The world has become increasingly connected, and virtually every business or healthcare interaction is automatically collected and filed in a database or the cloud. Systems allow the ability to access and use that data in real time. But when the data are not harnessed and used in real time, its value is greatly diminished.
When it comes to health insurance filings, real-time data are rarely used to help guide healthcare decisions, which could help control costs. And because private health plans pay an average of 241% of Medicare, according to one study, cutting costs is a priority.
In most cases, healthcare providers file insurance claims after providing treatment or a procedure. And when an employer has an insurance plan with a carrier or is using an Administrative Services Only (ASO) partner, data feeds based on those claims may come in monthly. As a result, the case manager typically does not see claims data until after those treatments or procedures have been completed, sometimes several weeks later.
When the case manager gets the claim data, he or she usually checks to make sure the patient met the criteria for that treatment or procedure. Then he or she will reach out to the patient to ask how the surgery or other treatment went, whether they contracted any infections, and whether they are completing follow-up treatment such as physical therapy.
Such follow-up is a positive step and may make the insured person feel cared for. But it does little to guide cost decisions or cut costs for the patient or the health plan.
There is a better way: Nightly data, well integrated into care management, can help employees navigate chronic illnesses and serious diagnoses—and ensure employers achieve savings.
When data feeds come in overnight on a nightly basis, the case manager sees activity almost immediately and can talk to the patient before he or she moves to the next step of care.
For example, if an employee has a mass on his brain, his doctor might refer him to have an MRI to help determine whether the tumor is cancerous. The doctor might automatically recommend the MRI center in his hospital, which charges $600 for the test. But if the order comes through on a nightly data feed to the case manager, the case manager can see that another MRI center, five miles closer to the patient’s home, can offer the same test for just $200.
Because the data are available so quickly, the case manager has time to call the patient and share concern about the health issue, as well as provide decision-making guidance. The case manager can share the details about the two MRI options and prices, and even make an appointment for the patient if needed. The case manager can also talk to the doctor to discuss the details before the patient undergoes a treatment or procedure.
Access to daily data allows the patient to have access to care coordination to ensure he receives optimal care, as well as help navigating the system. It allows case managers to identify needed treatments and procedures as they’re happening or as they’re being planned so they can provide guidance that will make patients feel secure, as well as minimize costs when possible.
Employers’ healthcare costs continue to rise: Large employers watched their spending on employee health costs increase 51% from 2008 to 2018, according to one study. And with daily data, employers and their TPAs can help minimize costs along the way instead of waiting to get involved after treatments are completed and charges are already incurred.
To learn more about nightly data can cut healthcare costs, visit https://lucenthealth.com.