Next Gen Behavioral Analytics: The How, The What, The Challenges
Employers of all kinds, particularly those who have a high percentage of employees with chronic conditions, often struggle to determine which health benefits will support their efforts to maintain a healthy workforce. Often, employers turn to their benefits brokers to guide them in the right direction. Brokers today leverage advanced analytics that use robust data sets in order to confidently provide data-driven consulting to their employer clients.
All employers seek to have a 360-degree view of their employees and dependents (members) in order to fully understand the current and potential clinical and financial risk their employees hold. This view is impossible when only using clinical or financial data. By incorporating behavioral data or social determinants of health, a clearer view of who the member is, what drives or motivates them and the best methods to interact and engage them are brought to light.
How to Use Behavioral Analytics
With such analytics in place, brokers can work with employers to:
- Develop advanced risk scores for each covered member (employees and their families). Go beyond traditional risk analysis by incorporating impactability into the view. Impactability is the likelihood that the member will achieve a positive outcome by closing a care gap. One can glean not only who is at highest risk, but who is most impactable.
- Stratify members into meaningful cohorts. There are many ways to look at members and stratify them into cohorts for care and wellness programs or outreach. Looking at various factors such as risk, impactability, conditions, open care gaps, etc. care program managers can better understand where and how to best focus resources.
- Understand how to communicate with members. The use of personas and risk scores can provide guidance on how to approach members and encourage them to make changes. For example, when data indicates that a heart disease care management program is needed, care managers can match the persona to specific, de-identified member profiles that include income, education, and other social determinants, and use that information to design an achievable plan of care.
- Measure progress and outcomes. Comprehensive program outcomes and ROI can be generated and used to detail the progress of implemented programs and the overall impact they are having.
What to Accomplish with Next-Gen Behavioral Analytics
When advanced analytics are leveraged in these ways, brokers can then work with employers to:
- Show which of an employer’s plans are delivering the best value for each condition
- Predict which chronic conditions are on the rise among the employee population, and within that population who is emerging to be high risk, as well as the risk of potential high-cost events down the road, such as surgeries or emergency department interventions
- Steer employees to health plans that will deliver the best outcomes for employees and their families at the lowest cost to all
- Encourage employees and/or their family members to make behavioral changes, such as using incentives for specific services by condition that help them avoid expensive, life-and-productivity-interrupting events
Challenges Associated with Behavioral Analytics
To truly take advantage of behavioral analytics, however, brokers need to work with employers to overcome challenges such as:
- The need to integrate information from multiple sources. Data required for in-depth analytics is fragmented across multiple data stores, including claims systems, electronic health records (EHRs), population health management (PHM), finance, and other siloed-system and ZIP Code data.
- The need to see the total picture. The development of a comprehensive picture requires bringing in de-identified data from health plans and other sources to create personas that represent different employee types. These personas deliver additional insights into who the employees are, using data such as income and education levels, where they live (ZIP+4), family situation, ethnicity, co-morbid conditions, lifestyle choices and other factors. With this information, it is possible to better understand the overall employee population, as well as the most appropriate use of health care services.
When brokers help employers overcome these challenges, they really become a trusted advisor and partner. They also move the focus of the conversation away from only focusing on premiums to attracting and maintaining a healthy, productive workforce. This blog is based on Chronic Problems, Next-Gen Solutions, an article that was recently published in BenefitsPRO Magazine.
This article was originally published on SCIO Health Analytics and is republished here with permission.