Nathan Kleinman, PhD Senior Research Analyst and Consultant Human Capital Management Services Adjunct Assistant Professor, College of Business University of Wyoming Introduction to Employer Health Benefit Data Types and Uses

 2006 HCMSGroup. All rights reserved. 10/12/2015 Introduction to Employer Health Benefits Data  Types of Employer Benefits & Data  Levels of Data Granularity  Examples of Employer Data  The Need for Data Integration  Data Uses –Business Management –Research

 2006 HCMSGroup. All rights reserved. 10/12/2015 Types of Employer Benefits & Data Types of Employer Benefits & Data

 2006 HCMSGroup. All rights reserved. 10/12/2015 Types of Employer Benefits & Data  Demographics, Salary, Job Type, etc. –Birth Date –Gender –Hire Date –Race –Salary –Exempt Status –Full-time/Part-time Status –Job Type –Job Title –Etc.

 2006 HCMSGroup. All rights reserved. 10/12/2015 Types of Employer Benefits & Data  Health Benefits –Health Insurance (HMO, PPO, Indemnity) –Prescription Drugs (Brand vs. Generic, Tiers) –Dental –Vision –Etc.

 2006 HCMSGroup. All rights reserved. 10/12/2015 Types of Employer Benefits & Data  Health Risk Appraisals –May include questions about: Height Weight Blood pressure Smoking status Alcohol consumption Exercise –May be required to get lower health insurance premium or in conjunction with gym membership –May be administered by corporate doctor or may be self- report

 2006 HCMSGroup. All rights reserved. 10/12/2015 Types of Employer Benefits & Data  Health-related Absence –Sick Leave –Short-term Disability –Long-term Disability –Workers’ Compensation –Family & Medical Leave Act (FMLA)

 2006 HCMSGroup. All rights reserved. 10/12/2015 Types of Employer Benefits & Data  Other Absence –Vacation –Paid Time Off (PTO) –Holidays –Floating Holidays –Military leave –Bereavement leave –Others

 2006 HCMSGroup. All rights reserved. 10/12/2015 Types of Employer Benefits & Data  Productivity, Performance –Population examples Profit per store Graduates per professor –Person-level examples Self-report productivity surveys Manager performance reviews Widgets produced, calls answered, boxes moved per day

 2006 HCMSGroup. All rights reserved. 10/12/2015 Levels of Data Granularity

 2006 HCMSGroup. All rights reserved. 10/12/2015 Levels of Data Granularity  Population –Each record summarizes data for many people  Person –One record per person  Leave –Example: One record per sick leave episode or disability leave of absence –Possibly several records per person  Transaction, Payment –Example: One record per medical service or prescription –Example: One record per disability leave payment –Many records per person

 2006 HCMSGroup. All rights reserved. 10/12/2015 Employer Data Examples

 2006 HCMSGroup. All rights reserved. 10/12/2015 Data Examples – Health Insurance Claims

 2006 HCMSGroup. All rights reserved. 10/12/2015 Data Examples – Prescription Drug Claims

 2006 HCMSGroup. All rights reserved. 10/12/2015 The Need for Data Integration

 2006 HCMSGroup. All rights reserved. 10/12/2015 The Problem of Separate Silos Human Resource Data Workers’ Comp Data Health Care Data Disability Data Productivity Data Sick Leave Data Drug Data

 2006 HCMSGroup. All rights reserved. 10/12/2015 Cost Shifting from One Benefit Silo to Another Total Cost Balloon $$$ Hokey Corporate Benefits Manager

 2006 HCMSGroup. All rights reserved. 10/12/2015 Integrated Information Eliminates Silos Workers’ Compensation Data Drug Data HR Data Sick Leave Data Productivity Data Disability Data Integrated Person-Centric Database Medical Insurance Data

 2006 HCMSGroup. All rights reserved. 10/12/2015 Uses of Employer Data

 2006 HCMSGroup. All rights reserved. 10/12/2015 Business Management

 2006 HCMSGroup. All rights reserved. 10/12/2015 Sample Employee Total Compensation Analysis (A Days Pay for a Days Work)

 2006 HCMSGroup. All rights reserved. 10/12/2015 Sample Integrated Health Benefits Trend Analysis Adjusted for Inflation

 2006 HCMSGroup. All rights reserved. 10/12/2015 Integrated Benefits Management Ad Hoc Pareto Analysis Analytic Finding: 14 percent of the workers used 80 percent of the total health benefits claim cost. Analytic Finding: 14 percent of the workers used 80 percent of the total health benefits claim cost. 8.6% 27.6% 35.2% 14%80% EMPLOYEES TOTAL HEALTH CLAIMS COST Non-Pareto Workers 86% Non-Pareto Costs 20% WC Medical STD/LTD WC Indemnity Group Health Non-Pareto Pareto Pareto Group WC Ind. WC Med.GH STD/LTD Source: OCI Research Group

