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Foundational Business Diagnostics Case Studies

PLEASE NOTE THAT THIS REFERENCE DATABASE IS OUTDATED AND DOES NOT REFLECT INFORMATION GATHERED ON VALUE BASED PURCHASING IN 2015.

Companies’ senior management teams understand that health care benefits are a strategic tool to recruit and retain valuable employees. On the other hand, health benefits are costly and need to be controlled in order for the business to survive and thrive. In order to successfully balance these pressures, one must truly understand the costs and the value that these bring to the business.

An employer survey published in the Journal of the American College of Occupational and Environmental Medicine found that:

  • 40% of employers had data sources that allowed for specific queries;
  • 40% had little or no health care data integrated with productivity data;
  • 11% had no detailed data on productivity at all;
  • 3.5% had no data on costs.[1]

There seems to be a misconception that only large self-insured companies have been able to successfully utilize health care data. This is not the case, although it is sometimes easier for these organizations to get their data from health care vendors. Self-insured employers, regardless of their size, have less of a struggle to collect their data, as they are responsible for payment and therefore “own” it. It is not as easy for a fully insured employer to get their data because they are not the direct payer. Those employers that are both small and fully insured will have the most difficult time obtaining health care data from their vendors. Often, data they receive will either be aggregated or de-identified. The trend is for all organizations – big or small, self-insured or fully insured – to move towards greater use of whatever data they are able to collect.

Data can have a significant impact on an organization and the health care decisions that it makes. One Fortune 100 Company found that by integrating pharmacy, medical and disability data, they were able to fully comprehend the effect of diabetes on their employees. By analyzing the utilization and costs associated with treatment for diabetes as well as the productivity losses due to the condition, the company was able to implement a plan that improved both direct and indirect costs resulting from one of the most prevalent conditions found in their corporate population.[2] Another organization was able to identify and reduce inappropriate costs associated with their mental health benefit. This reduction lowered the company’s inpatient mental health costs from a baseline of $1,000,000 to less than $400,000 in just four years.[3] This reduction could not have been achieved without the use of integrated data. The following case studies can illustrate an organization’s decision to utilize data as well how the data has been employed to address issues of cost and quality.

A correlation has been shown between activities associated with value based purchasing and the use of health care data, types of data collected and utilized, the greater use of benchmarking data with other organizations, the greater types of outcomes collected.[4]

Employers Partnering with Coalitions

There are times employers may choose to partner with coalitions. This partnership may be due to lack of resources or for additional analysis that can occur through the pooling of health data. Several of the case studies presented in this chapter are examples of data warehousing initiated by employer coalitions. The case studies are:


[1] American College of Occupational and Environmental Medicine. How Companies Consider Value in Health Policy and Design: Results of the Survey of Employer Decision-Making for Health and Productivity. 2004. http://www.acoem.org/uploadedFiles/Career_Development/Tools_for_
Occ_Health_Professional/Health_and_Productivity/AventisReport.pdf

[2] Ramsey S, Summers K, Leong S, Birnbaum H, Kemner J, and Greenberg P. Productivity and Medical Costs of Diabetes in a Large Employer Population. Diabetes Care. January 2002;25(1):23. http://care.diabetesjournals.org/content/25/1/23.abstract.

[3] Burgess AG. Managing Workplace Depression. Behavioral Health Management. May 1, 1999. http://www.allbusiness.com/health-care-social-assistance/277179-1.html.

[4] American College of Occupational and Environmental Medicine. How Companies Consider Value in Health Policy and Design: Results of the Survey of Employer Decision-Making for Health and Productivity. 2004. http://www.acoem.org/uploadedFiles/Career_Development/Tools_for_
Occ_Health_Professional/Health_and_Productivity/AventisReport.pdf

 


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 National Business Coalition on Health.
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