FROM THE TEAM - UNDERUTILIZED ASSETS
It's starting to become a cliché hearing about "tough economic times" but I suppose the reality is that there is no escaping that 2009 is shaping up to be a very difficult year for an extremely wide range of industries, including those we once viewed as recession proof. From a business management standpoint, the one silver lining to the current economic climate is that it has forced businesses to reflect on how they can be more efficient, and cut unnecessary fat out of their operating budgets.
Optimally utilizing all assets at a company's disposal to create greater efficiencies has become a primary focus for employers of all sizes. That is why we have seen such spectacular growth in the area of companies utilizing their own transactional claims data to determine where they can strip away costs that do not impact their plan members adversely. Every plan sponsor's situation is unique for the following reason: each plan has its own disease state and demographic profile, its own plan DNA, which makes it distinct from all others. That's why it's necessary to look at plan specific claims data to determine how a plan sponsor can streamline costs.
Transactional claims data is the most underutilized asset that Human Resources and Finance professionals have at their disposal to achieve greater returns from their investment in health benefits. It is incredible the range of insight that can be provided with plan-specific, transactional claims data:
- Isolate immediate opportunities for savings within the existing plan design (what can be done in the immediate-, near- and short-term to impact plan costs without adversely impacting members.)
- Determine the return-on-investment on established health, wellness and EAP programs (Is the money being spent in this area having any impact? Are we focused on the right areas?)
- Model the financial impact of an alternate plan designs to determine what the picture looks like under different structures before any decisions are made to go down a particular path.
- Determine the future plan cost increases under the existing plan design to assist in budgeting (or in the case of retiree plans, to more accurately calculate post-retirement liabilities).
- Integrate disability and drug claims data to ensure plan design changes don't move costs from one area of the plan to another, and to determine if disability cases are being optimally managed.
These are challenging times. Plan sponsors we have worked with have seen returns in the order of hundreds of thousands to millions of dollars by simply translating reams of blinded data into practical, usable information that can be used to support decision making.
Sincerely,
Mike Sullivan
President
| DRUG & DISEASE NEWS |
COMPUS Releases Insulin Analogue Reports
Cubic Health has been closely following the materials produced by the federally sponsored agency, Canadian Optimal Medication Prescribing and Utilization Service (COMPUS), which is charged with improving prescribing practices in our country. The first medication class this agency reviewed was the proton pump inhibitor (PPI) class, which resulted in important statements about the lack of a clinically important difference between the lower and higher cost agents. Recently, COMPUS released the results of its second major drug class review on insulin analogues.
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NOC Watch:
Pristiq® (desvenlafaxine)
Vynase® (lisdexamfetamine)
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| FOR THE PLAN SPONSOR |
What Plan Sponsors Are Doing in 2009
Plan sponsors have trouble managing their drug plan benefits spending for two major reasons: they have not had access to the necessary transactional claims data needed to dig beneath the surface, and they have not had access to tools that make sense of this transactional data. Even the largest ASO plan sponsors in Canada only have access to aggregate level data (as opposed to transactional level data)when they prepare for annual plan renewals. This puts plan sponsors in a difficult position because, while short-term trends are important, decisions need to be made now that will impact the next 3-5 years. Therefore, accessing information to allow plan sponsors to identify immediate opportunities, as well as those in the short- and long-term is vital. That's why analyzing and interpreting transactional claims data has become a key focus for plan sponsors of all sizes because aggregate level data available to plan sponsors does not provide enough insight.
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