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July 21, 2020

Benefits Cost Savings Strategies In 2020: Finding Avoidable ER Claims and Promoting Telemedicine

Artemis Health

The benefits landscape is constantly shifting, and it can be tricky for benefits professionals, brokers, and benefits consultants to find “stable ground.” This is especially true in 2020, which has seen enormous change in the world of HR and Benefits. Due to the novel coronavirus pandemic, HR and Benefits leaders are dealing with new ways of working, new ways to connect with employees, new strategies for employee health and wellness, and new tactics for employee engagement. 

Healthcare data analytics is one key way for benefits professionals to find stable ground and trustworthy recommendations for how to move forward. 2020 will be a key year for exploring benefits cost savings opportunities, and benefits data will be key to making sure these cost saving strategies don’t impact the quality of care and benefits for employees. At Artemis Health, we help self-insured employers and advisors identify and take action on wasted benefits spending. We’re sharing a few tips that can help you find cost savings in your benefits data. 

Tip #1: Track Avoidable ER with Healthcare Analytics 

We know from industry research studies that roughly 30% of healthcare dollars in America are wasted. It’s a shocking statistic that drives employee benefit leaders and their advisors to innovate, find waste, and take action. Do you know which 30% of your benefits spending is wasteful? 

A lot of little things add up to create this inefficiency within employee benefits. For example, maybe you have a fitness program that only your healthiest employees are using, so it’s not helping your high-cost claimants get healthier. Or perhaps you haven’t taken a close look at your network to understand which providers are offering better outcomes for lower costs. One thing we can guarantee from our experience in healthcare and benefits analytics: your members are visiting the emergency room when they should be using other points of care. 

Artemis Health calculates wasted spending on emergency room care using a unique data model, which drives our Actionable Overspending app. 

Charts showing dollars of avoidable emergency room spending.

The Artemis Platform uses some key measures to help benefits professionals track avoidable emergency room spending: 

  • The total cost of avoidable ER visits within the population
  • The percentage of total spending this represents
  • The percentage of OVERSPENDING this represents 
  • The overall trend (is the problem getting better or worse?) 

So how do we know if these ER visits are really wasteful, or if they were necessary for the members? The data model uses a peer-reviewed NYU Wagner study around emergency room utilization. It flags certain codes and conditions treated in the ER and calculates the cost of those claims. If these claims had been treated at the correct point of care (a primary care visit, urgent care, or telemedicine), the employer could save on those costs or use the money for other benefits initiatives. 

You can see for our sample data what types of conditions are driving this ER spending: 

The avoidable emergency room visits by condition and overspending.

Headache and abdominal pain were the top two cost drivers for this sample employee population. While these can be serious conditions, there are alternative points of care for these members that would have been more appropriate for milder symptoms. Additionally, urinary tract infections are driving significant wasted spending in the sample data. Many members would get relief and treatment faster with a telemedicine visit, saving costs for both the plan and the members themselves!

Benefits leaders are using emergency room spending as “low-hanging fruit” for driving cost containment. They are taking a few key actions to reduce this spending: 

  1. Educating members on their options for points of care
  2. Evaluating telemedicine as an alternative
  3. Targeting office locations with communications around ER vs. urgent care 

Avoidable ER spending just one easy way to save costs on employee benefits without sacrificing great benefits for employees. 

Tip #2: Use Benefits Data to Promote Telemedicine Usage 

Telemedicine got a big profile boost in 2020 due to the coronavirus pandemic. Primary care doctors, specialists, and other healthcare professionals went digital, conducting patient visits and prescribing medications over video calls. While this was new for many doctors, telemedicine is a tried-and-true strategy for benefits experts. 

Many employers are embracing the virtues of telemedicine as a means of protecting employees during the pandemic. According to national consulting firm Mercer, employers are taking this opportunity to educate members on their virtual visit options. 

“Responses to a poll on Mercer’s US Health News website suggests that many companies (69% of respondents) have communicated directly with employees about using telemedicine specifically to limit trips to healthcare providers during this pandemic, and another 15% say that they have not communicated this, but the health plan/telemedicine vendor has done so.”

With the rising popularity of telemedicine services like Teladoc, AmWell, MDLive, Doctor On Demand, and others, benefits teams are also tasked with making sure they’re getting the most from their investment. Members also love telemedicine, as it offers a fast, low-cost alternative to them. It’s truly a win-win cost savings strategy for benefits teams. 

The best way to make sure telemedicine is functioning as a cost savings alternative is to track and improve utilization over time. If you’re paying for a program that isn’t getting used, your benefits dollars are going to waste. However, if you’re successfully directing members to a low-cost alternative, you’re containing costs and making it convenient for members to get the care they need. 

Graphs that illustrate data around telemedicine program utilization.

A data partner can help pinpoint areas where telemedicine utilization is low, track demographic trends, and get the information you need to take action. One Artemis Health customer recently ‘relaunched’ their telemedicine program following an analysis that showed low participation. They looked at each office location and planned a series of educational meetings for those locations. They worked with their telemedicine vendor to prepare and mail educational materials to these members. They’re following up by keeping an eye on the same trends to make sure their efforts are successful. 

You can find more tips and helpful ideas for identifying cost savings with benefits data in our recent whitepaper. What other strategies are you using to find benefits cost savings in 2020? 

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