Use Data Mining to Lower Health Costs

November 22, 2013 ( – They say knowledge is power, and that can be true for improving health and wellness plan designs and costs.

According to Raymond Kim, director of Account Management at Corporate Synergies, the more plan sponsors know and understand about benefits utilization, the more they can tailor programs to suit participant needs. In an article on the Corporate Synergies website, Kim says such insight requires data mining to identify patterns and trends to glean information about what plan sponsors can proactively impact in the future.

Plan sponsors can get non-participant-specific data from insurance carriers on an aggregate basis, or request data through their benefits brokers, Kim told PLANSPONSOR. He suggests plan sponsors examine certain metrics like utilization statistics and average cost per variable such as gender, claimant, and dependent status within certain key benefits such as office visits, emergency room use, outpatient surgery, hospitalization occurrences and prescription drugs.

According to Kim, when they get the data, plan sponsors should segment it into buckets that are considered to be high cost to find opportunities to flex out health plan design. For example, he says if the data indicates emergency room abuse, it warrants increasing copays or cost share for emergency room visits, but lowering cost share for urgent care facilities or doctor’s office visits. In addition, the data could lead a plan sponsor to encourage online visits to address those costs.

There are also ways to address costs for the long term through wellness initiatives, Kim says. If data mining reveals a chronic medical condition that is prevalent among employees—for example, coronary artery disease—plan sponsors can start a specific wellness initiative—a healthy hearts program. As far as plan design, this data could be addressed by making copays for statin medications lower to encourage employees to use their medicine.

“Performing deeper dives into the data may reveal specific insight into your population’s preventive care compliance, medication adherence, and most prevalent disease states and cost differentials,” Kim says in the article. “Understanding these data sets can sharpen the focus on how you design your group employee benefits package and wellness programs. Data mining is the way to activate the potential of big data,” he concludes.