The landscape of employee benefits continues to evolve, and data will be a greater influence for all employers. The urgency to manage costs, provide better and more flexible benefits, and support employees has never been greater. This urgency is driving the need for employers to better capture, analyze, and utilize the data at their disposal to manage costs while still providing outstanding benefits.
Data is the untapped tool that employers can leverage to significantly enhance health care plans. Predictive analytics, targeted interventions, enhanced engagement, and personalized benefits all drive optimized plans and utilization.
Tune in on Monday, November 3rd at 2 pm ET as Stephanie Koch, Director of Human Resources, Hendry Marine Industries, Stan Jackson, Chief Innovation Officer, Apex Benefits, Sarah Michaels, Chief Clinical Officer at Kinetiq Health and David Murtagh, VP Product at Claritev join Alyssa Place, Editor-In-Chief on the Employee Benefit News LEADERS Channel to discuss how Data Driven Health Plans are redefining benefits and driving results for employers and employees alike.
Topics discussed will include:
• Using predictive analytics to identify and close gaps in care
• Driving better outcomes and lower costs through targeted interventions
• Increasing employee engagement with personalized benefit insights
• Supporting wellness and prevention with real-time data and early risk detection
• Optimizing plan design using behavioral data and utilization trends
LEADERS is a flagship channel spotlighting C-level executives and top experts as they share insights on the transformative issues shaping employee benefits. Designed for an audience of key decision-makers, the series delivers forward-looking thought leadership on the most pressing challenges and opportunities in workforce well-being, health care, and benefits strategy. The LEADERS series is made possible through the support of top industry collaborators, including Claritev.
Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.
Alyssa Place (00:25):
Hi everyone and welcome to Leaders. I'm Alyssa Place, editor in chief of Employee Benefit News. And today we'll be discussing how data-driven strategies are reshaping employee health plans. I'm joined by an expert panel of HR and benefit leaders and healthcare pros. Stephanie Koch, director of HR at Hendry Marine Industries. Stan Jackson, chief Innovation Officer at Apex. Sarah Michaels, chief Clinical Officer at Kinetic Health, and David Haw, a product and analytics leader at clarative. Thank you all for joining me today.
Stan Jackson (00:56):
Thank you for having us.
Alyssa Place (00:58):
So today we're going to be discussing one of the top concerns that's plaguing employers, which is double digit cost increases and finding strategies that balance cost control with member health outcomes. So I'm really looking forward to diving into this topic and hearing your strategies and solutions for that. But to kick us off, I'd really like to do a bit of level setting and hear from each of you, from your perspective, what the biggest challenges you are facing right now in terms of managing employee health plans. David, why don't you kick us off with this one?
David Murtaugh (01:30):
Yeah. I think everybody can cite various sources for seven to 10% annual cost increase on health plans. And in my mind that's if people want to keep everything the same, it's the do nothing increase. I think there's another few factors to think about though employment market is just very strong and it has been for at least half a decade, right? Coming out of the COVID pandemic. And so as much as ever you've got competition for employees and that goes beyond salaries, it definitely includes benefits. You've got a lot of emerging point solutions that I think as people get more exposed to, they kind of become expectations for future employers. And we know that they do have varying levels of effectiveness. Some of 'em are great, some of 'em, the jury is still out. But I think when you bring those things together, cost is increasing. Yes. But the number of data sources and data points to try to figure out and get your hands around those costs are also increasing tremendously. And so that's just not reasonable to expect most benefits managers or even benefits teams to effectively oversee. So to me, at its core, the starting point of this is really like a data aggregation challenge that you have to start with before you can do anything about the cost challenge.
Alyssa Place (02:57):
And Sarah, how does that sit with you?
Sarah Michaels (03:00):
I agree. Simply put, you asked us about challenges. I think employees want more and they want it for less. And so we are facing increasing premiums, but we're also facing increasing deductible levels out-of-pocket maximum. And so my background is nursing. So as a nurse, one thing that you unfortunately see as a result is a delayed care. People are not getting care until they're really sick because they fear the cost of care. So one thing we're oftentimes asked to navigate is the increasingly high cost as a result of your highest cost claimants, just million dollar claimants are on the rise year over year. And we expect to see that trend continue. But I think it comes back to what David just said, which is people cannot afford the cost of care today.
Alyssa Place (03:47):
And Stan, I'd love to get your perspective as well.
