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Manage Increasing Health Costs Through Data

All, Employee Benefits

With the rapid ongoing increase in healthcare data, point solutions, and benefits offerings – it can be a challenge for benefits leaders and advisors to know where to focus time and resources. However, M3 and their clients have seen firsthand – when your data has the integrity to tell the full story of your population – you’re empowered to make impactful decisions with speed and confidence.

CLIENT:

Employer client

ISSUE:

Diagnose

When working with an employer client, the M3 team began analyzing the claims trends and quickly realized that over 22% of their client’s total spend was through their pharmacy program. Taking their analysis a layer deeper, they identified the top five medications by total paid accounted for about 50% of the client’s overall pharmacy spend. These insights led the M3 team to believe that an alternative sourcing of specialty medication could be tremendously beneficial to the organization.

Measure

Through the data feeds available through M3 Dataffect, the M3 team could easily track the monthly spend specific to the Rx benefits. They created a focus population (cohort) of members with specialty pharmacy spend in 2020 to track trends in their total spend as the program was rolled out. Additionally, to measure ongoing plan performance for this population, the M3 consulting team collected metrics on total spend, pharmacy spend, and pharmacy utilization.

IMPACT:

Plan

With the plan spend insights in hand, the M3 team identified a Pharmacy Benefit Manager (PBM) with the flexibility and service to assist their client in administering a unique benefit configuration. Next, they sought out an employee advocacy vendor that would help members with this new benefit and locate the alternative sourcing solutions. Finally, M3 needed to ensure that the Third Party Administrator (TPA) could manage and integrate this benefit change. Throughout this process, the team found that when all plan items were set in place, there was an opportunity to reduce their client’s total spend by $34 PMPM (Per Member Per Month).

Evaluate

After the first plan year on the revised benefit, through various reporting analysis, the M3 team uncovered a $407,000 decrease in pharmacy spend for the client – equating to over 40% of their pharmacy spend and more than 10% of their overall spend.

These results occurred without removing the high-cost claims and are also a direct impact to their Stop Loss premiums with the mitigation of this risk from the plan.

Partnerships are wonderful – having the ability to bring multiple stakeholders together to deliver better health outcomes for members and for the bottom line of our health plan. M3 Dataffect allows us to connect all parties involved in a meaningful manner so we can leverage information and tools in order to help the most people live their best life.

— Jason Shanda
Account Executive | M3 Insurance
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