Guest blogger Linda K. Riddell has two suggestions for getting the most from your health plan data: Slow down and get the details right. Read on and let me know if you agree. —Andrea Davis, Managing Editor
You may have binders stuffed with reports from your health plan, and still be starving for useful information. Here are two ways to cut the clutter and beef up your insights:
- Slow down the frequency of reports
- Make sure reports have the right level of detail
Slow down
Quarterly reports are virtually useless for giving you any insight about your group. The reason is that very little changes from one three-month period to the next, and what does change is more often a natural fluctuation or a fluke. For example, if your employees go hunting on weekends, your emergency room visits will go up during hunting season and down afterwards. This tells you nothing about whether your nurse triage line or your new (higher) emergency room copay is working. It just tells you that your people do other, less dangerous things in the off-season. However, your nurse triage line service will point to the drop-off and take the credit for it.
You might see a sharp tick upward in surgeries in January. This probably has nothing to do with a failure of your disease management program, and everything to do with post-holiday letdown. When it drops off again in June, it’s not because your wellness program is succeeding: it’s because people tend to postpone surgeries during the summer.
Unless you are looking for seasonal patterns, you are better off looking at health data that covers 12 months. If you must look at each calendar quarter by itself, at least you can make valid comparisons. So, you would compare the January to March 2013 numbers to the January to March 2012 numbers.
Right details
Lots of standard health data reports give you a 30,000-foot view of your plan, which cannot guide benefit or wellness program changes. For example, most plan administrators will give you a report showing your group’s major diagnostic categories. Knowing that your group is spending a lot of money on “circulatory system” doesn’t tell you whether the problem is anemia, high blood pressure, or heart attacks. There are only 25 MDCs; there are hundreds of clinical conditions and thousands of illnesses.
Try to avoid the trap of guessing what your group’s illnesses are, based upon the MDC report. You may hear about employees having chest pain, but that doesn’t mean that your costs are piling up for heart disease. HR people are more likely to hear the extraordinary stories from employees (especially when it means they are out of work), and less likely to hear the stories of routine care.
For wellness programs, it may be more productive to focus on the everyday than the extreme. More people are affected by high blood pressure than by heart attacks, for example.
To get to that everyday level of detail, press the plan administrator for reports that list your group’s costs by clinical condition. Even if the report gives the clinical conditions only for your top two or three major diagnostic categories, this will give you a great deal more insight.
Linda K. Riddell is a principal at Health Economy, LLC. She can be contacted at
How frequently do you receive reports related to your health plan? Is it a challenge to get enough details? Share your thoughts in the comments.
