By: Nic Hayes
Data without context is just numbers. And numbers by themselves are quite frankly useless. When it comes to your health plan, in order to evaluate vendor performance, calculate ROI, and determine where utilization is low, it all starts with good data.
A Full Picture
Providing that necessary data is what Wellnecity prides themselves on as a data driven health plan manager. To provide a full picture of your health plan, Wellnecity sets up a Smart Hub where they take all of the data and information from every vendor in the stack – medical claims, pharmacy claims, eligibility information, point solutions, nurse navigators, pharmacy, etc. – and house it all in one place so that you can see a complete view of your health plan.
By having all of this data housed in one place, Wellnecity can look at the population as a whole and see the disease states of the population, what diseases states are driving spend, and what medications are driving spend. This population data is crucial because it allows Wellnecity and the client to understand what employees and dependents are struggling with on the health plan side. Knowing the pain points of the population also allows Wellnecity’s clients to tailor their vendor stack to address those problems.
Evaluating Performance
Furthermore, the data that Wellnecity collects and houses allows them to evaluate the performance of vendors. For each vendor, however, the way ROI is measured differently. Some vendors make claims of being able to reduce spend in specific areas, so with the data that Wellnecity has, they can take a look and determine what that actual savings number is for the client on a detailed level. Wellnecity can go into the data, identify exactly who the patients are that are enrolled in the specific program, get all of their medical and pharmacy claims, identify pre-activation spend, evaluate post-activation spend, and analyze whether spend actually decreased and if so why. Having this data allows Wellnecity to truly understand the before and after picture so that everyone can be held accountable and understand the ROI and true rates of utilization.
“By measuring key metrics and tracking program utilization, Wellnecity helps clients ensure they're getting the most value out of their healthcare investments," explains John Quinn, Founder and CEO of Wellnecity. "Our data insights empower clients to identify areas for cost savings and optimize their health plan design.”
For partners like Connect Healthcare’s Nurse Advocacy team, having Wellnecity as a data solution is a tremendous help freeing them to truly focus on patient care. “What Wellnecity has been able to do is take off that heavy lift on the Nurse Advocacy team,” Lauren Roberson, Head of Nurse Advocacy, added, “Wellnecity takes that lift off by putting us all into an ecosystem of data.” The Nurse Advocacy team works and communicates with plan members to deliver the best outcomes all while forming a trusting environment so that everyone in the health plan ecosystem benefits. Wellnecity’s data solution aids them in their work by providing them with medical and pharmacy claims allowing them to see a holistic view of what is happening for the patient. Additionally, when the Nurse Adovocates are engaging with plan members, Wellnecity’s solution tracks who is participating and where participation is dropping off allowing the team to push more communication efforts to get members more intrigued about plan vendors and how they can be utilized. Lastly, Wellnecity gets data as frequently as possible, so by partnering with the Connect Nurse Advocacy team, Wellnecity is able to flag plan participants for different programs depending on what the client has in place. Once these members are flagged, they are passed over to the Nurse Advocacy team so that they can immediately start on the case and get the member to the solutions they need.
While the data allows for Wellnecity to evaluate and assess vendor claims, other programs provide more of a member benefit than a financial performance benefit for the plan. For these programs, specific member stories and interactions are key to understanding the program’s performance. With the Nurse Advocacy team being on the ground engaging members from start to finish, they are able to provide Wellnecity with the stories, patient experiences, and highlights that demonstrate the impact of the solution and how it is working for the population.
The impact of this partnership between Wellnecity and the Nurse Advocacy team can best be seen through one of these such patient experience stories.
One month, a plan member reached out to the Advocacy team by replying to one of their monthly newsletters. The member needed help understanding if a medication they were prescribed would be covered under their plan. The Advocacy team was able to determine what tier the medication was on and what the assumed cost would be. Using the data collected by Wellnecity, they were able to see everything that was going on when it came to the member’s health, so they were also able to answer the member’s question regarding whether the new medication would impacts the other medications they were already taking. As the Nurse was walking the member through all of the medications they are currently on, once they got to the prescription-Advil, the member began to talk about the neck pain they were dealing with and how they have seen pain management. By looking at the medical claims, the nurse was able to see that the member had struggled with opiate addiction and misuse in the past, so, instead of sending the member down the pain management path due to this history, the nurse suggested that the member utilize the center of excellence program that was available for free through the employer to check on their neck and get a second opinion on whether or not surgery was necessary to correct a problem. As a result, the member was seen at the center of excellence, got a second opinion on a conservative treatment plan, and is now doing great!
In this case, like many others, the Advocacy team was able to connect with a member at a time of need utilizing the data and visibility provided by Wellnecity. On the impact of this partnership, Lauren Roberson said, “When somebody takes a heavy load of the data lift off and gets all parties to communicate in the health ecosystem, then the advocate team can truly focus on patient care.” And in the end, together they were able to steer the member to the appropriate plan resources to bring about the best health outcomes.
We are proud to feature Wellnecity and Connect Healthcare Collaboration on the Granite List.