Employer group identifies improvement with population health initiatives
EXL Health’s population health analytics supports successful initiative
A self-insured employer group needed to improve members’ health outcomes and enhance care experiences, while also reducing costs. This Triple-Aim challenge is nothing new in the healthcare industry, as it has loomed over organizations since the Institute for Healthcare Improvement introduced the concept in 2007.1 The leaders at the employer organization realized that they might be able to meet the hard-to-conquer challenge with a new strategy: Value-Based Insurance Design (V-BID) and population health analytics.
The employer organization worked with EXL Health to implement population health analytics, a longitudinal analysis service that sheds light on members with a variety of health conditions. The analysis compared EXL benchmark data to the employer’s data from 2017 to the present. Overall, the employer group found the EXLVANTAGE™ data and analytics foundation to be very powerful, as it offered descriptive, predictive and prescriptive analytics for the analysis. By relying on population health analytics, human resources leaders at the employer group were able to make informed plan coverage and benefits design decisions that would ultimately support a V-BID model. More specifically, the analysis of patient-level medical and pharmacy claims data helped the employer group develop V-BID plans by zeroing in on where it was providing low-value services and where it was offering high-value services.
By relying on population health analytics, leaders at the employer group were able to make informed decisions about benefits design and member interventions that would ultimately drive better outcomes by relying on population health analytics.
In addition, the employer group leveraged the analysis to identify the patients who were at risk for specific health conditions. For these specific health conditions, the employer group had a higher prevalence of ~48% versus the benchmark of ~39%. The members with these specific conditions accounted for 10% of total health spending.
The group then worked with EXL Health to discover which services result in low and high-value care for the patient populations. Additionally, the analysis empowered the employer group to assess the level of utilization of high-value services, such as preventive vaccinations or tests, versus the level of utilization of low-value services in a hospital setting versus in a primary care physician’s office.
In summary, EXL Health was able to identify a potential for ~15% savings for the employer group in those specific condition categories:
Unnecessary treatments based on various ‘standards of care’
Cost inefficiencies through a comparison of costs to benchmark data
Exactly where interventions can have the greatest effect
Screening tests or treatments that lead to better financial and clinical outcomes
Clinical pathways that result in lower adverse events such as inpatient admissions, emergency room visits, and readmissions
The impact of member co-payments on the use of high-value services vs. low-value services
Members recommended for early detection, cost efficiencies, and clinical pathway conversations
Key drivers or barriers for improving outcomes based on lifestyle factors, social determinants of health, and geographic locations