Medical Data Mining Enables Cost Containment, Health Improvement
April 24, 2008
(4/24/08) - "Clients that are using the latest techniques in medical data mining gain valuable insights into cost drivers and disease burdens within their workforces," observes Edward Kaplan, senior vice president and national health practice leader at The Segal Company. "This information enables employers to prioritize cost containment and health improvement strategies."
Among the findings from recent medical data mining for Segal Company and Sibson Consulting clients:
- One employer discovered that approximately 2,000 emergency room visits by employees (30 percent of total) were potentially avoidable.
- Another group discovered that members with diabetes (five percent of the employer's population) accounted for 22 percent of total prescription drug paid claims in 2007.
- The rate of early cancer screenings such as colonoscopies for several clients was well below targeted rates set by cancer experts and the federal government.
- One employer achieved 67 percent generic dispensing rates at retail pharmacies (highest observed of all cases).
- Forty-one percent of one client's participants had one or more major chronic health conditions, accounting for 82 percent of all paid claims.
- Patients with cancer from one organization accounted for one percent of the population and ten percent of total paid claims.
- Diabetes, hypertension and coronary artery diseases were the top reported conditions for seven clients based on dollars spent.
- Beta blocker use after a heart attack (one HEDIS quality measure) was high, ranging from 85 percent to 100 percent of targeted patients from three clients.
Eileen Flick, vice president and director of health technology services at The Segal Company, reports that data mining results are being used to modify plan designs, audit disease management vendors and introduce targeted wellness and patient coaching programs.