“Managing and monitoring high cost claimants” is the top health benefits strategy that U.S. employers will be focusing on for the next five years.
More than three quarters (77%) of U.S. employers with 500 or more employees said this strategy was “very important” or “important,” according to a recent analysis of responses to the Mercer National Survey of Employer-Sponsored Health Plans, 2017.
Generally, a relatively small number of plan members drive a large majority of the cost. According to Mercer’s database containing approximately 1.6 million members, on average the sickest 6% of an employer’s population represent 47% of the total allowed medical and pharmacy spend. Mercer says high touch, nurse-centered care coordination can often produce the best possible health outcomes and as cost-efficiently as possible.
A study of carrier claims data from Mercer Health Advantage (MHA), a program offered through select insurance carriers that features high-intensity care management for the sickest employees, revealed a rapidly growing percentage of claims classified as “high cost” by the participating carriers (>$50,000/claimant). “The important difference between standard health advocacy programs and high-intensity care management programs such as MHA is that the care manager works directly with the care team as well as the patient and family, stays in contact after discharge to provide support, and provides a supportive role in improving compliance with treatment plans,” Mercer says.
Companies using MHA experienced qualified participant engagement as high as 65.2% and high-cost claimant engagement up to 78%. “Employers can help workers most at risk better manage their care—and save an average $430 annually per employee,” Mercer says.More about Mercer Health Advantage is here. More about Mercer’s National Survey of Employer-Sponsored Health Plans, 2017, is here.