It’s news to no one that health care costs continue to burden consumers and employers of all sizes. Premiums rise without commensurate returns in improved access, quality, and meaningful outcomes. Instead, tensions arise where employers are tempted to shift more cost to employees.
Findings from the Kaiser Family Foundation’s 2018 Employer Health Benefits Survey show that the average premium for family coverage has increased 20% since 2013 and 55% since 2008.

 

Underpinning these costs is a constellation of increasing prevalence of chronic disease in the workforce, suboptimal use of acute care services, consumers’ fondness for or ignorance about using high-priced providers, and the challenges of navigating benefits design. Many employers have sought to remedy this with blunt strategies like pushing high deductible health plans (HDHPs) or severely restrict benefits. However, in our analysis, many employees do not understand the impact of such tradeoffs. Moreover, these strategies alone do not change the trajectory of healthcare risks and costs.

 

Realizing cost savings–as an employer, consumer, benefits consultant, or TPA–requires savvy analysis across multiple datasets, an acute sense of the local picture, negotiation chops, and concerted member engagement strategy

 

In this blog series outlined below, healthcare cost containment experts from zakipoint Health will walk through strategies to identify risks and cost drivers, actions to contain costs, and ways to track health and wellness outcomes. These can be used synergistically with HDHPs and Health Savings Accounts to incentivize more durable cost containment.

 

Map where your population is going for care:
Understand where your population is going for care, which providers for particular procedures, and how much cost is tied to those places of care

Map population risk:
Understand which conditions are driving costs now and are likely to in the future. Identify how comorbidities drive costs and risks, including behavioral health and chronic metabolic conditions. Close gaps in wellness and preventative care and optimize medication adherence and cost containment.

 

Once you have a mapped out utilization patterns and population risks, you can use the data to develop actions, such as:

 

Reference-based pricing:
Simulate the impact of a reference-based pricing strategy, using CMS reference price by procedure and by provider.

Steerage:
Using cost and quality data for top procedures by providers, you can understand the impact of different strategies like high-performance networks, preferred network, direct contracts, and proactively steer members to those providers.

Stop loss negotiations and management:
Use predictive analytics and clinical analysis on high-cost claimants to negotiate premiums and proactively manage high-cost members who are nearing their specification limits.

High-cost claimants:
Get a holistic view of your highest cost members and establish cost mitigation plans.

Pharmacy spending:
Pinpoint pharmacy trends and identify opportunities for cost-savings with generics, mail-order, and specialty strategies.

Emergency department utilization:
Assess avoidable ED utilization and promote the use of more appropriate care settings.

 

Pharmacy spending:
Pinpoint pharmacy trends and identify opportunities for cost-savings with generics, mail-order, and specialty strategies.

Chronic disease management:
Identify the costliest chronic conditions, promote high-quality programs to members, and track outcomes.

 

Whether you’re an employer, benefits consultant, or TPA, these topics should be top of mind as you figure out how to manage healthcare spending.

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