How benefits leaders can make smarter healthcare investments
Employers have a tremendous responsibility when developing a benefits strategy that will drive the best healthcare outcomes for their people. In an increasingly saturated marketplace, benefits teams are inundated with countless potential healthcare vendor solutions to choose from, but lack the resources to cut through the noise and confidently select the vendors that drive the best outcomes for their workforce's unique needs at the lowest costs.
Here's the challenge: No two employers’ populations are exactly alike. And no two clinical solutions are exactly alike. Populations evolve and their clinical composition changes - it is a dynamic environment that requires highly analytical skills to fully understand how to maximize healthcare investments. Even if employers and their consultants are able to work with a potential vendor to forecast their financial return on investment (ROI), this work tends to be time-consuming, manual, and specific to that single vendor's model. What's missing is the ability to get that financial analysis in a scalable way across all potential vendors.
Leveraging Savings Opportunity Forecast
This is where Accorded comes in to help. Think of Accorded’s Savings Opportunity Forecast as a crystal ball of sorts, but one that forecasts a clinical solution’s cost of care impact through actuarially-rigorous analysis. Using a standardized, actuarial framework, a Savings Opportunity Forecast enables employers to easily identify each solution’s projected cost of care impact on their own population. With a Savings Opportunity Forecast, employers can evaluate dozens of solutions and compare cost of care impact all with a standardized benchmark.
For example, there are multiple musculoskeletal digital health solutions that enable virtual physical therapy, many more to optimize treatment for diabetes and hypertension, and not to mention the myriad of mental health solutions that bring value in different ways.
With Savings Opportunity Forecast, employers have a systematic, data-driven way to evaluate all of these point solutions and its different clinical models. Employers will have a clear picture of a solution’s financial ROI, i.e, the total cost of care savings relative to the cost of the solution itself, and have the ability to compare options using a scalable and standardized process.
Crunching the numbers
A Savings Opportunity Forecast translates the clinical value of a solution into dollars-and-cents. We do this by:
- Codifying a vendor’s clinical parameters for a population
Using claims data, identify target patients by age, gender, or geography and further refine these groups by clinical conditions and/or comorbidities.
- Calculating the average annual healthcare costs and the cost differential
Costs for members with vs without condition that the solution is targeting based on your claims data and census. What is the difference in costs between the two groups?
- Estimate how many members will utilize the service
Use historical data or scenario modeling for the most accurate results.
The result is the projected savings per patient. This is an incremental cost reduction per patient based on factors such as the clinical experience of the provider, early research or white papers, and additional modeling.
Census-adjusted Opportunity Forecast
Improving member experience on all fronts
Enhancing member experience is a critical component of benefits strategies for most employers. In addition to member experience, a good vendor reduces overall costs, not just on the employer’s bottom line but also the member's, because everyone pays for rising healthcare costs through their premium contributions. As a result, a value-based benefits strategy becomes a part of a larger initiative to meet and exceed employee expectations. The right point solutions, when carefully and deliberately chosen, will resonate with members' needs and priorities, ultimately improving outcomes and lowering costs while simultaneously increasing member acquisition, engagement, and retention. However, solutions that are effective for one employer may not be effective for another. That is why an actuarial-backed approach is essential.
As employers continue to evaluate and implement solutions to maximize their healthcare investments, they’ll need a robust, scalable strategy to project and measure financial ROI. An actuarial-based process ensures that while patient populations and solutions fluctuate, value doesn’t. What might work for one population at one time may not be as effective in a year or two. It’s about keeping members happy, healthy, and engaged.
Looking ahead to 2023 and beyond, the healthcare industry will continue to evolve and innovate in tandem with a greater emphasis on cost reduction and value-based care. If there’s any silver lining to the COVID-19 pandemic, it’s this: Patients are more open to digital health and novel care models than ever before. Employers can leverage this momentum to transform healthcare delivery—but only if they invest wisely in solutions and programs that will actually make a difference.