CC Strategy

Clarke & Company utilizes communication between the client and our team to craft an integrated benefits strategy. We need to understand your fiscal and employee needs to develop this strategic plan. As we review your cost and historical claims we have strategic conversations on both your budgetary and employee needs. To review your claims, Clarke & Company Benefits has comprehensive data analytics capabilities. This data analytic tool allows us to produce a health plan and pharmacy management reporting package to our clients. Our data analytics tool is fully integrated with BCBS of SC. Our tool has the ability to benchmark our clients’ data to similar industries by region with a 19 million person employer claims database where we can model plan design changes in real time with cost changes.

Depending on the direction, needs, and goals of the client, there are several different options that can be developed to assist in health insurance programs. Some of these are listed below:

• Integrate a multiple benefit platform of different plan designs
• Incent consumer directed plan designs and reward good health behaviors
• Depending on claims data cost drivers, make plan design changes to affect behaviors and encourage disease management and health coaching
• Review plan funding alternates, fully funded, level funded and/or self-funded
• Tiered networks for providers (subject to carrier approval and funding)
• For healthcare providers, developing internal or high performance networks that utilize internal and external resources
• Wellness credits, deductible buy downs, and other savings measures for employees to participate in wellness programs including biometrics

When using Decision Master Warehouse (DMW) for claims analysis Clarke & Company is able to benchmark to a large database. The database used is Truven Health Analytics Marketscan Database along with the Kaiser Family Foundation. The database includes one of the largest claims aggregators, nationally representing several databases and containing fully-integrated inpatient and outpatient medical claims and encounters. The norms are further customized to meet the needs of the client based on location (specific state, region, and national norms). Some of the database statistics are listed below:

• 6 million lives in the database to benchmark against
• $73.6 billion paid in the database on 19.6 million lives
• 230 million unique patients since 1995 in the database have been compiled

One of the benefits of DMW over BlueData Connect is that we have a dashboard that gives us information on specific disease profiles and how the client relates to normative data. We do not have to dig deeper if we are at or below the norm to determine what is driving costs. We can go directly to the dashboard and easily identify and drill down on our problem areas. The tool is powered by IBM’s Cognos.