Using data to support more informed - and satisfied - employees
The charges on the right side of the graph clearly fall outside of the normal distribution of charges. Research into these charges may show that there were extraordinary circumstances involved with the provision of these services; however it might highlight a single practice that is consistently overbilling for the procedure. Companies can harness the power of data by comparing their plan’s experience to the overall market area to save costs and ensure the smooth operation of their benefits programs.
Data analyses provide great tools to ensure that self-insured plans meet the needs of both employers and employees. But a good plan is just the beginning. Self-insured employers need to invest in employee education to keep satisfaction high and costs low. To help employees make smart choices (and avoid surprises), employers need to provide clear plan information and decision support tools. With issues such as in-network and out-of-network fee schedules, as well as varying reimbursement rates, there is great potential for employees to incur unexpected out-of-pocket costs, which can lead to dissatisfaction, reduced productivity and compromised health outcomes. Data can help in this regard as well. Many companies are incorporating out-of-network cost estimation and transparency tools into member portals to help their employees make informed decisions when choosing providers. As more employers decide to selfinsure, they need clear, accurate data to manage risk and make smart choices. Data gives employers a window into utilization and billing patterns that can be a guide for plan and network design. Equally important, data helps employers develop smart communication and disease management programs, and ultimately achieve better, more affordable health outcomes. n Robin Gelburd is President of FAIR Health, Inc., a national independent, not-for-profit corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and research tools, all powered by the nation’s largest collection of medical and dental claims data.
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September 2013
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The Self-Insurer
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