In today’s climate, sustainable healthcare savings requires more than plan design. It requires designing behavior — educating employees that healthcare choices are financial choices, guiding them to cost-effective doctors and facilities, and making sure they choose the appropriate care setting at the right time.
Many employers are realizing that this is a new frontier in healthcare cost reduction. This analysis was conducted in early 2018 as an ROI evaluation for a large employer with nearly 10,000 employees across the country. They wanted to know:
- How much were they overspending?
- How much could they save if their employees used Amino to choose care instead?
For the sake of client confidentiality, we’ve chosen to keep the company anonymous — but we’d like to share a few key findings that many employers can relate to.
Without guidance, employees overspent on care
By comparing the employer’s health insurance claims data to our own comprehensive database, we found that they had overspent millions on healthcare last year. Just 25 procedures drove 58% of their total healthcare spend — and much of it was wasted. In our data, we could see that more cost-effective options were available, but their employees had no way to find it.
Just 25 procedures drove 58% of their total healthcare spend for the year — and much of it was wasted. Their employees had no way to find cost-effective care.
Among the cost top drivers were imaging (MRIs, ultrasounds CT scans, X-rays) and preventive care. We found that big price tags weren’t the only problem — cost variation across small bills added up significantly, accounting for more than $1 million in overspend.
The solution? Guide employees to the right providers, facilities, and care settings
With healthcare costs on the rise, the key to sustainable savings is changing behavior at the micro-level: making sure employees choose the most cost-effective providers, facilities, and care settings every time they get a service or procedure.
Amino does this in three key ways:
- Amino uses algorithms to identify providers that are safe, experienced, and cost-effective for your network and each employee’s plan. These providers are highlighted as a SmartMatchTM when employees search for care on Amino — and 70% of people who conduct a search on Amino select a SmartMatch.TM
- Amino has determined a Facility Cost RatingTM for every major hospital and imaging center in the country, which we use to guide employees to facilities that offer the highest quality care at the lowest price.
- Amino guides employees to economical care settings — like urgent care rather than the ER — and surfaces cost-effective options, like telemedicine, at the moment employees are searching for care.
About this analysis
This analysis was conducted in early 2018 as an ROI evaluation for a large employer with nearly 10,000 employees across the country. We have chosen to keep the employer anonymous for client confidentiality. To conduct this analysis, the employer sent us all 700,000 claim-lines from 2017 for employees covered by their Aetna plans.
First, we matched their data to ours by comparing claim lines at the code level — same region, time frame, and procedure types. Then, we calculated “typical” (median) and “cost-conscious” (25th percentile) Aetna prices for each procedure and compared those to the actual costs incurred by the employer in 2017. Due to the complex nature of health insurance claims data, including differences in structure between the two datasets, this matching process isn’t perfect, and cost variation due to inaccuracies in matching will affect the results. While Amino’s dataset is large, there are known coverage gaps which may bias the typical and cost-conscious prices in some regions. As such, figures presented as “savings” or “overspend” are estimates.
Amino can work with large companies using our product to create similar analyses. For more information, contact us at email@example.com.