Among all clinical health conditions, the top five are responsible for half of costs for U.S. employers and union groups served by the Health Action Council, according to a study by the group and UnitedHealthcare.
By the numbers: The analysis, which looks at the health care claims of more than 320,000 of the Health Action Council’s members, reveals 50% of nearly $2 billion in costs to the employers was limited to five conditions:
- Cancer 15%
- Musculoskeletal 13%
- Cardiovascular 9%
- Gastrointestinal 7%
- Neurological 6%
- Other conditions 50%
What can be done? The study indicates mitigation of these top cost drivers may come in large part by helping employees play a bigger role in maintaining good health.
According to a UnitedHealthcare analysis that considers 53 evidence-based decisions, highly activated members — those who are very engaged in their health care — are significantly less costly and far healthier than those who are lower on the activation scale.
With that in mind: Here are four focus ideas for employers who are looking for ways to address health care costs:
1. Engagement opportunities – Consider expanding your current employee engagement and wellness programming to address undiagnosed or untreated conditions. Topics for programs may include things like:
- Exercise or weight loss
- Dental care
- Sleep quality
- Smoking and vaping cessation
- Stress management
2. Transparency tools – Empowering employees with more information about their care options may help them make more informed decisions — and ones that could help save money. Consider sharing the value of disease-specific support groups or providing employees with digital tools for evaluating providers, comparison-shopping treatment options and estimating medical service costs.
3. Pharmacy affordability – Programs that promote lower drug prices may have a dramatic impact on health costs for employees and a company. For example, step therapy directs members to less expensive but equally effective medications that may be available within a drug class, including generics or biosimilars. This approach helps support the use of high-quality, lower-cost solutions before other therapies that are more costly.
4. Enhanced advocacy – Consider a strong advocacy program for guiding employees through the complexities of the health care system. UnitedHealthcare advocacy goes beyond basic customer service and uses advanced data algorithms to develop a deeper understanding of an individual and their needs, including any possible social barriers to health, to deliver personalized guidance. Goals of this enhanced advocacy include:
- A simpler employee experience
- Better, more cost-effective health decisions
- Connection to relevant clinical programs
- An understanding of lower-cost options
- Awareness of community resources
Worth noting: In addition to these employee-focused approaches to managing high-cost conditions, the study indicates an employer should consider what a deep dive into their company’s health data may reveal or how working with a third-party administrator to conduct provider outreach may improve the quality of care.