Summary
Understanding different types of benefits administration reports can help strengthen your benefits strategy. This blog covers important topics, such as:
- Seven benefits reports to consider, including plan enrollment, engagement and chronic condition management.
- The data points to track for each report.
- Understanding the purpose of each benefits report and how to use the data for plan optimization.
- Why it’s important to make data-driven benefits decisions.
Data analytics in benefits administration can be a powerful strategy to help identify cost drivers, understand your program’s return on investment (ROI) and determine where employees need additional support. Without access to comprehensive data analytics, human resources (HR) leaders may be making critical benefits decisions in the dark. This can increase the challenge of controlling costs and improving outcomes for employees and their families.
One way to bring structure and consistency to data analytics is to develop a list of employee benefits reports. Some of these reports can generally be created in HR technology platforms but may not include comprehensive data analytics. A benefits administration provider can be an additional resource that translates the data into recommended strategies. Medical and pharmacy claims can be obtained through a health care data analytics tool like Health Insights.
Here are seven essential reports that organizations can use to optimize their benefits strategy. Learn what each report tracks, the ideal frequency and tips on using the data.
1. Plan Enrollment and Cost Trends Report
What to track: Employee plan selections, premium costs by plan type, employer versus employee cost share and year-over-year changes.
Ideal frequency: Annually before open enrollment (OE) planning and monthly for budget tracking.
How to use: This foundational report can help you evaluate whether your plan portfolio meets diverse employee needs and remains financially sustainable. Use the data to model the impact of plan design changes before implementation. If employees consistently choose the most expensive plans, enhanced decision support tools that show personalized cost projections can help guide them toward optimal, and potentially different, choices.
Read more: The Truth About Why Your Employees Need Better Benefits Decision Support
2. Chronic Condition Management and Compliance
What to track: Common chronic conditions affecting the population and gaps in care for members.
Ideal frequency: Semi-annually.
How to use: This report is particularly useful for Case and Disease Managers to offer a snapshot of medication adherence and treatment compliance for key conditions. Proper treatment of these conditions may help reduce plan costs and support the health of members suffering from chronic conditions.
3. Prescription Drug Utilization Report
What to track: Brand-name versus generic prescription usage, high-cost medications, therapeutic alternatives and overall pharmacy spending trends.
Ideal frequency: Monthly for monitoring and quarterly for strategic review.
How to use: If you identify high brand-name and specialty drug usage, you may consider implementing education campaigns about generic equivalents. Another solution is automated prescription switching programs that identify lower-cost therapeutic alternatives. Educating employees on these cost-saving measures can be one way to demonstrate your efforts towards their financial well-being.
4. Preventive Care Screening Report
What to track: Utilization rates for preventive services like annual physicals, cancer screenings, vaccinations and wellness visits compared to the eligible population.
Ideal frequency: Quarterly
How to use: Low preventive screening rates signal opportunities for intervention before minor issues become expensive chronic conditions. Launch educational campaigns, offer paid time off for preventive appointments or implement incentive programs that reward employees for completing annual screenings.
5. Price Benchmarking Report
What to track: Average plan and member spend per service by procedure compared to the average negotiated rates across major medical carriers for those procedures.
Ideal frequency: Ongoing monitoring.
How to use: This report will help identify where the plan may be overpaying for services and opportunities for greater savings through transparent negotiations with claim administrators. This data will assist plan fiduciaries to ensure they are monitoring plan spend effectively.
6. Emergency Room (ER) versus Urgent Care Utilization Report
What to track: Frequency and cost of ER visits for non-emergency conditions that could have been treated at urgent care or through telemedicine.
Ideal frequency: Quarterly
How to use: High non-urgent ER usage may represent one of the most addressable cost drivers. This data can show opportunities to implement care navigation tools that help employees determine where to seek care or promote telemedicine options for minor illnesses. Organizations may achieve significant savings by redirecting appropriate cases away from hospital emergency rooms.
7. Plan Modeling Analysis
What to track: Historical claims data utilization patterns by plan service category (ex., Inpatient, Outpatient, Office Visits, Emergency Department, etc.)
Ideal frequency: Annually, several months before open enrollment and renewal negotiations.
How to use: This enables plan administrators to evaluate the financial and utilization impact of proposed health plan design changes by leveraging historical claims data rather than assumptions. Using 12-months of historical claims data, an effective plan modeling tool will re-adjudicate prior claims against new plan parameters (e.g. copays, deductibles, coinsurance) to simulate how costs would shift under different designs. This ensures projections are grounded in real utilization patterns rather than estimates.
Making Data-Driven Benefits Decisions
Organizations likely lack access to this level of reporting on their own. Benefits data often sits fragmented across multiple carriers, third-party administrators (TPAs) and vendors, making comprehensive analysis challenging without specialized technology.
Solutions like Benefitfocus Health Insights aggregate disparate data sources into a single analytics platform, providing the flexible reporting, data visualization and guidance needed to turn raw claims data into actionable strategies. The platform's ability to integrate medical claims, prescription data, biometrics and member eligibility information creates a complete picture of your workforce's health and benefits utilization.
The question isn't whether you can afford sophisticated benefits analytics—it's whether you can afford to make benefits decisions without them. When health care costs continue to rise and every benefits dollar must work harder, data-driven insights transform from a nice-to-have into a strategic necessity.
Download our guide to learn more about using health care claims data to enhance your benefits program and what to look for in a data analytics solution.
