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  • Following the CLUEs: Clinically Informed Benefits Consulting

    The healthcare insurance industry has become masterful at predicting future healthcare costs based upon historical experience. This actuarial work has resulted in significant accuracy in predicting what a company will spend next year on their healthcare. The assumptions in these calculations include the rate of inflation for the economy, medical spend, and pharmacy spend as a beginning. The age, location, and historical costs for the group and region are considered, and a relatively accurate estimate can be made for the future costs of the group, often a company.

    This is logical and has worked for decades to predict future costs. So, what else could one do? What are the options? What is not considered in these calculations? And what about the fact that the Institute of Medicine estimates that 30 – 50 percent of healthcare costs are due to fraud, waste, and abuse?

    Here’s the Problem with Traditional Employee Benefits Calculations

    The problem with the usual and customary way to calculate costs in the future is that the calculations assume that this fraud, waste, and abuse will continue and that things will not improve. But, what if they did? What if the health of the population actually improved, and the rate of unnecessary and inflated healthcare was reduced? What would happen to the costs and the health of the employees and the families in the corporation? What would happen to their future from a health and cost perspective? What would the implications be for costs and their companies?

    This is informed by the Holmes Murphy clinical consulting program and the Clinical Learning & Understanding Engine (CLUE) data analytics program. The data doesn’t lie, and Holmes Murphy is leading the charge to continually deepen and expand the opportunities to find ways for corporations and their employees to become healthier, save money, and create systems to minimize the fraud, waste, and abuse to which corporations are exposed.

    A notebook with a list of Clues

    So, What’s the Key to Affordable Employee Benefits?

    First, understanding that the enemy is disease, and how to attack and overcome disease form the foundation of this approach. Costs are driven by medical conditions, usually chronic conditions, that can be slowed or reversed. These conditions progress at a predictable rate based upon their current state.

    Holmes Murphy’s CLUE data analytics evaluate the health of every company to determine where the company is in the stages of key conditions.

    • Stage 0 is pre-disease.
    • Stage 1 is disease without complications.
    • Stage 2 is the presence of the disease with local complications.
    • Stage 3 is disease with multiple sites and/or systemic disease.

    Costs are commensurate with the Stage of Disease and every condition. Thus, with this understanding, the cost from chronic conditions is able to be slowed or reversed at Stages 0 through 2.

    There are several major conditions that Holmes Murphy considers. Diabetes, heart disease, blood vessel and stroke disease, cancer, and joint and spine conditions are the most common and most expensive conditions that are evaluated and for which recommendations are considered.

    With this innovative proactive approach, Holmes Murphy has set a new course for companies that want to do things a different way. This new way is not for every company today. But, for those companies who want to consider a new way, Holmes Murphy has the skills and resources to provide you with the CLUEs to chart a new, clinical path into the future.

    Published on: 01.23.20

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Following the CLUEs: Clinically Informed Benefits Consulting