 2006 HCMSGroup. All rights reserved. 10/12/2015 Person-Centric/Human Capital Approach The Type of People Using Health Benefits Cost per Person % ofLTDSTDWCIWCMGHM All Benefits % of Total People $$$$$$Cost Benefits-Centric/Medical Approach No Disability Claims 90% % With Disability Claims 10%1,2901,9125,3993,3613,39115,35274% Integrated Disability and Total Benefits Management The Type of Health Benefits People Use LTD 3% STD 4% WCI 10% WCM 9% GHM 74% Medical Managed Care Source: OCI Research Group

 2006 HCMSGroup. All rights reserved. 10/12/2015 Increases in LTD Claims Rate From a 10% Increase in each Variable 0.070% 0.324% 0.452% 0.768% 0.833% 0.543% 0.001% 0.003% % %-5.000%0.000%5.000%10.000%15.000%20.000% Suspensions FMLA Claims Medical Insurance Costs STD Claims West Region East Region POS Medical Plan WC Claims 1.310% 1.791% 4.121% % Sick Leave Female WC Wait Period Age % % % Exempt Pay for Performance STD Wait Period

 2006 HCMSGroup. All rights reserved. 10/12/2015 Sample Integrated Health Benefits Pareto Analysis with Dependent Costs QuintileAvg. CostCost RangeMedications 1$1,000$0-$ $5,000$4000-$10,0005 3$15,000$10,000-$25, $30,000$25,000-$40, $75,000$40,000-$450,00016 Average Cost: $2,000

 2006 HCMSGroup. All rights reserved. 10/12/2015 Pareto 1 st and 5 th Quintile Utilization Comparative Analysis Time Period 10/1/04 – 9/30/05 1st Quintile (N=16,000) 5th Quintile (N=200) Ratio of 5th to 1st Percent Change 5th to 1st Number of Diagnoses per person % Number of Providers per person % Number of Medications per person % Number of Tests per person* % *MRI, Radiology, Lab Procedures and ER Procedures

 2006 HCMSGroup. All rights reserved. 10/12/2015 Time Period 7/1/04 – 6/30/05 Diabetes/Cardio Metabolic Integrated Disease Pareto Analysis

 2006 HCMSGroup. All rights reserved. 10/12/2015 Integrated Cost Profile Mental and Nervous Claimants Productivity Loss Cost $4,300 Administrative Cost $854 Other Medical Cost $2,933 WC Cost $1,867 Disability Cost $18,010 3,637 People over 2 years Mental & Nervous ICD9s $854 Total Health & Productivity Cost $28,818 (3% of Total)

 2006 HCMSGroup. All rights reserved. 10/12/2015 Health Benefits Cost Shifting Analysis  Analysis comparing WC costs for HMO and Traditional Health Care Plans # of Employees WC Costs Traditional Health Plan18,000$ 850 HMO4,000$1,200  Potential Savings: $1.4M annually ($350 per employee)

 2006 HCMSGroup. All rights reserved. 10/12/2015 Research

 2006 HCMSGroup. All rights reserved. 10/12/2015 Cost of Bipolar Disorder

 2006 HCMSGroup. All rights reserved. 10/12/2015 Descriptive Comparison Employees with Bipolar Disorder vs. Employees without Bipolar Disorder

 2006 HCMSGroup. All rights reserved. 10/12/2015 Comparison of Annual Cost per Person

 2006 HCMSGroup. All rights reserved. 10/12/2015 Comparison of Annual Absence Days per Person

 2006 HCMSGroup. All rights reserved. 10/12/2015

 2006 HCMSGroup. All rights reserved. 10/12/2015 Real Annual Productivity Output

 2006 HCMSGroup. All rights reserved. 10/12/2015

 2006 HCMSGroup. All rights reserved. 10/12/2015

 2006 HCMSGroup. All rights reserved. 10/12/2015 Average Benefit Cost for Employees with Bipolar Disorder by Medical and Drug Cost Quintile