Unhealthy populations increase costs now and in the future. Breaking down barriers to underutilization of preventative care services and regular PCP visits is a fundamental tool for cost management.
Digging into social determinants of health reveals new insights into which parts of your population may be underutilizing care more significantly than others. This helps identify and then break down barriers. Prioritize where you focus innovation.
Here are some interesting insights recently shared at an innovation conference and luncheon roundtable.
Learn more
Ozempic has made headlines recently, for trending off-label uses.
HDMS Analytics Practice digs into a data set using new analytic content. See emerging trend insights that surprised our team.
Read now
Article with keen insights shared by HDMS client experience leader, Jason Elliott, published in HR.com.
There are tremendous point solution programs out there.
With so many diverse needs and suspected equity gaps, where should investments be made? How does one start to show evidence of the true value delivered?
Learn from HDMS clients finding answers.
Just read below – we’ve copied the article to this page.
Read on HR.com
By Jason Elliott | September 9, 2022 Read time: 5 min
Any HR executive today will tell you how challenging the current environment is for attracting and retaining talent. According to the US Bureau of Labor Statistics, there were 11.2 million open job positions (vacancies) across the US at the end of Q2 2022. Hence, it stands to reason that organizations are rolling out the red carpet to try to appeal to job-seekers, offering sign-on bonuses as well as comprehensive health and financial benefits. Wellness rewards and a varied suite of ancillary health benefits have become the norm rather than the exception.
While the impact of these comprehensive ancillary benefits can be significant, so can the cost—especially since inflation is at a 40-year high. Therefore, data analytics are more vital now than in the past for driving decisions around the offering, expanding, or discontinuing various programs. The rise in the availability of new data enables nuanced and sophisticated analyses to determine the value of “total rewards” packages.
For years, the set of metrics used to measure the success of any health benefits program was limited to simple data elements available in standard claims. For example, the number of members who enrolled in a program, or the number of members who had one visit with a health care provider. Unfortunately, measurable health impacts usually do not occur immediately. Therefore, the success of a program cannot be determined immediately with any level of confidence.
However, enrollment metrics are no longer the only available barometer for engagement. The aggregation of traditional claims with non-traditional digital data sets now allows us to connect dots that were previously either invisible or inaccessible, thus revealing new trends and powerful insights.
The ability to identify how members engage with a certain program—and why—gives organizations the power to build programs around their employees’ real-life needs and make progress in delivering on the triple aim of reducing cost, improving health, and improving quality and experience. Questions commonly asked of our data analytics teams recently include:
Engagement in a program has been redefined. For example, rather than tracking just a daily step count in a fitness program, granular metrics like the frequency and intensity of biking, running, weight training, or even dancing are used in tandem with medical and pharmacy claims to identify discernible, meaningful, and quantifiable value.
Other examples of data types frequently leveraged from various solutions include biometrics (e.g., BMI, BP), lab tests (e.g., blood sugar, cholesterol, A1C, etc.), sleep patterns, meditation and mindfulness minutes, mood changes, dietary changes, etc.
It is possible to then look holistically at a program’s impact on employees’ health, wellbeing, productivity, quality of life, retention, disability avoidance, and other indicators—driving more effective benefits decisions.
The concept of coordinated and continuous care is not new, but clinical and digital transformation across the industry is now bringing us closer to achieving it. Understanding an individual’s interactions with care when they are healthy and not just when they are ill drives policy changes to reduce the burden of illness.
All programs offer something and will benefit some of the people in an organization. Often, the question is whether the magnitude of the benefit derived is enough to offset the cost of the program itself. This, in turn, drives decisions around expanding or discontinuing a solution.
One large employer, for instance, offered two separate wellness programs that promoted a healthy lifestyle with diet and exercise goals. However, one focused more on the exercise component while the other concentrated on healthy and mindful eating. When the employer tried to assess the effectiveness of both programs to determine if one added more value than the other overall, the data showed a very interesting and unique pattern. It revealed that adoption and engagement in the two solutions differed along racial, ethnic, and income lines. Different populations engaged with these solutions at similar levels for reasons outside of health status. As a result, the company decided to retain both programs since they obviously were essential to varied groups.
Likewise, mental well-being is now universally recognized as a critical part of overall health. Many organizations are compiling a profile of those who engage with their mental well-being solutions (e.g., EAP mental health programs) and evaluating their impact on employees’ medical comorbid conditions.
