Whether you are an HR professional working to improve the health of your population or a consultant working to manage your clients’ health care spend, you are undoubtedly familiar with the health markers that have become ubiquitous throughout the industry. The more employers segment their population into “at risk,” “moderate,” and “healthy” members, the more empowered they tend to feel. Instead of waiting for the costly onset of chronic diseases, these markers have created a guide to address problems before they get out of hand. Your employees stay healthier, and so does your bottom line. It’s a win-win, right? 

Unfortunately, it’s not that simple. 

These broad risk categories offer plenty of benefits. They represent an opportunity to monitor a company’s population for chronic conditions. They allow you to design intervention programs that will more effectively target spending categories. They also allow you to tailor communication and education programs to maximize engagement. They even give you some nice-looking charts to present to the CFO. That is why we are seeing more employers incorporating biometric screenings and risk stratification into the measuring and reporting associated with their wellness programs. 

Ranging from venipuncture to finger sticks, these screenings are more widespread than ever, and they are dictating where the dollars flow for wellness initiatives. In fact, 81.5 percent of America’s “Healthiest Employers” conduct biometric screenings as part of their wellness program. Yet, even with this rapid adoption, employers still have large blind spots in viewing the health of their population. In this article, we will explore these areas and offer insights that can help brokers and employers alike minimize these blind spots in their populations.

Employers: What you don’t know can hurt you

Risk categories can be powerful guides and indicators for the health of your population, but are not comprehensive on their own. Nearly every organization has a segment without biometric data. In fact, based on the data we’ve seen from our health analytics platform, employers have, on average, 89 percent of their population in an “unknown” risk stratification. This “unknown” risk category is often overlooked, and it can have huge implications. Our platform has uncovered that, while average costs in your “unknown” population can stay relatively low, the volatility in this cost can be extremely high, representing real danger to self-funded employers

This fact can be jarring, but it is representative of today’s employer. Your unknown population can cost you more than your most at-risk “known” population. So, where do these large swaths of “unknowns” come from? 

It is important to note that an employer will seldom, if ever, have 100 percent participation in a screening. For starters, your population isn’t static. Between new hires and terminated employees, your population is in constant flux, meaning that your biometric report from six months ago has been out of date for approximately five months and 29 days. Furthermore, it is even more difficult to get spouses, partners and dependents to participate in the company-sponsored screening, even if they’re on your health plan. 

To illustrate, let’s take a sample employer population of 1,000 members.

  • If we conservatively remove 50 percent for spouses and dependents, we’re left with 500 employees in our population.

  • Let’s now assume there’s biometric participation by half of our employees. This takes us down to 250.

  • This means that you’re making wellness investments and programing decisions based on knowledge of only 25 percent of your total population. 

For many HR professionals, this fact can be daunting. Trying to make data-driven decisions with such a small amount of data can be terrifying. What’s worse is the fact that this “unknown” piece of the pie can end up costing you more than even your biggest identified risks. That’s where a strong, data-driven partner can come to the rescue.

Brokers: The right data can make you a hero

As technology changes the health insurance landscape, brokers are increasingly looking for ways they can provide more value to their clients, and this challenge presents a remarkable opportunity for forward-thinking brokers. In the past, employers looked to their broker strictly for foundational plan design help followed by retrospective reporting throughout the plan year. 

Today’s employers, however, are far more sophisticated. They view their brokers as consultants with expertise in designing plans that can maximize their population's health and financial outcomes. In the past, this kind of insight would require knowledge-intensive work behind the scenes. You would need to sift through carrier reports, vendor presentations, and spreadsheets to deliver recommendations, and this often couldn’t be delegated. This made it cost-prohibitive for many brokers as they tried to contain costs for their clients. 

Unlike your brokerages of old, you have access to health analytics tools and intelligence platforms that make it easier than ever to glean insights from this data, and generate predictive insights. This means that you can more easily identify leading indicators of health in your population and address them before they become an issue, instead of looking at lagging indicators after the fact. This means smarter decisions, based on cleaner data, leading to better outcomes. 

