How employers can use data to design a healthcare strategy

Data is one of the buzzwords du jour , and the healthcare benefits market is no exception. Basing an organisation’s health and wellbeing strategy on data about its workforce can be advantageous for both employers and employees. But what data is available to employers and how can they put it to best use?

A good place to start is by asking healthcare benefits providers for claims data, particularly for benefits such as private medical insurance (PMI) , group income protection (GIP), employee assistance programmes (EAPs), and health cash plans . This data typically details the number of claims made in a certain period, the cost of claims, and which medical conditions individuals are claiming for.

Patrick Watt, corporate director at Bupa UK, says: “If employers can really understand data, it will tell them why their costs are what they are and, more importantly, the health profile of their organisation. [This will tell them] if the claims experience is driven by employees or their families, and where are people having treatment. Understanding the data can really help in terms of the future and how employers would want to design a healthcare plan.”

Health and wellbeing strategy

Employers can then develop their health and wellbeing strategy accordingly. Key questions to consider include whether they have the most appropriate healthcare benefits in place to deal with prevalent health issues and whether those that they do offer are being fully utilised.

Wolfgang Seidl, head of health management consulting at Mercer, says: “With the data, they can create health pathways. For example, if mental health is the biggest issue in an organisation, it may want to create a health pathway to nip it in the bud and also do the right thing reactively.

“For instance, one would want to make sure all mental health issues are referred to the right treatment source. Very often you find people struggle with that. They might refer everything to an expensive psychiatrist, yet [the employee] didn’t need to go there because the EAP is under-utilised and counselling is perhaps a more important resource for some lighter psychological issues than psychiatry.

“If someone has stress at work or relationship issues, it might be better to send them to the EAP, yet doctors may not do that.

“Having a clinical pathway can make better use of [an employer’s] existing resources, but it could also identify where it might have a gap in provision.”

Utilising claims data

Claims data can also inform the design of benefits, such as PMI, enabling employers to work with their provider to structure schemes to their workforce and claims profile. Doug Wright, medical director at Aviva UK Health, says: “It allows us to present alternative ways of managing that spend to employers. For example, rather than just offering a completely free choice of specialists and hospitals to all corporate clients, we’re able to offer them a more focused choice where people are getting to the right outcome but also managing the costs in a different way.”

Bupa’s Watt adds: “Data is fundamental to the way [providers] price a corporate healthcare plan, so employers should take an interest in understanding their claims experience, because, ultimately, that is how they will understand what they’re paying for.”

Introducing clinical pathways to better manage key conditions within a workforce, as well as implementing initiatives to lessen the chances of these occurring in the first place, may also result in lower premiums for employers based on fewer employees submitting claims through benefits plans.

Health risk assessments

If employers are unable to obtain sufficient claims data or do not offer benefits that provide this, other data sources are available . Data from health risk assessments, for example, can give a broad overview of a workforce’s health profile.

Risk assessments can help to identify the proportion of a workforce engaging in lifestyle behaviours that could lead to poor health later in life. Shaun Subal, director of strategic projects at PruHealth, says: “There are three controllable behaviours – smoking, physical activity and nutrition – which lead to four diseases of lifestyle – heart disease , lung disease, diabetes and cancer – and these are responsible for 50% of deaths worldwide.”

Knowing that a large number of employees are smokers, for example, means their employer can focus its wellbeing activities and investment on supporting staff that want to quit, as well as raising awareness of smoking-related issues.

But Iain Laws, managing director of UK healthcare at Jelf Employee Benefits, warns that data from health risk assessments should be treated with care. “The picture [employers] get from that data can feel very powerful, but they have to recognise it is potentially skewed,” he says.

“It could be skewed in favour of all the people who are fit and healthy, but take a lot of interest.This could present [employers with a picture of] a fit and healthy workforce, when actually they haven’t got this because the people they need to treat just aren’t engaging with it. Or, equally, they get a picture of very poor health because it’s the worried well or the sick who have engaged with it.

“Data from health risk assessments has to be treated with care around who’s using it. But it can be a very valuable source.”

Benefits take-up data

Take-up data from wellbeing benefits, such as bikes for work or gym membership, that are offered via flexible or voluntary benefits schemes, are also a useful way for employers to identify the areas of wellbeing their staff are interested in and engaging with.

But perhaps the most important information employers hold in relation to employee health is absence data. This should be cross-referenced against providers’ claims data to obtain the fullest picture of health in their organisation.

Jelf’s Laws says: “Robust absence data that is complete and rich in detail is probably the most powerful and most enabling data source an organisation can look at. Fundamentally, it can guide an organisation about what health issues exist and are impacting the performance of the organisation.

“From that, employers can start to identify hotspots and guide the areas where health and wellbeing programmes need to focus because it will vary by organisation, location and demographic. For example, what are the hotspots? Where have employers got quick wins? And where are the long-term issues related to health behaviours that a health and wellbeing programme needs to focus around?“

Obtaining robust data

But, despite data’s uses in informing an organisation’s health and wellbeing strategy , it can be difficult for employers to obtain sufficient data for this purpose. Jelf’s Laws says: “I think it’s fair to say that the range of data in organisations and the range of data available to employers from suppliers is inconsistent and incomplete, in many cases.”

With claims data in particular, the most common issue stems from employers providing benefits such as PMI to only a section of their workforce, for example senior management. Therefore, any data they receive will not be representative of the health of their wider workforce.

Even where employers do provide benefits more widely, data will only relate to the health of employees who have submitted a claim, and will not take into account the health of staff who sought treatment through the NHS.

Employers must also consider that there is a limit to the level of data that providers can supply, Bupa’s Watt explains: “We are dealing with confidential data and medical information, so employers need to understand that this is highly sensitive data and, therefore, insurers won’t release information that discloses which individual had what medical condition.”

Although it can be tricky to achieve, there is a general consensus within the industry that employers that effectively use data to inform their health and wellbeing strategy can expect to see a return on investment of three to one.

Laws adds: “Data is a key enabler for shaping a well-formed healthcare management strategy. We see data analytics as an aspect all organisations have to pay attention to if they are to achieve an effective, engaging healthcare programme.”