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Wednesday, 27 July 2016 14:42

Cost Containment: Putting Your Claims Data to Work

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Let’s face it, there’s much about the continued rising cost of health care that you don’t have much control over. You can’t change the medical needs of a premature baby on your health plan, or change the costly medical and prescription treatment needed for chronic conditions in your employee population. However, you may have access to data from your insurance carrier that may help you get a better grasp on items that might help you curb your overall healthcare costs.

Several factors determine how much data you’re able to receive from your carrier:
  • Group size (groups over 100 employees typically get more data)
  • Funding type (partially self-funded groups have access to much more data than Fully Insured groups)
  • Insurance Carrier (each has a threshold at which you can get certain types of claims data)
If you are large enough or have the funding type to access your claims data, you can put that information to work and take control over costs. You can analyze your claims data to:
  • Identify utilization patterns and make plan design changes to encourage less costly consumer spending behavior
  • Educate and engage employees in opportunities to curb their costs and the employer’s costs
  • Target and focus your wellness program on the most relevant health conditions
  • Identify if your efforts are working as you begin to see the results showing up in your future data
 Remember not to get lost in all that data. Focus on longer-term trends, not anomalies that show up on one report but not another. Target the items that are actionable and that you can have the most impact on. Make sure that your broker is on board to assist with this data analysis and help you come up with real solutions. 
If you can affect your health plan costs and help your employees become healthier and better consumers, it’s a win-win for everyone! This email address is being protected from spambots. You need JavaScript enabled to view it. to learn more about how to best use your claims data.
Read 2270 times Last modified on Monday, 14 September 2020 19:48
Tonya Young

Tonya is our Senior Account Manager and brings eleven years of prior insurance company expertise to Fall River, having worked at Anthem Blue Cross and Great-West Healthcare (now part of CIGNA). Tonya holds a Bachelor of Science in Psychology from Texas A&M University. Originally from Minnesota, she loves the Colorado outdoors and enjoys family time with her young daughter.