How Employers Can Lower Employee Healthcare Costs While Improving Outcomes

By Miles Varn, M.D., Chief Medical Officer of PinnacleCare

According to research from the American Cancer Society, cancer care cost U.S. employers an estimated $264 billion in healthcare and lost productivity in 2010. Trends in cancer-related expenses are sure to capture the attention of any benefit manager. To add to the concern, costs are anticipated to continue rising along with the anticipated increase in cancer diagnoses.

New therapies for treatment, while welcome, exacerbate the issue by delaying mortality for those diagnosed with cancer. The number of people surviving a cancer diagnosis reached nearly 14.5 million in 2014 and is expected to rise to almost 19 million by 2024. While it is encouraging that people are living longer after being diagnosed, the cost of continuous treatment adds up for both the employer and the employee. According to the Harvard Business Review, many of these patients are in the workforce and cost employers about $150 billion to $250 billion or 60 percent of the total cost of worker illness. Additionally, chronic conditions like cancer combined with substance abuse and other factors like stress, fatigue and depression can impact the employer’s bottom line.

So what options do benefit managers have for adequately meeting the needs of an employee facing a physically, emotionally, and financially draining burden such as this, while managing their company’s financial and business risk?

Personalized Healthcare Experience

One effective healthcare strategy that can both encourage and facilitate proactive engagement is an employee-focused program that centers on a personalized healthcare experience. This often relies on strong vendor collaboration and integration facilitated by a trusted health advisory team acting as the go-to source for driving increased benefit utilization and engagement. By meeting employees where they are in their journey, at their most critical time of need, the advisor builds trust and subsequently guides the employee to extend engagement to the appropriate medical and benefit providers. This provides an integrated on-demand approach that helps to drive overall benefits utilization and potentially improve both the medical and financial outcomes for all stakeholders.

The healthcare tide seems to be shifting toward a more targeted approach that has a tangible impact and focuses on engaging employees when they need help the most. Typically, this approach best supports employees who are dealing with complex conditions or are at risk for escalating medical issues, such as a cancer diagnosis or recommendation for back surgery. The health advisory support model has three key advantages:

1. When overwhelmed by complex medical issues, employees are more receptive to a simple process that minimizes further complexity and routes their specialty care needs through a single point of contact.

2. The member experience leverages high-touch concierge type services to alleviate the stress and time burden associated with coordinating medical records, finding the right specialists, and timely scheduling of appointments and procedures.

3. The initial engagement creates opportunities for further engagement and benefit integration through warm transfers to other benefit services — strengthening and expanding the circle of trust.

Health advisors can guide employees through an outcomes-driven and evidence-informed approach that navigates their complex healthcare journey.

Considering these cost factors, it’s clear that the more patients are engaged with an advisor, the greater the opportunity for savings and better patient outcomes. According to the Northeast Business Group on Health, the goal is to guide employees even before treatment begins. During treatment, employees may require support to maintain adherence with their treatment plan or to manage their work schedules around chemotherapy, radiation therapy and other care-related appointments.

Personalizing the service and intervening at a granular level to develop a one-to-one relationship with the patient is paramount to a successful outcome. A complex and serious diagnosis does not have to be the end. It is where a health advisor begins to help employees navigate through a potentially life-changing medical issue — facilitating their access to the right care at the right time to guide them along their journey.

This content has been excerpted from a more comprehensive white paper on the topic, which can be found here.