A Fiduciary's Guide to Data Analytics with Agility Innovation Partners

This video provides an in-depth exploration of how data analytics, particularly in the context of the Consolidated Appropriations Act (CAA), is transforming health plan management for employers and the role of benefits brokers. Brian Behnken, Chief Data and Analytics Officer, and Drew Calistead, Chief Strategy Officer for Agility Innovation Partners, discuss the evolution of healthcare data analysis, the challenges faced by brokers and employers, and the opportunities presented by new regulations and advanced data platforms. They emphasize that the CAA, which mandates transparency in healthcare pricing, has shifted the employer's responsibility from a passive payer to a proactive fiduciary, necessitating the use of sophisticated data tools.

The discussion highlights the historical difficulties in accessing and utilizing healthcare claims data, from floppy disks in the 90s to today's complex digital landscape. Agility Innovation Partners addresses two primary challenges for brokers: the high cost of data analytics platforms and the difficulty in effectively using them without specialized staff. Their solution involves offering "at-scale pricing" for their chosen platform, Innovu, to small-to-mid-market brokers, coupled with a "data wingman" service – a dedicated data analyst who consults and assists brokers in maximizing their platform investment. This approach aims to democratize access to powerful analytics, enabling brokers to drive measurable changes to health plans and better serve their self-funded clients.

A significant portion of the conversation focuses on the post-CAA landscape, where employers now have access to claims and pricing data, empowering them to benchmark costs and ensure compliance. Innovu's platform integrates a CAA fiduciary tool stack, allowing benchmarking against millions of lives for plan design, claims costs, and fixed costs. Crucially, it also incorporates hospital transparency data, which reveals contracted rates by procedure, hospital, and payer. This unprecedented access to pricing information allows employers to compare what they are paying through traditional networks versus cash prices or alternative arrangements like Reference-Based Pricing (RBP), uncovering substantial opportunities for cost reduction (estimated 20-30%). The speakers present a compelling case for brokers to embrace data as a competitive advantage, transforming their role from merely managing renewals to actively leading clients towards more affordable and transparent healthcare solutions.

Key Takeaways:

• CAA's Transformative Impact: The Consolidated Appropriations Act (CAA) has fundamentally changed healthcare transparency, moving employers from passive payers to proactive fiduciaries responsible for ensuring reasonable health plan costs and compliance. Fines for non-compliance can be substantial ($100/day per employee).
• Low Data Analytics Adoption: Despite its importance, only about 10% of brokerage consulting firms are "all in" on data analytics platforms, indicating a significant market opportunity for those who embrace it.
• Common Broker Challenges: Brokers typically face two main hurdles: the high cost of data analytics platforms and the lack of internal expertise or staff to effectively utilize them, often leading to underutilized "shelfware."
• Agility's Solution: At-Scale Pricing & Data Wingman: Agility Innovation Partners addresses these challenges by offering Innovu, a data analytics platform, at "at-scale pricing" for mid-market brokers (5-15 self-funded cases), making it affordable. They also provide a dedicated data analyst ("wingman") to help brokers leverage the platform effectively, acting as an outsourced, part-time team member.
• Innovu's Fiduciary Tool Stack: The Innovu platform includes a CAA fiduciary tool stack that enables benchmarking of claims costs, fixed costs, and plan design against a database of over 4 million lives, helping employers determine if they are paying reasonable costs.
• Hospital Transparency Data Integration: Innovu integrates hospital transparency files, which detail contracted rates by procedure, hospital, and payer. This allows employers to compare what they are paying through their networks to what they "could have paid" under different arrangements (e.g., cash price), exposing significant cost discrepancies.
• Unlocking the "Black Box" of Healthcare: The combination of CAA regulations and integrated hospital transparency data effectively "unlocks the black box" of healthcare pricing, providing unprecedented visibility into costs and enabling informed decision-making.
• Actionable Cost Reduction Strategies: With data insights, employers can pivot from traditional networks to alternative arrangements like narrow networks, direct contracting, or Reference-Based Pricing (RBP) to reduce costs. RBP, for instance, is seen as a stepping stone, potentially 10-15% above cash/Medicare prices, but still significantly below traditional commercial rates.
• Significant Savings Potential: The speakers suggest that leveraging these data insights could lead to 20-30% cost reductions in healthcare spend, a dramatic shift from the typical 5-10% adjustments seen with traditional population health initiatives.
• Proactive vs. Passive Purchasing: Data empowers plan sponsors to transition from being "passive payers" to "proactive purchasers," making informed decisions about healthcare services based on transparent pricing and value.
• Competitive Advantage for Brokers: Brokers who proactively embrace data analytics can transform their marketing strategy, win new business by demonstrating tangible value and savings opportunities, and significantly improve client retention.
• Long-Term Strategic Decision: Investing in a data analytics platform is a long-term, lifestyle change for a firm, not a cyclical or reactionary measure. It requires a commitment to becoming a data-driven organization.
• Getting Started: The process of onboarding data onto a platform typically takes about three months. Brokers are encouraged to start educating themselves and their clients on CAA and data now, even during Q4, to be ready for January 1.

Tools/Resources Mentioned:

• Innovu: The specific data analytics platform partnered with by Agility Innovation Partners.
• CAA Fiduciary Tool Stack: A feature within Innovu for benchmarking and compliance.
• Hospital Transparency Data: Publicly available files from hospitals, integrated into Innovu, detailing contracted rates.

Key Concepts:

• Consolidated Appropriations Act (CAA): Federal legislation establishing protections for consumers related to surprise billing and transparency in health care, imposing fiduciary responsibilities on employers.
• Fiduciary Responsibility: The legal and ethical obligation of employers to act in the best financial interest of their health plan participants, now requiring due diligence on health plan costs and services.
• At-Scale Pricing: Offering a premium service or platform at a reduced price point by leveraging collective buying power, making it accessible to smaller entities.
• Data Wingman: A dedicated data analyst provided as a service to assist brokers in utilizing a data analytics platform, effectively acting as an expert consultant.
• Hospital Transparency Data: Mandated public disclosure of contracted rates by procedure, hospital, and payer, providing unprecedented insight into healthcare pricing.
• Reference-Based Pricing (RBP): A healthcare payment model where providers are paid a set amount based on a reference price (often Medicare rates plus a percentage), rather than negotiated rates with traditional networks.