Stan Jackson (03:50):
Yeah, I think to follow up with Sarah and David, when we look at our dataset, what we see a lot of is incremental cost increase. So for example, the cost to take care of a diabetic has risen substantially with the invention or introduction of the GLP ones, and we've got more and more people willing to be on those because yeah, the downside is I still have to get stuck with a needle. The upside is I can lose 25, 30 pounds that I haven't been able to lose or haven't been committed to losing. Meanwhile, I think for an employer or any insurer even, you still have to take care of people for all the other needs they have. So the growth of the cost is just incremental cost many, many times. But you also can't discount the innovation and the new therapies that have come out to help people, but they've come at a high cost to continue to take care of people that we weren't able to take care of five, 10 years ago.
Alyssa Place (04:55):
And Stephanie, you're really in the trenches with the employees. So what are your challenges and how is what everybody's saying that really applied to you today?
Stephanie Koch (05:03):
So I think all of those points are very valid. I mean, I've been working in HR for about 30 years and I have seen and done a lot, especially in the healthcare space, and there's been such an evolution in the providers that are available and then the laws that have been passed that have really put more of a responsibility on the employers and it's really shaping and changing that level of responsibility that we have to have because now we're the plan fiduciaries, the plan sponsors. So where before we used to rely on our insurance brokers and our advisors to be the smartest person in the room. I think it's very important for HR professionals to really be empowered to understand healthcare strategy as well as they understand employee relations and performance evaluations and everything else related to HR even more so since it's the second or third largest line item that a company pays for. So it's been very challenging, but there are a lot of great solutions, especially given the fact that if you're working with great providers, there is data available to help you know what lever to pull to create a very strategic healthcare plan that can be sustainable for years to come.
Alyssa Place (06:25):
So you've all spoken about the importance of data as part of a strategy, and I wanted to talk about predictive analytics and how that can help employers identify and address care gaps before it costs viral. And David, this is what you're doing at Declarative. So can you kick us off and explain what that is and how HR leaders are utilizing that in their day-to-day?
David Murtaugh (06:45):
Yeah, so we have a tool called Ben Insights that we've built that really starts with that data aggregation problem that I was referring to. At its core, it's a data warehouse. And what we're able to do is through our connectivity with a couple hundred carriers of whether it's medical, pharmaceutical or even some of the point solutions, wellness solutions that can send other data points, we're able to aggregate all the data and the plan definition for an employer and really display that in a way that's consumable. We've got a number of prebuilt reports. We also have the ability to create reports ad hoc, and so you're really able to start to drill down and find those opportunities. And the way the tool is designed is really intended to float those opportunities to the top. We are trying to see where any given employer's cost in a certain category deviates the most from what we would gauge a benchmark and highlight that, try to identify the drivers of it and then push forward some of where we interpret there to be opportunities. But you take that interpretation that we have and then you put it in the hands of somebody like Sarah Stan, Stephanie, and I think they're able to take it to the next level of interpretation, both from a cost driver's perspective as well as potential interventions, whether that's policy or clinical.
Sarah Michaels (08:24):
Super interesting. Yeah, I could elaborate on that. Part of my role as a clinician is consulting with brokers and their employer groups utilizing Ben Insights and other data analytics platforms. And I think you can't start anywhere without the data. Otherwise we would just be saying, here's what we think is happening. When in reality the data's going to tell you exactly what is and isn't happening. The care gaps in particular, you're starting to see who has a diagnosis and should be on a medication but has not filled that medication for several months. No surprise, those are going to be your individuals that land in a hospital and become your a hundred thousand dollars claimant. And so we use predictive analytics both ways, not only who are your largest claimants today, but who are going to be your largest cost claimants if an intervention is not done.
(09:15):
And we've chimed the term intervenable moments, we're always looking for when is the time to intervene at the right patient that needs care, and if you improve their lives as a result of improving that person's care, naturally you start to see the cost of care go downwards. So it's something that we love working with Ben Insights. We love diving into that tool to figure out who needs those interventions and what is the right intervention. It's not just a one size fits all. Yes, there's a lot of vendors you can work with in the marketplace that doesn't always make sense for all of our employer groups. So it's figuring out at that individual level, what is the moment that we need to intervene.
