THE CHALLENGE
EHE Health has a simple promise to its employer partners: when people take advantage of preventive care services available at EHE-owned clinics or partner providers in the EHE network, it can lower the total cost of care and improve employee health and productivity. Employers with ever-increasing healthcare costs – with close to double-digit increases year over year – know how challenging it is to remain competitive and recruit talented employees while feeling the squeeze of healthcare costs on the bottom line.
The challenge for EHE Health was quantifying the true impact of their services so employer partners could see the tangible benefits of a preventive care program. They had a lot of data on patient encounters at their clinics and with partner providers, but no visibility into total cost of care for the same patients once they got outside of the EHE network. Additionally, they couldn’t compare the results of people who received care in the EHE network with those who went outside the network for preventive care, or those who received no preventive care at all throughout the year.
Another challenge for EHE was the data itself. Many of EHE’s partners, especially large payer organizations, wouldn’t want to share the volume of data that EHE needed to conduct a thorough analysis. Healthcare organizations of all sizes often encounter a similar issue, with vendor partners who cannot or don’t want to share data for security or competitive reasons. Even if EHE’s partners wanted to share their data, the company doesn’t have a way to securely house the information, and thoroughly analyze it, so the added risk of a data breach is not something that EHE or its partners want to take
Everyone can benefit from our preventive care services, and it can save employers money when people engage with preventive care providers. We look at the data and help employers understand the health of their population and their specific needs.
OBJECTIVE
EHE’s program is simple to implement, requiring no plan changes for participating employers. The preventive care services available from EHE are conveniently billed through the medical plan with a single bundled payment for all the services. Both the employer and the employee benefit from a predictable total cost, with no surprise medical bills. Additionally, people who get their preventive care from EHE clinics or partner providers don’t have to worry about whether providers are in-network, whether preventive care services are covered, and what they might have to pay out of pocket.
For EHE, the biggest hurdle was showing employers the quantifiable benefits of engaging employees in preventive care services. They needed access to extensive data, including benchmarking data to compare results from the people who engaged with EHE’s preventive care network to those who went outside the network.
EHE’s bundled services include a wide range of preventive care – from annual checkups to recommended cancer screenings. But finding a way to quantify the impacts on cost, quality, and outcomes would be difficult without access to claims data that allows EHE to compare patients against other groups, like those with PCP visits outside their network, or without a PCP visit at all over multiple years. Cedar Gate’s extensive National Healthcare Benchmark Database, and it’s built-in tools for quickly building cohorts, make it easy for EHE to analyze a wide range of activities and metrics. They started by looking at total cost of care, utilization, and compliance, and plan to expand the cohorts and metrics they analyze in the future.
CGT SOLUTION
EHE Health implemented Cedar Gate’s Value-Based Care Analytics (VBCA) tool to gain greater visibility into the way their services impacted employees’ health, and employers’ healthcare costs.
“The marriage between Cedar Gate’s claims data and the data we have from EHE gives us the next level of insight to see, for example, what happens after someone is referred to a specialist for additional care,” said Rita Parhar, VP of Data Analytics at EHE Health. “Now we can see if a person got their recommended follow-up care, and if not, we can reach out and help them get that appointment scheduled.”
Additionally, Cedar Gate’s reputation as a data-first company provides EHE and its partners with the expansive data they need all in one place. Cedar Gate’s analytics tools – built on an enterprise data management system designed for interoperability – is the single source of truth EHE needed to bring together hundreds of disparate sources into a single, clean, enriched data lake so everyone could work from the same high-quality files. EHE also uses access to Cedar Gate’s data management capabilities and analytics insights as an added incentive for clients to share their data.
OUTCOMES
EHE recently examined data on outcomes for three separate cohorts:
The multi-year, multi-employer analysis of more than 35,000 working-age adults (ages 25 to 64) revealed significant savings on healthcare costs, and better outcomes for patients that engaged in preventive care with EHE network providers, including:
EHE excluded high-cost claimants (people with medical costs that exceeded $100,000 in a year) to improve the accuracy of its comparison study, but did a separate analysis on those claimants in their report. Among EHE patients, the incidence of high-cost claimants was nine people per 1,000 claimants – about half the overall incidence rate of employers’ overall high-cost claimant rates, suggesting that a long-term focus on preventive care can reduce the prevalence of these patients within a population. Additionally, the per-1000 incidence of high-cost claimants within the EHE network was 44% lower than the overall mean for the population, a 58% improvement over patients who received preventive care outside the EHE network and a 67% improvement over patients who received no preventive care.
“We use Cedar Gate’s extensive analytics capabilities to help us demonstrate ROI to our employer partners,” said Parhar. “We have lowered costs, we have achieved cost and quality goals, and now we can put a specific dollar amount around the cost savings and other benefits of continuous, comprehensive preventive care.”
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