The employer plan sponsors that I have met with since 2018 may have noticed a sterner tone when we discuss strategies around preventive medicine, well-being, or clinical programs. The reason is simple. I saw a system fail a family member and it impacted his quality of life when it was all completely preventable.

This is a story about my brother-in-law, Chris. He has given me permission to share his story in hopes that it will help others. Chris married my older sister, Natalie and is a fun-loving Kansas born midwesterner. He now acts like a native Texan who (like me), enjoys great BBQ, music and craft beer. Chris works in a factory and is on his feet a lot for very demanding work shifts. Like most guys, Chris felt a doctor was only good for visiting when you are sick. He began to complain of discomfort in his feet and tingling in his hands and toes. My sister finally urged him to see a doctor and he learned he was diabetic. Chris also learned his condition had deteriorated to the point where they needed to amputate his leg. The good news is that he got away with only losing a big toe. It is not uncommon when one toe get’s amputated that the probabilities are high to lose the other one as well. Chris has since had both big toes amputated and now better monitors his blood sugar on a daily basis.

Chris now adheres to a view of health and well-being that incorporates routine visits each year to care providers. His primary care doctor could have done better by reaching out. His employer is also to blame for not helping their workers “know their numbers” and what to do about them. Ultimately Chris and his employer paid the price for the oversight. I always cite Chris as an example of a claim that goes from zero over a four year period of time to $60k on a large loss claim report seemingly overnight. Everyone wonders what happened when the warning signs were all there. Similar patterns exist for those going through bouts of mental health, stress, anxiety, and depression.

At Alliant Insurance Services, our national employee benefit consulting teams are blessed to have high-quality Alliant Analytics and clinical teams on staff. They can do predictive modeling, assign actuarial risk scores to patients, capture biometrics and lab values along with updated medical and pharmacy codes, supplemented with third-party public data sources (like social determinants of health (“SDOH” and geographic determinants of risk (“GDOR”) and receive flags when interventions can make a measurable impact. Whenever our account teams consult with a plan sponsor, I have a saying. I tell people that I am looking for “Zeros and Heros”. Here is what I mean.

The picture above shows what most of our competitors review in terms of large loss claims (on the left). The exhibit shows both large loss AND zero dollar claimants over a 3 year time period. So many of our competitors fail to highlight and discuss the “Zeros” in the claim report. These are employees and their family members who received ZERO care throughout the year. This client was shocked to learn that over 25% of their covered participants got zero care. Our client felt this was due exclusively to COVID. This is why we showed the 2019 experience as well since this highly male dominant group did not receive care prior to COVID either. When I look for Hero’s within a company, we’re looking for members of the executive or HR/Benefits team who understand that Zero claims are bad. These are the people who say that they are feeling fine and do not need to go to the doctor. They are the Chris’s. Zero’s on your claim report are opportunities to do a better job in finding cancer sooner, flagging pre-diabetes/Mets, preventing a stroke, or helping someone reverse pre-diabetes, learn of their diabetes or avoid an amputation.

Next time you review your loss history, don’t just look at the large loss claims. Also look for Zeros and Heros.