Situation

We presented our latest findings to our gloves manufacturing company who was interested in learning more about cost savings and see if their healthcare costs were in line with industry benchmarks. Our goal was to present the data in such a manner that would be of use to the client. Member engagement was also a top priority for this client.

Approach / Outcome

We ran this client’s data on z5 and were able to pinpoint the following findings that came out of the data:

  • ER visit was found to be two times higher than the benchmark (169/1000). This client’s population’s visit to the ER was 422/1000 in 2016 and this number is projected to increase by 200% in 2017. The main reason why this number is so high is because the nearest healthcare facility is a minimum of 30 miles away. Hence, it was easier to visit the ER.

er-utilization

We proposed an alternative that could work for these high unchecked ER visits – Telemedicine. An access to a doctor over the phone would help reduce ER visits.

  • We also discussed the population risk with the client. We found out the exact percentage of the population that are at high risk. We were also able to identify members that were at a medium risk and were in danger of moving to the high-risk category. According to the chart below, 39% of the members are at medium risk and 11% are at high risk in September. A point to not here is that members the medium risk members have increased since May, 2016. Basically, 50% of the population is high and medium risk, compared to typically 25% in other groups we have observed.

pop-risk

We proposed that the client should communicate the findings with the employees so that the member engagement process can be made easier. We also proposed working with third party solution providers or our partners that would help in member enrollment.

  • Another observation that we made with the existing data is that the pharmacy costs of this client have shot up significantly and are predicted to be even higher in the next 12 months.

pharmacy

We were able to recommend that at least 57% of this Rx spend could be reduced if the members switched to the mail order option.

  • Under chronic conditions, we found significant gaps in care across conditions such as diabetes and hypertension.

diabetes

We proposed finalizing and deploying diabetes and hypertension management programs across the population. We suggested targeting and on-boarding as many of the 235 members with diabetes and/or hypertension. It would be important to review incentives at this stage to modify behavior across key cost drivers and risks.

In the end, the goal with this client was to develop a communication plan that would have to be shared with employees (division or individual level via mobile text) to promote alternatives and incentives: mail order Rx, preventative care, diabetes program and finally alternatives to ER.

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