Top Cost-Driving Conditions for Employer Health Plans
Amid rising health plan costs, insurers and employers are identifying the biggest cost drivers as the first step toward effective containment strategies. UnitedHealth Group, the largest health insurer by national commercial market share, leveraged its 2023 claims data to pinpoint three illnesses that cost employers the most per member per month (PMPM):
- Musculoskeletal (MSK) conditions affecting the bones, muscles, joints, and certain connective tissues
- Neoplasms: abnormal tissue growths, such as moles and tumors
- Circulatory disorders affecting the heart and blood vessels
The costliest driver was musculoskeletal conditions (MSK) with an average cost of $52 PMPM.[1]
In a 2024 survey where employers were asked to list the top conditions driving their annual healthcare spend, respondents listed the same three conditions: cancer (86%), MSK (75%), and cardiovascular (30%)[2]. As the workforce ages, these conditions will become even more prevalent and concerning to employers, employees, and the families and communities of the afflicted.
Point Solutions: A Targeted Approach to Managing Cost-Driving Conditions
The need for a targeted approach to contain costs and keep employees healthy is clear. More than half of surveyed employers ranked chronic condition management as the No. 1 area that could benefit most from healthcare innovation.[3] One approach that has gained traction with plan sponsors is healthcare point solutions, which are specialized services, products, or technologies designed to address specific health conditions. Over the last decade, these solutions have multiplied to cover a range from musculoskeletal care, cardiovascular programs, diabetes management, fitness, and wellness. While many vendors promise significant returns, they can’t deliver point solution ROI without utilization.
Boosting Point Solution Utilization Through Engagement
Boosting point solutions engagement should be embedded in an overarching strategy to improve employee engagement in healthcare, and should include the following steps:
- Proactive identification of members who can benefit from specific point solutions
- Early intervention to avoid illness progression
- Education on the potential value of a solution
- Encouragement from a trusted source
- Seamless enrollment experience to ensure utilization and avoid drop-off
- Follow-up and financial reporting to measure and quantify engagement
How a Solution like HealthActive Improves Member Engagement
At LaborFirst, our HealthActive solution includes all the necessary steps to increase engagement with the nation’s leading point solutions.
Proactive Identification of Members & Early Intervention
When members call LaborFirst, they’re connected with an Advocate on their dedicated team who knows their plan design, understands plan sponsor goals, and is equipped to guide care decisions in real time. AdvocateIQ, our proprietary technology, empowers Advocates with data-driven insights through analyzing claims, Health Risk Assessments (HRAs), and census data. AdvocateIQ immediately identifies a member who could benefit from a specific point solution and alerts the Advocate with all necessary information and next steps. In addition to inbound calls, Advocates conduct personalized outreach campaigns to drive adoption of relevant point solutions and close gaps in care.
Education and Encouragement from a Trusted Source
Our Advocates serve members daily: answering questions, resolving issues, and guiding benefit navigation. These interactions build trust, strengthen relationships, and put our Advocates in the best position to educate members about valuable point solutions and encourage participation.
A Seamless Enrollment Experience
Within our platform, Advocates can seamlessly enroll active employees into point solutions programs to ensure utilization and avoid drop-off from confusion or distraction.
Follow-Up and Financial Reporting
After enrollment, Advocates will circle back with a completion call to gauge if the member is actively engaged with the point solution program, and if it is progressing well. Our HealthActive clients also receive reporting on the financial impact of increased engagement with their offered programs.
By embedding point solutions engagement into our advocacy model, LaborFirst ensures higher awareness, improved utilization, better ROI from solutions vendors, and better management of cost-driving conditions.
[1] UnitedHealthcare Employer & Individual book of business data, Dec. 2023. Excludes Alaska, Hawaii, Puerto Rico and the U.S. Virgin Islands.
[2] 2024 Large Employer Health Care Strategy Survey. Business Group on Health, 2024: https://www.businessgrouphealth.org/resources/2024-large-employer-health-care-strategy-survey-executive-summary
[3] The future of health care: What matters to employers. Advisory Board, 2023. Available: https://www.uhc.com/employer/news-strategies/2023-employer-innovation-survey-report
Connect with us to learn how our HealthActive solution can increase member engagement and improve outcomes.