Stephanie Koch (09:55):
I couldn't agree with that more. I was going to add on that with the data and analytics, it is so important because it does create that path of some predictability about outcomes if not taken care of on the front end. So an example of a Hendry marine was back in, I started here in December 19 as a fractional HR director was hired full-time in May of 2020. And in 21 we determined that only 15% of our covered members were using the preventative wellness benefit. Now, a little context about the shipyard, we have 300 full-time employees, 80% of them are men, late forties, early fifties. And I see there's a little laughter. No because it's true. So unfortunately, a lot of men don't go to the doctor until something catastrophic happens. So when I identified that 15% as an oh, no moment, it probably was a little more colorful.
(11:04):
But that being said, it was a moment of, oh my gosh, we have to do something for our members or something catastrophic is going to happen. So in that moment, we decided that we were going to create access to care that was the most convenient care possible and we were delivering it as quickly as possible. So that being said, we were able to find an onsite primary care clinic that we adopted and we brought onsite in January of 22. And what's interesting was I try to be very thoughtful when we're implementing a new product or program, you want to think about the questions that the employees would ask and get ahead of those things, which we put together frequently asked question, document. And what I didn't expect to see was that the employees actually were reluctant to use it initially because they wanted to know why the company wanted to know about their health information.
(12:04):
They were missing the message about us wanting to take care of them. So we made some changes. We actually hosted a contest to get people on site at the clinic, and it was between January and April we were going to give away five days of PTO to one recipient, but you had to go and get your preventative wellness check in order to be put in the drawing. Well, we ended up having great utilization, but we also had some very scary outcomes from some of the visits. We had One person that went and had stage four cancer, he had no idea. Another person went and was extremely diabetic and didn't know. So there were some great outcomes. So having knowledge of what's happening can really slow down the course of catastrophic claims and really control your whole healthcare plan, spend a lot better.
Alyssa Place (12:58):
And Stephanie, another thing that you had mentioned earlier is the importance of partnerships. And in that description you kept saying we, David, you were also talking about the importance of working with benefit leaders as well. So I wanted to talk a bit about the role that those partnerships play when you're working with a broker, A PBM or consultant, Stephanie, what is that partnership like for you as a benefit leader when you're working with A PBM to really get and understand the data and then do something with it?
Stephanie Koch (13:25):
I will say that what my relationship is now with my vendor partners is much different than it was even five years ago because as we were saying, as planned fiduciaries, we're planned sponsors, we are required to spend the money for the healthcare plan prudently. So we want to oversee what's happening with all of our vendor partners. It used to be in the past where you'd work with your broker advisor, they would do all the talking on your behalf and you would then make decisions, pick the best of the worst plans you could or what was available. And now I'm the one that's involved with the vendor partners. It's not just the voice of the advisor or the broker. I'm the one that's involved. I'm asking questions directly. And I think it's really important to foster those relationships and not rely on someone else. So this way you're still able to get your arms around everything and understand everything that's going on from your own perspective?
David Murtaugh (14:25):
Yeah, I think about it as just like a evolution to having an equal seat at the table. Everybody has an important role to play, but you really have to, and this is the message that we try to promote consistently is like you own that data, you're the one writing the checks, you should have an equal seat at that table as well.
Stephanie Koch (14:49):
There's been an evolution in the HR role too, like I said, is it used to be where HR was thought of as very transactional and a cost center, and I completely disagree with that. HR has been and will continue to be even more so very strategic and really will be making contributions to the profitability of the company because we're handling this huge line item expense. So we have to be in charge of it and give us the leverage to do that.
Alyssa Place (15:23):
And I found it really interesting that you did use the data to find these. You mentioned diabetes and cancer, but then that still leaves you with the burden of paying for that. And obviously we all know, and we started the conversation this way, that the costs are truly surging out of control, especially when you're talking about GLP ones and different hospital markups. So Stan, I wanted to get your perspective on what are those biggest cost areas that you're seeing today and how is that impacting employer spend on their health plans?
Stan Jackson (15:55):
Yeah, so I would tell you that most of our groups, with the exception of maybe having a NICU baby from time to time, something like that, most of our groups are spending their money in cardiovascular, musculoskeletal, and oncology. And if we attack those three areas, that's where the cost drivers are coming from. And in that oncology space, which I would say is probably our number one spend in almost all of our groups, it's this creation of all these immunotherapy solutions in support of people after they've done their chemo round and their radiation round that are driving a lot of these high costs. And especially into that million dollar realm. It's not unusual for some of these drugs to cost a hundred thousand dollars a month. And many times what you're really doing is buying that person time in the hope there's a new therapy that comes out that it can actually cure them.
