But today’s business leaders face enormous pressure in providing employees with the comprehensive, affordable health coverage that helps them get and stay healthy. With anticipated employer-sponsored medical plan costs continuing to rise well above the general inflation rate—4% or more in 2015, and even higher this year—employers feel an urgent need to control costs while encouraging employee health.
C-suite leaders in companies of all sizes have long sought innovative solutions to manage healthcare costs, provide benefits that help recruit and retain top talent, and promote a healthier workforce. More and better solutions are possible today with the help of large datasets and sophisticated analytics to understand and support the healthcare needs of employees.
But how do you know if you have the data you need? Is it rich enough for you to plan your benefit strategy? Does it help your employees make informed, personalized decisions? Is it representative of the geographies and demographics of your work sites? Does it help you—and your employees—address quality as well as the cost of care?
These are critical questions we, as a healthcare insurance provider, ask ourselves every day as part of our commitment to advance a data-driven healthcare system. We have seen first-hand the importance of having comprehensive data on the utilization of healthcare and provider capabilities across the country and down to the ZIP Code level. The data is a critical starting point to driving systemic change. It is through the analysis of the data that we can draw important insights to help us build on what’s working well in healthcare—and make needed improvements. Those insights translate to action for employers, allowing them to design benefits that support a real shift in the healthcare market toward cost accountability.
For example, one large national financial services firm with 12,000 employees in 20 states worked with a Blue Cross Blue Shield (BCBS) Plan to leverage data to reduce healthcare costs by analyzing cost drivers for more than 1,600 treatment categories. The Blue Plan used sophisticated data analytics to calculate “what-if” scenarios, showing what would happen if procedures done at above-average-cost facilities were instead done at average-cost facilities. The results identified savings of more than $3 million—5.7% of the company’s total medical cost.
This is just one illustration of the progress we have made in using data to help business leaders drive decisions and tailor healthcare benefits to the needs of their workforce. But we are only scratching the surface of what a data-driven healthcare system can look like. Data will play an increasingly important role in helping companies develop forward-looking healthcare options for employees—options that manage healthcare costs with the least disruption to employees, whether through more targeted models for care management and wellness or new care delivery options. At the same time, by making available consumer-friendly tools that tap into rich data sources, employees can have access to clearer information—including the costs that hit their own wallets—helping them take a more active, informed role in their own choices about the doctors they see or the treatment options available to them.
Of course, affordability is only one part of the equation. Everyone who runs a business knows that people are our strongest asset and we depend on healthy, productive workers. Here, too, data plays a critical role. Insurers are partnering with hospitals and physicians across the country to build innovative models that incorporate rich troves of data to improve care delivery.
Data enables these providers to better coordinate care for the individual patient and to ensure that they are using the most effective, evidence-based treatment approaches. As just one example, by personalizing and coordinating outcomes-driven care in a high-cost, high-healthcare-utilization state, an insurer-led program covering 750,000 patients last year cut ER visits and hospital admissions by 5% and 8% respectively, improved cholesterol control by 7% and increased adherence to diabetes care plans by 6%. Employers and employees alike can benefit from the high-quality care available through these types of programs, and I am pleased to see an increasing number of business leaders calling for insurance solutions that promote them.
Scott Serota is president and chief executive officer of the Blue Cross Blue Shield Association, a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies. The Blue Cross and Blue Shield System is the nation’s largest health insurer, covering nearly 105 million people—one-in-three of all Americans.