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Managing through COVID-19: Using integrated data to drive decision making

Benefits Administration and Outsourcing|Health and Benefits|Inclusion and Diversity|Talent
COVID 19 Coronavirus

By Thi Montalvo | July 13, 2020

Despite lingering unpredictability, employers can leverage data to realign benefits, strategies and financial planning for 2021.

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About our Hit Reset on Health and Group Benefits series

This series covers opportunities for employers to evolve their employee benefits strategies as we emerge from the COVID-19 crisis. Our experts provide recommendations on actions employers can take as they re-evaluate benefits priorities, financing and employee needs.

In a span of less than six months, COVID-19 has changed our world in ways unforeseen, and frankly, unimaginable. The changes that have come about for society, the economy, employers, employees and their families have been daunting, requiring us to adapt rapidly. The pandemic has increased the need for data as leaders need it to gain necessary clarity to make decisions and for strategic planning – even more critical in times of crisis and volatility.

Instability from COVID-19 has disrupted employers’ well-laid 2020 plans and budgets. Yet despite lingering unpredictability, employers could be better equipped to plan for 2021 through effective measurement, use of integrated data and by allowing data to enable decisions.

Managing through COVID-19 by using integrated data to drive decision-making

The key for employers is to aggregate and create linkages across data sets to obtain insights that will guide the reshaping of benefit strategies and budgets accordingly. For example, pairing medical claims with non-claims data, such as social determinants of health (SDoH) data, will provide a broader and deeper view of population health, health care inequity, health care utilization and a critical view into what may manifest financially in 2021.

With an eye toward using data to drive benefits and financial planning coming out of this pandemic, employers should focus on three areas of data analytics and insights that:

  1. Reveal the impact COVID-19 has had on health care utilization, such as increased use due to respiratory disease, decreased use due to quarantine and changed use due to the shift to virtual care
  2. Expose disparities that are associated with health care inequities
  3. Provide a range of logical and plausible financial scenarios for 2021
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Health care utilization in the age of a pandemic

Early in the COVID-19 pandemic, many experts predicted large increases in medical spending. For example, in April 2020, the American Health Insurance Plans (AHIP) “estimated that the costs to the health care system from COVID-19 could range from $56 billion to $556 billion over the next two years.”1 What has come to pass has been a rather unexpected turn of events. True, the cost for treating a patient with COVID-19 may be significant, especially when hospitalization is required. However, COVID-19 spending has been vastly overshadowed by a reduction in medical spend and utilization due to deferral and elimination of care during the pandemic.

For employers, the call to action is to understand how utilization patterns have changed as a result of COVID-19 and what implications these changes have for health care value. To take it one step further, employers should look to effectively leverage the data on utilization changes to build strategies that will help sustain appropriate utilization of care such as the decreased use of emergency rooms for minor complaints.

Additionally, employers can mitigate utilization patterns that decrease health care value by, for example, income-targeting providers who suggest unnecessary care as the pandemic recedes. And, employers should monitor utilization data to understand if patterns such as virtual visits will become incremental spend rather than a substitution for in-person visits.

COVID-19 impact on health care utilization, high risk chronic conditions, hospitalizations, medical treatment. Value in maintaining positive utilization change, avoidable ER visits, ambulatory visits, high tech imaging. Value in mitigating adverse utilization change, appropriate ER vists, preventative care, chronic condition monitoring, behavioal health care COVID-19 related health care utilization, orthopedic, biopsies, endoscopies, sterilization, laparoscopies.
COVID-19 impact on health care utilization

The pandemic is shining a bright light on health care inequities

Organizations such as the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Kaiser Family Foundation (KFF) and the Robert Wood Johnson Foundation (RWJF) have aggregated vast datasets and research on SDoH.

The WHO defines SDoH as “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness”. The WHO further indicates SDoH as a “driver of health inequities”.2 The COVID-19 pandemic has brought forth the gravest example of health care inequity as we have witnessed in real-time the racial disparity of COVID-19 fatalities in the United States. The American Public Media has collected data from the 40 states (and the District of Columbia) that provided racial identities of those who have died of COVID. Black Americans continue to die at over twice the rate of White Americans. In June 2020, the data showed3:

COVID-19 Deaths by Race and Ethnicity in the U.S.
COVID-19 related deaths Deaths per 100,000
Black Americans 1 in 1,850 54.6
Latino Americans 1 in 4,000 24.9
Asian Americans 1 in 4,200 24.3
White Americans 1 in 4,400 22.7

Source: The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S., June 10, 2020

The COVID-19 pandemic is an inflection point on the significance of SDoH and race on health outcomes. Employers should look to leverage publicly available risk-factor data to pair with data on where their employees live and work. The integration of SDoH data with an employer’s demographic data and medical claims data provides a unique view into opportunities to close gaps in health care access and services. For example, the integrated data analysis may reveal geographies within the employer’s population that would benefit from partnerships with health plans and/or community-based organizations that have developed initiatives and made investments to address determinants of health such as food security and access to primary care.

What to expect for 2021 financials

With the initial 2020 health care financial projections revised downward due COVID-19 and the unanticipated volume of deferred or eliminated care, the key question employers are asking is: “How much of the 2020 projected yet ultimately deferred spend will be incurred in 2021?” The impact of COVID-19 on utilization patterns has been uneven. Therefore, we recommend leveraging an employer’s claims experience to develop a range of logical and plausible financial scenarios, to determine with reasonable confidence where 2021 financials may land.

The Willis Towers Watson financial benchmark model provides a comprehensive and complete deconstructed view of trend drivers by service categories (e.g., inpatient, outpatient facility, professional and pharmacy) and by type of service within each of the categories. By applying various scenarios of change in utilization to the financial benchmark model, a range of cost projections for 2021 can be best developed and monitored as financial experience continues to emerge.

As we continue to navigate the uncertainty that COVID-19 has brought, one thing is certain: There is indisputable value in integrating datasets to analyze changes in health care utilization, thoughtfully reset priorities to meet the needs of employees and mindfully project financials for 2021. Employers should:

  1. Perform a detailed analysis on health care utilization as a result of COVID-19 to effectively reset strategies and financial projections
  2. Integrate non-claims data such as SDoH and risk factor data to better understand and address the factors influencing health outcomes

Employers will likely be managing the fallout from COVID-19 for the foreseeable future. But by using data strategically, they can not only meet the challenges to come but also gain competitive advantage.

Footnotes:
1. COVID-19 Health Care Costs Could Reach $556 Billion Over Two Years, April 8, 2020
2. The World Health Organization, Social Determinants of Health
3. The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S., June 10, 2020

Author

Thi Montalvo
North America Health Analytics Practice Leader, Health and Benefits