Breaking down the conditions raising employer health care costs
Employers are struggling to cover health care costs for those employees who have serious health conditions.
About 129M Americans are currently managing a chronic condition, such as heart disease or diabetes.1
As the workforce ages, employers may be more likely to have employees who are at risk of, or are receiving treatment for, chronic conditions. In fact, 4 in 10 employers surveyed said they expect to see higher chronic condition management needs in the future due to more occurrences of these conditions and a higher level of severity.2
Anticipating a higher prevalence of serious or chronic disease diagnoses matters because the management of these conditions can be complex and expensive.
Because of this, it’s not surprising that many employers are seeking strategies to help employees and their families more effectively manage their health and reduce their overall cost of care.
Did you know?
- 55% of surveyed employers ranked chronic condition management as the No. 1 area they felt could benefit most from health care innovation3
- 29% of average total employer health care costs are due to chronic conditions,4 such as costly treatments, specialty medications, hospitalizations and a higher utilization of health care services
3 costliest chronic conditions
Looking at UnitedHealthcare data, 3 illnesses cost employers the most per member per month (PMPM)4
| Musculoskeletal 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 |
|
Top Diagnoses |
Spinal arthritis Osteoarthritis Musculoskeletal pain |
Benign tumors Breast cancer Secondary malignancies |
Cardiac dysrhythmias Other heart diseases Non-specific chest pain |
| Average PMPM cost | $52 | $43 | $43 |
| Highest % of total spend by demographic | 54% Women 74% Gen X and baby boomers |
56% Women 80% Gen X and baby boomers |
64% Men 45% Baby boomers |
While respiratory conditions, mental disorders and pregnancy don’t fall in the top 3 costliest conditions, they are the top trend drivers — accounting for the highest year-over-year cost increases for employers.
A word about metabolic conditions
Metabolic conditions like obesity, hypertension and diabetes can lead to more serious chronic illness down the road. Employees who have metabolic conditions drive the majority of costs associated with those chronic illnesses. For example, 86% of what employers spend on circulatory disorders such as congestive heart failure — approximately $80,000 per claimant — can be attributed to metabolic conditions, according to UnitedHealthcare data.4
In fact, 28% of UnitedHealthcare members have metabolic conditions yet they drive 56% of the total health care spend, resulting in upwards of a 4x higher average cost per claimant for members with metabolic conditions compared to those without.4
It’s important to note that UnitedHealthcare data indicates that some of these conditions impact different demographics more than others. For instance, circulatory disorders disproportionately affect men, who account for 64% of spend, and baby boomers, who make up 45% of spend.4
“At UnitedHealthcare, we’re striving to reach members newly diagnosed with a chronic disease sooner in order to make a difference earlier,” says Dr. Rhonda Randall, chief medical officer for UnitedHealthcare Employer & Individual.
Strategies for better chronic condition management and lower costs
Managing chronic conditions can be a long and costly road for both employees and employers, but there are strategies designed to help.
“Our goal is to help employees adhere to treatment plans, identify social determinants of health risks and enroll them in clinical programs when available,” Randall says.
Employers can also play a role in helping their employees manage or prevent chronic conditions by promoting a healthier workplace and providing support, which can help to reduce costs associated with chronic conditions.
Encourage preventive care
Consider health plans designed to encourage employees to engage in preventive care via employee communications and wellness programs with incentives or rewards. Selecting a health plan that requires employees to see a PCP to direct their care may also help prevent later-stage diagnoses.
Offer benefits designed to provide financial support
Along with medical and wellness benefits, employers also have the option to include financial benefits in their health plans. These resources can include 1-on-1 financial coaching, online educational sessions, budgeting tools and more. Employers can also help alleviate the financial stress that can come with managing a chronic condition by choosing health plans that offer $0 copays for services like primary care, virtual care and urgent care visits or condition-specific coverage for necessary treatments, devices or procedures.
Promote health and wellness
Unhealthy habits or behaviors, such as tobacco and alcohol use, poor nutrition and physical inactivity, can increase the risk of chronic disease. Developing or investing in health and wellness programs with incentives may encourage employees to engage in healthy activities that can help them get on a path to better health.
Invest in care management and clinical programs
Programs designed to step in and help employees and their families navigate care with a combination of timely outreach, clinical support and personal guidance can make a big difference for those managing chronic conditions. The goal with these programs is to get employees and their families the most appropriate care and treatment for their condition at the lowest possible cost.
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