Insights for Providers
Nov 30, 2023
Todd Gottula, President of Clarify Health, recently sat with Nick Schram, Principal, Mercer, to talk about how Mercer is leveraging health analytics to transform their employer benefit design process, increase transparency, and build higher-value provider networks. Mercer has completely shifted the benefit design model — they’re leveraging Clarify’s advanced analytics to evaluate and deploy higher-quality networks for their clients, which has reduced costs, improved quality, and enhanced patient experience.
Todd Gottula: We’re talking about how Clarify’s really tremendous partners, like Mercer, are taking advantage of our technology to deliver novel and important outcomes to their customers and ultimately to individuals in the industry.
Nick Schram: Awesome. Thanks for having me. First and foremost, I’m Nick Schram with Mercer US Health and Benefits. I sit in Chicago, and I work within a group that we call our Data Technology and Analytics Center of Excellence. I think over the course of the past three years, we’ve really seen a transition from health and benefits problems being HR-focused, to health and benefits problems really being business problems. And so what we’re doing is we’re out there trying to develop those strategies that are really going to deliver savings and deliver high quality.
Todd Gottula: Fantastic. So, when I think of the traditional employer who’s choosing their benefits provider, I think of a world where that carrier’s coming with their own network.
Nick Schram: Yeah.
Todd Gottula: So, what role does Mercer play in enhancing that network or essentially assisting with that aspect of business?
Nick Schram: We’re seeing more and more carve-outs for centers of excellence. And then, on the other side of the house, we’ve also just experienced that there hasn’t been much transparency in terms of what those networks are delivering and how they’re curated. And by leveraging the technology and by understanding the quality of the providers within a network, we can come to the table with our clients, and with all the other partners that are involved, and have a legitimate discussion about what’s being delivered, which has just been absent.
Todd Gottula: Got it. So let’s move to the proverbial million-dollar question, or maybe more than million-dollar question. What does Mercer think about, in partnership with their customers, when it comes to making recommendations, and how to make that selection or separate out provider quality?
Nick Schram: Yeah, as a consultant, I’m going to tell you it depends. But I’d follow that up by saying historically when we were looking at how to compare networks one to another, we would look at unit cost, and we would look at disruption. Disruption meaning will the members have the ability to go to the exact same provider? And we never really talked about whether or not that was a good thing. And so by looking at the cost efficiency that impacts, what I’d call process quality, and then by looking at quality kind of all sequenced throughout that conversation, we’re able to have a much more robust discussion. And I think what we’re finding… again, it is going to vary by market, and it’s going to vary by employer philosophy, but we are seeing groups becoming more and more ready to make change in that realm.
Todd Gottula: When you think about the value-creation story for Mercer as an organization, what are examples of how you’d say, look, this is the benefit of the unique approach that you’re taking to your customers?
Nick Schram: I think where we’ve really seen it hit home almost immediately is in thinking about how our employers are referring from their onsite clinics, back out into the market, for specialties and for more significant services. And just understanding that whoever held the low-cost contract, maybe wasn’t delivering the lowest dollar outlay, long term. Just having that discussion, being able to help employers move the needle on that has really been something that we’re pretty proud of.
Todd Gottula: As you were thinking about the landscape of technology providers, when you ultimately were making your decision on partners to work with, what were the key considerations that you went through?
Nick Schram: It was a number of things. We wanted to make sure that we had a robust and agnostic data set. A lot of the solutions that we were looking at were pretty narrow, in terms of where they were able to procure their data. And then we also wanted a lot of diligence and a lot of thinking put into the algorithms that were actually assigning quality. Cost efficiency was a cherry on top. And then, we were really compelled by Clarify’s focus on social determinants of health. In the health and benefit space, we’ve done a lot of really good things in the past, but I think too often, we focused on, we think we have a cost problem, so we need a new solution. But really it was a quality problem all along, but we didn’t know that. And so we end up compounding and masking the true problem and never actually solving it. So, by sitting back and using the technology, using the analytics that we now have available to us, we can design a much more prescriptive, much more kind of rifle versus shotgun approach, to helping employers get to the next level.
Todd Gottula: Awesome. Well, that kind of leads me to my final question, which is: what’s next? Either from a technology perspective, benefits design?
Nick Schram: No, what’s next for us is access is becoming more and more of a marquee discussion point. Now that we’re starting to be able to think through cost better, think through quality better, so access, whether it be delivering the member to care, delivering care to the member, that’s something that’s real high on our priority list. And then the other thing that my team is specifically focused on, and that I’ll be diving deep into once they get home, is try and take the seams out of the process. So we have a lot of really good technology, we have a lot of good partners out there, but there are huge gaps between them all. So we end up with a really clunky system, and my group is specifically focused on making that experience more modern for our clients, then also for us internally, as well.
Todd Gottula: Well, Nick, thank you very much. We’re incredibly honored to be your partner, and we look forward to continuing to grow as your business evolves.