In recent years, the number of point solutions targeted at employer health plans has exploded. These services are designed to add value to benefits programs by reducing the cost of care or improving care access and quality for members.  

Many health plan point solutions focus on managing member health conditions, ranging from cardiovascular disease to diabetes, musculoskeletal conditions, mental health, fertility, maternity, and more. Others strive to support members’ lifestyle changes, simplify benefits, or provide access to expert medical opinions. 

With so many options, employers often wonder whether they are getting the most impactful results for both their employees wellbeing and their company’s bottom line. Evaluating the value of multiple point solutions is complex and time consuming, especially if vendor claims about ROI need to be validated. The good news is that a data-driven, population health-based approach can cut through the noise, enabling employers to identify and deploy the best point solutions for their health plan members. The result: better health outcomes and lower healthcare costs.  

As you navigate the sea of healthcare point solutions, here are two important questions to consider…

Which Health Plan Point Solutions Actually Deliver Value to Your Specific Populations? 

Before deploying any vendor as a solution for your populations needs, you must first determine which will be the most effective. That means identifying high-risk health conditions. Risk prediction is only valuable when it’s based on the unique characteristics of your member population.  

Your organization’s medical and pharmacy claims data hold a wealth of insights that can help with this work. Using your medical and pharmacy claims data, you can get a clear picture of your member population’s health profile. It’s critically important to identify which conditions drive the majority of healthcare costs, where utilization gaps exist, and any variance in member engagement patterns based on demographic or geographic characteristics.

TIP: Keep in mind that an organization’s high-risk health conditions may not always align with point solutions

This is especially true for point solutions that take a monolithic approach to care. For example, your members may be at high risk for back pain, but at low risk for knee pain. In this scenario, a point solution targeting all musculoskeletal (MSK) conditions wouldn’t be a good match for your members’ unique needs.

Which Point Solutions Will Deliver a Return on Investment?

Once you’ve gained an understanding of your member population’s health profile, an essential next step is identifying the cost drivers for your organization’s health plan. This will inform which programs have the potential to drive the greatest ROI and therefore should be implemented first.  

The goal is to engage the right members with the right point solutions, create care pathways for them, and guide them to the next best step for their health.  

TIP: Evaluate the integrity of vendor ROI analyses 

Unfortunately, many vendors struggle to quantitatively prove the ROI of their offerings. Vendor ROI analyses may be biased, even if they have been created by seemingly independent, third-party validation institutes. 

It may be beneficial to generate your own ROI analysis for point solutions using member medical and pharmacy claim data that reflects a similar demographic mix as the vendor ROI study. Reach out to the  BenInsight’s team if you want to learn how. 

Point solutions can generate considerable value for employee health plans by improving financial outcomes and enhancing care quality, but the keys to success are identifying the programs that align best with your organization’s needs and optimizing their usage.  

Program evaluation and optimization aren’t one-time events, but continuous, ongoing processes which benefit from in-depth insights about your specific member population, customized analytics, and robust data capabilities. This approach can make the difference between a positive ROI and losing money on point solutions.

Claritev offers a comprehensive set of forward-thinking, data-driven solutions and custom services.