How can data (claims, utilization, absenteeism) guide our future plan design decisions?

Data is one of the most valuable tools for designing a benefits plan that truly works. Claims, utilization, and absenteeism data reveal how employees use—or avoid—care, helping you identify where your benefits are effective and where they need improvement. When used strategically, this information transforms your plan design from reactive to proactive.

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Claims data: Shows where your dollars are going
Claims data highlights which services and conditions drive your highest costs, such as emergency room visits, imaging, or unmanaged chronic conditions.

What to look for:

• High spending on preventable conditions like diabetes or hypertension.
• Frequent ER or urgent care visits for non-emergency issues.
• Low preventive or primary care utilization. 

How to use it:

• Strengthen access to primary and preventive care.
  Add $0 primary care or chronic condition management to reduce unnecessary claims.
• Review your network and pharmacy design to focus on high-value, evidence-based care.

Utilization data: Shows how employees interact with your plan
Utilization data tracks how often employees use services such as primary care, telehealth, mental health, and preventive screenings.

What to look for:

• Low preventive or mental health utilization, which may signal cost or access barriers.
• High urgent care usage, indicating limited access to primary care.
• Uneven usage across demographics or worksites.

How to use it:

• Simplify access with virtual or in-home care options.
• Promote zero-dollar care services to encourage early engagement.
• Reassess communication strategies if employees are not using covered services.

Absenteeism and productivity data: Connects health to performance
High absenteeism, disability claims, or presenteeism (working while unwell) often point to gaps in access or engagement.

What to look for:

• Frequent short-term absences for treatable conditions.
• Time off linked to stress or burnout.
• Productivity declines caused by poor access or long wait times for care.

How to use it:

• Add integrated mental health and primary care to address root causes.
• Offer virtual-first care to reduce time away from work.
• Introduce preventive or wellness incentives to improve engagement and outcomes.

Integrate your data for a complete view
The greatest value comes from combining claims, utilization, and HR data to understand the full story behind your numbers.

• Claims + Utilization: Identify overuse or underuse of specific services.
• Claims + Absenteeism: Measure how poor access affects productivity.
• All three: Forecast cost trends and pinpoint where better access can reduce spending.

Best practice: Build quarterly dashboards or scorecards that track cost, engagement, and outcomes over time.

Partner with experts to interpret and act on data
Even good data needs the right analysis. Collaborate with:

• Your broker or TPA: For claims analytics and cost modeling.
• Population health vendors such as Artemis, Springbuk, or Health Catalyst for predictive insights.
• Primary care partners like Vitable: To translate analytics into action.

Example: If claims data shows rising ER use, Vitable can redirect employees to $0 virtual or in-home visits, lowering future claims and costs.

Vitable integrates utilization and care engagement data to show employers how access influences outcomes. Employers can track:

• Higher preventive and chronic care engagement.
• Fewer ER and urgent care claims.
• Reduced absences related to treatable issues.

These insights guide smarter plan design, helping employers determine where to invest in access, affordability, and prevention to achieve measurable ROI.

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Each data type tells part of the story:

• Claims data shows what you are paying for.
• Utilization data shows how employees are using their benefits.
• Absenteeism data shows the real-world impact on your workforce.
  
  

By combining these insights and working with proactive care partners like Vitable, you can design benefits that are data-driven, cost-efficient, and centered on employee health and engagement.

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