Nearly 8 in 10 employers consider high-cost claims a significant threat to employer-sponsored healthcare, with an increasing number of companies facing claims in excess of $2-$4 million. To address this complex issue, the National Alliance of Healthcare Purchaser Coalitions (National Alliance) worked with member coalitions and 50 employers across the country to gain insights and develop strategies to manage costly conditions and therapies like cancer, rare disease and gene therapies, and specialty drugs.
The survey found the main employer concerns and priorities include:
- Employers are seeing a rise in high-cost claims for younger plan members, with $1 million+ claims that include cancer, prenatal/neonatal care, and treatment for COVID-19/long COVID
- Employers have historically been reliant on third-party administrators and pharmacy benefit managers to manage high-cost claims and must hold service providers accountable for better management
- Employers noted that stop-loss insurance is expensive – and while some are concerned about whether to cover certain classes of claims, others have been “rolling the dice” by not incorporating stop-loss
- Some employers are navigating high-cost claims as they get them, rather than taking steps to prevent the occurrence where possible
- Highest priority areas for employers to mitigate over the next couple of years include offering precision medicine for cancer treatment (45%); implementing centers of excellence (39%); negotiating and auditing hospital prices (34%); auditing intermediaries (30%); and mitigating costs and coverage for rare diseases (30%)
- Rethinking How Employers Address High-Cost Claims. National Alliance of Healthcare Purchaser Coalitions.