Chronic conditions: How to help pick the right health plan for employees

By creating health plan options that take into account the highest scores for impactability and intervenability, brokers and employers can address outcomes and cost more effectively. (Photo: Shutterstock)

One of the great challenges brokers face when recommending health plans and products offered by the health plan is determining the right choices for employers who have a high percentage of employees with chronic conditions. While the goal is obvious – keep employees as healthy as possible to maintain productivity and minimize presenteeism while minimizing per member per month (pmpm) costs – determining the best way to achieve that goal is not.

That’s starting to change, however, thanks to a new generation of behavioral analytics that combine financial data on the spend with clinical data about outcomes to show which of an employer’s plans are delivering the best value for each condition. These same analytics can also predict which chronic conditions are on the rise among the employee population, and within that population who is emerging to be high risk, as well as the risk of potential high-cost events down the road, such as surgeries or emergency department interventions.