Title: Health Plan Claims Data Analytics Source: https://ethosbenefits.com/services/claims-analytics Publisher: Ethos Benefits Summary: Your company owns its health plan data. Ethos Benefits connects your claims and pharmacy data to analytics and reviews it with you every month. 1. [Home](https://ethosbenefits.com/) 2. [Services](https://ethosbenefits.com/services) 3. Claims analytics. # Claims analytics. Your plan’s data. All of it, at all times. Your company owns its health plan data: claims, pharmacy, eligibility, enrollment and financial data, and every report built from it. Ethos Benefits connects that data to analytics, reviews it with you every month, and gives you the complete claims history whenever you ask, in a usable format, at no cost, including if you leave Ethos. [Request a Strategic Analysis](https://ethosbenefits.com/strategic-analysis) ## What you get. Many employers see their plan through a carrier summary once a year. The claims themselves, thousands of them, are one of the largest bills the company pays and never reads. 1. **Data access** Claims, pharmacy and eligibility data requested from your carriers, administrators and PBM, using the access federal law now protects. 2. **Analytics** Your plan data connected to analytics tools, so trends and outliers are visible as they happen. 3. **Monthly claims reviews** Cost against budget, large claimants, stop-loss position, pharmacy use, and emergency and inpatient trends, reviewed with you every month. 4. **Plan performance dashboards** Your plan’s results presented for leadership and the committee in one place. 5. **Your data, on request** The complete plan data and claims history, in a usable non-proprietary format, whenever you ask, at no added cost. 6. **Privacy built in** Data handled as a HIPAA business associate, with employer views limited to combined, de-identified numbers. ## Who owns _the data._ The Ethos agreement puts it in writing: > Your company owns all plan data, including claims, eligibility, enrollment, census, premium and financial data, and every report prepared for it. Ethos claims no ownership of it and will not sell, license or monetize it. You can ask for the complete plan data, including the full claims history for the whole time Ethos has served you, at any time, at no added cost. If the relationship ends, the data and work product come back to you within 30 days. ## What we look at _every month._ - Plan cost per employee per month against budget - Large claimants and the plan’s position against its stop-loss deductibles - Pharmacy spending, top drugs and specialty drugs - Emergency room and inpatient trends - Utilization patterns that point to the next cost driver ## Getting data _out of your vendors._ Since the Consolidated Appropriations Act, 2021, contracts can’t block a group health plan from getting its own de-identified claims data. Ethos requests the data from each vendor, writes data delivery into contracts during [procurement](https://ethosbenefits.com/services/procurement), and documents the request if a vendor resists. [How the gag clause ban works](https://ethosbenefits.com/benefits-101/gag-clause-attestation). ## Part of your Fiduciary Framework™. Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently. [See the Fiduciary Framework™](https://ethosbenefits.com/fiduciary-framework) · [How fiduciary governance works](https://ethosbenefits.com/services/fiduciary-governance) ## Related reading. - [**What happens behind the scenes with your health insurance?** Insight: Where an employer's health plan premium dollar goes, where costs hide in networks, PBMs and claims, and the plan data federal law says you can get.](https://ethosbenefits.com/insights/what-happens-behind-the-scenes-with-your-health-insurance) - [**The gag clause attestation** Benefits 101: What the gag clause attestation is, which employer health plans must file it with CMS by December 31 each year, and how to make sure yours is done.](https://ethosbenefits.com/benefits-101/gag-clause-attestation) - [**Medical vs. pharmacy benefits** Benefits 101: What counts as a medical benefit vs. a pharmacy benefit, why the same drug can be billed under either, and how that changes what an employer's health plan pays.](https://ethosbenefits.com/benefits-101/medical-vs-pharmacy-benefits) [Browse everything in Learn](https://ethosbenefits.com/learn) ## Questions employers ask about this. Who owns our health plan data? Your company does. Ethos claims no ownership of plan data, does not sell, license or monetize it, and uses it only to serve your plan. That is written into the Ethos agreement. Can a fully insured plan get its claims data? Yes, more than before. Federal law now bars contracts from blocking a group health plan’s access to its de-identified claims data, which applies to fully insured plans too. How much detail you get still depends on the carrier. Will our company see employees’ health information? No. Your leadership and committee see combined, de-identified numbers. Protected health information is handled by Ethos as a business associate under HIPAA. What happens to our data if we leave Ethos? Ethos delivers all plan data and work product to you or your next advisor within 30 days, and never conditions the return of your data on a fee or a release. ## Keep reading Related to this page. - [**Benchmarking and modeling** Ethos Benefits benchmarks your plan design and contributions against similar employers and models the cost and affordability of every change before you make it. _Read more_](https://ethosbenefits.com/services/benchmarking) - [**Claims, billing and eligibility audits** Ethos Benefits audits your health plan invoices and eligibility, coordinates claims audits with your vendors, and tracks every recovery to completion. _Read more_](https://ethosbenefits.com/services/audits) - [**Underwriting and rate analysis** Ethos Benefits checks the underwriting behind your renewal, projects claims from your data, and builds premium equivalent rates for self-funded plans. _Read more_](https://ethosbenefits.com/services/underwriting) ## See what your plan is really costing you. A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture. [Request a Strategic Analysis](https://ethosbenefits.com/strategic-analysis) [Call (407) 803-4710](tel:+14078034710)