Employers Need Quality Data to Provide Better, Cost-effective Health Benefits

Employers trying to balance the cost, quality and affordability of their employees’ health care often are working with incomplete, disparate data that can lead to incorrect assumptions about how to best predict plan utilization and select intervention strategies that will result in a more productive work force.  

“To keep people on the job and healthy, employers have to run their health benefits like they run the rest of their business – with good data and solid analyses that can be relied on,” according to Mike Scofield, director of research and development for the Employer Solutions Group at Ingenix. “Unfortunately, many employers are using flawed data and are making significant decisions based on that faulty data.”

As the cost impact of health care increases, Scofield said, employers need solutions that upgrade data quality, collection and analysis. With integrated data, employers can act with confidence as they tailor strategies to their workforce, because the results of plan design changes and benefit structures can be measured.

“Using integrated data is the first step to determining what health care trends apply to your staff and what their impact is on costs, health and productivity,” he explained. “Ingenix offers a combination of tools, methodology, analytics and consultants that will allow employers to figure out where they can make changes to influence problem areas.”

HRA as primary risk assessment tool lacks credibility

Most employers examining their benefits seek to sustain their employees’ health and productivity and offer the level of benefits necessary to attract and retain the right employees while also managing the company’s financial risk. Unfortunately they sometimes make investments in risk mitigation that are based on assumed cause-and-affect relationships, unsubstantiated vendor claims or misinformation on relative risk.

One source of misinformation likely is the Health Risk Appraisal (HRA), a tool that employers favor to learn more about their employees’ current health status and potential risks. However, HRAs should not be considered a primary source of strategic data, Scofield explained, because a number of factors call their viability into question.

For example, employees may fear that even though the data they provide to employers on HRAs are supposed to be confidential, any truthful information they provide about their health status may be used against them by an insurance company.  Further, employers may offer incentives or credits to employees for filling out the HRAs, which can significantly skew the results.

“People may fill HRAs out simply to get the incentive or to avoid being penalized for not filling them out, and often they have the attitude of ‘you can make me do it, but you can’t make me give the answers you want me to give,’” he said.

“One client with 80,000 employees offered $100 to each employee who filled out its HRA,” he added. “The company had a 50-percent response rate, which cost them $4 million to achieve, and the results showed that an unrealistically small number of employees smoked. Employers think this approach is useful, but measurement issues have never been addressed. Ingenix can combine their data with our vast database of claims data to give employers a more accurate way of evaluating risk.”

[Editor’s Note: To learn more about managing health risks, Ingenix is sponsoring a Webinar on health risk appraisal on Nov. 14 at 4 p.m., EST, and on Nov. 16 at 11 a.m., EST. Visit us at http://www.ingenix.com/News/Webinars/ in October for more information.]

Data coming from multiple sources, needs integration

Managing the data that inform health benefit decisions can be an unwieldy and sometimes impossible task for employers. Large employers often use several different insurance carriers in multiple states, and data reported by one plan may not match up with data from another plan, making analysis “difficult at best, and unreliable at worst,” Scofield remarked. In addition, the data may be hard to analyze because they may come from plans in PDF or hard copy form, which cannot be manipulated for advanced analysis, or in online formats that have limited online analysis capabilities.

“Solid, user-friendly data are critical to effectively operating and managing any part of your business,” he said. “Why should the management of health and disability benefits be any different?”

Ingenix offers employers the technology to link together all of their available data to provide a comprehensive look at the total costs of illness, utilization trends, plan design changes, where the employer can intervene to boost productivity and whether goals have been met.

“By integrating the data into a common format with a common coding scheme, you can make empirical judgments,” according to Scofield. “Employers can look at trends over time to estimate demand and future costs.” Employers also can use the data to identify intervention opportunities among existing employees and their dependents to support employees and ensure that they are following the prescribed course of treatment.

Good data leads to good business solutions

In addition to offering a foundation of comprehensive, integrated data and sophisticated analytics, Ingenix also employs a team of “analytically savvy” consultants to help employers reach their goals.
“We don’t just deliver a cool analysis or a reporting system to your desktop for you to run your own reports,” he said. “We talk to our clients about their business problems. A typical relationship starts with ‘What’s your most pressing problem for which you don’t have a solution?’ Based on their needs and goals, Ingenix also can conduct special studies or program evaluations. We will recommend a good starting point and then can run and/or interpret reports for them.”
Ingenix provides employer “solution sets” –  a comprehensive portfolio of technology and services packaged together to help employer organizations simplify care delivery, adapt nimbly to changing business requirements, access specialized expertise, and improve their return on every health care dollar. Solution Sets incorporate various applicable Ingenix tools, methodologies and expertise, with an emphasis on organizing consulting, data, analytics and reporting in the following areas:

• Benefits Strategy and Management
• Total Absence Management
• Program Measurement and Evaluation
• Actuarial and Financial Management
• Integrated Data Management
• Vendor and Plan Management
• Pharmacy Management
• Health Management
• Consumer Activation

Ingenix also has other health and productivity management products and solutions to meet varied employer needs. “The Ingenix team is very capable of analyzing plan design, methods of intervention, population risk characteristics and population health status to advise you on what truly are the best evidence-based approaches to risk mitigation,” Scofield said. “Our only interest is in providing you with accurate information.”

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