Using Claims Data to Contain Health Care Costs

The costs of an employee health benefit are like an iceberg: administrative service costs are the tip above the water, and paid claims the far more critical bulk hidden below the surface. In recent years, benefits managers have begun to reorient their attention from the administrative costs to the less obvious but much larger cost-saving potential represented in incurred claims. This shift is occurring because of the variable but shrinking and inevitably limited amounts of money remaining to be saved in the realm of administration of the benefit package, as discussed above, and because there are legions of recognized experts on whom a firm can call for advice—carriers, brokers, fee-paid consultants, third-party administrators, and other kinds of advisers.27 Most large corporations now have in-house managers with the expertise needed to protect the corporation’s interests and weigh the relative merits and risks of alternative funding arrangements. Having made such an assessment, implementation is relatively straightforward; it is a matter of locating the carrier or administrator offering the best package and entering into a contract. The effector arms are easy to identify.