The power of claims data: How the HTA saved employers $1 billion in healthcare costs

Employers are under increasing pressure to deliver high-quality, cost-effective healthcare plans. But in a country where the cost of care has put roughly 23 million Americans into medical debt, is it possible for employers to save their workers from the same fate?

Rob Andrews, the CEO of the Health Transformation Alliance (HTA), believes it is. Andrews served as a member of the U.S. House of Representatives for New Jersey for nearly 24 years and is considered the original author of the Affordable Care Act. But he turned to the employer and benefits side of healthcare after growing tired of how slow Washington moved.  

The HTA is a nonprofit cooperative of self-insured employers who come together to share their healthcare-related data in hopes of finding shared solutions that lead to better care outcomes for lower costs. Representing 4.5 million employees, the HTA has managed to do just that, saving their employer members over $1 billion collectively. 

The key to unlocking savings isn't necessarily ground-breaking — it boils down to prioritizing health outcomes above all else, underlines Andrews. 

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"Too much money is spent in U.S. healthcare in ways that are unrelated to the outcome," he says. "A radiology center, for example, that has a great record of correctly identifying problems may make the same money a radiology center with a terrible record makes. It shouldn't be surprising that when providers are paid on a basis that is not tied to outcome, they're not necessarily going to do a very good job all the time."

That's why HTA companies pull their claims and demographic data together and see which healthcare providers, medications and treatments are effective. From there, HTA can leverage its size to make impactful agreements with insurance carriers and providers on behalf of their members. 

"We pull this data in a way that still is HIPAA compliant and respects all privacy rights, but permits us to have insights into what's working and what isn't," says Andrews. "We then try to deliver to our members contractual arrangements that are economically superior to what they would have gotten on their own."

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This system also allows employers to see if they are truly getting a good deal with their carrier, since they can compare their health plans to other employers' benefits and annual spend. While Andrews emphasizes that he is not opposed to insurance carriers or pharmacy benefit managers, he does encourage employers to demand transparency, at least when it comes to claims data. 

"Be assertive about your rights to your own data," says Andrews. "So that you can understand what works and what doesn't. That's what we've done in the HTA."

Access to that data can lead to vital solutions that not only save employers money but employees' lives. For instance, HTA employers were able to see the increase of anxiety, clinical depression and substance abuse at the onset of the pandemic. It was obvious employees needed care as quickly as possible, so the HTA partnered with mental health benefits platform Lyra, which has a network of over 20,000 behavioral health providers. And instead of pushing the administrative burden of this benefit on overworked HR teams, the HTA worked with carriers to bring Lyra into their plan structure. Now around 600,000 employees have better access to mental healthcare.

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"You could be waiting to see a psychiatrist or psychologist for three to four months, but the wait time under Lyra is two weeks," says Andrews. "It's still long, but it makes a difference if your family is wrestling with a problem."

Andrews advises employers to exercise more agency in their healthcare benefits, rather than depending on brokers and carriers to find the right solutions at the right price. In fact, Andrews believes it's the employer's place to question carriers, and the healthcare system at large.

"Act like a customer, not a captive," says Andrews. "Carriers and PBMs are paid a lot by employers to help solve problems, and employers have the right to hold those intermediaries accountable for problems." 

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For Andrews, employers are the biggest hope the U.S. has for healthcare reform. Andrews saw firsthand how little is accomplished at the government level, but he is optimistic that employers and organizations like the HTA can make a difference. 

"Candidly, the government is a slow, arthritic and sometimes aimless process," says Andrews. "But employers have the tools at their disposal to act more swiftly and more decisively and create benefits that spread to the rest of the healthcare economy."