3 cost-management strategies for employee health care coverage

Health care spending in the U.S. is expected to reach $6.8 trillion by 2030.1 Perhaps even more noteworthy: 25% of that spending could be due to overtreatment, low-value care, fraud and other factors.2

Within that percentage lies a cost-management opportunity.

For an employer, it can be work that ensures they’re offering a high-value health care program that’s cost-effective — not only for the organization but also for its employees and their families.

Here are three examples of strategies that have been shown to be effective in dealing with certain health care costs:

1. Clinical and care management

recent report shows that consumers may make health choices that were less than optimal for their health situation more often when the options are complex or involve high stakes. A clinical and care management strategy that uses advanced analytics to identify employees with chronic and high-cost conditions may create opportunities for better health care choices and overall cost savings — by helping them understand what services are available.

For instance, in some UnitedHealthcare plans, clinical data can be used to help identify employees at risk for chronic, high-cost conditions, allowing nurse advocates to reach out and gauge interest in proactive support and to alert employees about clinical programs available through their coverage. Through UnitedHealthcare’s enhanced customer care advocacy models, employers can increase enrollment in clinical programs by up to 10% and reducing the total medical cost of care by up to 4%.4

2. Network and plan design

Research has shown that access to primary care is associated with positive health outcomes and that primary care providers (PCPs) can influence $0.61 of every health care dollar.5 A network and plan strategy centered around high-performing PCPs — and systems that deliver quality and efficiency — may make it easier to direct care appropriately, so members receive the right care at the right time.

For example, Point of Care Assist® can integrate an employee’s UnitedHealthcare health information into a provider’s electronic medical record. This merge of data gives the doctor real-time insights on care opportunities and a look at an employee’s specific benefits, including prescription coverage and costs, which may help identify lower-cost options.

Separately, some employers are opting for newer plan designs that eliminate deductibles and replace them with variable copays. This approach can help members clearly see – in advance of receiving medical services – what they will pay depending on the care provider and facility they select. For employers offering the Surest health plan, a recent analysis showed out-of-pocket expenses for plan members were 46% less and the cost for the company declined by up to 15%.6

3. Employee engagement initiatives

Giving employees tools and resources to help them maintain or make steps toward a healthier lifestyle may be another powerful approach. 

An employee engagement strategy that includes wellness and weight-loss programs tied to rewards for healthier choices may help prevent or manage chronic conditions — which may ultimately promote better health, improved productivity and lower overall costs.

For example, UnitedHealthcare Rewards® enables eligible members to earn up to $1,000* per year by completing various daily health goals and one-time activities, such as getting a biometric screening, completing a health survey and using a smartphone or smartwatch to log 5,000 or more steps each day and to track sleep for 14 nights. Additionally, a program called Real Appeal® supports weight loss by building healthy habits across key areas, such as nutrition, fitness, sleep and stress. It is available at no additional cost to eligible UnitedHealthcare members and dependents as part of their health plan benefits.

For a deeper dive into these cost strategies, watch the video below to hear the trends regional UnitedHealthcare leaders are seeing find traction within their respective markets. Or read a white paper on this topic.

1 UnitedHealth Group Sustainability Report, 2021.

2 Shrank WH, et al. Waste in the U.S. Health Care System: Estimated Costs and Potential Savings. JAMA. 2019.

3 UnitedHealthcare National Accounts Book of Business, 2019.

4 2019–2020 UnitedHealthcare employer study including 387 clients, 4.8M members and $19.2B in medical spend. Analysis completed on a continuous medical enrollment basis. Medical costs risk adjusted for age and gender. Value impact based on comparing clients by the adoption platform features vs. not (e.g., enhanced vs. Core advocacy). Actual client results may vary based on specific clinical programs the client has or maturity of implementation.

5 National Health Expenditures, 2020 Highlights. Centers for Medicare & Medicaid Services.

6 Surest self-funded 2021 book of business plan sponsors with at least 12 months of incurred experience in 2021 and both medical and pharmacy data within our warehouse; compared to matched comparison groups from a nationally representative commercially insured database matched by gender, age, urbanicity, and zip3 code using exact matching

*Financial incentives may vary by plan, including some plans being capped at $300 per member per year; incentives may be less due to limits under applicable laws.