How We Do It

Employers who self-insure are in a unique position because they own the medical and pharmacy claims that they pay. A self-insured employer working with us directs its TPA and PBM to send us its claims data. The employer then also sends us its HR records because inside those human resource files live the outcomes of the claims. These data feeds occur monthly over our secure FTP site, and everything is HIPAA and SOC compliant.

Other analytics firms may slice and dice the claims. Only we see the entire healthcare value equation, the claims, along with the productivity costs of the employees being off work and the outcomes of the care.

We define a good outcome as the employee returning to work. We then rank each provider on each condition based on their average risk adjusted cost to return an employee with that condition to work. And the costs are not only the claims, but the productivity costs of medical absences too.

Our analytics platform consists of layers of algorithms that sift through the employer’s claims and HR data. The end result is that for each diagnostic condition we rank the doctors and other providers in the employer’s network, and then calculate the opportunities for savings by steering the employees and their dependents away from the low value providers.

First, our algorithms group the claims by diagnosis, linking together all of the related claims on a patient-by-patient basis. We then combine the HR records with the claims and determine how long the employee was off, calculating the cost of the absence–and the cost of the employee being off can be several times the claims cost!

After combining the claims and productivity costs, we risk adjust the total. Young healthy employees should have lower costs than older ones with chronic illnesses, so we level the playing field.

Next we calculate each provider’s average risk adjusted cost for each diagnostic category (back pain, asthma, etc.). Those doctors whose average cost for a category is above the group average‒the low value providers‒are costing the employer too much.

When making these calculations, we pool the data so that all of the employers in a given geography benefit from each other’s experience. Each employer, however, only sees its own data on our web portal.

Our analytics platform is so revolutionary that we have patents pending on it.

To help employees and their dependents find the best doctors and hospitals, we encapsulate our rankings in a QScore–the higher the score, the higher the value of the doctor or other provider for a particular medical issue or procedure. All we have to do is show the employees how to find the high value doctors and they will, because if you have a heart condition or a sick child, who wouldn’t want to go to the top ranked doctor?

Employees just go to our web portal and enter their issue, such as a bad back or migraine headaches, and then we find the high value doctors and other providers for that problem in the employer’s network located within the employee’s geographic area. Alternatively, the employee can call our 800#, chat online with one of our healthcare counselors, or email or text us. During a call or chat we can even book the employee’s doctor appointment. We’re happy to get the employees and their dependents to high value healthcare in whatever way is easiest for them.

We also make a portal with the QScores available to all the primary care physicians in the employer’s network to use when referring the employees and thier dependents to specialists and surgeons, where high costs can flourish.

To maximize savings, an employer would roll out both portals. An employer, however, can choose to roll out only the portal to the primary care physicians. Most of the savings will be with the specialists and surgeons, and as this portal doesn’t touch the employees all the effort and expense of rolling out something new to them is avoided. With just this portal, an employer also doesn’t have to wait until the start of the next benefits year to begin.

An employer that has an HDHP with HSAs can even encourage employees to go to the providers with the highest QScores by contributing to their HSAs. The employer can structure these contributions so that it still pays less overall, with its employees now receiving better care.

An employer won’t get all of the employees and their dependents to go to the best doctors and hospitals, but it doesn’t have to‒the opportunities for savings are so fantastic that if just a fraction move the employer will reap a windfall!

Result = Decreased Costs + Better Care

By steering employees and their dependents to the high value doctors, hospitals and other providers:

Getting Started

To show an employer its opportunity for savings, we model the past three years of the employer’s claims data and HR records. The employer’s own data shows how much our proprietary analytics could save, and when we begin an ongoing relationship we have a three-year head start and a robust data set beginning on "Day One."

Moving to an ongoing relationship, the employer sends us its claims and HR data on a monthly basis. The employer, the employees and their dependents, and the primary care physicians in the network then have access to portals that contain real-time rankings of the doctors, hospitals and other providers in the employer’s network, along with dashboards and various reports.

We charge on a PEPM basis (per employee per month) plus a percentage of the net claims savings.

To begin, please contact us through the form below or by sending us an email at sales@integerhealth.com.

Stop-Loss Insurance Premiums

As we decrease the employer's medical and pharmacy claims, a side-benefit is that the employer's stop-loss insurance carrier should also decrease the employer's premiums for this coverage because the likelihood of the employer breaching the stop-loss threshold decreases.

YouTube Channel

We have an IntegerHealth YouTube channel and on it are several videos, including a three-minute profile explaining a little more about us, both a short and detailed presentation, and an educational presentation entitled "Decreasing Healthcare Costs While Improving Care with Data Analytics" that we give at conferences and to employee benefit and HR groups. You can also view these videos on the "Resources" page of this website.

Other Services

Personal Care Plans

As an outside third-party, we can analyze individual healthcare data that HIPAA bars an employer from accessing. Accordingly, we can use our analytics platform to identify the high risk individuals in a healthcare plan. Generally, a small number of a plan’s participants‒those with chronic illnesses‒account for a large portion of the plan’s costs.

These chronic illnesses include asthma, behavioral health, COPD (chronic obstructive pulmonary disease), diabetes, and hypertension (i.e. high blood pressure).

We will already be decreasing the costs of the high risk individuals with these chronic illnesses by steering them to high value doctors. By also placing them on personal care plans we’ll drive down their costs even further.

Although generic wellness programs don’t work, returning only 50¢ for each $1.00 spent, personal care plans tailored for high risk individuals do, returning $3.80.

As part of the personal care plans, our medical professionals perform annual health assessments and quarterly check-ups on the high risk individuals at the employer’s facilities. We bill these assessments and check-ups as medical claims to the TPA under the employer’s healthcare plan.

Health Assessments

On a variation of the above, instead of performing annual on-site health assessments on only the high risk individuals that our algorithms identify, we can perform them on all of the employees and covered spouses. The advantage of this expanded program is that we can identify additional high risk individuals and place them on personal care plans too. The health assessments also give us additional data on which our algorithms can work. Like the above program, we then put the high risk individuals on personal care plans and monitor their progress quarterly, billing the health assessments and follow-up visits as claims.

Plan Design

We may recommend changes to the employer's benefit set based upon our modeling of the employer's past data. Our solution works quite well with an HDHP with HSAs, along with the employer contributing to the HSAs to reward suggested choices (e.g. taking a health assessment, choosing a high value doctor, etc.). Even though an HDHP has a high deductible, the employees don't have to pay more than before because the employer will be making these HSA contributions.

An HDHP with HSAs make the employees the partner of the employer in driving down healthcare costs. The money in the HSAs (including the money contributed by the employer) belongs to the employees. Unused money rolls over from year to year. As the employees are spending "their" money, they make better healthcare choices, such as engaging in preventive care, using generic drugs, and opting for less invasive and expensive treatments.

RAC Services

In addition to using our analytics platform to identify the high value providers, we can use it to audit the medical and pharmacy claims that the TPA pays. We then share in any overpaid or unnecessary claims that we identify that the employer recovers.

Workers’ Compensation

We can also use our analytics platform to decrease the costs of self-insured, and non-subscriber self-funding, workers’ compensation programs. Similar to our healthcare plan services, we identify the high value doctors and steer the employees to them. When the employer has established a provider panel to handle its workers’ compensation claims, the employer can eliminate the low value doctors from the panel, creating immediate savings.

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