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Human Resources vs.
Finance
Leveraging Big Data and Technology while
Remaining Compliant within your Benefits Program
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The Opposing Teams Name: Scott Mayer
Title: Director, Data Analytics
Bio: Scott focuses on helping employer groups use the vast amount of healthcare data at their disposal to identify and stratify the risk within their employee population, and develop programs and strategies aimed at controlling and containing said risk. Scott is very active in the healthcare community, having served on numerous boards and committees such as: • Executive Board of the Baltimore Association of
Health Underwriters • The Navigator Advisory Committee for the
Maryland Health Connection • The NAIFA-MAHU Joint Legislative Committee
His legislative efforts have garnered awards and recognition at both the state and national level. Scott holds a degree in math and physics from Cornell University, and loves the challenges of working with big data sets to develop meaningful analytics, predictive outcomes and statistical projections for his clients.
Name: Lesli Corbin
Title: Director, HR Professional Services
Bio: Lesli is a veteran compliance professional
whose approach is characterized by
pragmatism and integration. She has
successfully consulted with thousands of
employers, providing creative and
customized compliant solutions that meet
client financial, operational and employment
goals. Lesli started the HR Professional
Services division over four years ago. Services
marketed under the brand HRtactix range
from proactive and timeline-driven
compliance support to outsourced human
resources services.
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Poll: What is the most challenging part of working with Finance/HR?
Lack of Communication
Different/ Undefined Goals
Misaligned Philosophy
Misunderstanding Departmental
Impacts
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Accessing Data
Human Resources Finance
HIPAA Privacy and Security
ADA Compliance
Employment Discrimination
Plan Utilization
High Claimants
Cost Drivers
Admin/Contract Expense
Data Set:
Health Insurance | Pharmacy Claims Wellness Data | Mobile Health
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Quiz: What level of claims/PHI are you legally allowed to access when managing an employee benefits plan?
Aggregate Information
Only
De-identified Member Level
Information
Identified Information for Employees Only
All Identified / PHI Data Available
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Segmentation &Classes
Finance: • High Risk
Group • Fully Insured
vs. Self-Funded • Demographic
Factors • Employment
Classes
Human Resources: • Bonafide
Classification • Age
Discrimination • Pregnancy
Discrimination • Protected
Classes
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Plan Design & Morale Human Resources:
Richer Benefits = Happier Employees
High Deductibles = HR Administration
Complicated Design + Components + Confusion + Bureaucracy = Burden
Finance:
Exclusion of Treatment and Services
Formulary Adjustments
Value Based Plan Changes
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Quiz: What is a reasonable difference in annual cost between Lipitor and its generic equivalent, Atorvastatin?
$240 $1,200 $2,400
$4,800
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Plan Design Incentives
Larger Networks
Open Access
Preventive Services
Dependent Eligibility
Coverage Tier (EE, EE+1)
Tele-Medicine
Happier/Healthier Employees = Productivity
Finance
Narrow Networks
Plan Eligibility Tied to Compliance
Coverage of Conditions Tied to Compliance •Treatment Compliance &
Medical Adherence
•Case and Disease Management
Greater Cost Share Tied to Compliance
Human Resources
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Premium Incentives
Finance: • Lifestyle
Surcharges • Demographic
Surcharges • Preventive and
Chronic Compliance
• Activity Based Premiums
Human Resources: • HIPAA • 30% and 20% • Wellness +
Tobacco • HRAs • Biometrics • Programming • Fitness
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Poll: Which closest represents the premium differential incentive you currently offer?
$0 $10/month $25/month
$50/month $100/month
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Employment Incentives
Human Resources Finance
Opt-Out Credits
Accessibility Concerns
More Flexibility
Non-Monetary Incentives
Monetary Incentives
Termination of Poor Risk
Advancement Opportunities
Plan Members vs. Everyone
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Technology Integration
ACA Reporting
Payroll Integration
Benefits Administration
Leave/Disability Administration
Push Communications
Finance
Wearable Devices
Mobile Health Technology
Consumer Tools • Pricing Transparency
• Reference Based Pricing
• Centers of Excellence
Human Resources
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Strategy Session
E.A.T, LLC owns 500 fast food franchises across the United States. Currently, they offer a self-insured health plan for their store managers. Health care claims and Health Risk Assessment data shows a high incidence of drug and alcohol abuse among the covered plan members. It is so profound that case notes even indicate the possibility of multiple liver transplants being required in the coming years.
What are some of the major concerns facing E.A.T., LLC and what are some ways to address those concerns and mitigate risk?
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Questions? If you have any further questions about the information discussed in this webinar please feel free to contact us at:
Crawford Advisors, LLC
• HQ: 200 International Circle | Suite 4500 | Hunt Valley, MD 21031
• 1813 Sweetbay Drive | Suite 10 | Salisbury, MD 21804
• 201 King of Prussia Road | Suite 650 | Radnor, PA 19087
• 280 Granite Run Drive | Suite 250 | Lancaster, PA 17601
• 2975 W. Executive Parkway | Lehi, UT 84043
(800) 451-8519 | www.crawfordadvisors.com
HRtactix – (443) 212-1630 | Data Analytics – (443) 212-1622
Download Slides – www.crawfordadvisors.com/webinars/
Questions & Requests – [email protected]
Please join us for our next webinar!
The Cost of Compliance: Evidence Based Medicine Adherence
Wednesday, March 23
1:00 – 2:00pm EST
