How data can bring clarity to health plan management

Recently, on a 6:25 a.m. flight from seat 3A, I overheard the captain and first officer reviewing their preflight plan, checking their instruments and all the data points available to make the best decisions on how to get us to our destination quickly and safely.

What the heck does this have to do with employee benefits? I’ll tell you: If you aren’t using data to guide your clients, you are flying blind.

With health benefits being the second or third largest item on an employer’s P&L statement, some advisers are crashing hard. Those who allow carrier rates and pricing to dictate the direction of a client’s strategy are failing to be a good steward. As the “captain” of your client’s health benefits program, you need to be using data to help guide your approach, strategic direction and advice, as well as the foundation of the commutation and education to their employees.

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Think about it — if you asked your flight pilot how the day looked for flying, and he hadn’t bothered to check the weather, you’d probably be worried. For advisers, not embracing (or demanding) data from carriers can be just as worrisome.

As experts in our field, it’s up to advisers to not just fulfill our roles as “captain,” but also serve as risk managers for our clients. Creating strategies, solutions and programs grounded with data can make an immediate impact on the health of their population and quality of the benefit being offered. It also will lower costs for both employers and their employees.

Here are a few ways you can use data to guide employers through clear skies.

Get a bird’s eye view
Using Rx data as basic as the employer’s Top 25 Report can help grant an employee or family member access to a Manufacturer Assistance Program or an opportunity to source medication through an International Purchasing Program. Both will allow an employer to save 70- 80% on specific medication while eliminating 100% of the cost for an employee or family member. Most of these medications are north of $70,000 in annual cost for the employer, and employees are typically hitting their deductibles and out of pocket (OOP) maximums. This hits home for me. My family filed bankruptcy because of just one medication, Revlimid, while my dad was battling cancer when I was in high school.

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Build a loyalty program
As a 12-year Executive Platinum Member on American Airlines, I do anything possible to stay on AA, because I get perks: free upgrades to first-class, early boarding, free checked bags and my own customer service line.

In the benefits world, the use of data can allow you to understand where employees and their families are accessing healthcare, and research the cost and quality of the most used facilities and providers. In turn, this will help you build an incentive-based plan design, encouraging participants to access the highest quality providers and facilities.

This is a winning strategy: Cost and quality have an inverse relationship in healthcare; focusing on steerage to the highest quality will lead to lower costs. Enhancing an employer’s value proportion improves recruitment and retention of great employees.

Go direct
Most flyers would rather take a direct flight vs. having a layover. Why? It’s more efficient, and often cheaper!

Using an employer’s data can help build a direct contracting relationship with a local provider or facility, which allows you to waive the OOP cost for that member while creating a more advantageous situation for that provider or facility. Average health plans have a $1,669 deductible while the average U.S. employee has less than one month’s rent in their bank account. This creates a challenge for both the facility and member.

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Using the data can help you frame out the value of a direct relationship with the facility to create a situation where each of these three stakeholders benefits. Employees get free healthcare, the employer saves money and the facility does not have to chase any OOP costs. Everyone wins, but only if you start with data.

So, would you let a pilot fly blind? Of course not! Then why are you guiding employer clients with little to no data? This single advancement in your agency can add tremendous value for your clients and their employees, while also allowing you to demonstrate why you are different. A data-driven approach will produce significantly better results and allow them to provide their No. 1 asset, their employees, a better benefits program for less cost.