(16:56):
So we're getting squeezed in that realm. And I think especially in the reinsurance markets, when we go out to buy reinsurance, we're seeing those rates rising and we're seeing a lot of pushback from the reinsurers to either want the group to take more of that risk by carving certain people out with a laser deductible or they want you to redefine your plan document to not cover certain things. The gene and cell therapy is a good example because those treatments are running into the two and 3 million range. And yes, they work or you hope they do, but they're very, very difficult to finance and afford and especially for a smaller employer.
Alyssa Place (17:43):
And Sarah, I want to get your perspective on this as someone who you mentioned started in the medical field originally. So what is your perspective on this and what are some of the strategies that you're utilizing today to perhaps get ahead of some of that before you're at that very high cost level?
Sarah Michaels (17:59):
And some of my story and why I entered the benefits field just over 10 years ago today was because you could treat people in the hospital setting, you could fix what was wrong, you would send them home on a care plan, and then they're right back in that hospital. And I said, surely there is a way to get people healthy and keep them out of the hospital setting. And there was just this breakdown that you saw with plan members of you're getting released and you don't even have a medication for the next month, and then of course you're right back in a hospital. And so that I really wanted to figure out how do we put patients first? How do we remember that if we treat the patient well, we can improve their lives? Again, back to the core of what I said, we're all about Stan, hit it head on top three conditions we see today or cancer, cardiovascular and musculoskeletal, and most concerning is the increase in the average cost.
(18:51):
So Sunlight did a huge study, they released it every year on their reinsurance book of business. They said that in the past three years, muscular skeletal costs have risen 54%. Now the average cost of anybody in that category is over a hundred thousand dollars. And we see this every day. And so I think for a while people get so fixated on the trends, right? GLP ones, we have to do something about it. But the reality is groups did something about it and a lot of groups had to pull back because of the costs. That didn't mean they didn't want to still help their people, but they knew they couldn't afford it as a business. And so when I go into groups, I say, what do we truly want to tackle? Because GLP ones are almost just this bandaid to some of the bigger things going on.
(19:37):
Obesity is what we're trying to tackle. We know as clinicians, obesity leads to conditions such as diabetes. And what somebody doesn't know is that musculoskeletal is directly coordinated with obesity. You've got all this extra fat that's sitting on your joints, it's breaking 'em down quicker. So the reality is we need to focus on that person as a whole and figure out intrinsically what motivates somebody to make these changes. So I love Stephanie's example with the clinics and motivating people because it has to start extrinsically. People say, what can we do? If you're going to reward people for any health behavior, it should be seeing your primary care physician. If we can catch people early on, we're going to prevent some of these largest costs from hitting. So I love Stephanie's approach and what their company is doing, drive people to primary care studies show year over year, almost 75% of catastrophic claimants have never been to a doctor in the 24 months leading up to that catastrophic event. So if we can do one thing and not invest a lot of money, I would say go back to the basics, establish primary care, whether that be setting up clinics or encouraging a program to get people to find a doctor, start basic and you're going to start to see some of these other costs dwindle down.
Alyssa Place (20:56):
And Stephanie, I mean you mentioned the clinic, which is great, and how did that approach really change the culture? I mean, you mentioned that people were going to the doctor more, you were kind of gamifying it. What have the outcomes been as you're looking back on that now? What is the culture today around that primary care utilization?
Stephanie Koch (21:15):
Well, it's interesting because it's actually my favorite project I think I've ever worked on in my career because it's been very rewarding because we look at this holistically. Yes, we have a primary care provider on site, but you think about recruiting, retention and what that comes with. And not only do we treat our employees, but we allow their covered dependents 16 and older to come on site. We let them go, doesn't cost them anything. We have prescriptions that are available onsite as well at no cost. The clinic is actually linked to our other healthcare providers. So it's a whole ecosystem we built. So it's all integrated. So it's been very rewarding too from an employee standpoint when we hear, wow, we've never seen anything like this before, or wow, we're so glad that this is here because we're able to take care of these things that we would otherwise have to take a half a day or a full day off for and if they can even get in, because primary care providers are more limited now than it used to be. And when you try to get into one, you're waiting forever. But we have them on site here two days a week and they're available via telehealth. So it has really driven more interest and people taking care of themselves and not just primary care. We also have, to Sarah's point, we have a whole health program incorporated in our primary care clinic on site where they're helping weight loss and we do have people coaching. So it's been great.
