Change the Benefits Game with Comprehensive Data Analytics

According to PwC’s Health Research Institute, employers’ medical costs are projected to rise nearly 8% in 2025 – a growth rate the industry hasn’t seen in more than a decade. Along with ongoing inflationary pressure, PwC said factors such as increased utilization of inpatient care, behavioral health services, and weight-loss drugs will drive additional spending.

This sobering trend indicates self-insured employers and payors must take meaningful steps to manage healthcare costs. One such step is optimizing benefits offerings so that what’s made available to employees/members generates improved health and financial outcomes. This is especially important for preventive care offerings for which the value proposition is clear but the return on investment (ROI) is not.

Determining the effectiveness of benefits is difficult without integrated data sets, benchmarking metrics, or purpose-built tools for optimizing plan design. BenInsights brings together disparate data and provides insights that enable employers to take action – and it comes with Claritev’s industry-leading expertise in delivering customized solutions for an employer’s unique needs.
 

Meaningful insights for maximum value

In addition to traditional data sources such as enrollment, medical claims and pharma claims, BenInsights ingests data from the many point solutions that complement an employer’s benefits offerings. After normalizing and deidentifying these data sets, BenInsights applies proprietary logic such as predictive models for spend or risk. The output of this analysis is a set of plan design recommendations that can help all payors maximize the value of the benefits they offer.

BenInsights helps employers in two important ways. One is overcoming the obstacles of bringing together data from multiple sources, losing data history when changing carriers, and receiving limited data on point solutions. With BenInsights, HR teams can now examine benefits offerings in a holistic way and better align decision-making with business objectives.

The other is enabling self-insured employers to provide more effective preventive care offerings. Using BenInsights, organizations can identify employees with emerging medical risks and make data-driven decisions about how to best meet their needs. While self-insured employers have many preventive care priorities, at Claritev we see three common areas of focus for 2025:

Muscular skeletal (MSK) conditions. Hip and knee replacements not only contribute to high medical costs; they also adversely impact productivity while employees take the necessary time to recover. Identifying employees who may need surgery in the future and navigating them to the appropriate preventive care resources can drive down utilization of expensive and invasive procedures while also improving employee quality of life.

Cancer screenings. According to the American Cancer Society, rates of diagnosis are rising for many of the most common forms of cancer – and for Americans under 65. Here, self-insured employers benefit from identifying at-risk employees and offering proactive reminders to utilize screening services covered by insurance. Additional analysis and consultation with Claritev experts can help determine whether a company should also consider broader coverage of downstream cancer prevention care options.

Weight loss. Though GLP-1 medications remain popular, their long-term effectiveness is under debate – both for clinical and financial outcomes. By combining medical claims and drug utilization data, BenInsights can help self-insured employers analyze the many options available for lifestyle and nutrition management that complement use of GLP-1. Doing so can help increase adherence with GLP-1 regimens, support employees’ efforts to achieve meaningful lifestyle change, and contribute to favorable long-term outcomes.
 

Benefits for the right populations

Both benefits offerings and digital health solutions are diverse. Evaluating them in a piecemeal manner is time-consuming. In addition, the data available from vendors and carriers can be limited. Without a holistic view of how employees use benefit offerings, as well as how those offerings impact the bottom line, HR teams struggle to make informed decisions.

BenInsights helps close these data and insights gaps. Beyond that, the combination of technology, process and people makes it possible for employers to run ad hoc queries, create custom reports and run what-if scenarios for plan modeling. This can help organizations engage the right members and impact the right population, which in turn supports the process of design compatible and competitive plan offerings. HR teams can also set realistic expectations for point solutions’ ROI, which helps secure buy-in, avoid sticker shock and make programs scalable.

Recently, a multinational company operating more than 100 sites in the United States demonstrated meaningful results from its BenInsights implementation. Driving engagement to colorectal, breast and cervical cancer screening services resulted in hundreds of additional screenings for at-risk employees. Increasing preventive care options for employees with MSK conditions led to year-over-year savings of more than $100,000. Finally, BenInsights highlighted the impact of expanding fertility lifetime medical and lifetime pharmacy coverage in response to a 22% increase in fertility treatment costs.

Learn more about BenInsights and the risk analytics and insights services available from Claritev.