Analytics only matters if it changes a decision.
Employers receive more data than ever: carrier dashboards, pharmacy summaries, vendor scorecards. The question is whether any of it changes what you do before the next renewal. We read the data against a specific decision, and we say so when the data is too thin to answer.
Each source answers a different question.
Each card opens the guide for that source. The skill is knowing which question each one can and cannot answer.
Claims Data
What it shows about cost drivers and large-claim exposure, and the limits you have to respect.
Trend Against Your Own Experience
How a carrier weighs your claims against the market when it prices a renewal.
High-Cost Claimants
How a few members shape a year, and what an employer can do about it.
Benchmarking
Whether a number is high or normal for a group like yours.
Pharmacy and Specialty
Where pharmacy spend sits and the contract terms behind it.
Population Health
How to read the health of a covered population without identifying individuals.
Price Transparency
What the published price files can and cannot do for an employer.
Claims Reserves
Why a claims report can look better than the year really was.
Our Method
The annual process that turns the data into decisions.
Three questions we put to the data before a renewal is priced.
If the data cannot answer one of them, that is worth knowing before the renewal arrives.
Is the Increase Defensible?
Compare the trend and your own experience, and see how much credit the carrier is giving each.
What if a Large Claim Hits?
Test how one large claim would move a renewal under a given pooling level.
Is the Quote Really Cheaper?
Put proposals side by side on the same basis before comparing totals.
Free calculators for reading your own data.
PMPM Claims Calculator
Enter paid claims, members and months to get the per member per month figure from a claims report.
Generic Dispensing Rate Savings Calculator
Estimate the savings from moving your generic dispensing rate toward a target.
Large Claim Renewal Impact Calculator
Estimate the renewal effect from a large claim, the pooling level and the credibility given to your experience.
Stop-Loss Attachment Point Calculator
Enter enrollment, expected claims and deductible to see the aggregate attachment point.
Specialty Drug Exposure Calculator
See how exposed a group is when a few members are on specialty drugs.
Health Plan Quote Comparison Calculator
Compare your current premium with up to three quotes for the yearly difference.
Where this connects.
Cost Containment
The levers that act on what the data finds, and the order to pull them.
The Cost-Control Playbook
Eight levers, in the order to pull them.
Benchmarking
How we compare your plan with groups like yours.
The questions that come before the first report.
Ten questions employers bring us about reading their own plan data.
What does healthcare analytics mean for an employer?
Reading claims, pharmacy and enrollment data to answer a specific decision: why the cost moved, whether a renewal is fair, what a plan change would do. Reports that do not feed a decision are reporting, not analytics.
What data do you need to start?
The renewal, the current plan summary, contributions and enrollment by tier, and the claims or pharmacy reports your carrier or administrator already produces. What is available depends on how the plan is funded. See what claims data can and cannot tell you.
Can we see which employees have large claims?
Generally no. Plan sponsors receive aggregated or de-identified reports, and privacy rules limit what an employer can see about individual members. What you can see is how many large claimants there were and what they cost, which is what planning needs. Managing high-cost claimants.
How reliable is a small group’s claims data?
Less than it looks. A few claims can swing a small group’s year, so carriers give small groups only partial credit for their own experience. Reading trend against your own experience explains how that weighting works.
What is PMPM and why track it?
Per member per month: paid claims divided by members and months. It puts different periods and group sizes on one scale, so you can compare this year with last and your plan with a benchmark. The PMPM Claims Calculator does the arithmetic.
What is IBNR?
Incurred but not reported: claims that have happened but have not yet been paid or processed. It matters most for self-funded and level-funded plans, where a claims report can look better than the year really was until those claims arrive. IBNR reserves explained.
How is benchmarking different from analyzing our own data?
Your data explains what happened in your plan. A benchmark tells you whether it is normal for a group like yours. You need both: your data alone cannot say whether a number is high, and a benchmark alone cannot say why. Here is how our benchmarking works.
Do carrier dashboards count as analytics?
They are a starting point. A carrier dashboard reports the carrier’s own categories on the carrier’s own schedule. An independent reading checks them against your renewal, your pharmacy contract and a benchmark, and asks what to do next.
What can price transparency data tell us?
It lets a plan compare negotiated prices for the same service across providers, which can inform network and steerage decisions. The files are large and hard to use without tooling. Transparency in coverage, explained.
How often should the data be reviewed?
Quarterly is a sensible rhythm for most groups, with a deeper read ahead of renewal. Waiting for the annual renewal means learning from the letter what the data would have shown months earlier. Send us your renewal and we will start there.
Ready? Upload your renewal, or talk it through with someone first. No cost, no obligation.
General information about plan data, not legal advice. Privacy and plan-specific questions belong with counsel, and we will bring them in.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents, two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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