Why knowledge is power in the search for the right benefits plan

The cost of health care has frustrated people from all sides, whether you’re trying to raise a family or lead a business. The good news is that there is a way for companies to track where the money is being spent and use that information to control costs and encourage healthier behavior from their employees.

“The key is an open mind and a willingness to make the investment,” says Ron Filice, president and CEO at Filice Insurance.

Health informatics is a discipline within health care that provides in-depth analysis related to claim utilization, population management, clinical outcomes and formal processes to address health care risk so as to mitigate future exposure. It involves detailed use of public health resources and national benchmarking data to optimize the true view of predictive losses.

Smart Business spoke with Filice about how health informatics can help you provide a better health care plan for your employees.

How does health informatics work?

The goal is to get a better sense of the overall health of your workforce and to use the data you compile to craft a benefits plan that best supports the needs of the group. If you have a group of employees that enjoys opportunities to be physically active, you may find a lot of support for launching wellness initiatives.

With an older workforce, perhaps you focus on health screenings or programs that address health concerns they may be facing. If you have a younger group that includes employees with growing families, options focused on the medical needs of children could become a priority.

When you take an in-depth look at the makeup of your people and begin to understand their unique needs, you can build a program that is more efficient and easier to navigate. By cutting out programs that don’t fit with your company, and working harder on programs that do, you can build a more cost-effective plan.

What is the best way to go about getting the information you need?

Your benefits consultant should take the lead on working with your insurance provider to come up with the best strategy for your company to collect data. Once the data is collected, engage your provider in a comprehensive discussion about the findings and the clinical risk of your health plan. Use their expertise to decipher the clinical language and get a clearer picture of what you can do to help your business.

As an employer, you must also ensure that you use the data you receive properly.   The data received from the carrier is only identified to the clinical team. Employers themselves will never see identified, protected health information data on their employees. This is to support the privacy and sensitivity needs around employees’ personal health records.

It’s important to communicate this message heavily with your employees so that they know that any data that is collected is not shared and is aggregated only to help the employer manage its health plan.

How much time is required to make this work?

This largely depends on your ability to implement an informatics and wellness solution. At minimum, implementation may take six months. While much of the heavy lifting falls on the benefits consultant you work with, you must be engaged to answer any outstanding questions and/or to provide guidance.

Can you provide a case study of how health informatics works?

A food manufacturing company was making the move to become self-insured. The benefits department required greater insight into the true drivers of health care cost, utilization and risk within its employee population. Leaders also needed to understand the financial implications of change and determine the best plan design to be able to predict trends into the future. It turned out that the majority of the employee population was predisposed to diabetes and hypertension and 80 percent of pharmacy utilization was generated by about 20 percent of the population. Of this group, a majority was undergoing treatment for chronic disease without using the most efficient arrangement of services.

Management was able to design a multi-faceted health strategy aimed at increased quality of care without increased costs.