In this climate of runaway costs, self-insured companies lack the necessary analytical tools and data to target and control spending or anticipate future trends. In fact, many are blindly investing in programs they hope will improve outcomes and reduce claims. Yet the desire to get patients to better manage their own health remains strong. That’s why fully 72 percent of employers now offer programs and services to raise participants’ awareness of their health status and risks (pg. 8).
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.
The ability to predict and address costly healthcare patterns linked to an individual’s behavior is the holy grail of data analysis for health plan performance. Employers need the ability to determine whether a particular employee is highly likely to result in excessive costs that could otherwise be moderated by alerting the local health provider to take immediate actions.
For self-insured employers, one purpose of predictive analytics software is to tell a narrative – to expound on the history of an employee population’s health. Lab data, claims and biometrics data (to name just a few data-sets) are analyzed and structured in a cohesive, refined and chronological order to help predict risk and avoid substantial health plan costs.
While health care costs vary significantly from market to market, and some areas have higher operating expenses, price transparency is considered one of the ways to stabilize health spending and – in turn – long-term, macro financial stability in the United States. That’s why more than 30 states have passed or have proposed legislation to increase healthcare cost transparency.
Hypertension (High blood pressure) affects more than 75 million — or nearly one-third of American adults according to the Centers for Communicable Disease (CDC) in Atlanta. About 28 percent of American adults ages 18 and older, or about 59 million people, have pre-hypertension, a condition that raises the chances of having heart disease or stroke or developing chronic kidney disease. Hypertension is often called the “silent killer” because many people do not have symptoms when their blood pressure is elevated.
In addition to the human toll, “high blood pressure costs the nation $46 billion each year” according to the Centers for Disease Control. “This total includes the cost of health care services, medications to treat high blood pressure, and missed days of work.”
Technology has significantly advanced within the healthcare industry over the past decade. From the Affordable Care Act to wearable device technology, healthcare is transitioning to a more comprehensive, accessible, interoperable and personalized way of managing population health. Employers, health insurance brokers and health plan providers who do not adapt to the rapidly shifting health management landscape will struggle to keep up with the clinical and financial outcomes of those who embrace the new opportunities provided by modern day technology.
To nurse care navigators, care management is exactly that – managing people with care.
Mentoring clinicians and health plan professionals in learning how to guide and support people, wherever they are on the healthcare continuum, is my opportunity to pass on the secrets of population health management that so many wonderful professionals have shared with me.
Making a difference in people's health, while optimizing resources so that people and health plans get the desired results, is my idea of success.
So, where are your hidden health-related cost centers? The same places they’ve always been: In plain sight. But for the lack of data transparency and integration of data tools and services, they remain elusive to spot. To uncover these cost centers, consider partnering with an analytics firm that not only can access data sets from everywhere patients access healthcare, but also combine them to create nuanced action lists.
Unlike the private-sector health plans, Medicare has a “Most Favored Nation” clause which means that providers cannot give a discount on billed charges to health plans or others that is greater than what they give to Medicare.