As payors and stakeholders move to more plan-centric health benefits models, fragmentation significantly impedes program efficacy. Point programs added to fill gaps in coverage, and bolt-on solutions, used to supplement cost containment, contribute to a disjointed, complex, and costly benefit strategy.

“When brokers or plan sponsors look for solutions, they need validation of the solution – specific to their plan, so they know if the solution works,” says Kenneth Wener, COO, Prescription Care Management, “Solutions should be vetted, monitored and then reported on. Five solutions across 25 clients mean 125 reports, files moves, setup, and monitoring. How often can stakeholders realistically monitor progress? Fragmentation causes complications and a great deal of overhead when there is so much to monitor and validate.”

In healthcare, fragmentation spans from pharmaceutical manufacturers to providers, health plans to third party payors; however, in the benefits space, fragmentation of data and vendors has the most direct impact on self-insured plans and, fortunately, an easy solution.

Data Fragmentation

Recent legislation empowers payors to demand access to high-quality data from vendors, specifically hospitals, insurers, and PBMs. Improved access should improve clinical outcomes and lead to better financial risk assessment and mitigation.

However, access does not equal connectivity.

Data from multiple sources can quickly complicate plan decisions. Formatting, file loading, managing, and reporting differences lead to more fragmentation of plan data as brokers, consultants, and CFOs piece together a cohesive, high-level view of plan trends.

Payors need to act on and share data to efficiently utilize the increase of data promised by current rules. Getting data out of silos and into a central, single point of truth is the key to defragmentation.

“Data warehouses allow stakeholders to defragment plan data. All of your data – third-party programs, analysis, reporting – in one place in a usable way. Assessable, sharable, and cleaned,” explains Mr. Wener.

By allowing for cohesive plan metrics, a holistic plan view, and better trend identification, data warehouses allow payors and brokers to validate plan decisions and third-party solutions.

Vendor Fragmentation

A recent survey shows that 40% of HR professionals see working with multiple third-party vendors as a leading cause of low participant utilization, which can have clinical and financial side-effects. Confusion and frustration can occur when participants, even a small percentage of the population, are required to engage with benefits through multiple doors, especially when engagement is low touch.

Underutilization of benefit programs not only affects participant health and well-being it also impacts the bottom line. Personnel and financial resources can become strained when benefits departments spend most of their time tracking data or filing paperwork for multiple vendors.

Creating a balance between necessary vendor programs and disruption to participants and the plan begins with engaging a single integrated platform.

Unifying various services helps patients get more proactive with their care, save money, and remain engaged. For plans, streamlining vendor management alleviates strain on vital resources and allows more time and energy to manage and implement positive plan changes.

With data-driven technology, like PCM’s Data Warehouse and interactive Pharmacy and Medical Platform, defragmenting data and vendors is possible. Streamlined management and monitoring results in a better benefits experience for participants and simplification for payors as business scales.

By identifying where data and vendor silos affect participant engagement and plan spend and implementing single, aggregated management platforms, payors and brokers can begin to build sustainable, client-centric benefits.

Implementing a single pharmacy and medical management platform is complex, and that is why Prescription Care Management (PCM) has done the work for you. Our data warehouse and file move tools, along with our interactive platform, provide a holistic plan view. For more information, click here.

Published: October 25, 2021