For one such organization, bringing together medical, pharmacy, and mental health EAP (digital) data brought to light an interesting link between anxiety and heart disease. Specifically, 30% of those with a new diagnosis of anxiety also had a new diagnosis of hypertension and/ or ischemic heart disease in the same year. They also sought care for other indicators of acute stress, such as flare-ups of autoimmune conditions. This insight helped the benefits team better align their concierge services to ensure a more holistic health model, where the mental, emotional, and physical health needs were addressed together.
Employers are also making major changes to benefit designs in a deliberate effort to remove barriers to care access, especially since the pandemic exposed the vulnerabilities of low-income and minority communities to weather major health storms.
As an example, several organizations have removed waiting periods (typically 30-90 days) for new employees to become eligible for health and financial benefits. Others have expanded paid sick time benefits for all workers, including hourly employees for whom paid sick time used to be rare. Some organizations that offer wellness rewards and incentives have done away with mandatory activities with incremental payouts.
Across health care, clinical and digital transformations are making it easier to analyze how people interact with health benefits—both mental and physical health, when sick and when well. Consequently, data also makes it possible to evaluate how the advantages of various programs differ for different subpopulations. When benefits are designed for total well-being, their value cannot be measured in silos—hence data analysts have become the new superheroes.
Vice President of Employer Customer Experiences
Health Data & Management Solutions (HDMS)
Jason Elliott is Vice President of Customer Experience for Employer clients at HDMS. A true public health enthusiast with a Masters in Epidemiology, he spent over a decade delivering dedicated clinical analytics and leadership at BCBS. Since then, Jason has managed the managed the Employer practice area. He brings very structured thinking into the types of problems his clients are trying to solve, and what can be done with the insights discovered.
Take a close look at how social determinants influence costs and utilization for your population.
How equitably do plans and networks meet diverse population needs?
Predictive models help you anticipate costs and identify ideal targets for specific actions.
See the value and impact of point solutions. How do they affect total costs and overall health?
Employers investing in wellness programs and point solutions, but the cost of the collection of programs is exacerbating inflated health care costs.
As decision-makers think about what to keep and where to reduce costs, the increasing amount of data available for insights is proving very worthy.
Read how HDMS recommends employers approach this – we’ve copied the article to this page.
Read on BenefitsPro
By Rani Aravamudhan | July 28, 2022 at 10:15 AM
Published in Benefits Pro
Inflation is accelerating — not just gas and food prices, but also health care costs, and at much faster rates than years past. At the same time, employers are working hard to attract, care for and retain employees with relevant and comprehensive benefits.
Healthcare point solutions (e.g., diabetes or blood pressure management solutions, fitness apps, etc.) have exploded in popularity as part of healthcare benefits, but they also cost a pretty penny. Hence data analytics prove to be vital now (more than in the past) in driving decisions around offering, expanding, or discontinuing various ancillary benefit programs. The rise in the availability of new data types from these solutions enable nuanced and sophisticated analyses to determine the value of the whole benefits or “total rewards” packages as they are dubbed.
For years, the set of metrics used to measure the success of any program was limited to simple data elements available in standard claims – the number of members that enrolled in a program or the number of members that had one visit with a provider. Enrollment metrics are no longer the only available barometer for engagement. For instance, the aggregation of traditional claims with non-traditional digital data sets allows for connection of dots that were previously invisible or had no access, thus revealing new trends and powerful insights.
Engagement In a program has thus been redefined. Rather than tracking how many people enroll in a certain wellness or fitness program, granular metrics like the frequency of use of apps or numbers of digital visits with clinicians are used in tandem with medical and pharmacy claims to identify discernible, meaningful, and quantifiable value. Other examples of data types frequently leveraged from various solutions include biometrics (e.g., BMI, BP), lab tests (e.g., blood sugar, cholesterol, A1C, etc.), sleep patterns, meditation and mindfulness minutes, mood changes, dietary changes, etc. It is possible to then look holistically at a program’s impact on employees’ health, wellbeing, productivity, quality of life, and other indicators — driving more effective benefits decisions.
The concept of coordinated and continuous care is not new, but clinical and digital transformation across the industry is now bringing us closer to achieving it. Understanding an individual’s interactions with care when they are healthy and not just when they are ill drives policy changes to reduce the sick times.
The ability to identify who is, or is not, engaging with a certain program — and why — gives organizations the power to build programs around their employees’ real-life needs. Questions commonly asked of our data analytics teams include:
A few case studies illustrate how data is impacting employer healthcare decision-making:
In the second case study, one large employer offered two separate wellness programs that promoted a healthy lifestyle with diet and exercise goals. However, one focused more on the exercise component while the other concentrated on healthy and mindful eating. When they tried to assess the effectiveness of both (to determine if one added more value than the other overall), the data showed a very interesting and unique pattern. Adoption and engagement in the two solutions differed along racial, ethnic and income lines. Different populations engaged with these solutions likely for reasons outside of health status. As a result, the company decided to retain both programs since they obviously were essential to varied groups.
