How we helped a large Midwestern employer in reducing their healthcare premium costs

Client Situation

Client description
  • Large Midwestern organization working with a TPA to manage health insurance for their employees and dependent members.
  • Premiums were set to increase up to 30% despite their best efforts to contain
Challenge
  • No easy visibility to underlying cost drivers and overall risk they were carrying
  • Inability to compare to regional benchmarks and set in place initiatives to set & achieve targets
  • Inability to reasonably predict future trends
Objectives
  • 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

  • Leveraged our HealthEX platform that can readily process key data sources
  • Quickly integrated multiple sources of claims data, internal HRA files as well as the Rx data to provide a holistic picture of their employee health as well as key insights around drivers of cost & outcomes
  • Designed & deployed a series of executive & business user level dashboards & composite models that not only provided robust reporting capabilities but also root cause analysis behind high value claims and future risk for the population
  • Provided automated insights and recommended actions on a monthly basis so HR & Finance staff can quickly define action items

Client Impact

  • Immediately identified that 12% of the population was contributing to 82% of the high value claims. Used insight to plan initiatives & renegotiate better rates
  • Identified “at-risk” patient cohorts and ensure appropriate interventions were planned so they don’t end up in high cost episodes
  • Achieved 40% conversion from random centers to centers of value thereby decreasing cost & increasing quality of outcomes