When I’m getting dressed in the morning, I depend on the weather report to help me decide what to wear. And when I’m planning a trip into the city, I depend on my GPS to tell me how long the drive will take so I can make it downtown on time. We all need reliable information to help us make the best possible choices in our lives.
At Independence Blue Cross (IBX), I know our self-funded customer groups depend on my team’s medical utilization trends data to inform the decisions they make on behalf of their employees and their families.
I take communicating and sharing this data very seriously. I know it can affect business decisions that could impact thousands of members’ medical and prescription drug coverage.
Why Health Care Data Matters to Our Customers
Companies with self-funded health insurance plans don’t pay IBX a premium. Instead, they pay their employees’ health claims themselves. IBX handles the claims processing and provides these customers with access to our network, services, and billing.
So, it is our self-funded customers, not IBX, who decide what health care services and medications they will cover. They have to decide how to offer benefits that are competitive, while still being affordable for both employer and employees. Deciding whether to cover a single expensive drug can mean the difference between sustainability and unsustainability!
Our self-funded customers need to know how much to budget for their employees’ health insurance claims, and they need to know what they can do to keep their health care costs under control.
That’s where my team comes in. We give our customers the insights they need to understand their employees’ utilization patterns, and show them all the ways IBX is helping their group manage and budget for health care.
We analyze their utilization patterns and costs; and, on an annual or quarterly basis, we give them a thorough presentation that addresses questions like:
On average, how much does the customer spend per member, per month (PMPM), for their medical and pharmacy costs?
How has that amount changed since the previous year?
What factors are driving that change in PMPM cost?
How has health care utilization changed for our employees and their dependents over time?
What is the cost breakdown between inpatient hospital stays, outpatient procedures, primary care and specialist health visits, and medication expenses?
We also look at what our customers might be able to do to control their costs. For example:
Since preventive health screenings can catch problems before they become more serious (and expensive), could members benefit from receiving screening reminders?
Are there any gaps in the care that members are receiving — such as annual A1c tests, biannual retinal exams, and kidney function testing for those diagnosed with diabetes?
Could money be saved if members accessed services such as diagnostic imaging and laboratory testing from less costly but equally effective providers?
Can members shift some of their health consultations from more costly settings (like the emergency room) to less costly settings such as urgent care centers, retail health clinics, and even telemedicine visits?
Could members save money by using more economical prescription drugs, such as generics, or use equally-effective biosimilars instead of more costly biologic medications?
In addition to advising employers directly, my team frequently works with our broker and consultant partners — giving them the analytics they need to help advise their self-funded group customers to make the best decisions about coverage for their specific employee population.
Actionable Insights and Customized Solutions
When our customer information consultants (CICs) share information with customers, our sales team members are always involved. They’re the ones who are most familiar with what our customers care about when choosing health plans and benefits for their employees. This helps ensure that our customers are getting the answers that matter most.
“The CICs are an integral part of our team, not merely an extension,” says Bradlee Huber, sales account manager, Premier and National Accounts. “Their ongoing involvement with our most complex accounts allows them to understand the ‘whys’ behind a data request, to analyze the information in light of client priorities and interests, and often to provide insights and recommendations that may not have occurred to the client or consultant.”
It’s no secret that data informs our everyday decisions, both big and small. Having accurate, up-to-date information communicated clearly serves a critical role in our lives, helping us make the right choices for ourselves and our families, day after day. And the same thing goes for employers who are seeking to do the right thing for their employees.
If you enjoyed this article, you may also appreciate reading Powering Better Health Care: Data Analytics at Independence Blue Cross by my colleague, Ravi Chawla.