For one such organization, bringing together medical, pharmacy and mental health EAP (digital) data brought to light an interesting link between anxiety and heart disease. Specifically, 30% of those with a new diagnosis of anxiety also had a new diagnosis of hypertension and/ or ischemic heart disease in the same year. They also had sought care for other indicators for acute stress. This insight helped the benefits team better align their concierge services to ensure a more holistic health model, where the mental and physical health needs were addressed together.
Health benefits are far too expensive and important to select based on partial insights or guesswork. Thankfully, the days of using proxy indicators to measure success are over. The growing convergence of digital and traditional data allows organizations to evaluate programs in the context of real value to support their most valuable resource — their employees.
Head of Clinical Advisory Services at HDMS.
Dr. Rani is a general medicine physician who cares for individuals yet connects experiences to population health perspectives using deep data expertise. Rani is known for her work in data-driven transformation, workflow design and development, value-based care, risk management and clinical quality and performance reporting. Her work and team guides clients to understand what is possible with data, find answers and insights within projects and analyses, and build context and scale across HDMS clients.
Why rely solely on metrics like number of enrolled? Don’t you want to quantify health outcomes?
Are you successfully engaging individuals who would most benefit? Or are only those who are already highly engaged in their health?
Achieving maximum ROI from wellness programs comes from changing behaviors. Who is most at-risk for adverse health events and consequently would benefit the most from an initiative? How can data help?
Read this article from BenefitsPro. It shares how HDMS recommends employers approach this – we’ve copied the article below.
Read on BenefitsPro
Wellness programs have become a staple of employer benefits offerings. According to one KFF trends report, nearly 9 in 10 employers with a workforce of 200 or more offered some sort of workplace wellness initiative in 2019.
While many employers are willing to invest in wellness programs—which often are offered through third-party vendors—they aren’t always clear on the goals for these benefits. Multiple surveys and studies across the industry attest to this. No clear goals mean no systematic approach to defining and consequently measuring ROIs.
Most employers rely on wellness vendors’ claims about the potential to improve health outcomes and reduce health care costs. They do not necessarily have the means and/ or expertise to independently verify the proposed advantages either prior to or after implementing them.
Metrics used by vendors to illustrate their successes are not always applicable to all populations or groups. For instance, let’s say a vendor’s “expected outcomes” include a 20% increase in smoking cessation rates. Is that 20% over three months or over three years since the last smoking incident? Or, is it based on a one-time pledge by the participant? What was the size of the overall smoker population in their sample data? Then there is always the question, “Is that the right metric for your population?”
Data analytics can provide objective insights to evaluate such partnerships before beginning, renewing or expanding a wellness program.
Like any strategic endeavor, effective ROI measurement requires diligent groundwork before actual data analysis can begin. It is essential to ensure that the right metrics are chosen for measurement of “before” and “after” states.
Concrete objectives will vary by employer as well as by program—but beware of setting goals focused solely on short-term “dollars-in” vs. “dollars-out.” An effective wellness program aimed at promoting better rates of preventive care with active engagement may actually increase expenses in the immediate and short term. In such cases, the true long-term objective should be to shift health care services from unpredictable, high-cost settings like the emergency department (ED) to more predictable, lower-cost settings like primary care physicians’ offices.
Today’s wellness programs tend to be more holistic in their approach to employee health than the offerings of just a few years ago. Many employers are looking for more than isolated reductions in smoking rates or ED visits. They are starting to understand the overall health and financial benefits to their businesses possible through programs that integrate physical health with mental health and well-being. This adds obvious layers and complexity to the ROI conversation.
Preparing for any ROI measurement requires assessing all the data sources at your disposal. It’s critical to obtain as close to a 360-degree view of the entire employee population as possible, which typically requires melding multiple disparate data sources. Medical and pharmacy claims, lab values, biometric and clinical data from electronic health records (EHRs) are some examples. Data warehousing and analytics solutions can help this process by aggregating, integrating, enriching and normalizing data along with consultative services to provide the right insights.
