Setting the stage (and writing the script) for interconnectedness within benefits ecosystems

At Evive Health, we recognize the potential for the positive changes that can occur when benefits ecosystems are interconnected and integrated. Like Amazon, Evive uses purchasing data (such as healthcare claims, program enrollment data, program participation, customer service encounters, balances, and contributions, etc.) to predict what benefits an individual will likely need next. Then, like Google, Evive makes information about these benefits easy to find and access—including incorporating single sign-on capabilities so that users can access their account on a benefit vendor’s website with just one click.

Leading the field in interconnectedness, Evive Health (as of September 2016) is connected to 30 health plans, seven eligibility administrators, four dental/vision providers, seven pharmacy benefit managers, and 54 benefits service providers (FSA, HSA, employee discounts and 401(k) vendors, second opinion, wellness, telehealth, and disease management programs, among others). And new ones are being added daily.

Here’s just one illustration of how interconnectedness and prioritization pays off. Take, for example, an individual who sees a doctor for nonspecific back pain. Evive receives data from the health plan and first calculates a propensity score for back surgery. Following an imaging test (like an MRI) and the filling of a prescription medication (a claim from the pharmacy benefits manager), the score is refined and, in this example, exceeds the intervention threshold. In other words, the propensity model predicts that the person is headed down the path of surgery (known in this case to be an unnecessary or unproven form of treatment), and knows that it’s time to nudge the individual to consider a second opinion from an Expert Medical Opinion (EMO) service within their employer’s ecosystem.

By getting a prompt to seek a second opinion for back pain arriving at just the right time and in the preferred medium, the individual takes action and is able to schedule a consultation with a second-opinion service. With single sign-on, the individual’s information has already been passed onto the vendor, so the member does not have to create a new profile.

The result? An individual who took advantage of a second opinion benefit before getting a costly and potentially unhelpful treatment. Interconnectedness within the ecosystem helped one benefit supplement another at just the right time.