HEALTHCARE CLAIMS DATA – THE HOLY GRAIL?

healthcare claims dataOne of the biggest frustrations that I hear from employers is that their health insurance carrier does not provide them with the data that they need in order to best manage their healthcare plan.  One of our distinct “value propositions” is our ability to capture detailed healthcare claims data – every claim from every member for any size employer.  Armed with that information, we can help you in very strategic ways:

  1. We can model alternative financing illustrations with REAL (not estimated) claims information so that you can make educated decisions on what (if any) financial risk you should absorb.  This is a game-changer – you can now KNOW what the total cost of your plan would be under multiple financing approaches.  We’ve found that even small employers’ claim patterns are stable / predictable year over year.
  2. Renewal Predictability and negotiations – if we know that claims are running below the insurance carrier’s target, we are empowered to negotiate a better deal. The game changes with the insurance carriers when you talk to them 90-120 days prior to renewal and you know the loss ratio and the carrier’s profitability relative to your claims performance.  If it turns out that claims are running poorly, we can seek details that might paint a more favorable picture to both the incumbent carrier as well as to other carriers who can provide competitive proposals.  We are able to determine if these claims are in the rear view mirror or is there is a likelihood of them continuing into the future.
  3. Targeted communications – when we know which medical conditions are most prominent, we can tailor our communication and education efforts to address the cost-drivers within your group for maximum impact.
  4. Plan Design Modeling – when we consider alternative plan designs with knowledge of each member’s claims, we can provide an analysis of “individual impact” to show very clearly the extent and severity of the impact of any proposed change.  For example, increasing your deductibles or out of pocket maximums might only impact a small minority of plan participants yet yield a significant premium reduction.

Unfortunately, most mid-market employers don’t have the healthcare claims data that they need in order to effectively manage one of their greatest expenses.  For information about how you can begin capturing game-changing claims data and how you can use that data to achieve better outcomes for all of the money that you and your employees spend on healthcare, please contact your CPI-HR benefits consultant, or call 440-542-7800.

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