Healthcare costs are continuing to increase at an alarming rate for US employers and by 2020, the average per employee healthcare cost including premium and out-of-pocket expenses, will reach $15,000. Containing healthcare costs is crucial for employers as it is often the second-largest expense after wages. Believe it or not, poor employee health and absenteeism costs employers roughly $530 billion dollars a year. Counteracting these issues requires that employers know what questions to ask so that they can create the most efficient benefits package for their employees. Well, the answer lies in population health management and here’s a starting point for every employer. Read on:
Before the concept of value-based care kicked in, the type of support employees received was more reactive and less proactive. In other words, a person would only visit a provider only after a few symptoms start showing up. But, risk factors have a different story to tell. According to the American Medical Association, it is not only diabetes and high blood pressure that are driving higher healthcare costs. Some of the chronic conditions that lead to high healthcare costs:
Combined, these conditions cost employers billions. If both employers and employees adopt proactive approaches, can costs be managed more effectively? Risk stratification can help identify the exact number of employees in need of proactive care to lower their risk of developing a chronic illness. Understanding the risk of one’s population will also empower employers to better negotiate contracts and quality incentives with payers..
Proactive care helps employees avert the risk of emergency room visits, improves overall health, and also prevents more expensive conditions from developing.
Workplace stress and burnout are one of the most pressing concerns for employees. A recent Gallup study found that 23 percent of employees feel the heat of burnout and healthcare spendings are to the tune of $190 billion a year.
Population health management for employers involves identifying and incentivizing activities employers can promote to improve the well-being of their employees. US employers typically use generic wellness programs that do not account for individual differences in health status and overall health goals. Additionally, employers must be able to understand and limit the impact of non-clinical factors impacting health costs such as:
All these factors are a component of social determinants of health and indirectly impact employee health and productivity. Employers must take note of these determinants and leave room to contain these factors while designing their wellness programs.
Most employers lack mechanisms to track whether employees are taking proactive steps to improve their health.
Preventive healthcare can help employees set and follow-through with fitness and nutritional goals for example. However, more than 44 percent of employees avoid regular checkups.
Surprisingly, the stats also include employees with valid employer-sponsored medical insurance. That’s the reason why most ailments get detected after the symptoms become more evident and lead to higher care costs. Therefore, study of employee population health can help employers spot people who have skipped mandatory health tests to ensure they receive the right preventive care at the right time.
Although there is no accurate data for private health insurance as a whole, we do know that readmissions cost Medicare about $26 billion annually. Most employees are readmitted because of one or a combination of these avoidable reasons:
When such challenges appear, the cost of hospital care outweighs out-patient visits. Among the crucial workforce health metrics, employers should ensure that employees have easy access to post discharge care. Hospital readmissions can lead to hefty claims for employers and employees and are a factor in driving higher healthcare costs. To manage, employers can work to ensure that employees receiving critical care are receiving effective outpatient care and both understand and engage with post-discharge instructions.
Healthcare is slowly transitioning to Value-Based Care (VBC) which means that providers are increasingly receiving performance-based incentives rather than simply fees for specific services. Targeted population health management ideally helps providers and payers meet common objectives and can also help employers improve healthcare outcomes and reduce costs. Employers ought to establish wellness programs that strengthen employees’ relationships with outpatient providers. These wellness programs can be aimed at:
When designing initiatives to address these issues employers must use data to ensure that the following items are addressed:
Data has a lot to offer when it comes to enrich employee engagement initiatives or in this case, reducing healthcare costs. To remedy these issues, employers must not only satisfy themselves with working once a year with a benefits specialist; rather, they ought to take an active role in using population health data to drive changes in the healthcare system. Expectation mismatch is one of the key reasons that keep employers from achieving healthcare objectives . Therefore, employers must focus on improving the experience of their employees, so they don’t have to run from pillar to post seeking answers to basic healthcare questions. Once employers know what bothers employees the most and how their healthcare expenditures are faring, a course correction is only a step away.
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