Trainwreck-Proofing & Cost Containment in Healthcare

Nearly everyone in employee benefits can immediately think of a case that made cost containment in healthcare impossible. Maybe they call it a high-cost claimant. Or perhaps they think of it as a trainwreck case.

Protect your people. Protect your plans with Goldfinch Health. Find out how we make surgery forgettable.

The patient faced a tough health situation. It likely included a significant diagnosis, a series of complications, a long-road to recovery and potentially life-changing circumstances. Not only that, but the patient, employer and insurer face a jaw-dropping bill on the back-end.

Trainwrecks and Cost Containment In Healthcare 

We recently evaluated claims data for a 400-employee company. This reflected the experience of many companies  attempting cost containment in healthcare. The details:

  • $2,000,000 in annual healthcare spend
  • $900,000 spent on chronic condition management (e.g., high blood pressure, high cholesterol, diabetes) for about half of the employee base
  • $700,000 spent on 8 cancer cases

In simpler terms:

  • 45 percent of the dollars were spent on 50 percent of the employees
  • 35 percent of the dollars were spent on 2 percent of the employees

With numbers like that, you can see why cost containment in healthcare is important. In fact, a recent national survey of employers showed 4 out of 5 companies rate managing high-cost claims to contain healthcare costs as important/very important to their strategic priorities.

How Can We Achieve Cost Containment in Healthcare?

Historically, employers workers compensation companies and employers attempted cost containment in healthcare by preventing or significantly reducing these cases. These efforts focused on two areas and achieved limited results:

  1. Wellness programs to proactively help prevent future high-cost situations
  2. More intensive nurse case management programs for patients already on a path toward serious health outcomes

When it comes to wellness programs, a benefits consultant with whom we spoke recently described them as “Jello slipping through your fingers.” While they can make a difference, they often see limited employee engagement. They require a lot of employee behavior change. As a result, they often do not see results for years. By that time, your investment is likely helping another company, as employees have moved on to new employers. So let’s set aside this strategy for now.

In the area of intensive nurse case management, the success of the strategy comes down to one key factor: How much behavior change is necessary. A perfectly designed program may fall flat if it requires too much. In these cases, the member just won’t be able or willing to make the long-term lifestyle changes.

While there is likely an opportunity for improvement with chronic care programs, employers should not overlook the easier wins. And with that in mind, optimizing surgical care holds a path for an easier win.

An Easy Win: Optimizing Surgical Care

Surgery is foundational to care in two high-cost areas — cancer and musculoskeletal care. A different approach to surgery and recovery holds great promise. That’s how you get an easy win in cost containment in healthcare.

You’re probably thinking:

  • Is there really an approach in surgery that’s better than what our members or employees are getting right now?
  • Can we effectively influence the surgery decisions, experiences and results for our employees and covered members?
  • And can we do it in a way that requires minimal disruption and behavior change by employees and covered members?

Well, yes. There’s a better way! This approach reduces the risk of these types of astronomically expensive cases today (not tomorrow). And it helps employees get back to their lives and back to work in half the time.

We worked hard to create a program that offered this to your members and employees. It helps them and it helps you.

Watch this video to learn more about how Goldfinch’s better approach to surgery and recovery makes sure patients like Amanda are never alone throughout their road to recovery — and significantly less likely to be an outlier case that won’t soon be forgotten.