Health care data analysis allows organizations to gain insights into patterns and correlations found in their member populations. Lacking those insights, an organization may be basing its population health management decisions on inference and conjecture with little evidence to support its decisions.

The following case study highlights how one Deerwalk customer used our Plan Analytics product along with information on its corporate wellness policies to foster early identification of members with breast cancer and lower associated condition costs.

Medical and Pharmacy Claims Data Review

The customer reviewed members who were in the top 1% of its population based on total dollars paid for the prior 12 months. The organization discovered that six high-dollar claimants who worked at its corporate location and had a diagnosis of breast cancer were driving its healthcare costs. The claims for these members revealed that five had advanced breast cancer and one was identified at an early stage.

The customer initially speculated that women who lived in smaller surrounding communities and commuted to headquarters each day were not getting mammograms. Member level detail screens in Plan Analytics allowed the customer to review and compare each of the six cases:

• All the women were over the age of 40 years.
• All the women had medical coverage for a minimum of at least the last 24 months.
• Two members lived in a small town approximately 20 miles from the corporate work location.
• Four members lived in the metropolitan area where the corporate office was located.
• None of the women had a screening mammogram in the 12 months before their diagnosis.
• Three of the women had not had any physician visit in the prior 12 months before their diagnosis.

The Impact of Corporate Health Care Policies

The company then turned to other factors outside of the claims data. It identified corporate health-related policies and procedures that potentially contributed to the women’s failure to get screening mammograms:

• The company required the member to take Paid Time Off (PTO) for medical appointments.
• Screening mammograms were covered under the group health insurance with a small co-pay.
• Corporate wellness initiatives had focused in the past year on getting employees more active and attaining/maintaining a healthy weight.
• A wellness flyer had been posted on message boards in the work areas which listed recommended age/gender preventive screening exams --- mammograms were included in the flyer.

An Informed Decision

This information gave the customer the ability to make an informed decision on action steps to reduce the impact of its policies:

• The corporate wellness program was updated to include an expanded focus on recommended preventive care along with other health activities. For instance, the quarterly company newsletter began including preventive health information.
• The client contracted with a local hospital to have its mobile mammogram van come onsite 2 times per year.
• Employees were no longer required to take PTO for preventive services/exams.
• Preventive services no longer had any associated co-pays.
• As a wellness incentive, the company awarded an additional two hours of PTO to each woman who had a screening mammogram as recommended by the U.S. Preventive Services guidelines.

A Positive Result

The company again used Deerwalk’s Plan Analytics 12 months after it implemented these steps. It evaluated the outcomes and discovered:

• Only two advanced breast cancer cases were newly-diagnosed during that period. And one of those women was diagnosed after she was referred to a physician following her screening mammogram – done in the onsite mobile mammogram unit.
• Four cases of early breast cancer identified and treated during that same period.
• The rate of mammograms done for women based on national quality recommendations went from 44% to 76%.

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