Plan Contracts 1,032
Health Plan Members 2,739
Members Per Contract 2.65
Average Member Age 33.47
Average Employee Age 48.15
Predicted Resource Index - Local 2.35
Inpatient Facility $251,631.58
Outpatient Facility $2,240,433.60
Outpatient Professional $1,447,140.33
Prescription Drug $1,143,544.85
Total Plan Payment $5,082,750.36
Total Medical & RX Payment $5,082,750.36
Predicted Cost Amount $11,944,463.35
Total Charges $10,931,271.80
Total Plan Payment $5,082,750.36
Employee Responsibility $535,141.54
Exclusions $1,562,667.63
Other Insurance $125,633.44
Overall N/W Savings Amount $3,631,919.28
Aggregate Risk
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Enrollments, Payments & SavingsHealth Plan Contracts 1,032
Health Plan Members 2,739
Members Per Contract 2.65
Average Member Age 33.47
Average Employee Age 48.15
Predicted Resource Index - Local 2.35
Inpatient Facility $251,631.58
Outpatient Facility $2,240,433.60
Outpatient Professional $1,447,140.33
Prescription Drug $1,143,544.85
Total Plan Payment $5,082,750.36
Total Medical & RX Payment $5,082,750.36
Predicted Cost Amount $11,944,463.35
Total Charges $10,931,271.80
Total Plan Payment $5,082,750.36
Employee Responsibility $535,141.54
Exclusions $1,562,667.63
Other Insurance $125,633.44
Overall N/W Savings Amount $3,631,919.28
How does predicted risk affect future cost?
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Now What?
Investigate Ways to Affect Change– Plan Design– Wellness Programs– Medical Tourism– Onsite Clinics
Budget Accordingly
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Fact-Based Plan Design
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Fact-Based Decisions
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What About Our Employees?
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Fact-Based Plan Selection
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The Benefits of Data:
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A MATTER OF
FACTS. www.Benefitfocus.com
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Learn more about the benefits of data at www.Benefitfocus.com