Group Background

A company with 563 medical lives has been self-insured since January 1, 2010.  Costs to the plan have increased with higher utilization, which the employer has mitigated with increased out-of-pocket costs to the employee. The company began biometric screenings several years ago, but had not implemented any cost reduction strategies.

Problem

Healthcare costs continue to rise becoming a larger portion of the company’s operating budget.  Standard utilization reporting from the plan administrator provided a historical perspective of claims and conditions contributing to the rising cost to the plan. In recent standard reporting, the plan had identified that 3% of the covered members were accounting for 41% of plan costs. Without understanding the health risk within the group, the company has been powerless to act to improve the health status of members reducing the total cost of healthcare.

How EBA Addressed the Problem

EBA met with the client and discussed the ability to identify the risk within the company using data analytics.  By imported raw claims data into a software program, the group was able to identify (de-identified to the company) over 140 members with chronic disease, of which 58 had more than one condition. These members accounted for over 80% of all claims cost.

Results

The company decided to implement several cost reduction strategies.  The first was to use the RX data to implement an International Pharmacy Management program.  This program sources medications using “tier one” countries like Canada & The United Kingdom to negotiate directly with the pharmaceutical manufactures saving the company almost 75% on most brand name drugs.

The company is now evaluating recommendations from disease management firms to identify at-risk individuals and establish baseline clinical & financial metrics. Recommendations include the firm put into action a personalized direct clinical counseling program to empower members to take control of their conditions with the resources and support to succeed in improving health which ultimately reduces the cost of these chronic conditions.

The company uses quarterly reports from the data analytics firm along with reports on the cost of care for the affected members to plan for future employee engagement.