David Murtaugh (22:55):
You still raffle off PTO days or was that a one time event?
Stephanie Koch (23:01):
So that was the initial push to try to, I really was thinking on my feet. I'm like, what are we going to do? We got to get people in there. So I was like, all right, here's what we're going to do. And I'm making this up as I'm going along, but we did it one time because it was one whole calendar quarter and we had one winner. But as a result of doing that, by May of 2022, we had exceeded because that year prior was 15%. We were upwards over 40% by May.
Sarah Michaels (23:35):
And the best part is people are advocates of their own health now. And so it takes one success story like the cancer that was caught and that person's going to talk about it and they're going to encourage people to start going as well. So those are always my favorite stories is now it becomes personal.
Stephanie Koch (23:50):
And I'm very maternalistic, I guess with my employees. I just want to make sure they're taken care of and their family
Stan Jackson (23:59):
And the onsite clinic experience is much, much different than standard primary care. You're usually talking about a 20 minute visit, not a seven minute visit in a busy primary care practice where you're in and out and you barely see the doctor because he or she has to get to the next appointment. And so it, it's a very settling, very personal touch when you have an onsite clinic type of an arrangement.
Stephanie Koch (24:27):
They don't have to pay to go and they don't have to clock out, so everything's handed to them. That was very intentional. I think that companies need to rethink how healthcare is being delivered via plan design with high deductible healthcare plans. I used to think they were the best thing when they came out, but a few years ago I really flipped the script on that and I thought, you know what? We're creating basically functionally uninsured people because they cannot afford the deductible in order to go. So it's really doing a mind shift as well in this space. So it's not just about the affordability, but making a plan design that suits your company's needs.
Alyssa Place (25:14):
So let's talk a bit about that. And Stan, I wanted to ask about, you were raising concerns about these costs and spiraling out of control, and Stephanie is saying that she really had to rethink her strategy there. So what are some of your strategies and tips for perhaps pushing back on things that just aren't working for your employee base? How would you advise other people to really either use data or looking at your population to say, this isn't going to work for me and these are my alternatives?
Stan Jackson (25:46):
I think by taking in the data and identifying specific diagnostic codes, so let's take musculoskeletal because that's one of our high cost drivers. When you start breaking that data down out of the analytics tool, you can start comparing all of the hospital systems in your area about what they're charging for specific procedures. And you would think, or you would hope that your national carriers, the anthems, the Blue Cross Blue Shields, the Uniteds, the Cignas would try to get the providers on some level of parity fee schedule. That just is not happening. And it wasn't until we started digging into the data that we kind of mined that out and realized, Hey, wait a minute. There's a huge price variation in this marketplace. And so from that, we started creating programs and went to the highest quality lower cost providers in town and went and made direct deals with them to help steer people over to their systems whenever people needed care.
(26:55):
The other thing, we created a program because one of our groups, one of our ortho groups here in town actually has six different urgent care sites. Well, if you get hurt after hours on the weekend, you usually end up at the er. So there's a high cost claim that you can avoid. And so what we did is we made that free for the employees to go to the urgent care clinic, they get their image for free. So if they need an MRIA CT scan or just a regular included in the package, and then if they need it, they get a follow-up visit with the appropriate specialist. So if it's your knee, you go and see the knee orthopod, they have all your information, they schedule your appointment. Then what would happen is when people actually need a surgical intervention, they're staying within that high quality lower cost group rather than wandering or as has happened with a lot of people, the integration of these health systems where they own everything from the hospital facility, the primary care and the specialty practices, we've kept that bond or we've kind of broken that bond through the program so that we get people to go where we want them to go.
(28:11):
And we've given 'em the financial incentive to do it. To Stephanie's point of people are scared to go because they never know what things are going to cost or how much they're going to be out of pocket. We've alleviated that at least so they can go get care and then if they do need follow up, we have them in the right place.
