By Becky Niehus, MedeAnalytics
This time of year employers are often making benefit design decisions for the year that follows. While many healthcare payers and plan sponsors have seen lower than anticipated costs in the first half of 2020 as consumers delay preventive and elective care, most models anticipate those costs increasing through the second half of 2020 and into 2021. These new models are designed to predict nationwide healthcare spending in the wake of the coronavirus pandemic and are not specific to the employer-sponsored insurance market.
Uncertainty over future outbreaks of COVID-19 may overshadow typical planning processes, but support using a data analytics tool can help.
In a typical year, an employer generally considers industry benchmarks as well as their population and utilization patterns to guide changes in plan design. This year, they have all the usual competing demands of employee morale and financial pressures, but also the unique challenge of uncertainty in both workforce and healthcare demand. Health plans have access to early indicators through claims and enrollment data to support what can be a potentially difficult decision-making process.
Target the right employee population. Workforce changes due to the pandemic may have resulted in changing employee demographics. Data can easily identify any changes in the underlying age, gender, or risk profile of the insured population. Any benefit modifications, including ancillary benefits, should be done with the utilization patterns of the employed population in mind.
Understand trends in preventive care and routine care for chronic conditions. Patients who delay routine care may find they need much more costly care in the future. Work with employer groups to expand outreach to high-risk patients who are delaying care to explain how care can be safely received. This can help mitigate potential new high-cost patients in 2021 and beyond.
Identify trends that employers would like to see persist. If employers see a decrease in non-emergent emergency department utilization or an increase in telemedicine, work with the health plan to craft an open enrolment message that encourages a continuation of these trends.
Compare elective surgery utilization to historical patterns. Are there particular areas that have seen more of a downturn? As a payer or plan sponsor budgets for the future, an elective coronary artery bypass graft (CABG), for example, likely cannot be put off as long as a knee replacement. There also may be an opportunity to discuss with members the differences between elective procedures of low value, such as spinal fusions, and to encourage instead higher-value care, such as physical therapy.
About The Author
Becky Niehus is a director of Product Consulting at MedeAnalytics.