EC Wisconsin News

Rising healthcare costs continue to exert pressure on employers, with recent trends indicating increases of around 7-8% over the past few years. Projections suggest that this upward trajectory will persist. Understanding the factors driving these costs is crucial for finding effective solutions.

The patterns observed among M3 clients reflect national trends. Claims data analysis reveals two primary contributors to cost increases: the types of conditions most responsible for overall spending and services experiencing rapid cost growth.

Analyzing claims data annually helps identify emerging patterns. Conditions are grouped based on related medical and pharmacy claims, highlighting areas where costs are concentrated. Currently, five condition groups account for more than half of the total cost trend facing employers.

Another important aspect is identifying services whose costs are rising faster than others. These often relate back to major condition groups but provide specific insights into where targeted actions could help control spending.

"Surgical procedures: Orthopedic surgeries, such as joint replacements and spinal procedures, are some of the biggest drivers," says a source. "Surgeries related to cancer treatment are also showing notable growth, both in frequency and complexity."

"Medical channel specialty drugs: These are high-cost medications that must be administered by a medical professional and are billed through the health plan rather than the pharmacy benefit," adds another expert. Examples include cancer therapies and treatments for autoimmune conditions.

Employers seeking to manage risk, support employee health, and mitigate rising healthcare costs should begin by understanding their own data. Advanced analytics can uncover significant cost pressures and identify opportunities for targeted action. Once strategies are implemented, measuring impact over time ensures effectiveness.

Examining top cost drivers across employers highlights several areas where intervention could yield results:

- For cancer: "Encourage age-appropriate screenings to support early detection and improve outcomes," suggests one strategy.

- For surgical procedures & bone, joint, and muscle conditions: Consider care navigation programs or alternative payment models like bundled payments or direct contracting.

- For diabetes management: Leverage data to identify care gaps and explore third-party management programs offering digital coaching or continuous monitoring.

M3 assists employers in addressing rising healthcare costs by transforming data into actionable insights. Through advanced analytics, M3 identifies key cost drivers and offers strategies for effective cost management.

"Tools like Springbuk allow us to uncover trends and make data-driven recommendations," states an M3 representative. BenchmarkPRO enables employers to compare their benefits with industry peers.

Ultimately, there is no universal solution for managing rising healthcare expenses; understanding unique data allows for tailored strategies suited to individual challenges.