In an extensive analysis of patient claims data, health plan member engagement has emerged as employers’ single best-practice solution for controlling costs and improving outcomes for their employees.
In the fifth joint white paper by the Health Action Council and UnitedHealthcare, a comprehensive analysis of 320,000+ covered lives identified 50% of nearly $2 billion in cost to employers was limited to five conditions:
Cancer – 15%
Musculoskeletal – 13%
Cardiovascular – 9%
Gastrointestinal – 7%
Neurological – 6%
The study, Costly Conditions: Identifying and Addressing Top Clinical Cost Drivers, offers insights into why employer cost varies so widely across gender, age, income, geography, and social determinants of health. In addressing these dominant conditions, the report shows why individual communities matter so much in terms of the total cost of care, billing patterns, treatments, and outcomes. In addition to the “why,” the report shows how employers can reduce costs by encouraging more employee engagement.
Best-Practice Recommendations
Patty Starr, president and CEO, Health Action Council, and Craig Kurtzweil, vice president, UnitedHealthcare Center for Advanced Analytics, stress that employer, management and budget priorities should focus on these strategic imperatives:
Transparency
Empowering people with more information about their care options may help everyone make more informed decisions and save. Integrated online resources available today provide personalized wellness support, decision-making power, and comparison-shopping options for employees. Employers can achieve significant gains by providing tools for employees to evaluate providers, treatment options, and cost estimates of medical services.
Engagement
Encouraging employee engagement – activation – helps optimize plans and incentives. For example, the UnitedHealthcare HAI™ tool evaluates 53 evidence-based decisions as well as life-stage, demographic and social determinants, to identify under-engaged individuals and groups. The report shows that highly activated patients are significantly less costly, and far healthier, than those lower on the activation scale.
Affordability
Lower drug prices have the greatest impact on plan affordability for the company and employees. Introducing pharmacy step therapies to support the use of high-quality, lower-cost generics or biosimilars before turning to more expensive solutions is one example. Also, look for differences in practice patterns by geographic region (over- and undertreating; low adoption of best practices) when targeting high-cost conditions. Did you know that neurological treatment differs greatly by location? For example, patients in Greensboro are eight times more likely to have carpal tunnel surgery than people in Phoenix. Billed charges also vary widely. The average billed by providers in Los Angeles is four times higher than in Philadelphia for the same procedure code.
Advocacy
Employers should also make sure their employee health strategy includes a commitment to helping their employees navigate the health care system. Using advanced algorithms to identify the next best actions personalized to each member, advocacy and clinical resources can go beyond basic customer service to develop a deeper understanding of an individual and their needs, including social needs, to deliver personalized guidance. The goal is to create a simpler experience, so a person can make more informed health decisions, improve their health, connect with relevant clinical programs, avoid unnecessary costs, understand lower-cost treatment options and find community resources.
Employers can learn more about how to lower costs and help employees achieve better health by reading the full white paper HealthActionCouncil.org/News/Health-Action-Council-and-UnitedHealthcare-Release.
Source: BPT
