High-cost healthcare claims are rising as spending per person has increased significantly over the last few years. While the increase is less pronounced in certain areas, many sectors of the healthcare industry, such as behavioral health, orthopedic procedures, and the youth have increased at astonishing rates. For employers with company-sponsored plans, this is a concerning trend.
Healthcare Spending
High-Cost Healthcare Claims Are Rising, and healthcare spending can be broken down into several categories, including hospital care, physician services, prescription drugs, and government administration. In the last three to five years, the sector that has seen the biggest increase has been physician services. This has been due to government-subsidized healthcare goods and services starting to decrease because of the end of the pandemic. These healthcare services increased by 7%, and only by 5.1% in 2021. Million-dollar claims per million people from employer-paid claims have also increased. At least twenty percent of employers have reported having at least one member of their company who has at least $1 million worth of claims.
Youth Healthcare Claims
Youth healthcare claims are increasing as well. Many of the above are common causes, with also prenatal care and treatment for disease resulting from the COVID-19 virus driving claims higher. Drugs additionally have gone up in cost.
Seek Plans That Implement Stop-Loss Measures
Some way employers can combat this trend is to seek plans that implement stop-loss measures. These can minimize the impact high-cost claims can have on both employers and employees. However, these plans tend to be more expensive to pay for. Employers should start with an average cost basis and seek ways to build their benefits packages around which plans offer protection against high-cost claims.
Seeking Third-Party Administrators And Brokers
Employers can further mitigate high-cost claims by seeking third-party administrators and brokers to help them with these rising costs. Other strategies include finding a patient assistance program and finding programs that help with the cost of medications, such as searching for other biosimilar drugs and seeking critical illness plans that cover diseases such as forms of cancer.
Employers Are Looking To Improve Their Health Benefit Options
Overall, employers are looking to improve their health benefit options over the next several years. High-cost healthcare claims are rising as costs per employee on employer-based plans will increase to upwards of $13,800 by the end of 2023. It looks as if this is caused by inflation across the marketplace since late 2021. Medical insurance is crucial to helping employers increase retention and recruitment while improving access and affordability to their employees. Despite medical costs continuing to trend upward, employers can have multiple strategies in hand to combat high-cost claims and rare diseases.
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Sources
https://www.ama-assn.org/about/research/trends-health-care-spending
https://www.healthcarefinancenews.com/news/million-dollar-claims-increasing-among-employer-plans
https://www.healthcarefinancenews.com/news/high-cost-claims-rise-especially-among-youth