Alyssa Place (28:29):
I like that idea of preventing employees from sort of wandering around to try to find the interventions that work for them. And Sarah, again, with your medical background, how are you today helping employers pinpoint those correct interventions and those correct pathways of care versus maybe responding more to trends or leaving employees to figure that out on their own?
Sarah Michaels (28:51):
Yeah, Stan's example was perfect because you're removing a barrier that somebody's s facing for care. Care navigation I think is huge. Second opinions being the best advocate for yourself. So that's something we very much encourage somewhere I think can be broken, is if you think about primary care, it doesn't matter where you're joining us from. A lot of these large hospital systems have bought out all of those mom and pop primary care physicians, but they lose money on primary care. They have bought those out because they are incentivizing you to go back for all referrals in house. And some people just, you want to trust your primary care physician. So if my doctor says that this is where I need to go, that's what I do.
Stephanie Koch (29:38):
I agree with what Stan was saying wholeheartedly because I believe in providing access and when you do exactly what Stan was recommending is you basically are bundling everything outside of a facility or a hospital situation. Your costs are going to go way down, even if it's in a hospital situation, maybe there's a direct contract, but you're still controlling the cost by steering your members to a place that they're going to have better outcomes, they're going to pay less out of pocket and there's less chance of a readmission. So I think that's a great strategy.
Sarah Michaels (30:17):
And I think when we talk about pharmaceuticals, for example, 80% of the top 10 cost drivers on drugs are cancer related, and a lot of these are high cost infusions that are happening in a hospital setting. When we worked and use the data analytics, we are able to get down to the granular detail about what is the drug, what is the dosage amount, and compare it against what is the acquisition cost of that drug versus what it's being marked up at in a hospital system. And I think a key quick success for employer groups is to figure out how do you incentivize plan members to go outside of that hospital setting, especially for infusions that can be either administered in a standalone facility or sometimes even in a house and yet can save 500% of what the markup is. So that's a huge area, but also making sure people are advocates for themselves, asking for second opinions, making sure they have the right diagnosis in order to start their treatment plan.
Alyssa Place (31:18):
Yeah, that's really interesting. Some of these emerging trends that you're talking about and at-home care. David, I wanted to ask, as you're digging into the data and looking at that, what are some of those emerging trends that you're anticipating in the next three to five years when it comes to healthcare and benefit design?
David Murtaugh (31:35):
I think the analytics will just continue to scale and enable deeper personalization. That's kind of the way we look at it. We have a broad array of solutions as a company and one of 'em is networks. And we talk a lot about employer specific networks. And I think the next logical step from that as you get more granular with analytics is even employee specific. What does this family need to best serve them and how can we optimize the cost for them, the cost and the quality in a way that makes sense for everybody? So to me, that's it. It's like the analytics are improving exponentially and it's just going to enable deeper personalization. And I do think that the population as a whole is increasingly comfortable with AI and analytics as a referral mechanism that when you see those polls that ask, where do you get your referrals for your doctors? And it continues to be the highest source. One is friends and family, but it's not as dominant. And I think even just over the last couple of years, like chat PT is three years old, people are more and more comfortable with analytics driving that and with their data, we see more employees opting into leveraging their claims data for coverage recommendations. And so I think just in general, those two things coalesce the power of the analytics and the comfort with people being guided by those analytics.
Alyssa Place (33:07):
And Stephanie, has that been your experience, the comfortability with technology and ai? Are you seeing that in your employees employee base as well?
Stephanie Koch (33:14):
So not exactly. Our folks are blue collar. They are adapting, but probably not as quickly as some of the other things we've done. For example, we tried to roll out a healthcare app a few years ago, and I think we were too early to try to do that. We're probably going to try again in the next year to get them more connected. But it's been an evolution. When I got here in 2019, they were still doing paper enrollment for benefits. So then we went to, yeah, hello in 1990, then we went to bringing people in and having one-on-one enrollments. And now as of last year we did employee self-service. So we are getting there, but it definitely takes time and it really does depend on the type of employees you're dealing with, and it's definitely not a one size fits all, regardless of where you are.
Alyssa Place (34:17):
And David, how would you advise employers to boost that comfortability and what advice would you give to employees perhaps to not be fearful of AI and the role of technology in benefits today?
