Data-Driven Benefit-Selection Tools Are Just Getting Started

Efforts to automatically import claims and health data face hurdles

By Greg Goth September 23, 2019
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Personalization lets shoppers use e-commerce platforms to pick products or services that meet particular needs, often based on their purchasing history. What if benefit selections during employers' annual open enrollment periods worked the same way?

While employers realize personalization can be powerful, the capability of actually helping employees to make data-driven decisions, such as those that draw on employees' own health data, is still in its infancy.

Decision-support tools can help employees make health care decisions around not only the choice of doctors and hospitals but also the best type of plan to enroll in. The suggestions are based on answers employees provide through the software's app or built into online enrollment portals, said Kim Buckey, vice president of client services at DirectPath, a benefits education, enrollment and health care transparency firm. Required data usually includes plan premiums along with employee information such as number of doctor visits and prescriptions filled during the past year, she noted, after which "the tool does the math for you."

But the information is only as good as the data employees enter, and often this task requires them to go through their health records, which deters many people from using these resources.

Employers also haven't widely embraced these tools. When health care navigation platform firm Castlight Health and the nonprofit National Business Group on Health teamed up last year to survey benefits leaders at 58 large U.S. companies, most with more than 5,000 employees, they found a large majority (84 percent) believed personalization has high or very high potential to match employees with the right health benefits to meet their needs. However, most respondents (71 percent) reported they are only providing personalization tools "a little bit" or not at all.

"Our survey found that employers widely recognize the power of personalization, but most believe they are not tapping into its full potential," said Maeve O'Meara, Castlight CEO, when the results of the survey were released in March.

Recently, when O'Meara discussed how to improve employer efforts around personalization, she added an important caveat: "Health care is hard. So, the idea that one could completely transform the experience into something like a shopping experience for clothing is not realistic."

[SHRM members-only toolkit: Leveraging the Value of Employee Self-Service Portals]

Clash of Cultures

Efforts to make decision-support tools easier to use by automatically importing claims data or health-assessment findings have encountered technical hurdles. Developers have faced "massive" barriers to obtaining permission to access data such as health savings account balances, O'Meara said. And even when some of the latest tools are shown to lower costs and improve user satisfaction, translating them to commercial products can be daunting.

One such tool for Medicare enrollees, developed by Stanford University School of Medicine professor Kate Bundorf and others, can automatically import information on patients' prescription drugs from their electronic health records and combine it with information on each of the stand-alone Medicare Part D prescription drug plans available in their area. When tested, this tool saved users an average of $71 per month in prescription drug costs. However, Bundorf outlined several obstacles to making such a tool available for the employer market.

"[The employer-sponsored setting] is a little trickier because we have lots of different employers and they offer lots of different plans, with different coverage parameters. One of the trickiest parts is the in-network versus out-of-network distinction [as] we don't have excellent data from each plan on exactly who is in and out of network."

[SHRM members-only toolkit: Managing Health Care Costs]

Big Data, Small Steps

"Even with a simple tool that imported people's drugs, a lot of people still said, 'I want someone to help me,' " Bundorf noted. "Human coaching could work, but that's not really scalable, so we gave them an expert recommendation from an algorithm, [which] helped guide them to a plan they felt more comfortable with."

Brenna Shebel, vice president at the Center for Data-Driven Insights at the National Business Group on Health, said employers should devise communications strategies that assure employees that solicited information is not intended to violate privacy.

"In order for an employer to drive some of that information to an employee, they have to collect some sort of data beforehand," Shebel said. Employers "want to provide the best information and programs to their employees, based on the health goals they are looking to achieve. To know which programs are best-suited to that end, they need some information to go on in order to personalize their offerings."

"People are looking toward their health plans to provide these solutions that make it easier for them," O'Meara said. "There is a huge opportunity" to provide the coverage and services employees truly need.

Data-Driven Decisions on Benefits Offerings

In addition to improving the tools consumers use to select the right plans, analyzing workforce health data lets employers use aggregate, anonymous information to decide which health and wellness benefits to offer. This data, provided by insurers, third-party administrators and wellness vendors, also can help employers to fine-tune existing health plan designs.

For example, if diabetes is common in the workforce, that's an area employers might want to address through wellness initiatives focused on countering obesity and improving diets and exercise habits, or by adding diabetes-specific telehealth counseling to their covered services.

Greg Goth is a freelance health and technology writer based in Oakville, Conn.

Related SHRM Articles:

Does AI Have a Place in Open Enrollment?, SHRM Online, September 2019

How to Boost Employee Adoption of New HR Tech, SHRM Online, September 2019

Online Platforms Transform Open Enrollment, SHRM Online, September 2018

Related SHRM Resource:

Open Enrollment Guide & Resources

 


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