Unlike traditional health plans, self-funding offers employers access to benefits data (generic data that in no way identifies covered individuals or employees). Caroline Fraker of MedBen explains how her company has been able to help clients use this data to identify major trends and savings opportunities. Fraker shares how analyzing de-identified plan data can help employers understand health risks and care gaps within their workforce population and ways these findings can be used to create targeted wellness programs. See how this proactive analysis has led to programs that have averaged 16% lower cost-per-insured for a number of chronic conditions. Learn more about Fraker’s thoughts on self-funding success in the article below.

For more information or to contact MedBen, visit www.medben.com or call (740) 522-8425.


How Using Benefits Data Led to 16% Lower Health Coverage Costs

All employers should have access to their plan’s own de-identified, generic trends and benefits usage data.  De-identified data (data which in no way identifies covered individuals or employees) is invaluable to understanding a health plan’s true costs. Unfortunately, if  your business has purchased health coverage from a national health insurance carrier, you probably know how hard it is to get access to your own benefits data.  Want that data to analyze metrics or forecast wellness trends? You’re out of luck.

One huge benefit to self-funding with an independent third party administrator (TPA) is access to generic trends and benefits usage data.  Independent TPAs have innovative reporting services and data analytics tools which provide self-funded employers with insight into critical financial and clinical risks, allowing them to make financially sound plan and coverage decisions.  And, these reporting tools can benchmark your data against a much larger data pool – all in a privacy-protected environment.

More and more, health insurance carriers are referencing the HIPAA privacy rules as a reason to keep from sharing with an employer the employer’s own costs and benefits data.  Independent TPAs understand and strictly comply with federal and state privacy rules to protect all member health and demographic data.  But highly sophisticated systems mean that independent TPAs can also extract de-identified benefits data without compromising that protection and offer employers and plans additional services that improve the lives of employees.

Knowing and understanding your specific plan’s data allows an employer to tailor wellness programs to the needs of its particular workforce.  Independent TPAs also have tools that can help identify health care trends and gaps.  By using those metrics, employers can create specialized wellness programs designed to reduce the risk of conditions affecting their employees.  They can target actual conditions and spend their wellness program money more efficiently with better results without the employer ever knowing specific employee health issues.  This attention to detail, while still protecting member privacy, is one of the many qualities that set independent TPAs apart from the national health insurance carriers’ self-funding options.

By providing this targeted analysis, MedBen’s worksite wellness programs have averaged 16% lower cost-per-insured over the last three years for the five most common chronic conditions.  As one client put it, “It’s all geared to educate people that their health and lifestyle choices impact claims cost, and consequently, the cost of their health coverage.”

Independent TPAs not only provide an employer with greater access to plan data, but they are experts in analyzing and interpreting that data.  This means that an employer gets both the reports and the expertise and assistance in applying that information to their specific plan in a way meaningful to each employer – all while absolutely protecting their employees’ private health information.