As illustrated above, if the “unknown” population is removed from this equation, there is a chance that the intervention and engagement efforts aren’t targeting the key drivers of poor health and runaway costs in a population. Today’s health intelligence platforms allow brokers to easily filter the population data to diagnose and recommend solutions that can truly impact the organization. Then, they can present a course of action that with greater accuracy.

How to identify and close knowledge gaps

The process of identifying and closing these gaps starts with data. Historically, data has been messy. They live in cumbersome carrier reports, are rarely up-to-date, and can’t be easily searched or filtered when you need a different view.

This is where a population health analytics tool comes in handy. These tools allow you to get all of your information into one single place to view the whole population and to make intelligent decisions. From there, you can start identifying problem areas. 

The first and easiest step is to remove the “unknown” members. That way you can compare health trends, costs and risk areas of the known group versus unknown. If you have your data available in a spreadsheet, this could be done with a pivot table, but you’d likely benefit from real-time software to augment your statistical prowess. 

Once you know how to leverage it, data can become your strongest ally. As you get organized and have the ability to make real-time adjustments and decisions, you can then tackle even more complex issues within a matter of minutes, such as filtering a population by location, job type, or tenure, to truly develop a targeted intervention strategy.

Takeaways: 3 things you can do today

Simply by reading this article, you’ve taken a giant step in the right direction. Now you know what you don’t know, and you’re ready to take action. You’re at a crossroads. If you’re truly ready to take your insights to the next level and more accurately measure the health of your population, here are a few things that you can do in the immediate future.

For brokers:

Evaluate your groups’ data sets to see what might be missing - Try to identify any gaps in data before you craft a strategy to increase participation in any program. After all, you want to ensure that you’re collecting all relevant data as you drive new “unknowns” into the “known” column.

Establish a plan to close the loop - You’re the trusted advisor to your clients. They look to you for guidance around tough benefits and health conversations. Provide that leadership here by providing your clients with a clear communications strategy to increase participation in these screening programs, and work with your trusted biometric provider to schedule more frequent screenings to close the gap.

Develop a feedback loop within this population - Just as preventative maintenance is the easiest way to prevent poor health in your population, it’s also true of your data. By leveraging a data reporting tool that can update and change with your groups’ populations, you can identify unknown populations as they develop, and catch them before they have the opportunity to surprise you with high claims. This reporting loop should be accurate, reliable and flexible enough to change with the population.

For Employers: 

Identify what data sources are available - Sit down with your broker or analytics team and ensure that all of your data sources are being incorporated into your decision-making process. These sources could include medical and pharmacy claims, lab or biometric results, or data from your clinic and intervention vendors.

Align your strategy to today’s known population - Next, you’ll want to take a hard look to ensure your current health and wellbeing strategy is aligned to your current population. Your evaluation will still be skewed, as you don’t have a comprehensive view of your population, but you should have a clearer picture with all of your data on the table.   

Craft a communication strategy to move people from the “unknown” column - Finally, you’ll want to put your communications hat on and create an internal plan that can articulate the value biometric screenings to your population. There’s also an opportunity to work with your vendor to schedule more screenings throughout the year to close the gap on the “unknown” population. The bottom line is the more you know, the less can surprise you.

The bottom line is this: If you still have a large portion of your population showing up as “unknown,” when measuring risk stratification, you have risk. By following the guidance in this article, you can dramatically reduce your “unknown” population and put your team in a position to have a larger impact on your population’s health as a whole.


Phil Daniels is Co-Founder of Springbuk, a health analytics company based out of Indianapolis. Over the last decade, he's managed the national Healthiest Employers Award Program that includes over 8,000 companies that represent 60 million employee lives. For more of Phil's thoughts on the health and wellness industry, visit Springbuk.com/Insights.