Finally, a realistic timeframe for measuring program outcomes is a must, especially when claims are part of equation, to allow for the time lag between services rendered and paid out. Hence 12 to 18 months serves as an optimal window to gauge discernible changes to patterns of care experience and member behavior. That said, periodic measurements throughout this time are essential for tweaking and adjusting workflows and processes to ensure proper data aggregation (e.g. presence of required code sets, uniform cadence in receipt of various data types, etc.).
Achieving maximum ROI from wellness programs comes from changing behaviors, especially of those who are most at risk for adverse health events and consequently would benefit the most from these initiatives. For example, employees with chronic conditions who struggle with medication adherence or with managing stress due to work and family obligations. Promoting and maintaining engagement in such groups is challenging, but key to the success of the program itself.
On the same token, initial engagement tends to be high among members who are healthier and would likely gain little from a wellness or similar program, especially when there are participation incentives involved. Engagement typically tends to decline once the incentive requirements are met or phased out.
Setting up cohorts of participants with these factors in mind is critical because the metrics chosen to measure success levels in each will vary. Leveraging the expertise of data analytics vendors and consultants to define and set up such study cohorts—with and without comparable controls—goes a long way in these endeavors.
For example, employees who are engaged in wellness programs tend to also take advantage of preventive services and have a primary care provider. Consequently, data typically will show that they have higher rates of primary care and in-network utilization—whereas those who don’t participate have more ED and out-of-network services.
t is vital to ask the question, “Are we measuring the right things for each cohort for this particular initiative?” Defining the right metrics for a cohort is therefore an important aspect of the study design. Example: Establishing new primary care provider relationships and closing care gaps would be good metrics for employees who have traditionally not sought regular primary care in the past. On the other hand, keeping pertinent lab or biometric values within normal ranges, or garnering low scores on health risk assessment tools may be better suited for healthier and more engaged populations. Establishing clear baselines for each metric on day 0 is imperative for apples-to-apples comparisons.
Many employers are using non-traditional data sources to track metrics like sick time, other leave utilization, and rates of disability claims to evaluate the effectiveness of a wellness program. Data analytics and warehousing vendors offer tremendous advantages in this area by integrating disparate data sources.
Pilot programs for a carefully chosen group with comparative control groups is always recommended, especially for new wellness initiatives. In addition to ironing out administrative and process challenges, they provide a great means of gauging the operational effort and resources required. This is an often-overlooked expense not featured in ROI calculations.
Results from a pilot program can go a long way toward determining an effective roll-out strategy. It’s essential to compare these results against the total employee population for the same timeframe. Example: An increase in the rates of flu vaccine compliance among employees in a pilot group does not mean much if vaccine compliance also increased in the total employee population due to onsite flu clinics. With successful pilots that show a definite improvement in outcomes for the participants, odds of further success are better when the program is expanded to demographically similar employees.
The last few months have brought renewed focus on the overall well-being of the workforce. Employers recognize the importance of the physical, mental and emotional wellness of their employees and their families. It’s not surprising that wellness program vendors, especially those that provide integrated services, are popular.
But rather than jumping on the wellness bandwagon or adding a program just to expand the suite of benefits, employers would be better served to make data-driven decisions. They would do well to engage the many data analytics vendors who provide evaluation services to answer key questions. “Is this right for our company?” and “Will this save me money on health care costs?” are the types of questions that can be answered even before the program is implemented, based on existing statistics or sample data sets.
Dr. Rani is Head of Clinical Advisory Services at HDMS. She is a physician (specialty – General Medicine) with extensive experience in the EMR/EHR and population health industries with a focus on clinical transformation, workflow design and development, value-based care, risk management and clinical quality and performance reporting. Her strong background in clinical medicine and experience in the HIT industry make her successful in navigating payer, provider and technology vendor landscapes.
Why rely solely on metrics like number of enrolled? Don’t you want to quantify health outcomes?
With staggering resignation rates throughout the country, employers are naturally looking at benefits. What’s the right mix to both retain employees to prevent expensive losses, and attract replenishment talent?
Navigating the “Great Resignation” to an advantage means directly addressing these unknowns. It requires a holistic approach to health benefits. It’s no longer enough to have a handful of options that seem like they should fulfill employees’ specific needs.
Think about the relationship between a doctor and their patient. Providers consider the whole patient, including their demographics, medical history, and social determinants of health. Yes, they focus on health outcomes, but also fostering better patient experience and satisfaction levels to ensure their practice maintains a stellar reputation. If you too can take a holistic view of your workforce population, you’ll nail it. You’ll offer competitive and thoughtfully designed health benefits that really resonate with employees.
Derive insights from powerful data stories that exist about your workforce.
