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Claims data analysis can be a critical tool in proving the business case for wellness programs to senior executives.
Group health, pharmacy, workers compensation and disability plan providers can supply data that helps companies measure savings from their wellness and disease management initiatives. However, sources said it can be tricky to coordinate information between various vendors that manage such claims.
“It's not easy,” said Gary Anderberg, Philadelphia-based practice leader for analytics and outcomes with third-party administrator Broadspire Services Inc. “It requires moving away from traditional silos.”
Claims information can help quantify how much money is being saved by improving employee health, said Dr. Dennis Richling, Lake Forest, Ill.-based chief medical and wellness officer for HealthFitness, a subsidiary of Trustmark Cos. that provides wellness programs.
To measure return on investment, HealthFitness analyzes medical and pharmacy data for its clients' wellness program participants. That information is compared with claims data for similar client employees who do not participate in wellness initiatives.
While claims generally have risen for clients in recent years, HealthFitness has been able to demonstrate lower claim utilization among wellness program participants. The return on investment, Dr. Richling said, can stretch from 120% in a program's first year up to 200% in the second year and beyond. These returns include program costs plus annual savings.
“The message that we're using is developed to be the type of ammunition that you can take in front of the CEO and CFO,” Dr. Richling said.
In addition to measuring savings, claims analysis can be used to help offer wellness initiatives to injured or unhealthy workers, said Kimberly George, Chicago-based senior vice president of the managed care practice and client services for Sedgwick Claims Management Services Inc.
"It could be we identify a smoking cessation opportunity because it would improve (a worker's) back surgery healing and post-op care of the patient,” said Ms. George, whose company coordinates its workers comp, disability and leave-of-absence claim data with client wellness programs.
Sources agree that claims analysis is helpful for employers. But they say it's sometimes challenging to aggregate claims data from different sources.
Atlanta-based Broadspire is working with an unidentified employer to coordinate its workers comp data with the employer's group health, pharmacy and disability data. The employer, which has about 28,000 employees, is using the information to tweak its wellness and data analysis procedures, Mr. Anderberg said.
Three claims providers are coordinating to provide information for the employer, Mr. Anderberg said. While the vendors have worked together well, he said that provider coordination is a sticking point for many other employers that hope to collect and study their claims.
“The hardest part really is bringing all of those pieces together,” he said.
Randy Jefferson, Wausau, Wis.-based director of data analytics for third-party administrator UMR Inc., said that claims analysis can be an inexact science when it comes to measuring wellness program return on investment.
While such models can help show wellness program savings, Mr. Jefferson said they provide limited insight on employee risk factors and conditions that could affect future claims.
"There are so many things that can impact what somebody's health is going to be, and consequently, what their use of services and what their costs are going to be," he said.
Mr. Jefferson recommends companies measure clinical outcomes and employee engagement in wellness programs, in addition to claims data.