David Murtaugh (34:29):
I think, I don't know. It is a very personal thing and there's always an adoption curve, and we're very early on that adoption curve. But I think as we start to see the evidence is here and it's in a lot of the things that we've been talking about in terms of at the macro level, how the data can be helpful and the level of effectiveness that it can have. And I think as we further demonstrate that, it's just kind of a natural transition that it gets more and more personalized. So I don't know that it's like a, hey, we have to convince people to take a big leap. I think it's more just taking those incremental steps, making sure that we're being transparent with what we're doing and demonstrating those successes along the way.
Stephanie Koch (35:14):
Can I ask a question if that's okay of the group? Because I'm curious because I mean, you guys have great resources and information, but what about employers that don't have access to data? So how is that handled? We have people that are fully funded or thinking about being self-insured, but they don't have data to help evaluate that as an option.
Sarah Michaels (35:39):
Ask your people. Your people are your best answer. So I only tell people if you're going to survey people, make sure that you actually listen to their responses and are prepared to act on some of that, right? Otherwise people aren't going to feel heard at all. But what do people want for their health journey? If you really want to build out a good wellness program, you want engagement, you need participation in order to see success in overall health changes. But you've got to get, so I had a lot of groups pre COVID days when I first started, it was to go in and do wellness programs and I could create the most fun, robust diabetes prevention programs, but it'd be the healthy people that showed up and it was the people that truly needed my targeted interventions that are nowhere to be found. And so first you got to break that stigma for people, but ask them, what do you guys want to see?
(36:33):
You'd be surprised post COVID that people want to see mental health above even obesity targeted interventions. So what are we doing to bring people what they want so they can actually engage in their health journey is one, but two, what access? What do you have available to you? So if you don't have any data, maybe you are a smaller fully insured group, do you have a clinic that you can utilize? Do you have surveys? Do you bring onsite biometric screenings that you could review those results and figure out an aggregate level? Is diabetes a concern? Is it blood pressure? What do we actually need? So use whatever data you have and if the answer is, I have nothing you actually do because you have zip codes. And there is a lot of research that shows the impacts of health based off of where you live. Are we in a food desert? People? Can they afford eating healthy and exercising? So be creative when it comes to what data do I really have available? To me, it would be my best answer. And Stan, I don't know, do you have anything you'd add to that?
Stan Jackson (37:34):
Yeah, I think to expand on Stephanie's question and your response, we at Apex have made it our philosophy to have all of our clients, if we can get the data, is to put them onto our analytics platform. On the fully insured side, Anthem has a different philosophy. They will give you the data on a fully insured group if it's above a hundred lives. United is more at 300 lives. So it's a little more of a struggle with them to get the data. But what we've told all of our fully insured groups, especially those that are above a hundred lives, you may think that being fully insured, that somehow you're protected from a bad case in your group that makes it look like self-funding is so risky. It's just untrue. Because if there is no limit from a legal standpoint on a fully insured group on what a carrier can provide you in an increase, you are not protected in that next year. They can pretty much do whatever you want. And unfortunately, we've had groups approach us who have had to fold their medical plans because of this risk or because there's somebody shows up in the group that's just so catastrophic. They have to disband the health plan altogether and just either give people money and tell them to go to their spouse's plan or to go onto the exchange and buy their coverage as an individual. And they all thought fully insured that they were completely protected from that.
Alyssa Place (39:12):
That sounds extreme. Stephanie, is that something that you've ever had to consider or something that looms large in the back of your mind?
Stephanie Koch (39:20):
Well, it does loom in the back of my mind just because I interact with so many HR people about data and availability. And a lot of them just say, I don't have any data. How am I supposed to do the things that we're talking about? So that's why I'm very sensitive to it because as a profession, again, we're expected to manage this huge asset, but we don't always have the data. And that's not my situation fortunately, but I know a lot of people that are in that situation.
Stan Jackson (39:48):
I just think it's unacceptable anymore to not have it.
Sarah Michaels (39:52):
Oh, sorry, I'm just to put it on in hr. HR already wears so many hats, and we expect them to not only then receive the data, but to understand the data and what they're supposed to do about the data, which is just, it's something that you can't expect anymore, especially every day. I'm even seeing new clinical terms that I've never seen in a hospital studying before. So it's really important not just to have that data, but to be able to have that interpretation, to know what to do with the data.
