August 6, 2025

Real Examples from Self-Funded Plans

In today’s health benefits landscape, employers with self-funded plans are seeking every possible advantage to manage costs and improve outcomes. One of the most powerful tools available? Data.

From detecting cost drivers to evaluating program performance, data analytics enables smarter, more strategic decisions. When employers, third-party administrators (TPAs) and brokers act on this insight, they can build better benefits that improve care while reducing wasteful spending.

Here’s how data helps self-funded plans deliver real value.

Industry Trends: The Value of Data

Across the industry, employers leveraging data have seen improvements such as:

• Lower ER utilization: By identifying frequent ER users and providing education or access to more appropriate care settings (like urgent care or telehealth), some plans have seen avoidable ER visits drop by double digits.
• Improved medication adherence: Data reveals gaps in prescription fills for chronic conditions like diabetes or hypertension. Outreach campaigns and targeted copay reductions help get members back on track.
• Better disease management engagement: By stratifying risk based on claims, employers can identify high-risk individuals and direct them to condition-specific coaching or nurse case management, often leading to fewer complications and better long-term outcomes.
• Early intervention for high-cost claimants: Analytics can flag rising risk before a catastrophic event occurs, allowing proactive outreach and support.

Real Impact: Nova’s Care Transitions Program

At Nova Healthcare Administrators, data is core to how we serve self-funded clients. One of our most impactful programs uses post-discharge analytics to guide outreach to members recently released from a hospital stay.

Through our Care Transitions program, nurses from our in-house medical management department follow up with members after a hospital discharge to reinforce treatment plans, ensure follow-up appointments are scheduled, and answer any questions. This program helps members avoid complications that could lead to readmission, an outcome that benefits both the individual and the health plan.

The result?

• $3.9 million in averted admission savings – based on successful outreach and averted 30-day readmissions.
• $5.0 million in potential admission savings – projected cost avoidance if all eligible members were successfully reached.

Takeaway for Employers

Data is more than reporting: it’s a roadmap to better plan design, more targeted interventions, and more meaningful member engagement. Whether you’re managing high-cost claimants, evaluating network performance, or enhancing chronic condition support, data gives you the clarity to act with confidence.

Want to learn how Nova can help your organization build a smarter self-funded strategy? Connect with us today.

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