Analyzing your company's claims data

Posted on Mar 09, 2016 by rob.mcbroom

In a 2015 report released by Pacific Prime it was found that the average inflation of international health insurance premiums in Singapore was 9.5%, for individual plans. This figure provides a good benchmark for group health insurance plans as well, which can expect to see premium inflation around this percentage as well.

One of the main predictions made in this report is that globally, health insurance inflation figures in 2016 will reach double digits. This highlights one certainty: premiums will always be increasing, an issue that many plan administrators and HR managers are aware of and constantly trying to mitigate.

Of course there are a near infinite number of strategies you can employ to manage premiums - the most common will be identified in an upcoming report by Pacific Prime - but there is one thing we wanted to focus on here today: The analysis of your claims data.

Why should you analyze claims data?

The data generated when your employees submit a claim is an integral indicator of the current health of your employees that can also identify trends or gaps in care. This information can then be analyzed and used to effectively implement new activities and campaigns that not only improve the health of your employees but subsequently their productivity.

In many cases, conducting an analysis of your claims data can also lead to the ability to make informed decisions around whether your current group plan is working, and help you to achieve the most cost-effective plan for your company should you decide to switch health insurance providers.

How to gather claims data

You can gather claims data from a number of different mediums. The first step is to start tracking data yourself. This includes information like:

Number of sick days taken - per employee, team, department, and total
Reasons for sick days - from employee communication and any medical slips
When sick days are taken - day of the week, month-to-month, etc.
Questions from staff regarding health insurance, health issues, concerns, etc.
New joiners to the schemes
Number who have left the scheme
Data from previous schemes and healthcare initiatives

The idea here is to track literally anything related to health insurance and try to identify things that can be related to health insurance or even health. For example, by tracking how many sick days are taken, when they are taken, and why they are taken, you will likely identify trends that will need to be addressed, and then take steps to either increase coverage around this trend, or implement a wellness plan to address the issue.

Beyond the identification of trends, this data you collect can actually help make the analysis of the actual claims data easier to decipher and understand, or at the very least provide context to the data and a historical benchmark from which you can begin to judge actions taken by your company.

As to the actual claims data itself, you are going to have to talk with your insurer. For almost all group health insurance schemes, the insurer will already be tracking this data and will usually make it available to you if you ask for it. Most companies actively conducting claims analysis will ask for the data on a semi-regular basis - around once every three to six months depending on the size of the plan. If you have secured your plan through Pacific Prime we can also help you gather and even analyze the data.

Important claims data to analyze

All of the data generated during the claims process will be useful in one way or another, but some data will be immediately more useful than others, especially to group plan administrators. Here are four sets of data that many companies find the most useful to analyze.

Cost of health care - Track and analyze the data around how much the doctor or clinic bill is for each and every claim, and the total cost of health care for each individual over the measurement period. This will allow you to see whether the cost of care is increasing, and also to identify individuals & types of care that cost higher than the average.
Health care utilization - This is the percentage of employees who have submitted a claim using your health insurance plan and what they are claiming for. Some of the more popular things to look at here include the utilization for colds, OB/GYN services, men's health exams, general checkups, emergency care, surgeries, screenings, specialist visits, etc. When looking at this data try to identify any standout requests e.g., a higher than usual number of claims for colds or cancer screening, as these can identify areas where a targeted wellness scheme can help reduce claims and potentially costs.
Time of claims - There are two aspects you should be tracking here. First is when claims are submitted by employees. This can help you identify potential high claim time periods e.g., cold and flu season, and thereby develop a plan to limit the impact felt through increased awareness programs and other health initiatives. The second aspect here is the amount of time insurers take to process and approve claims. Many will do this quickly, but if you see a spike in length this could indicate the need to talk with the insurer.
Claims for ongoing care - Care for ongoing conditions is always going to be one of the most expensive types of medical care, and if covered by your plan, this could be a contributor to higher premiums should the cost of care go up. If you identify high cost ongoing care, this is a perfect place to implement a targeted wellness plan that can help employees better manage the disease or improve their condition, while keeping costs lower for you.

The review of your data can be a long process but it is an essential step that should be taken at least once a year, if not more if you want the most effective health insurance plan for your business. The experts at Pacific Prime Singapore can help you analyze this data and then optimize your plan based on this data. Contact us today to learn more about how we can help.