Uncovering the Unique Needs of a Specialized Population

Every large employer and organization in the U.S. will find their population has unique healthcare challenges and needs. For example, industrial/manufacturing workers will likely incur more costs for musculoskeletal conditions, while those in an office setting might face conditions associated with sedentary work. But what about the member population of a large, diverse, and unique specialized population? In this case study, Artemis Health has teamed up with a client to explore their data and dive deep on the benefits challenges of a specialized population.

This population has unique places for providing and receiving healthcare. These members come from a wide set of socioeconomic backgrounds, age groups, regions, and ethnicities. They have different levels of experience with the healthcare systems. This client focuses on providing comprehensive coverage and education to help their population get the care they need.

The client’s members are unique in a few ways:

01   They’re largely digital natives. Many prefer to use technology to access healthcare and advice through programs like telemedicine.

02   The top conditions for this population are different from what we see with other self-insured plans.

03   They access healthcare largely through location-based health centers or the emergency room.

The analyses.

Artemis and the client are tackling three main challenges with data: behavioral health, avoidable ER spending, and predicting future costs.

Behavioral Health

Artemis tracked key behavioral health metrics to determine how to best serve the needs of the client’s college population. We looked at the number of mem- bers with claims, per 1k claims, Per Member Per Month paid amount, and total Employer Paid Amount. Here’s what we found:

Across the board, claims for behavioral health conditions are rising. This wasn’t necessarily alarming to the client’s benefits leaders. It can be explained by population demographics and a reduced stigma around seeking care. The benefits team is using this information to improve access to behavioral health resources and member education.

Avoidable ER

The data also showed that members were driving $17 million in ER visits each year. When we looked more closely at the diagnoses from these visits, we identified three easy opportunities that would save costs for both the plan and the members.

The client has developed a communications plan to help members access their 24/7 Nurse Line, visit with a doctor via telemedicine, and seek other points of care at a lower cost to them.

Predicting Future Costs

Finally, Artemis and the client’s benefits team analyzed risk scores using John’s Hopkins ACG risk scoring examining resource utilization banding. The Artemis Platform enables the client to compare month-over-month and from location to location.

This population’s risk scores are lower than average due to the age and demo- graphic make-up of the members. However, this analysis is valuable as a tool for predicting future costs. They’re using this data in three ways:

• Potential to lead to better case management
• Better disease management
• High-risk case identification

The results.

While this population is facing unique healthcare challenges and utilizing their benefits differently, access to actionable data is helping the benefits team in a familiar way. Just like any healthcare payer, this client is finding gaps in care, identifying opportunities for cost savings, and predicting the future patterns that will help them improve care for future members.