How can our organization reduce costly emergency and/or inpatient health claims among our employees’ spouses?
Spouses typically account for 20% of the population but incur 30% of total healthcare claims. Traditional wellness programs are not effective in reducing total claims costs and fail to address the needs of spouses. USI’s strategy to incentivize employees’ spouses to engage with their primary care physician identifies undiagnosed and unmanaged members and improves spouses’ health. Early detection can have a significant impact on claim costs and survival rates. USI’s network of resources can help ensure that the program is well-communicated, competitive, and compliant.
Health plan members with active primary care relationships experience 40% lower ER utilization and 33% fewer inpatient admissions, resulting in an estimated 3% to 5% reduction of employers’ total program costs. The average annual program cost is $15 per participant per year, when considering net cost impact.
We’ve estimated the financial impact for you. Feel free to update the assumptions.
- Proprietary analytics combined with carrier data to track physician engagement levels
- Programs designed to enhance compliance with physician-recommended screenings
- Year-over-year decreases in population disease prevalence
- With proper incentives, 60-90% of participants establish active primary care relationship within 12 months
Traditional wellness initiatives, including biometric screenings, health risk assessments, weight loss challenges, and tobacco cessation programs typically fail to drive engagement with primary care physicians. Behavior changes such as engaging with a provider on an annual basis may be difficult for some individuals, so many employers provide financial incentives to promote compliant behavior such as seeing their PCP, as well as with obtaining the physiological data such as cholesterol levels, blood pressure, and glucose levels. Many USI clients have seen improved member engagement by offering financial incentives such as a premium differential or a contribution differential.
Primary care measurably improves adherence to recommended screening and testing for early detection and prevention. Connecting plan members to primary care is the most effective first step toward improving overall health care and management of chronic conditions and, over time, reducing the severity and frequency of health care claims.
At the same time, spouses generally comprise 20% of the members on the plan, but they often cost 50% more than employees, and they generally account for 30% of the total health care spend.
Designing a comprehensive wellness strategy is a multi-step process. USI Population Health Management Consultants provide support with:
- Contribution strategy
- Compliance considerations
- Vendor selection and implementation
- Communications strategy
I’d like to explore further how USI’s Population Health Management Consultants can help our organization drive better primary care engagement among our employees and their spouses.
For USI clients, Incentivized Physician Engagement is the first step of the USI CORE Strategy, a multi-year program designed to reduce long-term costs and improve overall population health outcomes. To learn more about our CORE Strategy, let's set up a conversation with a regional USI Population Health Consultant.