How Artemis Is Using Risk Assessments to Influence Benefits Strategy

With mountains of data coming from all directions, it’s hard for a benefits manager to get a clear picture of their population’s health. Risk scores are one of the ways they bring this picture into focus, and Artemis Health makes it easy. Today we’ll look at how one Artemis customer is using risk scores to assess their population and inform their benefits strategy.

A risk score is a way to determining an individual member’s overall health. Each person’s risk score is based on their demographics, health status, and potential healthcare utilization. For example, someone with a high risk score may have a new diabetes diagnosis, while someone with a low risk score has only visited the doctor for the occasional seasonal cold & flu. When analyzed on a population level, risk scores can help employers assess the potential future health of their population, and even be used to predict future healthcare spend.

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Employers can use risk scores to determine ratio of healthy vs. unhealthy population. If we look at the risk bands in the above Story, we can see how many members fall into each risk category.  Artemis allows users to cross-reference this information with member status (active vs. retired, subscriber vs. dependent, etc.). You can see that for this population, the very high risk members are predicted to incur costs in the $50,000 to $125,000 range.

This gives the employer a basic overview of their population’s health, helps them get a sense for the balance of healthy users vs. high risk users, and offers some demographic information that can be used to conduct further analysis.  

Now let’s look at medical claims and diagnoses for these high risk members.

39 members who were categorized as high risk were treated in the ICU during our analysis period (one year), which resulted in over $100,000 in costs per member. This customer’s data points to “diseases of the heart” as the largest portion of ICU costs. They may take this information into consideration when adding or measuring the success of disease management benefits. As a recent RAND Wellness Program Study points out, disease management initiatives had 30% of a reduction in hospital visits (like the ICU) and resulted in 87% of savings for the employer.

Now let’s look at other trends in our data, but for our lower risk score population, the healthy users:

The data above shows that office visits account for the highest costs at $9.5 million, but ER visits also have a big impact: roughly $2.6 million. Employers can utilize this data to justify adding on-site clinics or educate employees about ER alternatives (urgent care and telemedicine). Benefits managers may also look at common diagnoses among lower risk populations as a means of justifying a telemedicine benefit.

Now let’s look at our potential costs for healthy users:

Here we can see that the majority of low risk individuals will have less than $2,000 in predictive costs. In this customer’s data, we found a relatively healthy population with a low overall risk score. Those with higher risk members would likely be looking at wellness programs, biometric screenings, paid gym memberships, and other ways to encourage a healthier employee population.

So you can see just how easy it is for Artemis to analyze risk scores, find areas for improvement, and make the case for disease management initiatives or wellness programs. These are just a few ways employers are using the Artemis Platform to explore and make decisions about their benefits strategy.