Just as companies otherwise utilize health plan claims data to manage health benefits and services investments to facilitate a healthy, productive workforce, employers can utilize their data to understand the status of their workforce’s substance and opioid use disorder (OUD) risks and trends. In this section of the toolkit, employers will learn how data can be used to understand how well current benefits are helping prevent, treat, and support recovery from opioid misuse or opioid use disorder.
Depending on the structure of their health offerings, employers can go to multiple sources to receive their data: health insurer or health plan administrator, pharmacy benefit manager (PBM), data warehouse vendor, or insurance broker. Health plans and data warehouse vendors often have standardized reports that group substance use disorders (SUD) with mental health. If not, included here are a list of questions and measures employers may want to request to better understand their workforce substance use risks and status. Different data vendors may define the recommended measures differently; it is important for employers to understand the meaning of the measures they receive. For general reference, detailed explanations of each measure can be found in the data specifications.
An employer’s data should be examined, at minimum, annually and compared to previous years to identify positive or negative trends. If available, the measures should be compared to national, state, regional, and industry averages. Most measures can be stratified into basic subgroups to identify differences among them, such as: gender, age, employee type (hourly/salaried), relationship to employee (self/spouse/dependent), innetwork/out-of-network, health plan types, and prescriber types (dental/medical). When looking at costs associated with each measure, employers should look at the total cost of care in addition to pharmacy or medical health costs separately. Reduced spending in one of these areas can often result in increased spend in the other.
Before an employer can utilize this data, the information must be de-identified within the requirements of HIPAA. Employers should also consult with an employment attorney to confirm compliance with HIPAA and any other applicable federal and state laws that may further restrict the use of claims data or include additional requirements for the de-identification of data.
What if an employer cannot access their data?
Each employer’s data analytics capabilities vary based on their size, investments in data and analytics, insurance coverage, and health plan structure. For instance, the fewer employees an employer has, the greater the risk for identification and breach of privacy. Additionally, whether employers are fully-insured, self-insured, or uninsured may present barriers in the data they can access. Integration of pharmacy benefit and health plan data can determine the extent to which employers can relate diagnoses, treatment, and medication data.