A benchmark tells you that you are expensive. Your claims tell you why.
Knowing your plan costs more than peers is only useful if you can see what is driving it. We pair the benchmark with claims and pharmacy analytics, gaps-in-care tracking and risk prediction, and put the result on one executive dashboard. Those insights feed the quarterly review in our health and cost strategy.
Cost is rarely spread evenly. The dashboard shows where it concentrates.
A renewal increase is usually the sum of a few specific things: a handful of high-cost claimants, a shift in pharmacy mix, care delivered in the wrong setting. We separate them so each has its own answer.
Medical Claims by Driver
We break spend into inpatient, outpatient, professional and emergency care, and separate high-cost claimants from the rest, so you can tell a structural trend from one bad year that will not repeat. Separating high-cost claimants reveals true claims trend. One bad year is not a trend.
Pharmacy, Including Specialty
Specialty drugs can move pharmacy cost faster than any medical category. We track utilization and cost per script by category, which is often where the first savings conversation belongs. Specialty pharmacy tracking is a key part of claims analytics. Specialty drugs move fastest.
Gaps in Care
Members with a chronic condition who skip routine monitoring tend to show up later as avoidable admissions. We track those gaps by condition, so outreach goes to the people it can actually help. Care gap tracking targets outreach where it helps most.
Risk Prediction
Rising-risk members cost relatively little today and a great deal later. We flag that group ahead of the renewal, which gives you time to act rather than a surprise to explain. Rising-risk analysis gives employers time to act. Act before the renewal.
You can see your plan’s data. You should not see your employees’ health.
Claims data is protected health information under HIPAA. How much of it reaches you depends on how the plan is funded and whether the plan documents allow it.
Aggregate, Not Individual
The dashboard reports populations, not people. Small groups of members are suppressed or combined, because in a small workforce a single line of data can identify someone. Aggregate reporting protects employee privacy in population health analytics. Small groups are combined or suppressed.
Funding Changes Access
A self-funded plan owns its claims data. A fully insured group often receives only summary reports, so we tell you up front what level of analysis your arrangement will support. Funding arrangement shapes claims data access. We tell you what is possible.
The Firewall Inside HR
If anyone at the employer handles identifiable plan data, the plan documents and HIPAA policies need to allow it and limit who sees it. We check that before the first report goes out, and counsel decides where the line sits.
A dashboard earns its place when it changes a decision.
We build the executive view around the few questions leadership asks at renewal, not around every chart the data can produce.
Before the Renewal
We bring the drivers of cost into the meeting alongside the benchmark, so a proposed plan change targets the category that is actually rising rather than the one easiest to cut. Claims drivers make renewal decisions more targeted. Target what is rising.
Through the Year
Monthly data shows a trend early. A spike caught in the spring can be investigated; the same spike found at renewal can only be priced. Monthly claims data catches trends early, while there is still time to investigate and act on them.
When Choosing Programs
If the data shows a concentration of one condition, a targeted program can be tested against it. If it does not, we say the program is solving someone else’s problem. Claims data shows which health programs fit your population. Test programs against the data.
What employers ask about claims analytics.
We are fully insured. Is this worth it?
Often, yes. Summary reports still show high-cost categories and pharmacy trends, and they are enough to test whether an underwritten funding option is worth exploring. Summary claims reports can still guide fully insured groups. They show high-cost categories and pharmacy trends worth acting on.
How does this connect to the benchmark?
Our benchmarking survey covers nearly a thousand employers. The benchmark shows where you stand among them; the analytics show what in your own claims put you there, so the number arrives with its explanation. Claims analytics explain your benchmark position.
Will employees know we are looking?
What you see is aggregate and de-identified. We still recommend saying plainly how plan data is used, because trust in the plan depends on people believing their privacy is respected. Transparency about data use builds employee trust. Say plainly how data is used.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
HIPAA Privacy Rule (45 CFR Part 164)
Federal privacy and security standards for protected health information held by health plans.
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.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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