Smart ways to harness the power of your benefits claims data.
Data is one of the most powerful tools in business, but only when it’s used effectively. While most cooperatives are familiar with the rising cost of employee benefits, far fewer are fully tapping into their benefits claims data as a way to manage those costs. When analyzed thoroughly and used intentionally, this data becomes more than just a record of past healthcare utilization—it becomes a roadmap to smarter planning, targeted wellness investments and better employee outcomes.
However, as access to data increases, so do responsibilities. Privacy concerns and legal obligations, especially under HIPAA and related protections, must guide every step of how data is collected, interpreted and used. For cooperatives that often serve as pillars of trust within rural communities, striking the right balance between data-driven strategy and individual confidentiality is essential.
THE HIDDEN VALUE IN DATA
Every time an employee visits a doctor, fills a prescription or gets a health screening, a claim is generated. These claims are anonymized and aggregated by your insurance provider, and they contain key information such as diagnosis codes, costs, treatment types and utilization rates. At a glance, they might appear purely administrative, but when grouped and analyzed, they can show broader health trends, identify preventable cost drivers and even highlight opportunities for early intervention.
According to a 2023 report by Mercer, nearly 63% of large employers who actively analyze their benefits data reported measurable improvements in cost control and employee health outcomes within two years. The potential impact is particularly high in rural cooperatives, where access to care, transportation challenges and aging workforces can skew utilization and drive up long-term costs. Identifying those patterns allows human resources and leadership teams to act, not just react.
FROM NUMBERS TO ACTION
The most effective use of benefits claims data is rooted in patterns. Is there a rise in musculoskeletal claims tied to repetitive labor or poor ergonomic practices? Are diabetes or hypertension showing up more frequently in mid-career employees? Are high-cost emergency room visits being used in place of primary care?
“When grouped and analyzed, claims can show broader health trends, identify preventable cost drivers and even highlight opportunities for early intervention.”
Start by working with your Wellmark contacts to receive de-identified, aggregated claims reports. These reports can help HR leaders identify “hot spots” in spending or gaps in preventive care. For example, if claims show a high rate of back-related injuries among seasonal laborers, it might justify investing in improved safety training or lifting equipment.
If mental health prescriptions are rising but usage of Connections Employee Assistance Programs remains low, the issue might be awareness or stigma— something educational campaigns can help address. Your team at ABC has resources available to help educate employees on all benefit offerings.
Prescription data also offers key insights. An uptick in brand-name drug use over generics may indicate that employees don’t understand drug formulation. High-cost specialty drugs may justify a deeper dive into case management offerings. Each of these findings offers an opportunity to design smarter, more effective benefits plans that meet employees where they are, without compromising on coverage.
BALANCING INSIGHT WITH INTEGRITY
The line between ethical data use and privacy violation isn’t just a legal matter—it’s cultural. Employees need to trust that the cooperative’s intentions are to support, not surveil. That trust starts with strict adherence to data privacy best practices. All claims data provided to employers is governed by HIPAA and must be de-identified. This means data must not contain names, social security numbers or any other information that could be tied back to an individual. Human resources teams should work only with aggregate-level data sets, where trends are observed by group, such as age, job type or geographic location, and never by individual identity. HR teams should also implement strong internal controls. Data analysis should be handled only by authorized personnel, with access logs, data encryption and audit trails in place. You can be assured that ABC will follow these same data protection protocols if consulting with you on your findings.
Importantly, communicate openly with your employees about how their data is being used. Explain that the goal is to improve benefits, reduce unnecessary costs and invest in preventive care, not to monitor individuals. This transparency builds trust and reinforces the cooperative’s values of putting members and employees first.
63% of large employers who actively analyze their benefits data
IMPROVED COST CONTROL & EMPLOYEE HEALTH OUTCOMES
PROACTIVE PLANNING
Some cooperatives are now taking data analysis a step further with predictive analytics. By using historical claims data in combination with demographic or occupational data, it’s possible to forecast potential health trends before they happen. For instance, a cooperative with an aging fleet of drivers with long distances to cover might predict an increase in cardiovascular claims. An agricultural cooperative may anticipate an uptick in illness following a busy season like planting or harvest, when employees have less time to care for themselves and are more susceptible to sickness. By identifying these trends early, cooperatives can budget more accurately, target outreach campaigns and have strategic negotiations with insurance carriers.
Predictive modeling doesn’t require in-house data experts. Many insurance carriers now offer these services as part of their package, especially for mid-size and large employers.
THE KEY IS TO ASK THE RIGHT QUESTIONS:
- What health risks are most likely to rise in the next 12 months?
- What preventive steps can be taken now?
- How do those risks vary across departments or locations?
START SMALL
For cooperatives just beginning to explore claims data analysis, the process can feel daunting. Start with simple quarterly reviews and identify one or two trends to explore. Utilize your partners at Wellmark and ABC— we’re here to help. Most importantly, treat the process as ongoing. Claims data is not a one-time report, it’s a continuous pulse check on the health of your people and the sustainability of your plan.
Regularly benchmark your co-op against industry peers, using national data sources like the Kaiser Family Foundation’s annual employer health benefits survey or the Business Group on Health’s workforce strategy reports. These benchmarks offer context that helps cooperative boards and executive teams make informed decisions.
HONORING COOPERATIVE VALUES
At its core, using benefits claims data strategically is about honoring the same values that guide the cooperative business model: stewardship, transparency and a long-term investment in people. It’s not about cutting costs at the expense of coverage, it’s about making data-driven decisions. With continually rising healthcare expenses, unpredictable labor markets and shifting employee expectations, cooperatives that embrace strategic benefits planning are better equipped to navigate change. More importantly, they are better positioned to care for the communities they serve, starting with their own teams.
By combining thoughtful data use with privacy safeguards and clear communication, cooperatives can transform a pile of paperwork into a powerful tool for better health, stronger retention and lasting trust.
By combining thoughtful data use with privacy safeguards and clear communication, cooperatives can transform a pile of paperwork into a powerful tool for better health, stronger retention and lasting trust.