Increasingly, high cost claimants account for a greater share of employer health care spend. Year to year variations in high cost claimant spend are often the greatest driver of overall medical cost spend trend for employers.
The traditional focus on overall utilization patterns remain important, but are no longer the primary challenge employers face in health care plan spend. The cost of specialty medicines and other new medical technologies are emerging as leading costs drivers.
Whereas chronic conditions remain an important concern for populations covered by employer plans, many of the costs related to these conditions actually accrue in patients over the age of 65. Other drivers such as orthopedics, maternity and neonatal care are equally significant drivers of employer health care spend.
What is and what isn't covered by employer-sponsored health plans increasingly requires informed decisions around benefit design, as well as, careful oversight of carrier and TPA utilization review practices.
Assuming fixed resources to invest in overall health-related solutions demands a careful accounting of how dollars spent translate into value for employers.
Targeting high cost conditions require solutions that are specific to the condition being targeted. Success in targeting diabetes requires very different tactics than acute trauma, extended neonatal care or cancer treatment.