It is no secret that we need to start focusing on prevention to minimize health care costs, reduce morbidity and mortality and improve overall health.
To build an effective wellness program and employees to have best employee engagement, organizational business leaders need to plan strategically. One way to do this is to incorporate claims data and analytics into the corporate Insurance program’s design. Insurers and TPAs being the custodian of this raw claims data, it’s important that the wellness or risk mitigation planning and implementation strategy is agreed between Insurer, Broker, and the Client, way in advance at the placement stage so that the wellness activities do not end up being a mere check -box activity.
Some best practices with examples for using claims data to improve your employee wellness program:
- Identify the risks and cost drivers among the employee base: If a policy shows increased number of Upper respiratory tract infections with low value claims i.e. high frequency and low claim amount, few things to consider are Air conditioning of the offices, space between each employee seatings, sick leave policies etc. Minute changes (One at a time) can be made to see the outcome on the respective claims.
- Wellness activities done should be outcome based rather than an output based: If a policy shows increased number of Musculoskeletal conditions, an event on ergonomics awareness where there are many participants can be a success from an output perspective but will have negligible effect on the outcome in mitigating this risk. For an outcome-based program focus on one or two problem areas to make it tangible and access the problem from various directions to mitigate it.
- Dig into the demographics and relativity towards the claims: If a policy has high number of upper respiratory tract infections among kids, we tend to ignore during our analysis considering that these are small value claims however this has a repulsive effect such as upper respiratory tract infections in adults, anxiety in parents, frequent leaves, women talents dropping off etc. These are controllable with adequate measures to support parents, particularly new parents. Technology today can be a major support to create solutions around these.
- Analyse data to assess the efficacy of your Wellness program: You can use claims data to help evaluate the efficacy of your current wellness program. For example: Same population comparisons?can help you identify groups of employees who have participated or engaged with different aspects of your wellness program over time. Participant and non-program participant comparisons?can be used to give you a clearer idea of who is participating in the program, engagement patterns, per member costs, and the health status of program participants. A cost analysis?can help your organization compare overall company health risks and costs on an annual basis.
- Reward programs: Major roadblock in targeted employee wellness programs is patient confidentiality, where Broker or Employer cannot be aware of the employees who need assistance or Wellness support. Here Insurers/TPA can play vital role. While AI can identify the ICD, CPT and DRG codes. With AI assistance, Insurers can group employees in their system based on their medical diagnosis codes. Tailored reward programs can be pushed to the individual apps to encourage them towards wellness. e.g. There are apps which can identify virtually if employee is doing the yoga in the right posture and every day. rewards can be allocated based on the consistency and performance. Corporates can also be rewarded basis discounts in their premium for their employee engagement in Wellness programs basis evaluation report from third party provider.
- Collect & leverage employee feedback: Surveys should have questions which can give data for both quantitative and qualitative analysis. Happened to interact with Mr. Jonathan Bentley from Govox Wellbeing and feel beholden as a Wellness professional to have such support systems in providing a comprehensive care to our clients. The sample image of a NPS score on employee happiness is added with this article.In summary, corporate medical claims analysis can play a crucial role in analyzing the development of an annual wellness program by providing data-driven insights that help in targeting interventions, setting priorities, assessing effectiveness, and tailoring initiatives to the specific health needs of the employee population. Wellbeing programs should always be outcome driven and not output driven. All implemented programs should be tangible at short-term and long-term stage with various parameters.
Veena Kumar it was an inspirational conversation with you and thank you for sharing our insights as part of this insightful thought leadership article.