07 Aug Healthcare software addresses "90 million" misclassified Americans
Appleton, Wis. – Imagine a decision-support tool that misrepresented something simple about more than 90 million Americans – their location.
Then imagine employers basing their health plan buying decisions on the often inaccurate information contained in that tool.
Employers don’t have to imagine such a scenario because they have been living it, unbeknown to them, for years.
Now a Wisconsin software developer believes it has come up with a more accurate way for employers to assess where their plan participants actually live, and as a result provide better access to quality healthcare providers.
Quest Analytics, an Appleton-based developer of software analysis tools for healthcare providers, has identified a gaping hole in how employers have been analyzing health plan access. The company made the discovery while adding an access piece to its analytics suite, which already helps employers, consultants, and health plans evaluate risk-adjusted outcomes, cost, and quality measures.
What Quest found was that older zip code classification techniques, which were based on assumptions of population density rather than hard U.S. Census data, misclassified more than 94 million people that actually lived in urban zip codes as living in suburban or rural areas.
“That’s about one-third of the population, yes,” said John Weis, co-founder of Quest Analytics.
How far off was the old density method? According to Quest, the density approach classified 34.8 percent of the American population as urban, 19.3 percent as suburban, 45.9 percent as rural.
In contrast, Census Bureau statistics, which Quest has leveraged in developing its access function, classifies 68.4 percent as urban, 10.7 percent as suburban, and 20.9 percent as rural. The Census Bureau numbers are almost identical to Quest’s breakdown.
Urban legend
For those who reside in urban areas, this misclassification increased the degree of difficulty in finding convenient, accessible healthcare options through employer-sponsored insurance.
Weis said employers, in evaluating health plans, typically want to know how many high-quality providers are within a certain number of miles of their employees. While companies may have higher access standards for urban employees, Quest has three sample standards for measuring access:
• Simple Access Standard – Two primary-care physicians within 10 miles.
• Compound Access Standard – Two primary-care physicians within 10 miles and one hospital within 20 miles.
• Qualitative Access Standard – Two primary-care physicians within 10 miles and one “high-quality” hospital within 20 miles.
“Where the healthcare market is heading is toward that qualitative access standard,” Weis stated.
Guessing game
In the past, Weis said, employers “would selected a health plan, and then they would hear complaints from their Human Resources Department that people don’t have adequate access, even when they thought they were doing their due diligence.”
The older systems, he said, was tantamount to “using your best guess.”
Since rolling out the access piece a year ago, Weis said Quest Analytics is seeing a difference in the way clients use the software, including customers such as the Wisconsin Physicians Services (WPS) Insurance Co., WEA Trust, and Associated Financial Group, a multi-line insurance agency formerly known as Jabas Group.
One of the services provided by Associated Financial Group, which has nine offices in Wisconsin and Minnesota, is the evaluation of Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs) for corporate clients.
David Kracht, vice president and senior benefits consultant for Associated Financial Group, said different employers have different parameters when it comes to access. He called the Quest access piece an improvement over its previous access software in helping clients evaluate the best health plan fit.
“When we have a multi-state client,” he said, “it becomes an even more valuable access tool.”
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