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Foundational Business Diagnostics Literature Review


Employers and employer coalitions have been collecting data and building data warehouses for almost a decade. Unfortunately, little has been documented on the efforts that these organizations have put forth in this endeavor. Although there is little written on the subject, that which is written consistently speaks of the strength that data can bring to the decision-making process. The process that has been used in the collection of data, the building of a functional data warehouse and the translation of the data to usable information is documented in these few articles. The obstacles that employers find when attempting to build a data warehouse seemto be consistent across the articles. Another constant across the organizations found in these articles is that most of these companies begin with medical and pharmacy claims and over time expand their data reach and capabilities.

The use of data within an employer-based coalition has also been documented. The research has shown that the coalitions are collecting the data both with personal health information included and aggregated data lacking personalized information. The research is not as instructive in explaining how these coalitions are utilizing the information andthe outcomes associated with their data warehousing activities.

For purposes of examining the literature according to various topics related to data warehousing, the research is divided into the following categories:

  • employers perceptions of issues related to health care costs and value;

  • data driven decision-making; and

  • employers’ application of data warehousing.

Employers’ Perceptions of Issues Related to Health Care Costs and Value

Business coalitions have been a catalyzing force in bringing more awareness of performance and value issues related to employers’ health care investment. Employer and coalition surveys conducted over the past several years show that coalitions have moved more aggressively in this space and as a result have helped propel many employers into collective data warehousing projects. These projects are leading to more detailed assessments of value/quality that include performance metrics of providers and productivity metrics of employees. In addition, the evaluations have examined not only the direct costs attributable to employee/dependent health care, but also the indirect costs, which may be harder to calculate.

For more information, see references (1), (2), (3).

Data Driven Decision-making

Although more and more employers are assessing data to drive their health care decisions, the majority of employers are still making decisions based on immediate bottom-line concerns. The high prevalence of chronic diseases such as diabetes coupled with employers’ lack of understanding on how best to assess value is a costly combination for employers and their employees. The research shows that data-driven decision-making can be a long-term strategy to increasing value and performance, changing individuals’ behaviors, and curbing costs. However, it is essential to understand and overcome barriers with certain data sets—such as performance data.

For more information, see references (4), (5), (6), (7).

Employers’ Application of Data Warehousing

Employers of all sizes—including state and municipal governments and business coalitions share their experiences with value-based approaches, starting with their data warehousing efforts. The research reveals that over the past two decades, there has been a lot of trial and error. Yet, the endeavors have led to more sound, data driven decision-making that has enhanced the health of individuals and helped employers better predict the cost-drivers related to their health care investment and devise effective strategies to combat to address those problems.

For more information, see references (8), (9), (10), (11), (12), (13), (14), (15), (16).

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