Over the past several months, you’ve put a lot of time, effort, and energy into building a benefit plan that will help better manage costs for everyone and improve employee health and satisfaction.
Like you, the benefit leaders we work with know how important population data and analytics are in helping to shape these strategies. Now that the heavy lifting is done and enrollment is underway – we thought we’d share some of the important questions our customers used Benefit IQ and CertHLM to answer during this year’s benefit planning season.
But first, here’s a quick overview of the Certilytics solutions benefit leaders are using to answer their most pressing questions:
- Benefit IQ: An AI-powered data and predictive analytics solution to help benefit leaders make important benefit decisions based on the future outlook of your population.
- CertHLM: A GenAI-powered healthcare chatbot that provides instant, proactive intelligence so analysts no longer have to dig through data and dashboards to find the important insights they need to make decisions. The questions identified in this report are based on the top questions healthcare analysts asked CertHLM.
Top 5 Questions
1. What future risks should I anticipate in my population, and how will they impact costs and outcomes?
With this question, benefit analysts are seeking insights into population groups that may drive a disproportionate amount of spend in the future. The goal of asking this question is to identify potential high-risk individuals before they become high-cost claimants and implement strategies that may help mitigate this risk.
By asking this question, benefit teams are uncovering insights such as:
- Which members are showing significant risk movement from lower risk to rising risk.
- The number of members who are at high risk for disease onset, such as diabetes.
- Where there are opportunities to lower avoidable spending through intervention or disease management programs.
2. Based on my current population summarize the pharmacy utilization and cost drivers, and suggest ways to reduce future pharmacy spend?
Each year pharmacy drug costs and spending are rising. This question highlights how important it is for benefit leaders to better anticipate future pharmacy utilization and costs to optimize their plan design.
When asking this question, benefit analysts who are using Benefit IQ are gaining important intelligence including:
- Key trends informing which drugs will dominate their spend in the future.
- By therapeutic class, which medications show the highest PMPM and growth.
- Identifying which categories of drugs show the strongest growth trajectories in both utilization and cost.
3. What are my biggest opportunities to drive cost savings across my benefit plan?
Benefit leaders are under a lot of pressure each year to build strategies that lower costs. Predictive intelligence is critical in helping design plans that are tailored to the unique needs and opportunities for a population.
With this question, analysts and benefit leaders are provided valuable insights into:
- The highest value opportunity areas. With our Opportunity Analyzer benefit analysts can see in dollars where they can make the biggest impact across emerging clinical onset, impactable gaps in care or redirection and utilization management.
- An evaluation of opportunities into specific areas, such as specific diseases, re-direction, clinical quality measures, and more.
- A financial summary showing savings opportunities by Metropolitan Statistical Area (MSA) or geographic region.
These insights can help determine the right clinical intervention programs for a population and where to direct resources for the biggest impact.
4. Which programs are driving measurable improvements in cost and care quality?
Most benefit plans offer an array of health management solutions to help their employees stay healthy and improve their long-term health risks. But it can be difficult to determine the ROI of those programs.
With this ask, benefit plan designers are given valuable intelligence into how each program is performing – helping determine which programs are making the most impact. Insights, such as:
- Which programs are having the highest impact by engagement percentage and PPPM savings.
- The specific impact the program has had on pharmacy costs, professional services costs, and more.
- A breakdown of impact by both clinical outcomes and cost savings.
5. I have a last-minute meeting and need three bullet points about the key cost drivers for my population today and next year.
This question affirms just how under pressure analysts and benefit leaders are to discover insights and make recommendations quickly. With CertHLM, analysts no longer have to spend hours digging through their data and dashboards to find the answers they are looking for.
In this question, CertHLM was able quickly surface the following key insights and give an analyst a path to finding the right information more efficiently:
- Current year cost drivers by service category, condition, service and insights into its high-cost claimant population.
- Future year outlook with opportunities for savings, pharmacy trends and recommendations for future cost management strategies.
If you have many of the same questions as the benefit leaders we work with, but are lacking the healthcare intelligence to answer them – Let’s Talk.
We’re confident our solutions can quickly help you improve the predictive intelligence you need to build the right benefit strategies for the future.
