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Analytics, Group Benefits Design and The Battle Against Addiction


It’s no secret, every great war general knows that knowledge is power. In the fight against diseases that ravage a health plan, data is knowledge. The days when data analytics was viewed as an emerging trend, and its benefits known to only a select few are over. Today, cost-effective group benefits design relies heavily on a vast accumulation of insight derived from individualized data reporting.

However, group benefits design is difficult to implement and optimize. Like the war general, the best benefits brokers know that implementing a good benefits plan (or war plan) requires a mixture of science, art, technology and even psychology. When it comes to preempting costly diseases and health plan pitfalls, anticipation and an outside-of-the-box mentality is everything. To have a comprehensive understanding on how individuals function and behave within the health plan design is to be a step ahead of the curve.

Addiction is a common human behavioral trait that is often overlooked in the fight to optimize a health plan, but is an integral part of the human experience - individually and collectively - and has significant influence on health plan performance. Fortunately, benefit brokers have a secret weapon: data analysis and reporting at the individual level.

An individualized prescription report that provides insight into a plan member’s prescriptions, dosages, Rx costs, and even the prescribing physician, in one easy-to-read file can be an invaluable resource for case managers. With data health intelligence (or data knowledge), case managers can initiate decisive health and cost interventions that would otherwise go undetected, which can be translated into key insights for improving population health and disease management. Let’s consider a few different addictions that can impact health initiatives and cost prevention at the individual level.

Smoking addiction and how it effects group benefits plan…

Tobacco is one of the most addictive and destructive substances, not only for a member’s health but for the health plan’s cost efficiency. Smoking worsens and perpetuates the costliest diseases ravaging a health plan (diseases such as chronic bronchitis, heart disease and even lupus) and is one of most difficult addictions to kick.

The addiction to tobacco is staggering. According to health plan unitypoint.org, smoking causes up to $289 billion dollars a year in medical care expenditure. 

Eating addictions and how it effects costs:

Poor nutrition can also negatively influence health plan cost efficiency. Diabetes, high cholesterol (hyperlipidemia), and obesity are just a handful of the most difficult diseases and disorders to keep in check in addition to being some of the costliest for a health plan to shoulder.

For these diseases, early detection is everything. It is important to know exactly who within the plan is suffering from these disorders as soon as possible so that case managers can use the reports “to develop interventions that address specific individual risks, as well as financial and quality variances identified in the population.” To preempt bad eating habits from perpetuating or worsening diseases like diabetes it is crucial to have as much individual information as possible – from sedentary levels to cholesterol levels and everything in between.

Rx addictions:

oor prescription management can cripple a health plan because unnecessary Rx costs can be extremely expensive. Better insight into provider prescribing behavior and a holistic view of prescriptions being consumed by patients can reveal the potential for addictive behavior.

Especially specialty drugs:

The share of spending for specialty drugs has increased dramatically over the past decade and they now account for a third of medicine spending, a trend expected to continue.

However, with comprehensive individual reports on health plan members (include member, disease, prescription, prescription costs, prescribing physician and more) a case manager can take the necessary precautions to avoid duplicate therapy, and stifle cost of drugs and specialty drugs via generic brand supplements, ensure out of network prevention and incorporate wellness initiatives.

Just as the war general requires reports and knowledge to succeed, case managers absolutely need reports and insight into the populations they manage to optimally improve health outcomes. Insight comes through knowledge, knowledge through data.

Addiction is often perceived as a failure that significantly devastates morale. A great war general would undoubtedly attest that once a platoon’s morale is defeated, the battle is half lost. The happier the employee population is, the better the health plan will perform. Addiction may not be the biggest factor impacting health plan performance, but it is significant and a good reminder of just how nuanced and difficult it can be to optimize a health plan, which highlights the importance of staying informed and ahead of the curve with data intelligence and knowledge.

For more on how to successfully manage risk and optimize health care benefits and costs through analytics, click here. 

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