Employer group reporting is a requirement for most health plans and third-party administrators in today’s healthcare environment. Almost every large group employer seeking healthcare coverage has some requirement in its selection process related to reporting on membership and claim experience. These requirements can vary significantly, depending on the analytic sophistication of the employer and/or broker working with the group. The real questions are, what do employer groups really want from employer group reporting and what do employers really do with these reports?
Milliman MedInsight has recently added to its portfolio of standard reports a new “storybook” employer group report that focuses on meeting the needs of employers looking to understand their healthcare spending. Additionally, the report can serve as the foundation for data-driven discussions with brokers or sales agent about how to better tailor benefit design and healthcare investment to better serve employees’ needs and the employer’s investment.
The report development process was a collaborative effort between several Milliman clients and MedInsight data analytics consultants. At the start of the project the development team identified two primary objectives for the new storybook employer group report:
1. Enable the employer to understand and reconcile its historical healthcare spend.
2. Provide the employer data-driven insight into how it might wish to change its benefit offerings in the future—identify action items.
As the report specification evolved further, several secondary requirements emerged: the report had to be easy to read and understand, the report had to have meaningful comparative benchmarks to help an employer put its experience in context, and the report needed to be modifiable at run time by the sales group to add comments and adjust report output.
Some of the analytic tactics employed in the report to achieve the goals for the first objective above are:
1. Analysis of both paid and allowed amounts by Milliman’s Health Cost Guidelines™ categories.
2. Trend analysis between a definable current time period and prior time period.
3. Benchmark comparatives between a similar block of business for the health plan and/or a set of benchmarks derived from Milliman’s research database.
4. Reconciliation analysis of claims by paid date.
5. Membership analysis by demographic and benefit design dimensions.
6. Concurrent risk scores to measure the illness burden of the population between time periods.
Some of the analytic tactics employed in the report to achieve the goals for the second objective above are:
1. Use of Milliman’s Chronic Condition Hierarchical Groupings (CCHGs) to identify medical condition prevalence when considering wellness program initiatives.
2. Evidence-based measures to identify gaps in preventive care that influence the long-term health of the population.
3. Predictive risk scores for the employer group and the other similar groups within the health plan to forecast how future healthcare expenditures might compare.
4. Frequency of potentially avoidable emergency room use.
5. Provider network utilization analysis.
6. Pharmacy use analysis for mail order, generic use, and specialty drug use.
Milliman’s design of the employer group report will continue to evolve as we present the report to more clients and get additional feedback from our user base. If you’re interested in learning more about this new feature or would like to contribute your ideas to future versions of the report, please contact your Medinsight consultant.
This article first appeared at Milliman MedInsight.