|Title:||United States national health expenditures in dollars and their share of gross domestic product in percentages for 2000 to 2009|
|Source:||Risk & Insurance|
Start of full article - but without data
National Health Expenditures and Their Share of GDP
Health expenditures, shared between insured and employer,
are eating a greater portion of the GDP.
Expenditures as Share of Year Expenditure GDP
2000 $X,XXX.X trillion XX.X%
2001 $X,XXX.X XX.X 2002 $X,XXX.X XX.X 2003 $X,XXX.X XX.X 2004 $X,XXX.X XX.X 2005 $X,XXX.X XX.X 2006 $X,XXX.X XX.X 2007 $X,XXX.X XX.X 2008 $X,XXX.X XX.X 2009 $X,XXX.X XX.X
Source: Centers for Medicare and Medicaid Services, Office
of the Actuary, National Health Statistics Group, Kaiser
* Analysis of claims data is giving companies the ability to take a closer look at employee health.
* The data, even more of which are expected to be available through electronic medical records, is enabling insureds to challenge health carriers at renewal.
* Health carriers say they, too, have programs to help employers analyze their claims data.
In September 2009, the SCOOTER Store, a leading national provider of power wheelchairs and scooters for disabled people, obtained a new report on its pharmacy and medical claims that provided numbers in a way the Texas company had not seen before.
The report, an analysis of the health of its employees, allowed the company to reach out with a targeted approach to at-risk employees. With that information in hand, the company took a quantum leap in its effort to control healthcare costs.
The SCOOTER store, which like many of the nation's largest companies, was self-insured. It had access to the claims data before receiving the new analysis, but it never had been able to pull the data together in a way that made it compelling and usable, said Deanna Scott, vice president of human resources and corporate operations.
Through the use of predictive modeling and data analytics provided by one of its vendors, Wellnet Healthcare Group, the company now had an analysis showing how many employees were at risk of a serious health problem.
It also had an analysis of the top medical conditions facing its employees, the types of medications that were being prescribed, and whether the medications were brand name drugs or generics.
Of the company's X,XXX employees, XXX were at high risk of a significant event, such as a heart attack, and XXX were at medium risk, Scott said.
The New Braunfels, Texas-based company then reached out to those at-risk employees through care-management specialists.
One of the employees was a woman who was considered a medium risk by the predictive model. A care manager who contacted her learned that she had gained a lot of weight after she had quit smoking.
After some additional questions, the care manager also learned that the woman ate mostly processed foods and was not a very good cook.
The care manager kept in touch with the woman, encouraged her to work on her cooking skills and helped her find healthy recipes in books, online and in magazines. The employee added walking to her daily routine, and soon began losing weight as a result of the exercise and a better diet.
For an employer, every employee who starts exercising, eating right, and taking their medications on time and in proper sequence is a major claim that is less likely to happen.
But without an analysis of claims data, companies are flying blind when it comes to knowing where to focus their efforts, said George Pantos, executive director of the Healthcare Performance Management Institute, a Bethesda, Md.-based organization calling for the more efficient delivery of healthcare through the use of technology and management principles.
The analysis of the pharmacy and medical claims data reveals important clues about employee health that allows companies to intervene with those who are most at risk.
The combination of the data analytics and outreach to employees is at the core of an approach known as Healthcare Performance Management, which uses technology developed by Wellnet Healthcare and its affiliate Healthcare Interactive.
Other healthcare companies also have recognized the importance of predictive modeling and data analytics of pharmacy and medical claims data as a way of helping plan sponsors manage rising healthcare costs.
In 2005, for instance, Aetna acquired ActiveHealth Management, a technology-driven health management and healthcare data analytics company as part of its own effort in this area.
And MDI, based in Ponte Vedra, Fla., earlier this year released a major enhancement to its Viewpoint Analytics, a web-based data warehousing management and reporting solution. As part of the database enhancements, MDI has integrated more pharmacy data, which provides better analytics and reporting of patients' pharmaceutical expenses.
For SCOOTER, the upshot is that the company's 2010 healthcare expenses came in at XX percent of expected claims, the first time since 2006 that they came in under XXX percent, Scott said. That translated into annual savings on its health benefits of XX percent, or $X.XX million.
The company, however, does not attribute all the improvement to Healthcare Performance Management, Scott said. In 2008, the company had opened an onsite gym and health clinic, and had begun some other wellness programs focusing on exercise and weight loss.
EMPLOYERS GET INVOLVED
The cost of health benefits has been a top concern for almost every business in the United States for more than a decade. There's no reason for businesses to think otherwise. Most are expecting healthcare benefits cost increases in the range of X percent to XX percent in 2011 over the previous year, according to a number of leading national consulting groups.
"Executives at the highest ranks need to pay attention," said J.P. Hannah, the chief financial officer at Atlanta-based Cumulus Media Inc., the second-largest owner of radio stations in the country. "It's a runaway expense. It's not something you reel back overnight."
Average annual premiums for employer-sponsored health insurance plans have risen from $X,XXX in 1999 to $XX,XXX in 2009, according to the Kaiser/Health Research & Educational Trust survey of employer-sponsored health benefits.
While that represents a jump of XXX percent, workers have shouldered the brunt of the increase as the portion paid by them has gone up XXX percent over the period, the survey found.
As the cost of health benefits soars, some businesses are no longer content to sit back and wait for their policy renewal, before paying attention to the issue.
In other areas of business--customer-relationship management, sales, logistics--executives and claims managers have a wealth of data to manage their operations. Not so where health benefits are concerned.
For years, businesses have renewed their health insurance plans without much in-depth analysis of the drivers of the cost of their premiums.
In some cases, it has been force of habit. Senior management has often been willing to delegate health benefits to human resources managers, who then rely on their brokers and health insurers for information.
In many cases, the health plan sponsors had no way of obtaining the information from the claims data, either because their insurers wouldn't provide it or because the technology was not in place to crunch the raw data.
At Cumulus Media, the rising cost of health benefits had management worried.
"It was the single fastest growing expense every single year," Hannan said. "When it's your fastest growing expense and you feel completely helpless to stop it, something has got to change."
Cumulus Media began using Healthcare Performance Management software in January 2009 and had a XX percent reduction in its medical and pharmacy claims that year, said Tony Cannata, chief executive of Clearview Group in Atlanta, who works with Cumulus Media.