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Review Claims Data

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Reviewing claims data will provide data that you can compare to the employee health survey/health risk assessment.  This comparison will give you a stronger basis for wellness program development and making the business case to senior management.  Reviewing claims data periodically will also help you evaluate the effectiveness of your wellness efforts.    

Pharmacy Data

Your company’s pharmacy vendor can provide information on medications that employees are purchasing. Information will be provided in a report that does not list specific patients/employees but will list medication types, what they are used for and the number of employees who take this medication. This information can be used in planning Diabetes at Work programming.

For example, if employees are filling their prescriptions regularly, they might have fewer complications. Fewer complications can mean greater health care savings over the long term. In the short term, however, there may be an increase in pharmacy costs. But savings from fewer emergency room visits and hospital stays generally offset this increased cost.

Medical Data

Your company’s medical vendor can provide aggregate information on employees’ medical services, diagnoses, and treatment. Understanding this data before the start of a worksite wellness initiative will help you design programming. Measuring claims data periodically will help you determine the initiative’s effectiveness.

In reviewing claims data, look for visits to general medical providers or specialists, such as endocrinologists for diabetes consultations. Look for consultations with diabetes educators and/or Certified Diabetes Educators, vision specialists, podiatrists, and dentists, as well as laboratory tests. Important claims data also might be related to diagnosed diabetes, prediabetes, gestational diabetes, obesity, high blood pressure, heart disease, or kidney disease.

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