Healthcare Claims Data Is Becoming Expectation… And Is Possible

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Healthcare Claims Data Technology is Becoming an Expectation

I recently read an interview with Anne Brunson, VP of Service Operations at Maestro Health published in the July 14th issue of BenefitsPRO. In this article, she outlines the trend of self-funded healthcare and the need for claims data to help drive that decision. Data will become increasingly more important in driving plan creation for employers of all sizes. But, the article stops short of addressing that this data has historically been next to impossible for employer groups under 100 participants to obtain. This is where we enter the equation and can help TPAs, brokers, and employers drive better healthcare decisions. 

Access to Real Participant Claims Data is Possible

With our Claims Harvesting technology, Brokers, HSAs, third party administrators, and others can access real participant enrollment and EOB healthcare claims data seamlessly — which is good for employers, brokers, TPAs, and employees alike. 

For example, if an employer is considering going self-funded, Ms. Brunson recommends the employer work with their broker to obtain past claims reports. She goes on to say, the insurer probably will not provide the specific claims data to analyze, but instead could offer reports.

How to Get Real Participant Claims Data

Using TPA Stream’s Claims Harvesting technology, however, the participants provide consent for their claims to be harvested, opening up the opportunity for employers of all sizes and brokers to craft a specific healthcare package that meets the needs of their unique population and controls costs. For the participant, claims are paid faster and more accurately, leading to higher satisfaction with their benefits overall. 

Mitigate Rising Costs with Data

The National Business Group on Health (NBGH) reports that healthcare costs have topped $15,375 per employee last year, and to expect an additional 5% rise this next year. This 5% increase applies to employers that adopt cost management strategies; those that do not make cost management adjustments can expect an increase of 6%. And according to the National Conference of State Legislatures (NCSL), small employers typically pay around 8% to 18% more than their larger counterparts for the same health insurance plans.

Small and medium businesses bear the brunt of the healthcare costs because they do not have the scale to reduce the risk relative to the overall pool of participants. What they can do, however, is obtain accurate claims data to control for the risk by working with a broker or TPA that works with TPA Stream. 

Employers Need Data for Accurate Stop Loss Quotes

Rising costs are even more daunting when we examine the growth in high-cost categories with claims over $1M+. According to the most recent data from Sun Life, from 2016 to 2019, 24% of employers had at least one member with claims over $1 million.

One of the most important decisions an employer has to make is how much stop-loss coverage they’d like to elect. But, without data from Claims Harvesting, fully-insured companies (particularly small and medium-sized businesses) are left in the dark about utilization data, making it next to impossible to obtain an accurate stop-loss quote for their unique member makeup. Typically, the broker uses a model, but these are notoriously unpredictable for smaller groups. 

How to Confidently Transition to A Self-Funded Plan

Data will be increasingly more valuable to the benefits forecasting process. Brokers working with small and medium-sized businesses can help their clients transition to a self-funded plan by implementing Claims Harvesting. In less than 30 days, the broker will have a full picture of medical claims for any population. The process is simple: Employees enroll to provide their claims data. We harvest the claims. The EOBs are securely housed in a HIPAA-compliant database. The data is exportable for further analysis, allowing unprecedented accuracy with plan creation and stop-loss quotes. 

What the Employer Really Wants

Using this data-informed approach, our broker clients can offer high-value consultative services using this data. Employers want technology that allows teams to make important decisions about the health plan of the company. 

We’re on a mission to reduce the friction of benefit information that limits choice and adds costs. Since 2014, TPA Stream’s claims harvesting technology has helped brokers and TPAs provide more customized, profitable recommendations to their clients. We provide accurate, real-time healthcare claim data for any size group, including those under 100 participants.   

Accurate plan creation for clients of all sizes is within your reach. We’d love to show you how. Schedule a consultation call or demo with us. 

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