Healthcare Analytics to the Rescue!

Why does my health insurance cost so much?

It’s that time of the year again. No, I am not talking about the holidays. It’s the time of the year, when you figure out how much more money you need to make, in order to afford the rise in your healthcare costs. It’s Annual Enrollment time! But as most folks have already realized, there probably won’t be any raises, bonuses, etc., this year to help off-set the rise in healthcare premiums. The economy is experiencing its biggest downturn since the Great Depression and yet our quoted health insurance cost for next year is rising at a double-digit pace. How is that possible?rising-bar-chart

“Over the last decade, employer-sponsored health insurance premiums have increased 131 percent”.

My wife and I calculated that pre-tax, she would need to earn another $ 1,200 a year this year to off-set the rise in the monthly premiums being charged for an HMO plan with family coverage. Currently, we belong to the #1 ranked Health Plan in the country, which is increasing its rates to the tune of $100 a month for the  same level of coverage as last year. Unfortunately, we have been experiencing this trend for more than the past 20 years.

I realize its not a simple answer, and there are several external factors including rising pharmacy costs, inflation, etc. However, one could argue that since the economy is in a tail-spin, unemployment is sitting just under 10%, and the federal government is wasting time and my tax dollars trying to create a new public option for health coverage, that the best option for insurers is to hold premiums steady and to finally get a handle on what are the true drivers of cost and utilization. Thus, they would not risk losing its most important constituents, their employer groups and members, who every year are now faced with the idea of reducing their level of healthcare coverage just to make ends meet.

If the #1 health plan in the country is raising their premiums by $100 a month for a basic HMO plan, can you imagine what the lower ranking health plans will charge to their members? There are no quick-fix-it solutions for the healthcare industry. However, with so many inefficient processes, fraud, overhead, flawed reimbursement methodologies, expensive compliance and technology projects, etc., the industry is ripe for opportunities to become more analytics focused. With today’s business intelligence and data warehousing technologies available, health plans now have the ability to create high-value metrics that involve integration of disparate data sources from key areas such as: sales & marketing, operations (ex. Claims processing), and cost and utilization across members, providers, and employer groups.

Despite the quoted savings achieved by health plans from a variety of medical management programs, disease management, formularies, network discounts, etc., why is it never passed onto a subscriber’s premium? Are health plans not evaluating the right metrics? Pushing the boundaries for increasing the use of payer analytics will allow health plans to truly understand the drivers of cost and utilization and thus to migrate their business model to become more predictive in nature. Maybe this is wishful thinking, but a health plan could actually reduce their monthly premiums if they can drive out the unknown costs and inefficiencies. A futuristic but intriguing thought would be to have benefit plans that are created and priced for each member, which is based on both historical utilization and predictive analytics to determine the monthly premiums.

At a minimum, can we stop the double-digit price increases?

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