Your health benefits will not only address your employees’ needs but anticipate them. You won’t fear the sticker shock that comes with an expansive benefits package. Having analyzed health data you will have eliminated under-utilized and costly benefits that your employees don’t need or want. You’ll get better value for what you are spending.
A record 4 million people quit their jobs in April 2021 alone, for reasons largely stemming from dissatisfaction, whether in pay, flexibility, or work-life happiness.
Read the NPR Article
Use data to design the right health and wellness programs for YOUR population.
Happy, healthy employees – the building blocks for success and long term loyalty.
No guess work or finger crossing.
With so much data available from multiple sources, how can you interpret and utilize it properly?
Health data is key to successful transformation as a side effect of the “Great Resignation” trend. Use analytics to evaluate specific benefits and associated holisitic wellness. Do mental health apps reduce reliance on prescription pain medications or chiropractic visits? Get a better understanding of employees’ wants, needs, and what’s working. Unfortunately the individual reports you have today can’t always connect the dots for you.
Using data differently gives is broader understanding of people, wellness, and ultimately, productivity. It’s easy with connected health data and even fun (!) with a predictive analytics system. Equipped with data-driven insights, you’ll create a competitive advantage beyond just hiring, by offering benefits that really work for your employees. You’ll have happier, healthier employees bringing their best self to work everyday.
A connected view of your health data makes it possible to spot emerging trends more quickly and evaluate employee behaviors as they evolve. You can monitor in real-time how your population uses their healthcare services to identify opportunities for improvement and increase employee retention.
For example, you can use prescription data to view trends in new medication for anxiety and depression as an indicator of your workforce’s overall wellbeing. This canary in a coal mine can help you implement wellness perks for your employees more quickly, such as mental health days or increased behavioral health services. Connected health data creates a birds-eye view of your population’s greatest commonalities and shared wants and needs. If many of your employees have dependents, childcare coverage might resonate more than the social benefits that young professionals may seek.
By integrating all types of employee benefits data — from traditional sources (such as medical, eligibility, and pharmacy) and non-traditional sources (such as wellness programs, disease or care management programs, biometrics, wearables, provider and lab data) — you have the power to create a benefits program specifically targeted to your employees.
More than ever, employees need to feel valued and employers need to improve retention rates with competitive and custom health benefits. Understanding the “Great Resignation,” particularly how to address it, is critical for your company’s success in the immediate and long-term future.
It’s not just about retention or hiring.
Nurture happier, healthier employees who bring their best self to work everyday.
Arm yourself with data visualizations, cohort analysis, and other tools. Easily evaluate your workforce and adjust health programs to meet their evolving expectations. We’ll help you deliver measured results and continued success… long after the Great Resignation.
Your friends at HDMS
How are organizations approaching SDoH in their analytics? What are they doing given the insights and measurements they find?
Here are some specific examples of HDMS client projects.
See how organizations use insights for action and innovation.
Learn more
Things like care gaps by Socioeconomic index.
HDMS clients – have your team walk you through available possibilities. There’s so many new options. Where will you take this next?
We’ll help tailor new analytic views to any specific needs you have.
See how easy it is to look at how social determinants influence your population.
Learn more
HDMS provides predicitive models, pre-defined segments, model scores, historical predictions and more.
Bring member-level scores and cohorts into a cross-prediction analytic view.
There’s power and sophistication wrapped up in an intuitive user experience – so you can do more than look back on historical trends.
Learn more
HDMS clients – have your team walk you through the latest models.
What do you do next? We’ll make sure your data supports your next steps and actions.
Review an analytic framework and methodology for analyzing abortion health care services.
Ask your team if you are interested in additional analytics surrounding abortion services. We will make sure you have access to the types of metrics and dashboards that best support your business questions and benefits strategy.
Get more details
– HDMS client
The supreme court ruling overturning Roe vs. Wade resulted in HR teams all across the country assessing impact and planning for shifts in member benefits both short and long term.
As legislation continues to evolve at the state level, changes, employers naturally wish to review in depth how it is impacting their workforce and benefits offerings.
Read specifics around the analytics available to provide relevant facts for informed decisions and quantified planning.
Get the Spotlight
Easy access to answers.
Even when the questions change.
Use Analytics to dig into specific parts of your population and better understand unique health concerns, emerging needs, and guide decisions for a more thoughtful benefits strategy.
HDMS clients have access to Transgender Health dashboards.
Look at some of the insights that clients may find.
Get the Spotlight
HDMS clients – have your team walk you through your dashboards. Where can you take this next? We’ll help tailor and expand this for you!