TPA using medical data to address gaps in employee care and shift corporate culture
By Darren Reynolds, President, Consociate Health
Today’s healthcare landscape is increasingly complex. For years, healthcare costs have been rising exponentially and for many employers the investment in healthcare has become unsustainable. Companies across sectors of the healthcare industry have been working on ways to shift the paradigm. While there have been a number of successful efforts, as an industry, we have barely scratched the surface in making wide-scale impact.
Third Party Administrators (TPA) by nature are not clinical. But we have access to a mountain of data that, if used in the right way, can create solutions to the soaring costs of healthcare for employers. Historically TPA’s process data, handle claims and analyze costs, but don’t take the time to really look at what those numbers mean and how they can be used to make meaningful change.
That’s where we saw the biggest gap and made a decision early on to be a proactive part of the solution. We are taking Population Health Management (PHM) to the next level by breaking down the data and focusing on one employee at a time to improve the health of the overall company population. We use data to extract each one of their stories to determine how we can help shift the course of events to write a better ending for employers and their employees.
Through the Consociate Health process, we analyze claims and identify gaps in care. We take medical data, claim data, biometrics and information from bloodwork, and embed that information in a tool that provides patient-centric medical records. In many cases, we’re able to isolate what was driving up individual healthcare costs and provide preemptive services that minimize or eliminate future claims.
Another benefit is this data is all readily available to a hospital system and can be used by care coordinators to establish care plans and set goals based on the services a person is receiving or potentially receiving. We assist our clients in developing high performance health plans through partnered relationships with area health care systems that can better clinically manage care and data.
Corporate executives use numbers to drive nearly every decision in their business. Healthcare coverage should be no different. Employer’s partnered health care systems or case management vendors can now make significant changes just by looking at gaps in the care individuals are receiving, and lowering costs by offering proactive services. Not only does it cut costs, it encourages a stronger internal culture of caring and encourages a healthier work environment.
As employers put a heavier focus on individual plans and care for their employees, the corporate culture grows stronger. Employees feel their personal health is a priority to the company, which increases productivity.
We believe there is room for improvement in the way companies like Consociate Health drive change in the industry and would like to see more TPAs industry-wide adopt a stronger system to analyze and use data to further the industry.
Earlier this month, Consociate was recognized on a national stage for excellence in data accuracy, using key analytics to transform the customer experience.
We are proud of what we have been able to accomplish so far, which has allowed us to manage health care costs for employers as well as enable health care systems to make the strongest possible recommendations related to treatment of chronic conditions. Our future impact can be much greater by partnering with more hospital systems and using data to positively affect not only healthcare costs for employers, but also healthcare outcomes for employees.