3 Areas Where Data Can Positively Impact Population Health
AUGUST 2, 2022
As population health management (PHM) evolves into a more holistic approach, the number of services and solutions has also expanded, each one promising something different and new. While PHM solutions can have a meaningful impact on the overall health of plan members, investing in the latest innovation or app, without understanding what’s driving health plan costs, can be an additional expense with little long-term benefit.
When evaluating different PHM solutions and services, it’s important to understand what the utilization data says about the health plan’s population. Once top cost-drivers have been identified, employers can make informed decisions about the solutions that will have the greatest impact on improving a member’s health and the organization’s bottom line. Following are three areas that USI Insurance Services has identified where data analytics can have the most impact.
The pandemic underscored the growing need for behavioral healthcare services, but also exposed the lack of access to care. Twenty percent of U.S. adults experienced mental illness in 2020, including depression and anxiety, yet less than half of those individuals received treatment.
It’s vital to address behavioral health needs, as they are often connected to other serious health issues. For example, people with depression have a 40% greater risk of developing cardiovascular and metabolic diseases such as diabetes than the general population, which may contribute to the severity of claims.1
Like most health conditions, early intervention with behavioral health can reduce the likelihood of complications and associated costs. Many vendors and apps exist in this space; understanding which solution(s) to implement will depend on health plan utilization data and employee needs.
Diabetes is the one of the most expensive chronic conditions in the U.S., with $237 billion spent each year on direct medical costs and $90 billion on reduced productivity related to diabetes care. Poor adherence to medical treatment severely compromises patient outcomes and cost while contributing to patient mortality.
For a person with diabetes, it is estimated that 48% to 64% of their lifetime medical costs are related to complications such as heart disease and stroke.2 Other serious complications may include chronic kidney disease and end-stage renal disease, which typically requires dialysis or even a kidney transplant.
USI takes a multifaceted approach to identifying options to improve diabetes care. Diabetes management is contingent on patient compliance with multiple treatment requirements (e.g., nutrition, medicine and exercise). Rather than relying solely on vendors to manage patients, USI begins by evaluating the group’s plan design to make sure members have access to the required testing protocols. Another way USI helps individuals who have diabetes is to evaluate options to medically manage glucose. We continually evaluate technological and pharmaceutical advancements, so practitioners can provide patients with the appropriate resources to manage their condition. USI also reviews obesity-related claims and recommends often overlooked lifestyle programs and resources, which can further improve health status and slow disease progression.
Cancer care in the U.S. cost $150.8 billion in 2018. In 2020, the U.S. was expected to see over 1.8 million new cancer diagnoses and 600,000 cancer-related deaths.3 Costs are likely to increase as the population ages and new, more expensive treatments become the standard of care. Delayed primary care and cancer screenings due to the COVID-19 pandemic are expected to contribute to 10,000 additional deaths from certain cancers over the next 10 years.4
General preventative care is foundational to the early detection and prevention of certain cancers. Early intervention not only reduces the overall cost of care but significantly increases the survival rate. Breast cancer detected by Stage 1, for example, has a survival rate of over 90%, while Stage 4 has a 22% survival rate and nearly double the cost of care.5,6
When evaluating what programs may be a good fit, USI has determined not all cancer management solutions provide the same service. We focus on closing gaps in care for recommended screenings, and linking members to existing care management solutions. Depending on the prevalence and severity of cancer cases, USI may recommend reviewing a cancer care resource that can manage complex cases and potentially improve outcomes.
How USI Can Help
USI uses our proprietary 3D data analytics tool to help clients identify cost drivers and opportunities in their claims data, so they can make informed decisions on solutions that improve health outcomes and reduce costs. We help you identify:
What’s driving your employee population’s risk
What’s trending in in-patient costs and utilization
Which procedures are highest-cost, highest-volume
Where there are inefficiencies, improper plan utilization and/or gaps in care
How chronic disease impacts overall medical spending
We can then recommend various solutions, such as leveraging carrier resources, adding a third-party service or solution, and in some cases, making plan design changes that encourage and increase health plan utilization, prevention, and early intervention.
Determine what’s driving your health plan costs, and which solutions can have the most impact. Contact your local USI benefits consultant or email firstname.lastname@example.org to learn more.