How USI Utilizes 3D Data to Help Employers Optimize Health Plan Costs
MAY 4, 2021
Claims data reports from insurance carriers confirm what we already know: Healthcare is getting more and more expensive. While many factors are beyond an employer’s control when it comes to rapidly rising healthcare expenses, there are a few areas employers can address that will help them manage costs. Unfortunately, the generic claims data typically provided by carriers and benefits consultants fails to connect the source issues of costly claims with solutions designed to mitigate them.
USI recognized the need for a claims analytics platform that could identify specific factors within a population that contribute to an employer’s rising healthcare costs. With this vision in mind, we created our proprietary platform, USI 3D, to provide real insight into healthcare claims.
USI 3D has since evolved to be one of the largest claims analytics platforms managed by benefits consultants in the U.S., and is used extensively across USI to identify key cost drivers within health plans. With a database of more than 1,200 employers and more than 1 million members, this exclusive platform features 36 months of claims data from more than 80 of the largest claim payors in the country.
Our teams use USI 3D to assess health plan efficiency across a number of areas including clinical, utilization, financial and pharmacy. Once the claim issues and their causes are identified, we recommend solutions from Omni, our proprietary knowledge engine of proven solutions built by USI subject matter experts.
How USI Uses 3D Data
According to the Centers for Disease Control and Prevention (CDC), all U.S. states and territories report that more than 20% of their adult populations are obese, with the South and Midwest reporting that more than 33% of their adults are obese. Obesity is associated with cancer, diabetes and cardiovascular disease, which grow more expensive to treat the longer they go undetected.
USI population health consultants review our client’s 3D data to identify what percentage of employees are accessing preventive care. From that, we recommend that employers with a low rate implement incentives that encourage employees to have an annual wellness visit with their primary care physician (PCP). By engaging with their PCPs, employees can discuss their risk for disease and receive counsel on practicing good health habits such as weight management and avoidance of tobacco products. Annual visits with a PCP contribute to reductions in emergency room (ER) utilization.
USI demonstrated this for a client that had received higher-than-average premium increases for two years. This company, which had 725 employees, was spending $8.1 million on its health plan annually, and needed to gain better control of plan costs. USI reviewed the company’s 3D data and identified high catastrophic claims and low compliance with annual preventive care protocols. We met with the company to explain how lack of preventive care protocol compliance leads to costly undiagnosed diseases, and to recommend offering incentives for employees who have an annual physical.
The company agreed to offer a premium contribution differential as an incentive for employees to participate in an annual wellness visit. USI launched a comprehensive communications campaign for the client using multiple forms of media, such as direct mailers and on-demand webinars, that explained the new opportunity for premium savings as well as the importance of preventive care and how to find an in-network PCP.
As a result of the incentive, the client saw a 50% increase in employee preventive care visits, with 69% of employees participating. ER utilization decreased by 15% and hospitalizations declined by 22%. Most importantly, several employees reported early diagnoses of chronic conditions, such as diabetes, that would have translated into catastrophic claims if they had continued undetected and untreated.
USI 3D is also used to identify excessive utilization patterns within an employer’s population. For example, USI 3D identified that an employer was experiencing a spike in ER utilization. We reviewed the data and the plan information, and noted that the higher utilization began after the PCP office visit copay had increased from $25 to $50. The higher copay had led many plan members to avoid office visits when ill — and ultimately led them to seek care from the ER when their illnesses unfortunately worsened.
USI explained that the ER utilization spike was an unintended consequence of the higher PCP copay, and recommended that the employer implement a telemedicine solution with a $0 copay. After the employer implemented the telemedicine solution, ER utilization dropped.
USI underwriters also use 3D claims data to help clients negotiate renewals with carriers. For instance, when a client was facing a trend assumption of 12% for its health plan renewal, the underwriter benchmarked 36 months of the employer’s 3D claims data and discovered that the employer’s trend was lower than the benchmark. The underwriter contacted the carrier with these findings, and was able to negotiate a reduction of the trend to 8% on a multiyear basis, which ultimately lowered the plan’s premiums, saving significant money for the employer.
What's Next for USI 3D?
USI also studies the aggregate data in the USI 3D platform, and recently analyzed 740,000 individuals. Some of the individuals had completed a preventive office visit within the past 12 months, and some had not. When USI looked at the utilization for ER and hospitalizations, we found that the individuals who didn’t have a preventive care visit in the past 12 months had higher ER utilization and hospitalizations compared to those who did have a preventive visit. This study is additional confirmation that preventive care is critical to reducing high catastrophic claims.
USI continues to expand the use of 3D data and is introducing new reporting modules that project and demonstrate the impact Omni solutions can have on clients’ claims.
While carriers and other benefits consultants offer claims data reporting, many do not help employers utilize that data to make decisions that manage rising healthcare costs. USI stands apart from other consultants in our ability to identify the causes of key cost drivers and to recommend proven Omni solutions designed to mitigate them.
To learn more about how you can better manage rising healthcare costs, contact your local USI benefits consultant or email firstname.lastname@example.org.