We give insights into your data that can reduce costs and increase effectiveness

    Using a robust data analytics platform, our in-house team performs a monthly analysis of medical and pharmacy claims incurred by a large, self-funded manufacturer. In addition to comparing current spend to budget, gross claim amounts, cost per member by relationship and a host of other data points, considerable time is invested analyzing high-cost claimants and points of care.

    By keeping a finger on the pulse of the plan year-round, our team can identify troubling trends and look for cost-control interventions.


    A year-to-date comparison of members visits revealed a 5% increase in emergency care visits for this client and a 19% increase in outpatient visits.

    Observation: Data revealed the increase in emergency room visits was attributable in large part to non-life-threatening incidents. Members sought care for strep throat, back spasms and flu-like symptoms, all of which could have been treated in an urgent care or primary care center at significant savings to the patient and the plan.

    Intervention: Our Bukaty team developed an employee communication piece that compared costs in the different care centers. The piece was designed to bring greater awareness to the appropriate use of emergency room services versus urgent care and primary care settings. Additionally, this topic is addressed in all annual enrollment materials to keep it top of mind.

    At first glance, the increase in outpatient visits seemed alarming. However, our data drill down discovered that the increase in outpatient visits was directly related to a significant decrease in inpatient visits. Outpatient copay and coinsurance amounts were set to incent members to seek care early to avoid more costly in-hospital care.