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May 19, 2020

How to Start Thinking About Benefits Cost Savings in the COVID-19 Era

Artemis Health

The hardest part of any task is getting started. Ask any writer, and they’ll tell you that they spend a large chunk of their time staring at a blank screen. This is especially true in stressful times like these. COVID-19 has made it harder to concentrate, focus, and think innovatively. 

You’re likely facing this dilemma with employee benefits. Many benefits professionals are now tasked with finding ways to cut costs on healthcare and other wellness benefits, especially as organizations plan layoffs or otherwise trim their budgets due to coronavirus. You might be overwhelmed on how to approach expenses without eliminating programs that employees rely on. Or maybe you don’t know how to tackle your budget because it’s daunting. We think you need a little help from data. 

Employee benefits data and healthcare analytics tools can assist benefits professionals, whether they’re HR teams or consultants, with knowing where to start. Here’s what we suggest. 

Identify Key Metrics 

Choosing the right metrics and ensuring the data is timely is a crucial step to finding useful conclusions. Learning what to measure can be crucial, and it's very important to ensure you have access to all the data you need. Start by gathering data from these sources:

  • Medical claims
  • Prescription drug claims
  • Wellness programs
  • Biometrics data
  • Eligibility data
  • Care management program data

Artemis helped one customer find savings by looking at their out-of-network spending. When your members use out-of-network providers, your costs, and theirs, rise. And these costs are often preventable. After our client found out that their employees were using an out-of-network dialysis treatment center, it helped them focus both on network steerage and ensure their network is meeting members’ needs.

You can learn more about network steerage strategies here. 

Pick the Low-Hanging Fruit

Sometimes, the most straightforward solution might be under your nose. You know that your members are visiting the emergency room for injuries and illnesses that can be treated at an urgent care center, onsite clinic or primary care office. On average, the rate for a regular office visit (and some urgent centers bill as office visits) totals $150. If your member decided to visit the emergency room instead, the same outcome could cost $1500. Working with your benefits provider to offer better messaging around avoidable ER visits can result in big savings without impacting the quality of care.

Artemis offers a unique data model (we call it Actionable Overspending) built into our healthcare analytics platform that calculates the potential savings in a few key areas. The Avoidable ER Story is a great example of how the right healthcare analytics tool can provide you with that low-hanging fruit. 

Charts from Artemis Platform showing Avoidable ER costs and trends

In this sample data, you can see that we’ve calculated over $5 million in ER visits that could have been treated at a more appropriate point of care. Diving deeper, Artemis shows users which conditions these claims were for, how this overspending is trending year over year, the location of hotspots where members are using the ER, and even how a telemedicine solution might impact this spending. 

Access to holistic data is really the key to calculating overspending and finding benefits cost savings. Employee benefits leaders need to see a 30,000-foot view of how members are behaving and why in order to take action that can lead to cost savings.

Engage A Healthcare Analytics Expert

Sometimes you need an expert. Whether it’s a consultant or data partner, these benefits pros can find savings in unexpected places. Working with a pharmacy expert can help you better engage with your Pharmacy Benefits Manager (PBM) and assist you with asking tough questions. PBMs can be intimidating, and they’re not necessarily incentivized to pass savings (like drug manufacturer rebates or discounts) to your organization. But knowing what to look for and what to ask can create an opportunity for your PBM to minimize your Rx spending. Aim to have your PBM adjust your formulary—a list of approved drugs in your prescription plan—to eliminate costly medicines or replace them with less expensive generic alternatives that are just as effective for your employees.

Here’s a good example. One of Artemis’ clients was concerned about their spending on the common Type II Diabetes drug Fortamet. They were spending approximately $1500 per claim on this drug, but a generic alternative offered significant savings. They worked closely with their PBM to change their formulary to allow the generic metformin instead, which still gave members the exact same medication they needed. This small switch resulted in a cost of just $0.10 per claim without impacting member care! 

Chart from Artemis showing side-by-side costs for Fortamet vs. metformin drugs

While many organizations are working through how to help members return to work, how to prioritize the safety of employees, and how to move forward post COVID-19, we know cutting benefits costs is one big question mark. We believe access to holistic, actionable benefits data and easy-to-use tools is essential for employers and their advisors. We hope this tips give you an idea of where to start. If you’d like to learn more about how Artemis can help, check out our COVID-19 Resource Center

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