Big Data Can Help Producers Provide More Value to Self-Insured Clients

Pinnacle Claims Management - Producers Using Big Data Can Add Value

As health care costs continue to climb, providing employee benefits gets increasingly challenging each year for your self-insured clients. What are helpful to them are fresh ideas and strategies to keep their health cost increases to a minimum. 

Utilizing data analytics is one strategy to help your clients find new solutions to their cost cutting measures. Big data in health care comes from a number of sources, as discussed in a 2012 reportThe authors stated that data comes from a variety of existing healthcare sources including personal medical records, radiology images, clinical trial data, FDA submissions, human genetics and population data. More recent data sources include 3D imaging, genomics and biometric sensor reading.  

How Can Big Data Help?

Data analytics can help in a number of ways including identifying what are the health care and benefit administration trends that are affecting each client’s bottom line, improving on implementation and maintenance of employee benefit program initiatives and providing assistance with budgeting and forecasting. 

Three Ways You Can Use Big Data to Help Your Clients

Work with your TPA partner such as PCMI to capture and centralize all client placement data. This partnership can help you to find where there are spikes in claims data – such as high utilization of emergency room services. This allows you to work with your client to plan strategies that can help them to educate employees, implement programs or modify benefits to address those target utilization patterns.

Examine the data to determine the overall effectiveness of your client’s cost-containment programs like disease management, care management, prior authorizations, utilization reviews, wellness and/or corporate health clinics to see if any adjustments need to be made. Perhaps more money can be put in some programs while decreasing the amount in other less-effective initiatives; an adjustment to the benefit plan could help to mitigate costs for unnecessary medications and procedures. PCMI strongly encourages corporate health and wellness centers to be a part of an overall strategy to improve healthcare delivery to employees in the most affordable setting possible (see related article by David Zanze). 

Review your client’s present health care costs to help them budget and forecast for the coming year. Data analytics can help your client analyze group risk by looking at costs for each group size, location and/or business segment; track trends in costs and utilization to understand the biggest cost drivers and establish more accurate pricing assumptions and financial reserves for future claims payments, administrative costs and stop loss premiums.

To learn more about this topic, check out another article we published back in March on data analytics.