How we helped a large Midwestern employer avoid a significant increase in their healthcare premium costs

Client Situation

Client description
  • The customer was a large Midwestern employer working with a TPA to manage Healthcare provision for their 1000+ employee base across 4 locations.
Challenge
  • They were facing a situation where their premiums were set to increase up to 30% despite their best efforts in containing costs.
Objectives
  • In this situation, they wanted to put in place a long-term sustainable solution that tracks& predicts key health metrics to help them control costs, increase productivity and drive employee engagement.

D Cube Approach

Implementation of the Prudence platform
  • Step 1: Integrated multiple sources of claims data, internal HRA files, Rx Data, Direct Contract and Direct contract aggregator data
  • Step 2: Identified the high cost items and evaluated the potential options to bring the cost down
  • Step 3: Designed & deployed a series of executive & business user level dashboards & composite models to monitor the cost in future as well as provide actionable insights for keeping the healthcare cost down in future

Client Impact

  • We were able to identify a small subset of members (12%) contributing disproportionately (82%) to the overall costs. This was used against the justification for an uniform increase in premium costs.
  • Further, we were also able to identify & isolate “at-risk” patient cohorts and ensure appropriate interventions were planned so they don’t end up in high cost episodes.
  • These insights combined with the system in place to manage risk and prevent avoidable high cost episodes helped the customer to renegotiate to a more favourable premium for the next year.