U.S. employers expect their total health benefit cost per employee to rise by 5.4% in 2024, even after making changes to their plans to limit cost increases. Small and mid-size employers — those with 50-499 employees — predict an even steeper increase of 7.5% come renewal time, according to data from Mercer.
*Projected 2024 results are based on preliminary data. Beginning in 2020, results are based on employers with 50 or more employees.
Captive Resources’ Health Risk Management team has developed a suite of innovative cost-containment solutions designed to bend the trend of rising healthcare costs while supporting a healthier and more productive workforce. Our experienced Health Risk Management professionals have built out a suite of solutions (with more to come) backed by best-in-class vendor partners to support members of the Medical Stop Loss (MSL) group captives we support.
Here are details about several cost-containment solutions our Health Risk Management team has developed to help member-companies control their healthcare spend.
It’s essential to partner with a TPA that does more than just manage claims. Companies should work with TPAs that can support the best strategy for their organizations.
A strong PBM is essential because it helps manage prescription drug costs while ensuring employees and plan members access essential medications. A well-aligned PBM supports better health outcomes and more effective cost control for captive members by offering transparent pricing, smart formulary management, and data-driven strategies.
MSL group captive members have significantly more access to their plan data than insureds in other programs. According to McKinsey & Company, companies using healthcare data analytics have achieved average annual cost savings of 8%. Through data analytics, a typical member can determine that a few health conditions account for a disproportionately high percentage of spending.
Once members identify those conditions, they can implement specific point solutions to address them. This could include solutions like:
Continuity of care with a primary care provider (PCP) is associated with better health outcomes, yet nearly half of adults in the U.S. haven’t seen a PCP in a year. Offering onsite preventive screenings or virtual primary care can improve employees’ access to care.
Improving the experience of plan participants can reap rewards for employers and employees. Augmenting in-person care with telemedicine and virtual care can remove access barriers and improve health outcomes. Additional solutions include advocacy, navigating the various resources, and mobile software applications.
This category of solutions focuses on enhancing employee experience and overall health, covering a range of clinical areas such as mental health support, financial wellness, lifestyle coaching (nutrition, exercise, sleep, etc.), and social/environmental well-being.
Organizations can benefit greatly from strategies like partnering with treatment and surgical Centers of Excellence, establishing onsite or near-site clinics, using reference-based pricing, and identifying high-performance provider networks. These approaches help control healthcare costs, improve quality of care, and ensure employees have access to efficient, high-value medical services.
The captive can support solutions such as carve-out policies, claim negotiation, bill review, and claim audits.
