Anthem has found a competitive advantage in offering employers integrated health benefits for medical, vision, dental, pharmacy and other services, and in using the data to identify gaps in care across a billion-and-a-half claims a year.
In 2018, Anthem identified 1.2 million gaps in care, including 33,000 diabetes cases through the beneficiary having an eye exam.
WHY THIS MATTERS
Learn on-demand, earn credit, find products and solutions. Get Started >>
Anthem, the employer and the beneficiary save money and see better health outcomes from early identification.
"Every time you can identify a diabetic and manage that earlier, it saves $1,500 annually per beneficiary," said Jeff Spahr, vice president, Specialty Business Development for Anthem's Dental, Vision, Life, Disability and Workers' Compensation businesses.
Anthem has seen significant growth from the integrated health benefits model, according to Nick Brecker, president of Specialty Business at Anthem.
"This has been probably been the key: our customers have found this to be the biggest value driver and has been the single biggest contributor to our growth," Brecker said.
Anthem has been on this path for more than five years, investing millions of dollars each year, Spahr said. The employers are not charged.
The ROI is through the cost savings of identifying health problems early and in connecting the healthcare dots in ways that aren't done when the data is siloed.
THE BUSINESS MODEL
Anthem does most of the analytics in-house, having whole teams that are using AI, machine learning and data science, Spahr said. Though the insurer has leveraged vendors to some degree, there's more value to managing the data internally, and it's a proprietary.
"It's incredibly complex," Spahr said. "We've hired the best in the industry from a data science perspective."
The clinical data, prescription information and other findings are shared with their network providers. Clinical teams get notice of gaps in care.
"We have a data repository within Anthem where the claims and clinical data are collected," Brecker said. "We're able to funnel data to clinical management teams."
Anthem conducts surveys of their employer market every two years. The most recent results show a significant increase in large employer interest in implementing an integrated healthcare approach.
More than 71 percent of the 222 employers with 100-plus employees surveyed are either actively integrating or are considering integrating their medical, pharmacy, dental, vision and/or disability benefits under their employer's health and wellness programs in the next five years, according to the biennial Integrated Health Care Report conducted by research firm TRC Insights, on behalf of Anthem. This represents an 11 percent increase from the study conducted in 2016.
One reason for the growing interest is a competitive workforce market. While the cost and ease of administration remain an important consideration, there is a shift towards hiring and retaining more satisfied workers.
Eighty-eight percent of employers agreed that integrated healthcare benefit programs make an organization a place where people want to work, 90 percent said it makes a compensation package more attractive and 86 percent said it helps to reduce employee turnover and attrition.
Nineteen percent of employers, an increase from 8 percent in 2016, reported initiating their own integration programs because "it's the right thing to do," the study said.
THE DATA AND ITS CHALLENGES
There are unexpected connections in the data collected, especially in the area of prescribed drugs. Of the 25 most commonly prescribed drugs, all have a potential impact on vision or oral health, according to Spahr. A member may be going to an optometrist for blurry vision, which could be caused by an allergy medication.
Prescribing patterns have shown that dentists prescribe about 9 percent of opioid prescriptions, Brecker said.
"We see a tremendous value to our members and the employees of our customers through integration," Brecker said. "We also agree it's a challenge. One of the challenges is to do this well, we need to integrate data across a variety of programs and payers."
Clinical information is often in different siloed buckets.
"There's different dental, vision, pharmacy carriers," Spahr said. "The industry has grown up fragmented."
ON THE RECORD
"By addressing 'whole person health' we can identify and communicate opportunities to positively impact employees' health, provide them with a simplified experience and lower their healthcare costs," Brecker said.
Email the writer: firstname.lastname@example.org