Among all clinical health conditions, the top five are responsible for half of the 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 that 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%
“Our long-term collaboration with the Health Action Council has led to significant discoveries that not only identify opportunities to improve health care access and affordability but also to advance health care equity,” said Craig Kurtzweil, vice president of the UnitedHealthcare Center for Advanced Analytics, who recently shared insight on the study at 2022 IBI/Conference Board Health and Productivity Forum.
What can be done? The study indicates mitigation of the 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.
Here are four focus ideas for employers who are looking for ways to address health care costs:
- 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
- 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.
- 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.
- 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. The 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.