Friday, October 27, 2023

Breaking Down Employee Benefit Data Silos

Collecting health data can provide numerous insights into cost drivers, unnecessary costs, and potential savings. It is obviously very important to capture this data. Sometimes getting a big picture view of your health benefits isn’t easy. Silos can exist among health data—medical, pharmacy, biometric/wellness, telemedicine, and disease management—obscuring your view of total population health.

Read colleague Sashi Segu’s previous blog, Analytics Gets to the Root of Your Employee Benefit Cost Drivers, to learn more.

The abundance of actionable insight available when you integrate all health program data has been well documented. Here, I am going to break down much stronger silos and discuss human capital analytics—also known as integrated risk management or workforce risk.

Many barriers prevent employers from viewing human capital analytics:

  • Consultants/brokers are contracted to work on different lines of business like health benefits, retirement plans, and property and casualty. Internally, these benefit program functions are handled by different departments, so there is little to no interaction across product lines.
  • The data itself is housed with mulitple third party administrators or carriers.

The abundance of actionable insight available when you integrate all health program data has been well documented, says Brandon Conroy, ASA, FCA, MAAA, Innovu Practice Director, Retirement.

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A Common Issue from Lack of Data Integration

The benefits of holistically reviewing employer benefit programs are tremendous. I’ve provided an example of how these programs intertwine.

Joe is an employee of Company X. Joe is a good employee with an impeccable safety record. Joe’s wife is diagnosed with a disease and becomes a high cost claimant on the medical plan. Joe’s unplanned absences increase because he now occasionally needs to care for their children. Unplanned absences cause a safety hazard at Company X because coworkers take on extra shifts to cover in his absence.

Joe then takes a loan out of his 401(k) retirement plan. Because of all these unfortunate situations, Joe is very stressed. Joe gets into an accident at work, causing a large loss for his company. Joe’s safety record is blemished. Because of Joe’s stress, a couple of worker’s compensation claims have been filed.

Read my previous blog, The Toll of Financial Stress on Health, to learn more.

If Joe’s safety record was looked at in a silo, Joe, a valued employee otherwise, could be fired. Instead, Joe needs assistance. Company X realizes that the financial wellness of the company is lacking, and most employees don’t have emergency funds, causing them to borrow from their 401(k) plan. Borrowing against their 401(k) plans could cause employees to delay retirement.

The Value of a Holistic View of Your Programs

I am going to show you the value of integrating workers’ compensation data, and the additional sightlines provided by using health and workers’ compensation data hand-in-hand.

A holistic view of data can help you identify the ticking time bomb of workers’ compensation cases and how to properly direct a claim. Workers’ compensation professionals can intervene early and deploy the right treatments throughout the life of a claim. The workers’ compensation carrier finds value in member level data to identify chronic conditions and co-morbidities to properly intervene and treat your injured member.

Worker’s compensation carriers can:

  • Assign the claim to a more experienced adjuster
  • Increase the level of managerial review
  • Direct the case to a nurse case manager
  • Retain the best lawyer available
  • Engage a medical professional to help make treatment changes
  • Use a team approach to defend the claim.

By integrating workers’ compensation data with medical and pharmacy data, you get an additional sightline into issues and costs that may be occurring. Integrating these three data sources can identify patients who use all three channels to obtain opioids.

Borrowing against their 401(k) plans could cause employees to delay retirement, says Brandon Conroy, ASA, FCA, MAAA, Innovu Practice Director, Retirement.

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To learn more, read colleague Sashi Segu’s blog, Employers Paying a Large Portion of Opioid Crisis Costs.

Another example of workers’ compensation claims management is when a worker claims a job-related herniated disc injury occurred. A carrier can review medical records more quickly to help determine if the worker had a previous medical claim for a herniated disc.


Comorbidity is two or more medical conditions existing simultaneously regardless of their causal relationship. The presence of comorbidity in a workers’ compensation claim can:

  • Lead to higher medical costs
  • Confound diagnoses
  • Complicate treatment of an injury
  • Delay the worker’s return to work
  • Increase the overall duration of the claim.

The chart below shows the average medical costs for people by number of chronic conditions.

Source: RAND Corporation – Multiple Chronic Conditions in the United States

Breaking down the walls of data silos is imperative for you to get a true handle on your employee risk.

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