Healthcare Interactive uses risk management analysis to shape employer wellness plans

The employer wellness space is getting more and more complex. The sector includes 8,000 companies with the largest player owning a scant 6 percent of the market, according to one industry insider. One segment where Healthcare Interactive hopes to dominate is benefit management adjudication. It is using the first venture investment it’s received to expand […]

The employer wellness space is getting more and more complex. The sector includes 8,000 companies with the largest player owning a scant 6 percent of the market, according to one industry insider. One segment where Healthcare Interactive hopes to dominate is benefit management adjudication. It is using the first venture investment it’s received to expand into new markets and add a COO, CFO and sales staff.

Benefit management adjudication doesn’t exactly roll off the tongue easily. But the complexities surrounding the business of helping companies assemble wellness plans and the benefit design they choose is fueled by big data and risk analysis tools. Those decisions can have a big impact on how effectively companies can trim their healthcare costs. Healthcare Interactive works with payers and health systems to determine the wellness goals and incentives to include in wellness plans.

The eight-year-old company has gotten along with the $5 million provided by co-founders Keith Lemer and Harry Kovar when it was started, so why go for institutional investment at this point? CEO Henry Cha told MedCity News in a phone interview, “The market is so active right now that it would be foolish not to accelerate growth.”

It currently has 53 staff but it wants to add another 30 over the next three to four months to help it expand westward from the East Coast where it has built a strong presence, anchored by its headquarters in Glenwood, Maryland. Grotech Ventures and Harbert Venture Partners led the $8 million financing round.

Despite the need to cut healthcare costs, many have mixed feelings about employer wellness plans, especially the invasiveness in managing their personal health. The way Cha sees it, Obamacare is tying personal health choices to health insurance costs in the same way car owners’ driving habits are tied to their car insurance. Just as unsafe driving and car accidents lead to increased car insurance costs, reckless personal health choices will drive up health insurance costs. It may feel more invasive but companies need a way to control costs.

Cha believes that the kinds of services his business offers will grow in demand as self-insured companies search for ways to control these insurance costs.

One of the services it provides is helping payers and their self-insured employers design their plans so that they can manage wellness incentives around high deductible plans. How do you incentivize members to make the right choices in managing their health and engage in wellness programs? It takes siloed data such as medication pharma claims and biometric screening data such as high blood pressure, body mass index, and weight and combines it to develop the most effective incentive drivers for each payer’s employer wellness program.

This kind of big data analysis is helping its clients gain information on outcomes like gaps in care such as blood pressure. If blood pressure is an outcome measure, then it shouldn’t be a gap in care.

It can also add digital health coaching modules and disease management. It can also identify undiscovered risk in cases where an employee may be sick and not even know it.

Cha also talked about its Wellness Calculator that lets an employer know what the likelihood of employee participation in these programs to assess their ROI. The calculation depends on how many years they have had a wellness program and the types of incentives that are used.