Companies Need More Than Employee Claims Data to Improve Overall Health

Data almost always tells a story, and it’s no different when it comes to your employees’ health. You’ve likely been looking at health claims data since early on in your human resources career. That information can be a good transactional view of your total employee population’s use of healthcare services. However, employee claims data by itself can’t assist you in improving employee health or help you lower costs.

To get a stronger picture of the health of your employee population, a much more holistic view of employee health is necessary. That’s where employer-sponsored healthcare models like Marathon Health help. They not only offer onsite health centers, near-site Network centers and virtual healthcare, but the care teams and clinical support teams review claims, electronic medical records, health risk assessment surveys, biometric screenings, clinical interactions, and more to provide you with better data. All of those details can help you put a strategy together to improve employee health.

“Our main goal is to share de-identified, high-level health data and information with our clients to allow them to understand how well their employee population is doing and ultimately help them in maintaining a healthy, more productive and engaged workforce,” says Robert Simes, Marathon Health’s Vice President of Business Intelligence & Reporting.

The Marathon Health teams also leverage data to put together a comprehensive healthcare view of each patient and the entire employee population. “With the data, we can identify healthcare conditions; effectively stratify short, mid- and long-term risks; and also appropriately address clinical gaps in care to work to improve health outcomes and bend the cost curve,” Simes says.

In the initial phases of the partnership with an employer-sponsored health center, employers, unions or benefits consultants can expect to see how many employees or members are engaging with the health center and the types of services they’re utilizing.

For example, Simes says our partners can determine if care teams are seeing a high volume of patients for sick care, health coaching, preventive care services, behavioral healthcare, etc. They’ll also receive early indicators of patient satisfaction. For clients who offer a hybrid approach to care, they can see if employees or even dependents covered under the health plan are using the onsite health center, near-site Network centers or virtual healthcare services.

“As time progresses, we start to link claims data with member experiences with our health centers and through the EMR, we get indicators of clinical success and opportunities to improve overall population health,” Simes says. “Results from Health Risk Assessment surveys, biometric screenings, clinical interactions and claims data all start to paint a picture of the health of the member and the population.”

After 15 to 18 months, Simes says trends in the data will also show the financial success the client is seeing by leveraging Marathon Health. “It’s always interesting to see some of the comments from Marathon Health patients who have been using our services for several years,” Simes says. “If they mention their satisfaction with our clinicians, they also often mention their appreciation for their employer for providing the service. We see engagement, clinical and financial results, along with satisfaction, that clients couldn’t capture before their investment with Marathon Health.”

Engagement data, for example, helps employers and our teams better understand if they need to increase communication about the health center and available services to boost utilization.

Read about the four steps to build an employee communications plan

Lisa Tribble Brown has been a Medical Assistant for Marathon Health for 12 years, where she helps employees who work for the City of Plantation, Florida. She regularly reviews employee health data to connect with patients and get them into the health center.

“We do a lot of outreach, especially for high-risk patients who haven’t been in for a visit in a while,” she says. “A lot of times, I go into the conversation and say… “You don’t want to see me, I miss you.” I put a little guilt in there, start with small talk and then talk to them about their numbers, like blood pressure and ask them if we can schedule their visit.

Lisa says one of the patients hadn’t realized his diabetes had gotten out of control, but with her outreach, she was able to get him in to see the doctor at the employee health center. “He’s on top of it now and he’s doing really well. He’s watching what he eats and he’s also going to an endocrinologist now.”

Care team outreach in combination with employee communication from Beverly Ambrosio, the Benefits & Wellness Manager for the City of Plantation, has yielded successful results. The employee engagement rate with the health center has reached 96%. High-risk employee engagement stands at 100%, and the average member satisfaction rate hovers around 99%.

“I’ve said it from the beginning that Marathon Health knows how to hire the right people,” Beverly says. “We know if we can get employees over the center, the care team will keep them coming back. That’s why the engagement data is so important to us.”

Prior to partnering with Marathon Health 12 years ago, Beverly says they were only using employee claims data to look at the health services used most. “If we saw hospitalizations go up, we would change hospitalization copays. It was straightforward, but it wasn’t resulting in any improvements in overall employee health.”

Today, Beverly is not only seeing engagement numbers, but much more. She receives information on the types of health center visits employees are leveraging, such as preventive care, acute sick care visits and lab visits. She can look at appointments by day of the week and how long the visits last. For example, the average (non-lab) health center visit at the City of Plantation Marathon Health lasts 36 minutes, compared to the US benchmark PCP visit averaging 18 minutes.

Beverly says she receives a lot of other data, and especially likes the highlights that show top chronic conditions among employees and spouses, along with how employees are making improvements in those high-risk health areas overall.

The data helps to drive programming to educate employees, too. “We utilize the information to give us ideas on topics for our Wellness Wednesday webinar series or wellness challenges,” Beverly says. If they see a bump in high blood pressure, a webinar might focus on living better for a healthy heart.

City of Plantation employees get points for attending the webinars and participating in the wellness challenges. They also can earn points for receiving a biometric screening, completing the health risk assessment, getting an annual physical, and receiving preventive care and health coaching visits. “If they get 5 points, they get a $75 gift card. When they get another 5 points, they get an additional $75 gift card,” Beverly says. By incentivizing employees to get healthy, they’re seeing employees get healthy and saving on healthcare costs.

“Literally in the first year with Marathon we had cost savings,” Beverly says. “That was like $90,000 in the positive. Then in year 12, it’s $6.6 million in savings. But most of all, I’m super proud of what we’re doing here to help our employees get healthy. It’s so heartwarming to have employees share their stories of how they got healthy and we have a lot.”

Beverly recalled a story about the wife of one of the city’s employees who came to drop off FMLA paperwork. “She’s handing it to me and says, ‘I don’t know who’s in charge of this Wellness program, but I need to thank them. I need them to know how important this is and what the City does because my husband hasn’t been to the doctor in 17 years and he didn’t want to get help. But, for that stupid $75 gift card, he went.’

“The clinical team got him to go for colonoscopy and they found cancer and now he’s being treated,” Beverly adds. “It’s amazing what they do at the health center.”