Preventing high-cost claimants in “healthier” employee populations

When employers are assessing ways to control health care costs, one segment they can’t overlook is their “healthy” populations. These employees may not have complex chronic or catastrophic needs, yet they still could demand a strategic approach that focuses on wellness and proactive, personalized care — helping employers more effectively manage their total cost of care.

Data shows that 84% of employees were generally healthy yet still generate 56% of medical costs at a rate of $50,000 or less per employee per year.1 While an employer may consider that segment a healthier population — especially when combined with the 14% of the population that didn’t generate any claims — those employees still may need the right programs in place to help keep them in that category.

3 key takeaways in supporting healthy employees

  1. When employers are assessing ways to control health care costs, one segment they can’t overlook is their “healthy” populations.
  2. Building wellness programs that are simple, integrated and relevant for employees can help foster their engagement with the health care system.
  3. Leveraging a care management model that looks across the full spectrum of the employee population helps maximize medical savings by combining value drivers and engagement. 

“From a cost perspective, this group is a critical population to manage because you want to sustain their health and the onset of more severe disease by managing early risk factors,” says Dr. Brenda Bruns, Chief Medical Officer and Senior Vice President Health Services Transformation at UnitedHealth Group. “Having the right strategies can help create a health care system that engages each employee at the right time on their individual journey, whether they’re generally healthy or dealing with a chronic condition.”

To help manage costs and sustain outcomes for these employees, employers can:

  • Focus on building a culture of wellness and employee engagement.
  • Proactively support employees through challenges, such as COVID-19.
  • Prioritize personalized care management for employees most willing to engage and able to generate the most cost savings.

Building a culture of engaged wellness

Employee wellness programs are not new, but the challenge is typically employee engagement. Building simple, integrated and relevant wellness programs for employees may help generate results, as these examples from UnitedHealthcare programs have shown:

  • 12% medical cost reduction in 3 years for participants in Real Appeal®, a weight loss program2 
  • 51% of participants had quit smoking in Quit For Life®3 
  • 70% of new participants reported increased activity level after joining UnitedHealthcare Motion®, a rewards program for being active4

Here’s an example of how an employee might engage with Real Appeal:

The image showcases a member’s health care journey connecting her experience with wellness programs, including incentives, rewards and results.

Of course, creating employee awareness of these programs often is critical.

“‘If you build it, they will come’ doesn’t work for wellness programs,” says Dr. Gerald Hautman, Chief Medical Officer for UnitedHealthcare National Accounts. “Employers can help build a culture of wellness by internally marketing these programs to their employees as aggressively as they market their products to customers.”

Employers offering a range of qualifying fitness and activity options, and celebrating employee successes can go a long way in building an overall employee culture of wellness. That’s where more on-site resources can help. Regular workplace access to lunchtime fitness, yoga or physical therapy options may enhance day-to-day productivity and help avoid more costly and prolonged absences for preventable conditions.

Digital tools and devices are another way to support a wellness culture and keep employees engaged in healthy behaviors. For example, more than 75% of consumers believe that wearable devices to track health or activity data helps them to change their behavior.5 Wearables integrated into UnitedHealthcare programs are used for everything from logging miles walked to monitoring blood sugar to tracking sleep patterns. They have broad applications in their ability to engage and inform employees and their care teams.  

“Different people are motivated by different things,” Bruns says. “For some it might be healthy recipes, while for others it might be a fitness app. To improve results, employers will want to target their offerings to address where the member is with their health, where they want to be and what actions will optimize their specific situation, taking into consideration social determinants of care.”

Addressing the health challenges of the COVID-19 pandemic 

The pandemic may be presenting challenges to healthy populations in terms of increased health risks. For example, behavioral health issues have risen from the effects of COVID-19 as well as possible social and economic challenges due to the pandemic. The percentage of adults with symptoms of an anxiety or a depressive disorder increased from 36% to 42% during August 2020 through February 2021. In addition, the percentage of those reporting unmet behavioral health care needs increased from 9% to 12%, according to the Centers for Disease Control and Prevention.5

Left unchecked, untreated behavioral issues may result in more costly medical services or treatment, in addition to adversely impacting quality of life.6 Identifying such issues early and connecting individuals to care and support may be critical to success. One way employers can do this is by offering tools such as the Sanvello® app, which may help individuals monitor symptoms of stress, anxiety and depression on a daily basis and track their progress toward feeling better. For employees who may need more support, behavioral telehealth options continue to grow for employees who prefer not to meet a provider in person or need more flexibility.  

Pandemic-related lifestyle changes such as more time at home and fewer opportunities for outdoor activities may have health consequences, too, including increased obesity rates. Having obesity puts people at risk for many other serious chronic diseases and may increase the risk of severe illness from COVID-19.

Wellness and incentive programs and services may help buffer employees against adverse health outcomes. They include Real Appeal to support weight management, UnitedHealthcare Motion to support physical activity, and Rally® Health and Wellness on® to reward actions toward healthy living.

Implementing proactive, personalized care management

Those participating in wellness programs are proactively choosing to engage with the health system. For many employees, though, engagement may be more passive and indirect, putting some onus on employers and insurers to build the best system possible when that engagement occurs.

Traditional care management programs identify employees for participation or outreach based on a hierarchy of medical conditions or events. 

With employees making less-than-optimal health care choices 38% of the time,8 UnitedHealthcare’s care management program, Personal Health Support, focuses on timely outreach and proactive engagement that may help prevent higher care costs down the road. 

The 3 components of the program’s formula help to generate the strongest outcomes and savings:

  1. Value drivers are interventions to help close gaps in care and reduce costs. They provide insight into clinical intervention opportunities, enable consistent care management among nurses, and are generally simple to document and report to help maximize the benefit to employees.
  2. Likelihood to engage index uses predictive models based on employee attributes and historical enrollment data to help determine how likely they are to engage in programs and successfully close gaps in care.
  3. Value opportunity methodology allows employees to be prioritized for engagement based on their perceived overall opportunity for better outcomes and savings, as opposed to historical approaches focused primarily on clinical hierarchies.

Combining medical histories, personal communications and lifestyle choices with health care systems, care management teams use this formula to help predict trends and identify employees with health risks. They reach out to provide information and support to help keep chronic conditions from escalating and monitor the effectiveness of care. The goal is more information available when employees need to make important care choices.

Specialty medications call for specialized cost-control strategies

Integrated medical and pharmacy data, appropriate site of care and customized techniques may help manage the costs for specialty prescriptions.

Small population, large expense: Managing high-cost claimants

Supporting employees with complex care needs requires a holistic approach to manage costs while providing strong outcomes and experiences.

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