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May 8 , 2006
New project will help fine-tune health insurance,
wellness plans

BY michael terrazas

It’s no secret that health care costs have been climbing far more rapidly than inflation in the last decade, and analysts expect that trend to continue nationwide in the next several years.

To provide the best, most appropriate health insurance plans—and at rates that don’t become financially unsustainable—Emory has launched a new program, called the Management Service Organization (MSO). Using anonymized data, the MSO will analyze health insurance claims made by all University employees and dependents, study them for trends, and use the information when designing insurance plans and health-management and wellness programs.

Provost Earl Lewis and Theresa Milazzo from Human Resources (HR) rolled out the MSO program in face-to-face presentations to campus governance groups in April, explaining how it works. The concept is actually rather simple: Emory’s insurance companies (Aetna, Blue Cross Blue Shield, Medco and United Behavioral Health) collect all Emory insurance-claim data over a given period and send them to a third party, called ManagedCare.com, whose job it is to completely scrub the data of all information that could be used to identify individual claimants. ManagedCare.com then makes the data available to Emory for analysis after it is anonymized.

Each individual claim is assigned a randomly generated ID number to enable ManagedCare.com to combine data by individual across the vendors. The random ID numbers prevent Emory from determining the identify of the individuals who file these claims. In fact, as a further step to protect employees’ privacy, data analysis is handled by a team in Emory Healthcare (EHC). EHC Information Systems has installed a dedicated server especially for this project, further segregating and safeguarding the information. The claims information will be used only by the MSO; it will not be available for other research purposes.

The MSO is overseen by a board made up of the provost, the executive vice presidents for finance and health affairs, the EHC chief counsel, the top HR officers from both the University and EHC, and two faculty members.

“We take the privacy of our employees’ health care information very seriously—a lot of hard thought went into this project to safeguard confidentiality, and we delayed its launch for many months to go beyond industry standards in that respect,” said Mike Mandl, executive vice president for finance and administration.

The MSO brings in-house a function Emory’s insurance vendors have performed themselves in recent years. According to Emory HR Vice President Peter Barnes, most insurance vendors perform services similar to that of the MSO for all large, self-insured employers like Emory.

“Our vendors routinely provide us with quarterly reports that show trends in in-patient admission, diagnoses and expenses of catastrophic claims, and cost by major disease categories,” Barnes said.

How would the MSO yield concrete results? Consider the following example: In the course of its analysis, the project may discover that an above-average number of Emory claimants are visiting the emergency room for services that should be performed by their primary-care physicians (ManagedCare.com also supplies to Emory benchmark data of national averages for comparison).

The MSO could look at the particular service in question (say, treatment of chronic asthma, or of painful ear infections) and ask several questions: Should Emory hire additional primary-care providers for this service?

For ear infections, better access to urgent-care facilities could be one answer. For patients with asthma, could a wellness program be designed to help people better manage their condition? Would broad-based communications about both conditions help inform employees about non-ER options? Any of these alternatives, over the long run, could be better for employees’ health and more cost-efficient than frequent visits to the ER.

“The MSO will enable us to be better stewards of our employees’ benefit dollars. Because of fragmented care—seeing different providers in different places, often episodically rather than according to a comprehensive plan—many employees do not get the integrated, high-level care they need,” said Michael Johns, executive vice president for health affairs. “Data from the MSO will enable us to make our health system more responsive and will improve our employees’ ability to manage their health care. This will not only save time and money—it will make for better health care experiences and better outcomes.”

The MSO recently completed a pilot program (using claim data from EHC employees) to determine whether ManagedCare.com could sufficiently remove all identifying information (Social Security numbers, employee ID numbers, etc.), and the MSO board determined the pilot project a success. Over the summer, claim data from University employees from the past two years will be loaded into the system, and after that there will be periodic updates to refresh the data.

“We needed to be convinced that there was no traceability in the data—that it was completely anonymous,” said Provost Earl Lewis. “We are indeed satisfied. Based on the feedback we received from Employee Council, University Senate and Faculty Council, we’re confident people understand the many ways this program will benefit the University and its employees.”

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