Group insurers are considering data more intelligently to develop products, services and plan designs that are optimal for plan sponsors, but also engage members by using their own personal health and transactional data to involve them in their own well-being.
Speaking at Benefits Canada’s 2019 Halifax Benefits Summit on Sept. 24, Chris Goguen, manager of pharmacy benefits strategy and partnership at Medavie Blue Cross, said health plan analytics collect, aggregate and integrate claims data in a way that generates actionable insights around plan design, health management products and engaging members.
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“But also, to drive prioritization in the process, including risk stratification [and] starting to identify if there are patient groups or cohorts of members that have certain claiming patterns driving particularly challenging health outcomes or costs in the plan.”
It’s not just about considering data, he said, it’s about generating these actionable insights into how to design, measure, manage and monitor health and drug plans against four key strategic objectives. These are: helping plan members helps optimize the use of health plans; using data more intelligently improves the population health of plan members at the aggregate and individual level; if data can’t be measured, monitored and targeted, plan sponsors can’t manage costs; and, in the information age, considering how to use claims patterns and health plan information more intelligently to engage members.
The practical applications, according to Goguen, include automated prior authorization, co-pay adjustments and using claims history to trigger notices for either message or treatment controls. Using the example of the PCSK9 class of drugs, he noted it’s important for plan members to first try traditional first-line therapies. So an automated prior authorization algorithm would “look for patients’ statins history and their drug experience, and calculate the extent to which they’d adhere to statins in the prior six-month period. And when that factor was detected on the system, it facilitated the auto-prior authorization of that drug.”
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It’s also important for analytics to take an integrated view of health plan claims and expenditures, said Goguen. “For example, if you look at diabetes — diabetes costs in this weighted comparative analysis includes not only drugs but testing supplies — [it] puts context into which diseases, more broadly, are driving costs in my plan and how those costs in my plan compare to other comparatives.”
In terms of mental health, Medavie Blue Cross has done a lot of analytics and mapping to understand the profile of depression in organizations, said Goguen. A deeper dive into claims and treatment patterns point to a number of opportunities for plan sponsors to expand the types of services available to their members.
“Optimize their drug use, including cognitive behavioural therapy delivered through digital means. Earlier intervention — providing access to qualified mental-health services. And even considering pharmacogenetic testing — we’re seeing lots of switching in patients in trying different drugs. Providing access to testing to help patients get to the right drug more quickly, it would be a design strategy to consider.”
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A better integration of data analytics can translate into real insights about how plan members progress through their treatment journey with certain conditions, said Goguen, noting it’s now an essential strategy to actually design, target and focus interventions to ensure plan sponsors understand which patient factors are driving cost and value in the plan.
“To develop programs, plan designs [must] target those issues and measure the outcomes more holistically going forward. The whole question about targeting individual members using their plan data — there seems to be increasing receptivity. According to the [Sanofi Canada health-care survey], two-thirds of plan members would be open to receiving targeted communications based upon their plan claiming behaviours.
“There’s a number of considerations in terms of privacy and other factors,” he added. “But over the course of the coming years, there’s going to be significant opportunities to leverage technology to bring this all together and to improve health outcomes for members and sustainable cost for the plan by using data more intelligently.”
Read more stories from the 2019 Halifax Benefits Summit.