Mercer, a global consulting leader in advancing health, wealth and career, and a wholly owned subsidiary of Marsh & McLennan Companies (NYSE: MMC), announced today that “managing and monitoring high cost claimants” is the top health benefits strategy that US employers will be focusing on for the next five years. More than three quarters (77%) of US employers with 500 or more employees said this strategy was “very important” or “important” (see figure 1). These findings come from a recent analysis of responses to the Mercer National Survey of Employer-Sponsored Health Plans, 2017.
The rapid rise in high cost claims is most likely a key driving force behind this strategic prioritization by employers. A study of carrier claims data from Mercer Health Advantagesm, (MHA) a program offered through select insurance carriers that features high-intensity care management for the sickest employees, revealed a rapidly growing percentage of claims classified as “high cost” by the participating carriers (>$50K/claimant, see figure 2).
“High cost claims are clearly one of the issues that keep employer health plan sponsors up at night,” said Mercer’s Jean Moore, Senior Director, Health Specialty Practices. “Fortunately there are ways employers can improve the experience of employees and family members dealing with serious conditions while also mitigating cost. This can be done by helping to ensure that patients are receiving the right care, delivered in the right place at the right time.”
Generally, a relatively small number of plan members drive a large majority of the cost. According to Mercer’s database containing approximately1.6 million members, on average the sickest 6% of an employer’s population represent 47% of the total allowed medical and pharmacy spend. High touch, nurse-centered care coordination can often produce the best possible health outcomes and as cost-efficiently as possible. MHA has achieved a 3.3:1 Return On Investment for plan year 2016, maintaining the same strong result of 2015, while also improving patient outcomes.*
The important difference between standard health advocacy programs and high-intensity care management programs such as MHA is that the care manager works directly with the care team as well as the patient and family, stays in contact after discharge to provide support, and provides a supportive role in improving compliance with treatment plans. Real life MHA patient success stories include:
A patient in a car accident spent months in a hospital and then a rehabilitation facility to recover from severe injuries. The patient’s nurse care manager kept in contact with the providers and the family to ensure that the patient progressed through the proper course of care and had a full understanding of his treatment and health status. The nurse also helped him apply for disability and set up care and durable medical equipment in the home when he was discharged. Careful monitoring and follow-up ensured a smooth transition from facility to home and prepared the patient and his family on what to know or avoid to prevent relapse or readmission.
For an older patient having a hospital admission for hip replacement, the care manager spoke with the member prior to admission to set expectations regarding the surgery and recovery. Once home, the nurse spoke with the patient and her daughter about pain management, proper medication dosage, helped schedule follow-up appointments and arranged for physical therapy to begin at home.
Another patient credits his nurse care manager with saving his life by convincing him that his chest pain (the onset of a heart attack) warranted a trip to the emergency room for immediate care.
“Employers are justified in placing high cost claims at the top of their worry list,” said Ms. Moore. “As the prevalence of high cost claims encroaches on limited plan dollars, plan-sponsors must be mindful of the value or return-on-investment derived from solutions focused on high cost claims management, not simply cost alone. Value should be the starting point for any employer’s strategic planning and action when it comes to high cost claimants.”
To learn more about Mercer Health Advantage, please visit https://www.mercer.us/what-we-do/health-and-benefits/specialty-solutions/health-advantage.html.
*This Return on Investment figure reflects aggregated results across all participating carriers for a given plan year. Actual individual employer results may vary.
Mercer delivers advice and technology-driven solutions that help organizations meet the health, wealth and career needs of a changing workforce. Mercer’s more than 23,000 employees are based in 44 countries and the firm operates in over 130 countries. Mercer is a wholly owned subsidiary of Marsh & McLennan Companies (NYSE: MMC), the leading global professional services firm in the areas of risk, strategy and people. With nearly 65,000 colleagues and annual revenue over $14 billion, through its market-leading companies including Marsh, Guy Carpenter and Oliver Wyman, Marsh & McLennan helps clients navigate an increasingly dynamic and complex environment. For more information, visit www.mercer.com. Follow Mercer on Twitter @Mercer.
Figure 1: Large employers* rate key strategies for the next five years
Source: Mercer National Survey of Employer-Sponsored Health Plans, 2017. *Large employers equates to 500 or more employees.
Figure 2: High cost claimants per 1000 claims – various MHA carriers (anonymized)
Source: Mercer analysis of carrier claims >$50K/claimant related to MHA June 2016-July 2017.