How to manage high-cost health events

Building a better picture of employee health: How to manage high-cost health events

High medical costs are unavoidable. But they are also predictable and manageable with the right data and the right partner.

The challenge for employers is to understand the needs of their employees in order to anticipate, address and manage high medical costs.

Helping you understand the needs of your employee population and closing gaps in care is what Cigna does best. And our industry-leading analytics models and integrated care solutions mean you’ll not only have a healthcare partner, but a growth partner as well.

Consider the following:

  • Multi-million dollar claims are on the rise, due in large part to expensive specialty drugs and the increase in people living with chronic illnesses.
  • The companies spent $2.5 billion to treat diabetes, hypertension, mental health/substance use disorders, asthma, and back disorders for employees between July 2018 and July 2019. More than 60% of workers have at least one of these chronic conditions.
  • Five chronic diseases or risk factors (high blood pressure, diabetes, smoking, physical inactivity and obesity) cost US employers $36.4 billion a year due to employees missing work days.
  • About 4% of the population use specialty medications, but they account for 65% of total drug costs and 19% of total health care costs, according to Cigna’s 2022 National Trends Report.

These kinds of concerns about medical costs can have a big impact on your company’s bottom line and profitability. They can also take a huge physical, emotional and financial toll on your employees, affecting their productivity and hindering their ability to grow. The Integrated Benefits Institute estimates that the cost of ill health among workers amounts to 61 cents of each dollar employers spend on health benefits.

Do you know what your employees need today to get and stay healthy? Do you know how to help people with chronic conditions get the best care? Your employees are diverse and so are their health needs. But companies that implement benefits strategies based on the specific health conditions of their employees can help improve the health and well-being of those employees, their greatest asset.

It all boils down to viewing health benefits as a long-term investment in your people, not simply an expense.

An investment, not a cost

Providing more significant health benefits doesn’t always mean spending more money; After all, an expensive specialty drug could, for some patients, reduce the total cost of long-term care while improving that patient’s health, well-being, and productivity.

How does the high initial cost pay off over time? How do the decisions you make today drive the total cost of care? To answer these questions, you must anticipate and manage risk to your business and your employees.

Meet employees where they are

To anticipate medical costs, you must understand the composition and diverse needs of your employee base. Many factors can impact claim costs. Some, like age, current health conditions, and health care utilization, are more obvious. Others, many of which may be related to social determinants of health, are less so. These may include:

  • race and ethnicity
  • health goals
  • Location (including access to primary care and healthy eating)
  • Gender
  • Entry
  • Education
  • life events
  • care responsibilities
  • Role in a company
  • motivations

The pandemic has made it clear how important it is to take into account everybody factors that contribute to a person’s health. From its disproportionate impact on people of color to the strain on caregivers, the pandemic has taught us all that supporting employee health is a comprehensive and iterative effort.

To capture the nuance, consider the humans behind the data. Engage and listen to employees to understand what they really need to be satisfied and productive.

Group employees to reduce high medical costs

With this information, derived from claims data, conversations with your employees, and other sources, a health partner like Cigna can, through sophisticated predictive analytics, provide a detailed picture of different segments of employee medical conditions. From this, you can gain insight into those who are most likely to experience high medical costs.

For example, him Peterson-KFF Health System Tracker found that those over 55 years of age accounted for 56% of total health spending in 2019, but comprise only 30% of the population. And, people diagnosed with certain chronic conditions have much higher average spending than people without these conditions.

Furthermore, according to Commonwealth Fund, cancers are usually found at later stages for black adults. And, black people are more likely than white people to die before the age of 75 from preventable causes.

By understanding what employees need, designing benefits to meet those needs, and targeting workforce communications, you engage employees where they are. It can improve productivity, improve employee health and happiness, and bend the cost curve.

Integrated Data, Integrated Care

The best way to access and analyze all relevant claims data is by integrating mental health, pharmacy and medical claims data.

Recent Cigna research shows that when you truly integrate those benefits, you achieve comprehensive care that improves engagement and outcomes and lowers total medical costs. In Cigna’s case, she averaged $227 per person per year. For people identified as having a health improvement opportunity, it was $4,741.

A key part of an integrated benefits plan includes appropriate and timely interventions for chronic conditions. The health care industry knows that early intervention leads to better outcomes, which leads to lower costs. Take musculoskeletal conditions (MSK), for example: they are debilitating for patients and account for some of the highest claims spending of all chronic conditions, with 4% of patients responsible for approximately 35% of direct costs for musculoskeletal pain.

One reason for this is a care process where providers, health data, and treatment plans are siled from each other, causing interventions to be delayed. To help better guide its employees to the right care at the right time, Cigna seeks to clarify, streamline and personalize care at every step of the patient journey, while propelling businesses down the path of continued growth. In the coming months, you’ll see new integrated care solutions that are designed to help lower costs and improve health outcomes for employers and patients facing complex and costly conditions.

Transform your health benefits

Understanding and addressing your employee segments and closing gaps in care isn’t easy, but you don’t have to do it alone. You have a partner: Cigna can work with you to create a comprehensive ecosystem of financial protection that starts with contracts, fraud protections and quality integrated care solutions that reduce the likelihood of high medical costs.

Because at Cigna we believe that caring for your employees’ health is the new business care. That’s why we’ve invested in data-driven technology that tailors wellness recommendations for each of your employees, prioritizing holistic health of the whole person within all of our plans so your entire organization feels valued and supported.

Our data-driven insights help turn your benefits from a reactionary system where high medical costs come as a surprise to a preventative investment where costs are managed. And we not only recommend improvements for your company as a whole, but also for your individual employees and their unique needs. The result? Healthier team members and healthier business growth.

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