When it comes to health plan management, the stakes are high – and the risks are even higher. Data is a self-funded gold mine. But employers need to act on the data they have. With so much information to analyze, where – and how – do you start? Nova Healthcare Administrators has identified 4 helpful ways to use data. The third party administrator (TPA) found that, with the right approach to interpreting plan data and understanding population trends, employers can transform data into an effective strategy for health plan success. This success can come in the form of both improved health outcomes for plan participants and reduced health care spend. Check out the full article below to learn more.

For more information or to contact Nova, visit www.novahealthcare.com or call (716) 932-5105.


4 Ways to Transform Plan Data into Healthier Employees & Reduced Health Care Spend

Success in health plan management boils down to managing risk. A key component of risk management is recognizing it, understanding how to categorize it, and ultimately, minimizing it.

Effective plan management begins and ends with data – what matters is what you do with it.
When it comes to consuming health plan data, it’s important to keep asking questions. Why is this happening? What is driving cost? Where are plan participants seeking services? How can we manage it? Answering these questions will help guide a health plan’s trend management strategy.

4 Areas of Risk & Opportunity
In health plan management, risk is part of the game. Turning areas of risk into areas of opportunity is key. Plan risk can be categorized into four key areas of opportunity for managing trend, reducing plan risk and improving health outcomes for plan participants.

1. Emphasize Prevention & Early Detection of Illness
Incorporating biometric screenings as a service to plan participants provides a depth of information to assess the current health status of the population and provide insight into what actions need to be taken to manage future risk. Screening results can empower plan participants to make necessary changes to improve their health. Additionally, a targeted approach can spur plan participants to utilize their preventive care benefits. Through consistent monitoring of plan utilization, it’s possible to identify gaps in utilization for preventive care.

Monitoring claim data is essential to maximize utilization of preventive services. Adding a layer of biometric screening data deepens the data pool as it’s possible to identify unmanaged disease states and costly future claims, and it provides a data set for those without claims utilization. On average, Nova’s clients who offer biometric screenings avoid a cost of $2.03 per dollar spent on these screenings.

It’s also important to consider employee satisfaction with wellness and prevention strategies. With careful messaging, these programs can serve as a strategy for employee loyalty and retention – and that’s essential from an organization-wide risk management approach.

2. Improve Treatment Plan Compliance
A successful approach to improve treatment plan compliance includes targeted outreach campaigns to plan participants with chronic conditions. Additionally, when clinicians work one-on-one with plan participants, they’re able to address patient needs and potential barriers to care. Information sharing with physicians helps improve communication with the provider and patient, addressing behaviors that may result in more costly urgent and/or emergent care. Nova leverages a patient health summary to bring all the data points (medication, labs, utilization, etc.) together, ensuring clinicians have access to a comprehensive view of each patient.

The goal is to ensure plan participants follow through with prescribed treatment plans. Success measures can include evaluating the health status of plan participants year-over-year, medication compliance, gaps in care and plan utilization. With a focus on improving treatment plan compliance, the chart below demonstrates the increase in medication compliance Nova’s clients experienced year-over-year.


3. Manage Appropriateness of Services
To build a strategy designed to manage cost, it’s important to understand the plan’s cost drivers. For some clients, modifying plan design to include a telehealth solution or creating targeted education and notifications can mitigate unnecessary utilization of costlier alternatives. Additionally, a robust precertification list can create visibility into potential future high-cost claims and serve as a forum to trigger outreach to enroll plan participants in case or disease management programs.

The goal is to promote the right care at the right time. Plans should assess performance against a standardized benchmark which is most effectively measured against prior plan performance. A review of utilization metrics will help stratify results by type of savings (contractual, medical necessity, out-of-network service moved in-network) to easily categorize and analyze the effectiveness of the overall benefit strategy. With a strong focus on in-network utilization, Nova’s comprehensive approach to utilization management resulted in an estimated savings of $7.03 for every dollar spent on utilization management.

4. Reduce Cost of Necessary Utilization
Assessing the utilization of in-network providers helps determine whether a plan’s current network solution is appropriate. If not, it may be time to explore alternatives such as narrow/limited networks, established reimbursement schedules, reference or Medicare-based reimbursement, and direct negotiation. Additionally, bill audits can cut costs by uncovering coding or billing errors.

This may be the easiest area to measure success because it translates into hard-dollar savings. The end goal is to better manage the cost of services without sacrificing patient care or resources. For a client using a direct primary care model and reference-based pricing as a wrap, Nova established a strong partnership and data exchange to manage both health and cost outcomes and the patient experience. Current trends for this client demonstrate the value of partnership between a client’s vendor partners.

The key to managing risk? Managing trends. Dig into the data, engage in conversation and implement strategies to meet plan goals and balance plan participant satisfaction. No matter what type of strategy a plan uses for reducing cost, it should be able to drill into solution-specific savings to gauge what’s working best for its unique needs. Implementing strategies to address the four areas of risk can help transform a plan’s data into actionable opportunities to reduce health care spend and improve population health outcomes – with measurable, attainable and consistent results.