Situation

A pharmaceutical company with 3,500 employees was spending over $22 M on their healthcare spend, with their biggest issue being the lack of clear insights into their healthcare risks and cost drivers. This employer has a mainly young population and had assumed that they were healthy in general, but wanted to know of any issues or hidden factors that might impact the productivity and well-being of their employees.

Appproach

The preliminary step in all such analysis is to load the client’s data onto our z5 Risk Management Platform. Immediately upon doing so, we discovered that while average age of the group was “young”, the number of individuals who were a higher than normal risk was relatively high for this group. Actually we observed 20% higher than average risk for members aged 30- 40 years old.  Moreover, while overall the health was good, and the most expensive members were consuming lower than typical costs, the mid-risk range population was driving higher than typical cost for this population. In fact, this year’s highest risk members were in the lower half in previous years.

Our clinical analysis supported these indicators, with fundamental shortcomings in care gaps.  We observed almost 45% non-compliance in areas such as fundamental preventative screenings including cervical cancer and PSA testing. This group of Emerging High Risk members created an opportunity for identifying those ~1,400 members, and targeting them with pro-active programs to mitigate their risk factors.

Other factors easily surfaced in the platform were certain high-costs related to an unusual number of high-risk deliveries, as well as much higher-than-typical ER utilization, presumably by a population with no time (or patience) to visit a PCP.

Outcome

While the employer’s perception was that the population was healthy as a whole, using our platform, emerging risks that had the potential to spiral out of control without any intervention were uncovered, and we were able to make specific recommendations for mitigation:

  1. We targeted four areas for a focused program around reducing gaps-in-care for members with the three most significant chronic conditions, as well as general and preventative wellness measures:
    1. Asthma: improve use of medications
    2. Hyperlipidemia: drive compliance with annual lipid screenings and medication adherence
    3. General wellness: improve age-appropriate medical screenings as well as routine and preventive office visits
  2. This group had strong indication for prenatal therapy and pregnancy management. Utilization of these programs has been noteworthy.
  3. Telemedicine alternative were recommended.  We modeled almost 10% ER cost savings based on a modest channel redistribution.
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