Using data to manage health care Featured

6:37am EDT December 28, 2005
Managing rising health care costs and understanding where those premium dollars are going is a growing concern many companies. In this information age, measuring and tracking health care data is one way employers can get their questions answered and take proactive steps to manage their health care investment.

“Health care is a big expense item for companies of all sizes,” says Anne Boland Docimo, MD, MBA, chief medical officer at Pittsburgh-based UPMC Health Plan. “They want to know what they can do to get a handle on medical costs and get the most out of their premium investments.”

Smart Business spoke with Docimo about the data collection and management strategies that companies can use to improve their health care strategies and employees’ health, while saving money along the way.

Overall, what role does data play in health care management?
Information like enrollment data, paid claims information, pharmaceutical details and other pertinent data that’s available through a health care provider is very valuable to employers. Through this data they may learn, for example, that 10 percent of their work force has been diagnosed with diabetes or asthma.

They can take that information...and use it in a clinical fashion to get a limited picture of opportunities they may have to address health care needs within their employee population.

What kind of data does a company need to collect and track regarding health care?
Enrollment data and paid claims are basic health plan functions, and that data should be available through the health plan provider’s database. Where the company can add on is by doing health risk assessments, which are reviewed and tabulated by insurance providers.

These assessments comprise a series of questions that employees self-report on their own health status. Studies have shown that results of self-reported health-risk assessments are quite accurate.

Health screenings are mini-exams performed on-site at a work place. Health screenings usually include measurement of height, weight, blood pressure and blood test screenings for high cholesterol and blood sugar.

How can a company collect and track health care data? Is there new technology that may help this process?
Employers can turn to their health insurance providers, and augment that data with one of the many online health risk assessment tests available. Fifty percent of the cost of care in the U.S. is for patients with at least two chronic illnesses.

Insurers can identify them and get them into programs that improve the management of that chronic illness, and which, in turn, lessens the cost trend for the company.

In other words, insurers can identify employees who are diagnosed with diabetes or asthma, and then use queries to identify gaps in care (missed annual tests and screenings, for example), and then do outreach to those employees.

How might HIPAA and other regulations affect the collection and storage of health care data?
Insurance firms can share data with the patients’ physicians on an individual, patient-specific level because HIPAA regulations allow covered entities to exchange information for treatment, payment or operations, as well as disease management program purposes. HIPAA regulations also govern the security of information that is collected.

All covered entities must address how they protect information from several different standpoints: administrative procedures and processes; facility security as well as electronic/IT safeguards. With employer groups, the data must be further protected in that generally only aggregated data — that is the entire group’s statistics — can be shared. So the insurance provider won’t be able to give an employer any employee-specific or dependent-specific data, as that type of disclosure to an employer group would be against HIPAA.

What benefits can a company expect from collecting and tracking health care data?
Employees who have chronic illnesses are going to have higher health care costs than those who do not. If you take the former, and ensure that their care is well-managed and that they’re following guidelines, then they’re going to be less expensive than if their chronic conditions were not managed.

As employers receive actionable information as a result of tracking data, they can develop communications, wellness and prevention programs addressing employee needs. These efforts will heighten employee interest and understanding about their personal role in managing their health. Once employees become engaged, the benefits to their personal health will follow.

Anne Boland Docimo, MD, MBA, is chief medical officer at UPMC Health Plan in Pittsburgh. Reach Docimo at (412) 454-5516 or docimoab@upmc.edu.