David Murtaugh (40:21):
We call it eating year old dog food. We put our own health plan data into Ben Insights and we make available to our benefits team. And to Sarah's point, exactly, they're like, this is great. I love the insights. Let's sit down and talk about it because I'm not going through here independently and interpreting it with the degree of confidence to actually go out and make decisions about our benefits. I think I'm seeing things, but I need that advisor. And thankfully we have a lot of experts here. We're building these tools, but most companies, you're not in that industry. You need that external expertise. And I think it's generally very positive ROI to make that engagement.
Alyssa Place (41:08):
And just to start finishing up, obviously a lot of challenges, and that's probably not going to get easier. Perhaps you learn more about the data and how to interpret it properly, but employees are still going to have a lot of these challenges and you're going to have to respond to 'em. So Stephanie, we'll start with you looking ahead, what are you anticipating for the next couple of years and what is your go-to strategy for navigating that particular challenge?
Stephanie Koch (41:40):
So everybody has already talked about some of the bigger ticket items that we're seeing in our claims data, and one of them in particular is oncology. That has really been driving up our costs exponentially. But what's interesting is, and Alyssa, I think you said this, that there are opportunities to make changes to mitigate some of those expenses moving forward, which are things we're looking into, or maybe Sarah was you, I'm sorry. But when we talk about oncology, for example, we have a person that is getting two infusions a month and it's to the tune of $80,000 we're being billed each time. Now, in order to try to mitigate that kind of expense, we are going to be building some things into our plan design that will essentially make it a requirement, a medical necessity to have it done at a facility versus an infusion center or a home-based infusion.
(42:37):
So those are things that we're doing. We're looking at shifting some of our other pharmacy costs, making sure that people that are eligible for or specialty or alternate funding or an international fill that we're shifting them over there. Maybe I will say we're putting some incentives in our plan for people to do that. And I love what you guys were mentioning before about the hospital systems, how they've bought up so many of these smaller practices and they're now owning the facility, the imaging, the pharmacy, and there's all these huge conglomerates and it's causing an issue because once an employee goes into a visit for whatever one of those facilities, they're in what I call the trap. So they're going to go to the imaging center, they're going to go to whatever place they're being recommended to. So we're also going to have to be looking at tiering our facilities and trying to minimize the amount of visits to certain hospitals. We know they charge so much more much so there's different levels of things that we're looking at, but it's going to hit the bigger costs.
Alyssa Place (43:51):
And Stan, how about you? What is on your hit list in the next couple of years?
Stan Jackson (43:56):
Yeah, I think for the next couple of years we'll still have to keep watching over what we're spending and where we can actually intervene. The oncology space is going to be difficult, and I think if there's any, one thing I'm afraid of is it's the number of younger people that are appearing, and we're not talking about people that smoke or what you would think are exposed to toxins and chemicals and all the things that might be cancerous, but just seeing the number of cases that are coming through of younger and younger people with cancer diagnosis, it's actually quite frightening. And those are people that we're probably going to spend the most money on because they can probably withstand the treatment better than an older type of person. So they're going to cost the plans a lot more money. So to some of the things that Stephanie has said and Sarah as well, early detection, early diagnoses, and if you start seeing it, maybe that's when you start considering paying for colonoscopy at 40, paying for mammogram below 40, even if there's not a family history. We're seeing a lot more of that where that predictability of the braa gene showing up in people and doing the genetic testing. That's not the case anymore. That is not early detection, we thought it was. It wasn't the secret to unlocking who should and shouldn't be. We're just seeing a lot more of it, and I think continuing to find ways to manage that cost is going to become more and more important.
Alyssa Place (45:43):
Sarah, do you have anything else to add of what you're seeing in your realm?
Sarah Michaels (45:47):
Yeah. Recently we analyzed a book of business for a broker out on the east coast, and they found that for their self on a book of business, 1% of total plan members made up over 33% of the total plan spend. And I always take that one step further to say, it doesn't matter if you have a hundred lives on your plan, you have thousands of lives on your plan. It's usually about five people that make up way greater than 50% of overall spend. So the one thing I tell employer groups is start to reject the premise that claims are claims. Because the reality is, if we can intervene on those five members driving the cost of your total plan spend, that's where we're going to start to decrease this trend year over year.
Alyssa Place (46:34):
Well, thank you all so much for all of these insights. I mean, it's a very involved and complex topics. I really appreciate you taking the time today to explain all this and best of luck navigating this with your own workforces. Again, thank you so much for participating today and we appreciate your time.
