Title: Quality Analysis of Employee Health and Health Care Introduction: The issues related to the quality of health plans and the effectiveness and efficiency of their health care services to an employee and dependent population are emerging issues in occupational health management. Analysis of specific markers of quality and performance of healthcare will reveal issues of cost, cost/benefit, health-state drivers, risk factors, and comparison to benchmarks. HEDIS measures related to performance of health plans report only limited information which are not specific to the employee group or industry. Methods: The entire health claims database of a large employer (63,000 members) was analyzed to produce population specific health data analysis. The database included medical claims, pharmaceutical claims, and behavioral health claims. Data was analyzed to produce rates of specific disease states, utilization markers, cost measures, HEDIS measures, and performance measures of providers and health plans. Results: Findings revealed possible under-diagnosis of Diabetes among the population group, prompting development of a company-wide Diabetes screening program. HEDIS findings revealed disparities in healthcare among the four major geographical locations of the employer. Analysis of rising pharmaceutical costs revealed appropriate prescribing methods of maintenance drugs resulted in decreases in absenteeism due to acute disease states. Comparison of behavioral health claims with medical claims revealed disparities in services for same or similar health complaints, suggesting a need for coordination of benefit design. Discussion: Examples of detailed, specific analysis are presented to demonstrate revelations specific to the employer, with discussion of relevance to management decisions and actions.
Learning Objectives: LEARNING OBJECTIVES: Participation in this session will assist the individual in identifying key drivers of health care quality and performance related to specific employers and industries. An understanding of risk analysis, cost/benefit analysis, and benchmarking will be emphasized. Participants can expect to demonstrate the following outcomes or actions following participation in this session: 1. Participant will be able to identify a minimum of 10 important variables for analysis of population specific health data 2. Participant will be able to articulate the limitations of general HEDIS data for measurement of healthcare quality 3. Participant will be able to critically review at least one cost driver(s) of employer sponsored health care 4. Participant will be able to identify two potential areas for further research in their own setting 5. Participant will be able to apply two specific relevant benchmarks by disease state and industry
Keywords: Employer-Provided Health Insurance, Quality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Dyanmic Health Strategies
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am employed by Dynamic Health Strategies. I performed the work as an employee. However, the company's services need not be discussed in the presentation.