August 06, 2024

At the intersection of increasing health care trend and an array of point solutions, employers are taking a step back to reassess current solutions and ensure that they are impactful, cost-effective and high value. On August 6, 2024, over 40 members met to discuss the challenges and opportunities in measuring and evaluating the success of existing solutions.

Employers Face Challenges when Gathering Data to Assess Effectiveness

Employers on the call indicated challenges in collecting the necessary data needed to measure effectiveness. Many use data warehouses to consolidate data and validate the reporting and return-on-investment (ROI) measures that vendor partners provide. In the same vein, as part of their contract, many employers now require that new vendor partners integrate with their data warehouse and “play ball” with the other vendor partners in their ecosystem. Some employers ensure that new vendor partners can integrate with their existing benefits ecosystem by adding the solutions through existing contracts with other vendors, such as the medical plan. While it streamlines contracts, it can also make employers feel disconnected from some of the vendors in their ecosystem, making measuring ROI and holding partners accountable for outcomes more difficult.

How Employers Measure Effectiveness

Once the data is gathered, employers must then use it to determine whether the solutions they have in place meet their needs and the needs of their populations. Many employers face issues when assessing the effectiveness of new and existing solutions. Common challenges include a lack of data transparency, limited integration capabilities and difficulty validating ROI. Many employers expressed skepticism with the reporting provided by vendor partners, instead turning to cohort analyses, outcomes-based assessments and other third-party validations to measure the effectiveness of current solutions. Leading employers indicated that cohort analyses can illuminate whether a particular solution is working. For example, an analysis can demonstrate whether employees engaged with a musculoskeletal (MSK) solution use fewer opioids than a similar cohort not engaged with the solution. Some have used cohort analyses to illustrate the success of a fertility solution, measuring variables like average treatments to successful births. Other cohort analyses incorporate more broad-based data, including attrition and economic factors, to pinpoint changes in their population.

While cohort analyses can offer significant insights, there are also limitations to the approach. Employers with high turnover indicated that some long-term cohorts were hard to track given their population churn.

Using Data for Change

Even with the insights provided by data warehouses, cohort analyses and other third-party validation, many employers acknowledge that ROI can still be difficult to pinpoint. Outcomes presented by vendor partners may have built-in assumptions (e.g., unforeseen circumstances) that can be murky and hard to verify. Some employers are holding vendors accountable by adding additional layers of evaluation and accountability with their partners. For example, one employer implemented an MSK vendor backed by the Validation Institute. If the MSK vendor does not meet certain performance requirements, the Validation Institute will send the employer a reimbursement. Another employer said all data and reporting shown to their executive leadership team must be vetted by a third party. Likewise, employers are working with carriers, consultants and data warehouse partners to attain data and insights to create compelling stories with data instead of relying on canned reports.

Once the initial measurement is complete and insights are gathered, employers are using the available data to enhance or modify existing programs. One example is claims triggers. Many employers indicated that they use claim triggers to proactively identify and reach out to members who could benefit from available programming. Some claims-based triggers mentioned are pregnancy, cancer diagnoses, GLP-1 prescriptions, high blood pressure, MSK claims and overuse of emergency rooms. One employer even has a dedicated team member that develops the target communications to be used in tandem with these triggers.

Looking Ahead

As employers work to accurately assess and validate vendor solutions from a ROI perspective, some are considering leveraging emerging Artificial Intelligence (AI) and predictive analytic capabilities to enhance these efforts. These approaches are still in their early stages, and most employers have yet to incorporate claims data into AI due to privacy concerns. Nevertheless, employers recognize the importance of measuring the impact of innovative solutions – with some even having data scientists on staff dedicated to doing so. Moving forward, it is clear that employers will continue to enhance approaches to measure and verify vendor programs – safeguarding their investment in employee health and well-being.

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