The Benefits of Data

© 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 1


Vickie Rice, GBASolutions Manager, Data & Analytics

© 2015 Benefitfocus.com, Inc. All Rights Reserved 3

All Your Benefits. One Place.• Founded in 2000• NASDAQ: BNFT• Headquartered in Charleston, SC• Offices in Greenville, Tulsa and

San Francisco• Over 23 million consumers

© 2015 Benefitfocus.com, Inc. All Rights Reserved 4

Transforming the Way Benefits Are Managed

Voluntary Benefits

Financial

Third PartyAdministrator

Broker Consultant

Government Reporting

Health Insurance

LEGACY ERP/HR

The Old Way The Benefitfocus Way


7-15% 70% 4%Percent of healthcare costs are

rising on average per yearPercent of all healthcare costs caused by unhealthy behavior

Percent of companies can perform predictive analytics

about their workforce

The Facts about Healthcare Data

Strategic benefit administration is only as good as the data that drives it

Aggregating enormous amounts of data will be essential

Make data useful and actionable to drive decision making



Employer vs Benchmark: Cost Per Employee

National, Ove

rall*

200 or More EEs*

South Region*

State/Lo

cal G

overnment

$0.00

$2,000.00

$4,000.00

$6,000.00

$8,000.00

$10,000.00

$12,000.00

$14,000.00

GroupBenchmark

2014

National, Ove

rall*

200 or More EEs*

South Region*

State/Lo

cal G

overnment

$0.00

$2,000.00

$4,000.00

$6,000.00

$8,000.00

$10,000.00

$12,000.00

$14,000.00

GroupBenchmark

2013


National My Size My Region My Industry My Group$8,000.00

$8,500.00

$9,000.00

$9,500.00

$10,000.00

$10,500.00

$11,000.00

$11,500.00

$12,000.00

$12,500.00

$13,000.00

20132014

Employer vs Benchmark: Cost Per Employee

© 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary 9BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary


+ + +

Tailoring Benefits Plan Design

What have we been spending on healthcare?

Who’s on our plan? What will be spending in the future?

How can we lower expected costs?

= Custom Benefit Plan Design

BENEFITFOCUS © 2015 Benefitfocus.com, Inc. All Rights Reserved | Confidential & Proprietary


First Things First – Get Access to your Data

Benchmark Data Case ManagementWorkers comp Premiums

Claims Member Eligibility Misc. FinancialHRA/BiometricsPBM/Rx

Secure UI

DATA WAREHOUSE Episode Grouping Engine


Learn About The Past

Jan Feb Mar Apr May

$1,046

$663

$1,118

$897

$1,249

$441 $286

$482 $387

$540

PEPM PMPM


Who’s on your plan?

940

66Employee Gender Member Gender

1,508

1143



Employee

Dependents

$2,933,767

$2,148,982

And how do they affect your cost?


If you don’t make any changes, what can you expect to spend in the future?


• Multiply your current expenses by – National Trend (7-15%)– Your group’s trend (4%)

• Hire an Help– Consultant– Actuary

• Know and understand the health of your population and how that impacts your plan’s financial risk

How Do You Determine What the Future Will Cost?


• Hierarchical Condition Categories (HCCs): Part of the Medicare Advantage Program for CMS, HCC contains 70 condition categories selected from ICD codes and includes expected health expenditures.

• Adjusted Clinical Groups (ACG): Developed at Johns Hopkins University, ACG uses both inpatient and outpatient diagnoses to classify each patient into one of 93 ACG categories. It is commonly used to predict hospital utilization.

• Elder Risk Assessment (ERA): For adults over 60, ERA uses age, gender, marital status, number of hospital days over the prior two years, and selected comorbid medical illness to assign an index score to each patient.

• Chronic Comorbidity Count (CCC): Based on the publicly available information from Agency for Healthcare Research and Quality (AHRQ)’s Clinical Classification Software, CCC is the total sum of selected comorbid conditions grouped into six categories.

• Minnesota Tiering (MN): Based on Major Extended Diagnostic Groups (MEDCs), MN Tiering groups patients into one of five tiers from Tier 0 (Low: 0 Conditions), Tier 1 (Basic: 1 to 3), Tier 2 (Intermediate: 4 to 6), Tier 3 (Extended: 7 to 9), to Tier 4 (Complex: 10+ Conditions).

Member Risk Scores


Member Risk Scores

Prescription Compliance

Frailty

Pregnancy

At-risk Births

Emergency Room Utilization Patterns

Non-Chronic, Expensive Treatments

Likelihood of Hospitalization

Chronic Conditions


No Conditions 1 Condition 2 Conditions 3 Conditions 4 Conditions 5 or More Conditions0

100

200

300

400

500

600

700

615

20198 65 24 11

What are your plan’s Comorbidity Rates?


Individual Predicted Risk


Enrollments, Payments & SavingsHealth Plan Contracts 1,032

Health Plan Members 2,739

Members Per Contract 2.65

Average Member Age 33.47

Average Employee Age 48.15

Predicted Resource Index - Local 2.35

Inpatient Facility $251,631.58

Outpatient Facility $2,240,433.60

Outpatient Professional $1,447,140.33

Prescription Drug $1,143,544.85

Total Plan Payment $5,082,750.36

Total Medical & RX Payment $5,082,750.36

Predicted Cost Amount $11,944,463.35

Total Charges $10,931,271.80


Employee Responsibility $535,141.54

Exclusions $1,562,667.63

Other Insurance $125,633.44

Overall N/W Savings Amount $3,631,919.28

Aggregate Risk



Enrollments, Payments & SavingsHealth Plan Contracts 1,032

Health Plan Members 2,739

Members Per Contract 2.65

Average Member Age 33.47

Average Employee Age 48.15

Predicted Resource Index - Local 2.35

Inpatient Facility $251,631.58

Outpatient Facility $2,240,433.60

Outpatient Professional $1,447,140.33

Prescription Drug $1,143,544.85


Total Medical & RX Payment $5,082,750.36

Predicted Cost Amount $11,944,463.35

Total Charges $10,931,271.80


Employee Responsibility $535,141.54

Exclusions $1,562,667.63

Other Insurance $125,633.44

Overall N/W Savings Amount $3,631,919.28

How does predicted risk affect future cost?



Now What?

Investigate Ways to Affect Change– Plan Design– Wellness Programs– Medical Tourism– Onsite Clinics

Budget Accordingly


Fact-Based Plan Design


Fact-Based Decisions



What About Our Employees?


Fact-Based Plan Selection


The Benefits of Data:


A MATTER OF

FACTS. www.Benefitfocus.com



Learn more about the benefits of data at www.Benefitfocus.com

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The Benefits of Data