While the Patient Protection and Affordable Care Act (PPACA) has made the health care insurance landscape a confusing one for many employers, companies of all sizes are now beginning to self-fund their benefits, and are looking to their brokers for innovative solutions. Now more than ever, corporate health and wellness strategies are front and center, as new reimbursement models and behavior incentives support the funding of wellness and prevention programs. Astute brokers should be fully prepared to discuss these latest options and present meaningful strategies as a way of adding more value.
Many brokers now understand the importance of adopting health information technology that generates data critical for tracking individual health costs and prompting appropriate interventions or behavioral changes. They are coming to understand why data analytics is such a powerful tool. It gives employers a comprehensive set of utilization data that can be used to help streamline inefficiencies and design strategies to improve population health, both overall and on an individual level.
The diabetes case study
Take, for example, an employee with diabetes who doesn't take their medication as prescribed or adhere to such standards of care as dieting and exercising to maintain low HgA1c results. Inevitably, other co-morbidities will surface; cardiac, circulatory, and vascular problems, in particular, can emerge and ultimately lead to catastrophic costs. In fact, many different types of costs are at stake here: When health is compromised, employees become less productive, both personally and professionally.
In cases such as these, the right data analytics can allow for:
- The monitoring of progress over time
- Improved care for the overall health of a population
- The ability to identify and address significant medical issues
- Determining gaps in care, and intervening when necessary by prescribing appropriate medication, recommending a diet, outlining an exercise program, or advising other protective measures.
Analytics-based management
When paired with the latest, cutting-edge data analytics technology, health management programs can help self-insured companies achieve fiscal sustainability over the long run. Why? Because health information can be quickly sifted and sorted by age, medical conditions, chronic illnesses, risk factors, lab results, and drug interactions. On a large scale, this allows employers to take action and provide optimal prevention and wellness programs.
The point of health management based on data analytics is to ensure that every communication about employee health is personal, relevant, and effective. Success often stems from finding the right partner that can provide the best health plan management along with the best possible data analytics – one that provides:
- Comprehensive data
- Complete analysis of the data
- Potential individual and organizational solutions
- Decision-support tools
- Remote monitoring tools
- Real-time care when it is needed, based on the idea that effective care continues even after the patient leaves the doctor's office
The health care roadmap
As workforce health begins to improve, companies will be able to use data analytics to reassess the status of individuals, as well as the key health issues of the company, whether these stem from diabetes, obesity, or chronic heart conditions. Company-wide performance can be reported on a monthly or quarterly basis for optimal efficacy. Newly at-risk employees can also be identified and monitored. Ideally, previously enrolled employees should be reclassified into lower-risk categories as their health improves. In this way, the severity of at-risk health categories and health care costs diminish over time.
Given the country's current economic pressures and the provisions laid down by PPACA, companies are more than ready to implement wellness and prevention programs – and this gives brokers a chance to differentiate themselves in an ever-tightening field. It is in the broker's best interest to advocate health plan management partners that rely on powerful data analytics, and to explain that this can make all the difference to a company's bottom line and overall health and productivity.
The focus is no longer on the cost of health care, but on making an investment in workforce health and wellness. Workforce health data that can be consistently refreshed and reanalyzed – combined with predictive modeling – gives companies the ability to identify heath issues and cost drivers. Think of it as a roadmap for developing an effective, long-term wellness strategy for healthier members, lower claims costs, and increased productivity.
Joseph Berardo, Jr., is chief executive officer and president at MagnaCare. He is responsible for the strategic management and financial performance of MagnaCare's business operations.
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