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How to Predict Next Year’s Largest Insurance Claim

How to Predict Future Claims with Population Health Analysis

Every year companies experience unexpected expenses, and the most costly can be in health insurance benefits. Ultimately, if your business doesn’t know how to predict which employees will have the highest number of costly claims next year, you could be in serious trouble. 

It’s up to business owners to stay vigilant when it comes to their employees’ health to make sure everyone gets the care they need before expenses get too far out of hand. Without the proper insight, you may be overlooking important risk factors that could threaten your business, such as high cholesterol or high blood pressure—both of which are often completely preventable. 

Fortunately, taking the time to do a population health analysis will allow you to identify these risk factors and implement programs to reduce them before they result in expensive claims.

What Is Population Health Analysis?

Simply put, “population health analysis” is the collection of data to predict potential risk factors in your employees’ health. This data can then be used to determine what claims will be made next year, while also giving employers the opportunity to put strategies in place to prevent the most expensive claims.

“By aggregating all that data, we’re able to see if the big risk factors are present, like hypertension, diabetes, and obesity,” says Travis Riker, Vice Principal of Client Solutions at Arista Consulting Group. “You first must know what’s going on so you can understand where you need to go next.”

The Benefits of Predictive Analytics in Claim Prevention

With a proper population health analysis, you can predict your company’s claims, which in turn provides opportunities to reduce risk and implement cost-saving measures.

For instance, when Arista partners with a third-party company to provide our clients with health insurance predictive modeling, our next steps include supplying:

  • A breakdown of what the data means
  • Predictions for next year’s largest claimants
  • Actionable strategies to reduce risk factors
  • Benchmarks of measurable success
  • Proactive employee outreach methods

“You can’t manage what you can’t measure,” says Riker. “What you don’t know can and will hurt you.”

Should a business not leverage such an analysis for health insurance claim prevention, the risks go beyond employee absenteeism due to sickness and costly insurance claims; you also lose negotiation power during the renewal process of your insurance

“If you don’t have this data, you lose leverage with your insurance providers,” Riker says. “When we work with a client and have had a population health analysis implemented, we can then come to the negotiating table with the deck stacked in our client’s favor. We can call bluff on the insurance companies who may say they’re expecting all of these large claims, because we know all of the precise data ourselves.”

This has a tremendous impact on the financial well-being of companies renewing their insurance.

Managing Risk Factors

Above all, maintaining a healthy workforce is key in preventing unnecessary insurance claims. Conducting a population health analysis of your team allows you insight into the specific health issues your employees are most at risk for, which you can then use to put forth preventive measures that will reduce their likelihood of needing medical care.

So, what kind of strategies can companies put forth to lower risk?

To foster a healthy culture in the workplace while also preventing hefty insurance claims, consider the following tactics:

  • Offer wellness programs and on-site clinics to control chronic illnesses
  • Ensure employees understand their benefits include well check-ups to get ahead of preventable issues
  • Encourage a physically active lifestyle through team sports and field days
  • Offer one-on-one meetings to go over benefits plans

Employer Takeaway

Predicting insurance claims is not only doable, but one of the wisest financial decisions you can make for your company. Moreover, it is integral to the overall health and well-being of your workforce.

By conducting a population health analysis, businesses are empowered to put forth strategies that could prevent future claims, as well as negotiate lower rates with their insurance companies. Understanding your risk factors is key to developing proactive solutions that will keep your company healthy as you grow.

At Arista, we work side by side with our clients to provide the corporate insurance risk management they need to reduce costs. Get ahead of next year’s largest insurance claims by contacting us today.

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