<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=905697862838810&amp;ev=PageView&amp;noscript=1">

4 Best Practices for Using Claims Data to Improve Employee Wellness

It’s no secret that the cost of providing employee health benefits is rising. In fact, the average per-employee cost of employer-sponsored health insurance jumped 6.3% in 2021.

In light of rising costs, employers have begun putting greater emphasis on implementing and improving corporate wellness programs for their workforce. Unfortunately, many organizations are taking an ad-hoc approach to building their corporate health strategies, and as a result, their wellness programs are falling flat with their employees.

To build an effective wellness program employees will actually engage with, business leaders need to plan strategically. One way to do this is to incorporate claims data and analytics into your program’s design.

Here are four best practices for using claims data to improve your employee wellness program:

1. Identify Risks and Cost Drivers Among Your Employee Base

If your organization has a self-funded health plan, you should be able to access anonymized medical and prescription claims data for your employees. Reviewing this information carefully can help identify the most significant health risks and cost drivers for your workforce. You can use this information to guide your decision-making process around which kind of wellness programs and initiatives you should focus on.

For example, prescription drugs are a major driver of healthcare costs for many employers. Prices increase an average of 4% a year, and specialty drugs—already the most expensive category—increase by 21% per year.

If you review your claims data and find that employees are using more expensive brand-name prescriptions, you could provide helpful resources to educate your employees about the cost differences between brand-name and generic prescription drugs. Be transparent about how their decisions affect claims costs (and the ultimate trickle-down effect it can have on the business).

2. Dig Into the Demographics of Your Workforce

The success of a targeted wellness program is defined by each organization’s unique employee population. Building a successful wellness program that positively impacts the health of your employees begins with understanding their demographic makeup, baseline health status, and overall health and wellness education.

When creating wellness programs for your employees, it’s crucial to understand their living conditions, income and education levels, and access to care. Understanding the population is the first step to creating a successful targeted program.

According to the Office of Disease Prevention and Health Promotion, “By working to establish workplace policies that positively influence social and economic conditions and those that support changes in individual behavior, we can improve health for large numbers of people in ways that can be sustained over time.”

Understanding the demographics of your workforce can help you determine what types of benefits will be most effective for your business and employees.

3. Analyze Data to Assess the Efficacy of Your Wellness Program

You can use claims data to help evaluate the efficacy of your current wellness program. For example:

  • Same population comparisons can help you identify groups of employees who have participated or engaged with different aspects of your wellness program over time.
  • Participant and non-program participant comparisons can be used to give you a clearer idea of who is participating in the program, engagement patterns, per member costs, and the health status of program participants.
  • A cost analysis can help your organization compare overall company health risks and costs on an annual basis.

4. Collect and Leverage Employee Feedback

It’s important to understand how your employees feel about the benefits you’re offering them so you can continue to optimize your program over time.

You can find out how your employees feel about your program by conducting surveys, analyzing provider reports, or studying provider and actuarial research. If you’re aware of what your employees like or don’t like about their benefits, you can highlight those things in your regular communication.

Learning how your employees feel about their benefits will arm you with the information you need to revise your communications to meet realistic goals and expectations, your employees’ needs, your communication plan objectives, and your business requirements.


Whether your company would like to add a corporate wellness program to your employee benefits plan or would like to enhance an existing program, SWBC’s Employee Benefits Consulting Group can provide consulting services to help you design and maintain a plan that meets the requirements of your organization. We will provide analytical support, develop custom communication materials, and tailor wellness programs to help meet your unique goals.

Learn how to boost employee engagement while minimizing healthcare costs for your organization.

Blake Herring

Blake Herring is an Employee Benefits Executive who joined SWBC in 2021. He strategically consults and partners with employers across all industries, with a strong emphasis on mid to large-sized employers. Blake is a Licensed General Lines Agent—Life, Accident, Health, and HMO

You may also like:

Reduce Expenses Tax Season

Texas Commercial Real Estate Outlook for 2023

The Texas commercial real estate market is up against unique challenges in 2023, with ongoing inflation, the potential f...

HR Administration Reduce Expenses

3 Ways Businesses Can Reduce Health Benefits Costs in 2023

Employer health costs have increased each year since the dawn of the millennium. This happens for many reasons including...

Reduce Expenses Employee Health & Wellness

How Healthcare Consumerism Reduces Employer Benefits Costs

Imagine a world in which every American is a subject matter expert in the price and process of purchasing medical servic...

Let Us Know What You Thought about this Post.

Put your Comment Below.



Navigating Mental Wellness: Strategies for Conquering Workplace Challenges

Join our webinar for strategies on mental wellness and prioritizing your and your employee's well-being. 
On Demand | Duration: 52 minutes

Watch Now