Buy the program after you know the problem, not before.
Wellbeing vendors sell solutions to the conditions that are expensive everywhere. Your plan may be expensive for a different reason. We look at your claims and, where available, biometric data to find out what is actually driving cost before we recommend anything.
Most cost comes from a small part of the population. The question is which part, and whether it can be changed.
A population health review sorts spend into what a program can influence and what it cannot. That distinction decides whether any wellbeing investment makes sense.
Catastrophic Claims
A premature birth, a transplant or a cancer diagnosis can dominate a year. These are rarely preventable by a wellness program, so we separate them out before judging what is left.
Chronic Conditions
Diabetes, heart disease, musculoskeletal pain and behavioral health build cost slowly. This is where programs can work, because the spending recurs and the drivers are known.
Pharmacy Patterns
Rising use of a drug class can signal a condition trend before medical claims show it. We read pharmacy and medical together, so the picture is not half complete.
Biometric Results
Where screening data exists, it shows risk that has not yet become a claim. We use it in aggregate only, which lets us see where the next few years of cost may come from.
Health data about your employees has to stay away from the people who manage them.
Plan claims data is protected under HIPAA, and screening results raise their own ADA and GINA questions. The review is built so that decisions about people are never made from health data.
Aggregate Reporting Only
We present findings by condition and category, and suppress small groups, because in a smaller workforce a single data point can identify someone.
What Funding Allows
A self-funded plan can analyze detailed claims. A fully insured plan often gets summary reports only, so we tell you before the review starts how deep it can go.
Plan Documents First
If anyone inside the company will see plan data, the plan documents and privacy policies must permit it and limit it. We check that before the data moves, and counsel decides the specifics.
A good review sometimes ends with “do not buy a program yet.”
The output is a short list of cost drivers, the ones worth acting on and the ones that are not, with a view on which kind of intervention fits each.
A Plan Design Fix
Some drivers are best addressed in the plan itself: a site-of-care rule, a pharmacy change, a network steer. Those cost less than a vendor, so we put them first where they apply.
A Targeted Program
Where a chronic condition concentrates, a program aimed at it can be justified. We define what success would look like before selection, so the program can be measured later.
Nothing Yet
If cost is driven by one-time events, a program will not change it. We say so, which saves the budget for a year when the data supports acting.
What employers ask before a population health review.
What if we have no biometric data?
Claims and pharmacy data alone usually show the main drivers. Biometric data adds a forward view, but the review does not depend on it.
How often should it be repeated?
Once a year, ahead of renewal, so program decisions and plan changes are made from the latest data and last year’s choices can be checked against results.
Will it tell us who is sick?
No, and it should not. The review describes the population, not individuals, which protects employees and keeps employment decisions clear of health information.
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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