Survey reveals ‘managing high cost claimants’ is employers’ top health benefits strategy

“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, according to a recent analysis of Mercer’s National Survey of Employer-Sponsored Health Plans, 2017. More than three quarters (77 percent) of U.S. employers with 500 or more employees said this strategy was “very important” or “important.”

The rapid rise in high cost claims is most likely a key driving force behind this strategic prioritization by employers. “High cost claims are clearly one of the issues that keep employer health plan sponsors up at night,” said Jean Moore, senior director of health specialty practices at Mercer. “Fortunately there are ways employers can improve the experience of employees and family members dealing with serious conditions while also mitigating cost. This can be done by helping to ensure that patients are receiving the right care, delivered in the right place at the right time.”

Generally, a relatively small number of plan members drive a large majority of the cost, the survey noted. According to Mercer’s database containing approximately 1.6 million members, on average the sickest 6 percent of an employer’s population represented 47 percent of the total allowed medical and pharmacy spend.

“As the prevalence of high cost claims encroaches on limited plan dollars, plan-sponsors must be mindful of the value or return-on-investment derived from solutions focused on high cost claims management, not simply cost alone,” Moore continued. “Value should be the starting point for any employer’s strategic planning and action when it comes to high cost claimants.”

Visit our News Library to read more news stories.