Trion Group, A Marsh & McLennan Agency, LLC Company

Marybeth Gray

Healthcare costs for companies are typically the second largest business expense behind compensation.   They have remained at the top of the essential “must haves” to recruit and attract talent to run our businesses…  and it has become a bigger challenge to manage this runaway expense.  As a consultant looking at utilization data for hundreds of employers, we are seeing and understanding new patterns and trends emerging.   Several areas of focus now and in the future must be new strategies for Cancer Treatment and Chronic Illness Management.  

United Healthcare, the US largest insurer published startling new statistics last week that show an emerging concern with the millennial population and their utilization patterns.  These findings were unexpected and may lead to higher future spend for employers than may have been anticipated.  There is great hope in the medical advancements in the US.   Understanding the new cutting edge medical breakthroughs in medicine, employers have a new opportunity to enhance the plans, raise the quality and outcomes for our members as well as reduce costs.  Adding simple programs to the benefits packages being offered could change the way we approach healthcare in America – changing from treating to preventing illnesses.   Employers need a new playbook.

What happened during the pandemic that has impacted healthcare?   Hospitals shut down many departments and elective surgeries and in turn, that negatively impacted their financials.   We are seeing the effects of this with the vast majority of hospital systems posting large financial losses.   What does that mean for employers?   The per diem rates will likely increase at unprecedented levels when the contracts with insurers come up for renewal.   These costs will impact employers that are self insured in the claims and utilization costs in the coming years.   As it relates to cancer, our number one cost driver for employers in the US, the lack of screenings and traditional preventive checks are also a negative impact of the pandemic.   In 2022, cancer became the number one cost driver for employers in the US.  Companies are looking at the new opportunities to develop programs around cancer to provide members with resources and assistance to navigate treatment options during this scary diagnosis.   We can break this down into three parts.  

The first step is embracing the breakthrough in knowledge and understanding of the human genome.  Understanding how your genetics affects your health.   For the first time in history, humans can understand what their genetic predisposition for certain types of cancer are and take measures to prevent rather than treat!  Think about that, if I know that I have the BRCA gene, I then understand the elevated risk of breast and ovarian cancer.  I can then step up the proper screenings to ensure if there is an issue, treating it early can make an extraordinary difference in the survival rate.   Outcomes will improve and it will be less costly under the medical plan.  One in eight cancer patients has a genetic variant according to the JAMA Oncology Study and nearly half of those patients had no family history.  This suggests that a physician just asking about family history isn’t good enough anymore. Now that we have the technology to identify risk – we need to suggest a better way.  Across cancer types, universal hereditary genetic testing can help personalize your treatment and approach to care.  Employers can incorporate these opportunities into their benefit plans and make this available to raise quality and lower costs.  

"There is great hope in the medical advancements in the US. Understanding the new cutting-edge medical breakthroughs in medicine, employers have a new opportunity to enhance the plans, raise the quality and outcomes for our members as well as reduce costs"

The second step may be adding one of the 3-4 cancer concierge programs available in today’s marketplace that make integrating these plans easy for employers.  One could even argue that making these programs available to employees over a certain age could check the DEI program box as well.   Many of the new benefit programs employers have embraced over the past few years have been tailored to the younger workforce with benefits like family leave and infertility benefits.  These cancer programs may appeal to the employees in the higher age brackets with longer company tenure – hitting the retention goals.

The third step would be designating a Cancer Center of Excellence Program or a High Value Network approach to the benefits programs.  Center of Excellence strategies are being embraced by large employers as a way to help members get the treatment they need in the most effective setting.  The higher outcomes reduce employer costs and the benefits to the member can be extraordinary and life-saving. 

Pharmacogenomics and Precision Medicine have earned their seat at the table in our strategy sessions…

The second challenge that employers are solving for is the chronic illness epidemic we are seeing in the US.  The CDC estimates six in ten adults currently living with a chronic disease such as cancer, cardiovascular disease and diabetes.  An estimated 133M  Americans – that is nearly half of our population- have a chronic illness to manage.  Yesterday’s playbook will no longer work.  We need a new approach to shift away from the failing strategies of the past.   Additionally, Millennials are exceeding all older generations in chronic health conditions.   The findings are unexpected and foretell a much higher future spend than employers ever anticipated.  According to the Health Action Council and UnitedHealthcare Center for Advanced Analytics, this new data provides insight to a social shift and future healthcare costs. Employers, now understanding this new challenge, need to develop solutions for employees and members to support health and minimize healthcare spend.

Millennials (aged 27-42) experience chronic conditions (diabetes, obesity, hypertension, back disorders and osteoarthritis) at significant rates compared to other age groups.  This generation and their children are high utilizers of the healthcare system.  Behavioral health utilization is also higher for Millennials and their children.

Here is something to consider; why are employers comfortable auto enrolling employees in the 401(k) plan and taking money out of paychecks without asking but we are not considering auto-enrolling our unmanaged diabetics in the disease management program?  Members can opt out if they would like,  but wouldn’t that be an easier approach to providing coaching and help to these members?   Employers can ask their pharmacy carrier to provide an adherence report for medication for the prescriptions in the 90 days maintenance category.   This is an easy way to see if members are taking their medication as directed.   If they are refilling a 90 day supply every 165 days, they are not taking the medicine as directed.  There are many easy ways to add utilization trend management and cutting edge medical advancements into the plan designs to achieve higher quality and lower costs.   

We will see more change in health care in the next five years than we have in the past fifty years!

Affordable, quality health care.

For everyone.

Together we can make it happen!