FInancial Crisis
FINANCIAL CRISIS IMPACTS HEALTH BENEFITS



In the midst of one of the worst financial crises in the nation’s history, corporate executives
are concerned about the impact on their company, their access to credit, and their cash management strategies.

Ask yourself these questions:
• Is the data we receive from
our health plan vendors
complete and reliable?

• How much are we spending
on consulting services
to analyze the data?

• Do we have timely access
to the information necessary
to understand the true
drivers of health benefit
costs?

• How will we fund our reserves
or borrow money in
order to come up with any
shortfall?

• How can we reduce the
cost we are spending on
data warehousing and employee
portals?

It is more critical than ever to scrutinize where money is being spent and the ROI for those financial investments. One area where costs continue to increase at a rate double that of inflation is your employee health benefit programs. The current credit crisis dramatically increases the overall financial risk of self-funded health benefit plans due to unpredictable future costs and the resultant impacts to cash flows.

So what can be done to minimize financial risk and maximize financial performance of your health benefit programs?

VitalSpring Technologies can help you validate your investment in your health benefit programs. As a first step, we recommend you conduct a Data Quality
Audit to evaluate the correctness and reliability of data you receive from your health benefit vendors.

Based on our industry best practice data quality management processes, VitalSpring can show you where your existing data is insufficient, and if you so
choose, make recommendations on how to improve the data you use to make critical health benefit decisions.

Some of the data gaps we see that can have a costly financial impact include:

  • Social security number or date of birth fields are not in proper and expected order according to the vendor’s data layout
  • Missing ICD-9 diagnosis codes
  • Missing provider specialty codes
  • Lack of in-network/out-of-network flags
  • Missing specific revenue codes
  • Non-summing paid amount fields do not match your total employer and employee responsibility
  • Discount and non-coverage amounts are not provided
  • Enrollment data contains gaps even after vendors rules are applied

VitalSpring’s Data Quality Audit consists of the following steps:

  • VitalSpring acquires 1 enrollment and 1 medical feed from you or your third-party administrator
  • VitalSpring conducts data quality processing
  • VitalSpring provides a report of findings (within 4 weeks after receipt of data)
  • As an optional service, VitalSpring will present recommendations to improve data quality and work with your carriers on data improvement measures.

To learn more about how VitalSpring can help you maximize your health benefit investment, please contact us at dataquality@vitalspring.com


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