Despite the overflow of health care data, some organizations findaccessing that information surprisingly difficult. (Photo:Shutterstock)

The health care industry has evolved a lot in the last severaldecades. It wasn’t that long ago that doctors made local housecalls to sick patients. Today, physicians can teleconference with patients on the other sideof the world. This rapid advance in technology has generatedtremendous amounts of data on virtually every aspect of the healthcare industry, from patients and physicians to hospitals andinsurance carriers.

There’s considerable opportunity lurking in all that data foremployee benefit plan sponsors and organizations eager to maximizethe impact and efficiency of their benefit offerings. But with somuch data and so many sources of information, the challenge forplan administrators has become distilling all that data intoactionable insights.

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Those insights can be used to drive cost savings and employeesatisfaction. They typically play out on two fronts:

• Improving how members utilize benefits
• Improving how carriers and providers administer care.

With the right data, administrators can adjust plan offerings,supplemental initiatives and participant communication to bettermatch benefits programs to participant needs. At the same time,good data can drive better decisions about carrier and providerrelationships.

An experienced broker or other partner can be a valuable ally inhelping organizations and plan administrators advance dataanalytics tools and turning insights into results. Thesepartnerships should focus on a few core areas.

1. Better access to data

Despite the overflow of health care data, some organizationsfind accessing that information surprisingly difficult. Self-fundedplans take on all the risk and therefore can access any and all oftheir own data.

The challenge for these plans is more in wrangling the data intoa meaningful structure. For large organizations, a data warehousecan be a powerful business analytics tool that effectively storesand structures data in meaningful ways. Fully insured plans, on theother hand, need to request data from an insurance company that’sassuming the risk. Insurance companies can be reluctant to sharedata for smaller organizations–plans with fewer 300 lives are notconsidered fully credible.

Brokers can often leverage existing relationships with carriersto access datasets for smaller plans. Insurance companies may bemore willing to share data knowing the organization has a partnerthat can glean accurate insights from the reports.

2. Better opportunities for actionable insight

For all employers, regardless of funding arrangement, the rightpartner is a key resource in determining what kind of data torequest. Most employers tend to focus on data centered on claims.Rightfully so; there are powerful insights to be gleaned fromreports detailing monthly claims and out-of-network costs. Withinclaims, there are more advanced reports brokers will recommend,like one that shows emerging high-cost claims. These reportsidentify individuals who have recently increased utilization ofhealth care services and may benefit from carrier casemanagement.

There are countless other datasets that offer a revealing peekbehind the curtain of any employee benefits plan. One example of anext-level report is a preventative screening test. This reportidentifies all the participants in a population who should bereceiving preventative screenings–mammogram, colonoscopy, etc. Itthen cross-references that list with the actual number ofscreenings provided during a certain period. These kinds of reportsoffer an opportunity to be proactive and use tools like populationhealth, wellness programs and participant communication to reducefuture claims and costs.

3. Better benchmarking

Understanding where your organization’s benefits offering fitsin within your competition is becoming an increasingly criticalrecruitment and retention tool. Data analytics with the rightpartners can offer a deeper look at how specific benefits stack upwithin a particular industry. It can also account for changes inpricing and services depending on the geographic area so sponsorsand administrators can be sure they’re comparing apples toapples.

Benchmarking data can provide a marketable differentiator inhiring top talent based on the plan offering or contribution costsor can be used to internal analytics to verify the efficiency ofclaims adjudication and other processes.

A data-driven future

The future promises to bring more disruption to the health carespace. New technologies from implanted health devices to roboticsurgeries are changing how patients receive care. Evolvingregulations around how pharmaceuticals are developed and patentedare changing how new treatment innovations are advanced. Newmergers in the health care space including Berkshire Hathaway,Apple and J.P. Morgan Chase’s partnership are changing how theindustry provides services and pays for them.

All of these disruptions have the potential to change theindustry in significant ways. One thing won’t change–health care’sgrowing reliance on data. Smart plan sponsors and administratorsare turning to the data and using strategic partnerships to ensureplans are running efficiently and participants are empowered tomake the most of their benefits.

Tammy Brown is a managing director for theLarge Client Practice and Data Analytics Group of Conner Strong &Buckelew. She has over 25 years of Large Group Underwriting andAccount Management experience. As senior vice president for theEmployee Benefits practice, her responsibilities include developingand implementing the overall strategy for the practice, includingstrategic planning, benefit evaluations, financial analysis andmanaging the collective bargaining process. She is also responsiblefor delivering the financial targets established for the practicein addition to managing client expectations.

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