The Benefits of Data

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  Benefitfocus Data & Analytics Solutions Manager Vickie Rice explains how you can transform your benefits data into significant cost savings for you and your employees. During this webinar, you’ll learn how data analytics technology can help you.
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  • 1. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 1
  • 2. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 2 Vickie Rice, GBA Solutions Manager, Data & Analytics
  • 3. © 2015 Benefitfocus.com, Inc. All Rights Reserved 3 All Your Benefits. One Place. • Founded in 2000 • NASDAQ: BNFT • Headquartered in Charleston, SC • Offices in Greenville, Tulsa and San Francisco • Over 23 million consumers
  • 4. © 2015 Benefitfocus.com, Inc. All Rights Reserved 4 Transforming the Way Benefits Are Managed Voluntary Benefits Financial Third Party Administrator Broker Consultant Government Reporting Health Insurance LEGACY ERP/HR The Old Way The Benefitfocus Way
  • 5. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 5 7-15% 70% 4% Percent of healthcare costs are rising on average per year Percent of all healthcare costs caused by unhealthy behavior Percent of companies can perform predictive analytics about their workforce The Facts about Healthcare Data Strategic benefit administration is only as good as the data that drives it Aggregating enormous amounts of data will be essential Make data useful and actionable to drive decision making
  • 6. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 6
  • 7. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 7 Employer vs Benchmark: Cost Per Employee $0.00 $2,000.00 $4,000.00 $6,000.00 $8,000.00 $10,000.00 $12,000.00 $14,000.00 Group Benchmark 2014 $0.00 $2,000.00 $4,000.00 $6,000.00 $8,000.00 $10,000.00 $12,000.00 $14,000.00 Group Benchmark 2013
  • 8. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 8 $8,000.00 $8,500.00 $9,000.00 $9,500.00 $10,000.00 $10,500.00 $11,000.00 $11,500.00 $12,000.00 $12,500.00 $13,000.00 National My Size My Region My Industry My Group 2013 2014 Employer vs Benchmark: Cost Per Employee
  • 9. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 9BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary
  • 10. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 10 + + + Tailoring Benefits Plan Design What have we been spending on healthcare? Who’s on our plan? What will be spending in the future? How can we lower expected costs? = Custom Benefit Plan Design BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary
  • 11. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 11 First Things First – Get Access to your Data Benchmark Data Case ManagementWorkers comp Premiums Claims Member Eligibility Misc. FinancialHRA/BiometricsPBM/Rx Secure UI DATA WAREHOUSE Episode Grouping Engine
  • 12. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 12 Learn About The Past $1,046 $663 $1,118 $897 $1,249 $441 $286 $482 $387 $540 Jan Feb Mar Apr May PEPM PMPM
  • 13. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 13 Who’s on your plan? 940 66 Employee Gender Member Gender 1,508 1143 BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary
  • 14. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 14 $2,933,767 $2,148,982 Employee Dependents And how do they affect your cost?
  • 15. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 15 If you don’t make any changes, what can you expect to spend in the future?
  • 16. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 16 • Multiply your current expenses by – National Trend (7-15%) – Your group’s trend (4%) • Hire an Help – Consultant – Actuary • Know and understand the health of your population and how that impacts your plan’s financial risk How Do You Determine What the Future Will Cost?
  • 17. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 17 • Hierarchical Condition Categories (HCCs): Part of the Medicare Advantage Program for CMS, HCC contains 70 condition categories selected from ICD codes and includes expected health expenditures. • Adjusted Clinical Groups (ACG): Developed at Johns Hopkins University, ACG uses both inpatient and outpatient diagnoses to classify each patient into one of 93 ACG categories. It is commonly used to predict hospital utilization. • Elder Risk Assessment (ERA): For adults over 60, ERA uses age, gender, marital status, number of hospital days over the prior two years, and selected comorbid medical illness to assign an index score to each patient. • Chronic Comorbidity Count (CCC): Based on the publicly available information from Agency for Healthcare Research and Quality (AHRQ)’s Clinical Classification Software, CCC is the total sum of selected comorbid conditions grouped into six categories. • Minnesota Tiering (MN): Based on Major Extended Diagnostic Groups (MEDCs), MN Tiering groups patients into one of five tiers from Tier 0 (Low: 0 Conditions), Tier 1 (Basic: 1 to 3), Tier 2 (Intermediate: 4 to 6), Tier 3 (Extended: 7 to 9), to Tier 4 (Complex: 10+ Conditions). Member Risk Scores
  • 18. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 18 Member Risk Scores Prescription Compliance Frailty Pregnancy At-risk Births Emergency Room Utilization Patterns Non-Chronic, Expensive Treatments Likelihood of Hospitalization Chronic Conditions
  • 19. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 19 No Conditions 1 Condition 2 Conditions 3 Conditions 4 Conditions 5 or More Conditions Patients 615 201 98 65 24 11 615 201 98 65 24 11 0 100 200 300 400 500 600 700 What are your plan’s Comorbidity Rates?
  • 20. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 20 Individual Predicted Risk
  • 21. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 21 Enrollments, Payments & Savings Health Plan Contracts 1,032 Health Plan Members 2,739 Members Per Contract 2.65 Average Member Age 33.47 Average Employee Age 48.15 Predicted Resource Index - Local 2.35 Inpatient Facility $251,631.58 Outpatient Facility $2,240,433.60 Outpatient Professional $1,447,140.33 Prescription Drug $1,143,544.85 Total Plan Payment $5,082,750.36 Total Medical & RX Payment $5,082,750.36 Predicted Cost Amount $11,944,463.35 Total Charges $10,931,271.80 Total Plan Payment $5,082,750.36 Employee Responsibility $535,141.54 Exclusions $1,562,667.63 Other Insurance $125,633.44 Overall N/W Savings Amount $3,631,919.28 Aggregate Risk BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary
  • 22. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 22 Enrollments, Payments & Savings Health Plan Contracts 1,032 Health Plan Members 2,739 Members Per Contract 2.65 Average Member Age 33.47 Average Employee Age 48.15 Predicted Resource Index - Local 2.35 Inpatient Facility $251,631.58 Outpatient Facility $2,240,433.60 Outpatient Professional $1,447,140.33 Prescription Drug $1,143,544.85 Total Plan Payment $5,082,750.36 Total Medical & RX Payment $5,082,750.36 Predicted Cost Amount $11,944,463.35 Total Charges $10,931,271.80 Total Plan Payment $5,082,750.36 Employee Responsibility $535,141.54 Exclusions $1,562,667.63 Other Insurance $125,633.44 Overall N/W Savings Amount $3,631,919.28 How does predicted risk affect future cost? BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary
  • 23. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 23 Now What? Investigate Ways to Affect Change – Plan Design – Wellness Programs – Medical Tourism – Onsite Clinics Budget Accordingly
  • 24. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 24 Fact-Based Plan Design
  • 25. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 25 Fact-Based Decisions BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary
  • 26. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 26 What About Our Employees?
  • 27. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 27 Fact-Based Plan Selection
  • 28. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 28 The Benefits of Data:
  • 29. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 29 A MATTER OF FACTS. www.Benefitfocus.com
  • 30. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 30
  • 31. © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 31 Learn more about the benefits of data at www.Benefitfocus.com
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