Reinventing How A Public-School Consortium Processes and Interprets Health Data: A Case Study

The Problem

An Ohio based educational purchasing council of public-school districts (Company A), was spending arduous hours manually inputting health plan premiums data via spreadsheets that were compiled and sent in by their insurance carriers. Every month, the Benefit Plan Administrator would manually input:

1. The number of lives per health plan and per district for 150+ school districts
2. The coverage level of each life per plan, including Cobra premiums
3. The calculated stop-loss based on monthly input
4. The calculated dollar amount to be paid to each carrier based on the sum of the variables

This tedious and time-consuming monthly process resulted in inefficiencies and was subject to multiple costly errors to Company A and was not the best use of the Plan Administrator’s time and energy.

Simply put, the process was too manual, time-consuming and ineffective.

The Solution

The problem Company A had is a familiar and surprisingly common one among many employers and organizations: Too much available data without any data organization, governance and interpretation processes in place. This manual, low-tech problem required a high-tech solution.

After an initial requirements-gathering process and feedback from Company A’s stakeholders, Health Cost IQ (HCQ) was able to successfully automate Company A’s manual processes and implement new data management and processing methods that almost completely eliminated manual data input, greatly optimizing workflow efficiency. Utilizing HCQ’s custom-developed web application, the plan administrator’s sole manual intervention that remained after the automation project was inputting monthly premiums.

The Health Data IQ system now pulls monthly data files directly from the carriers and data vendors into Company A’s enterprise data warehouse in order to calculate metrics such as number of lives, coverage levels, admins fees, and more, completely eliminating this time-consuming process for the plan administrator. This data is now presented in a live, interactive dashboard for Company A’s stakeholders to consume wherever and whenever needed.

The Result

In addition to a highly upgraded data warehousing solution, processes, and workflows, HCQ also provides Company A with predictive analytics, risk stratification, risk modeling, population health management and a host of other business analytics dashboards and reports. These sophisticated analytics allow Company A to accurately predict, interpret and act on their health data to make more evidence-based, data-driven decisions regarding their health plans with the goal of improving member care and reducing health plan costs.

Our solution provided Company A the following benefits:

• Thousands of hours of work time saved annually with the complete automation of existing manual processes
• Timelier and more accurate enterprise reporting
• A fully functional enterprise data warehouse solution that automatically acquires and processes data from multiple carriers and vendors on an ongoing basis
• A single source of truth for all enterprise data-related questions and issues
• A very close and trusting working relationship with HCQ and Company A

Unsolicited client testimonial from Company A

“I ran November HCQ reports versus my spreadsheets and can’t contain my excitement 😊 😊. I had to share the excitement with all of you as ALL YOUR HARD WORK IS PAYING OFF!! I am so ready to go live with reports 😊 😊. David, Holly & Khan, I couldn’t have done this without your patience during all our calls, emails to understand our structure craziness!! YOU GUYS ROCK!!! Jude, you have an AWESOME crew working for you!!”

-- Asst. Benefit Plan Administrator – Operations, Company A