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Key Business Trends in Health and Care

And what these mean for Employers

The business of care

What are some key trends impacting the business of healthcare and what can this mean for you, as a self-funded plan sponsor?

What we know...

- costs are rising
- the health system itself is evolving
- DEI, SDoH and artificial intelligence invite new opportunities

In two words – EXPENSIVE + CHANGE.

The big takeaway?

Take control and use the massive amounts of data available.  Health analytics will help you strategically navigate market transformation, minimize excess costs, and gain first-mover advantage to secure cost avoidance. All with optimal outcomes.

1. Healthcare costs are rising, and this will continue.

Just how much are costs rising? shared that U.S. health care spending increased 9.7 percent and reached $4.1 trillion in 2020.  The health “share” of our economy is projected to rise from 17.7 percent in 2018 to 19.7 percent in 2028. The most significant driver behind this is primarily driven by increases in health sector wages.

What this means for employers as plan sponsors:

As a payor, you’ll want to have the right tools and/or partnerships in place to be able to accurately anticipate and confidently strategize regarding your portion of costs.

What to do:

Offset increases in costs by optimizing plan performance.  Use analytics to surface savings opportunities.  The Great Resignation and turnover may have changed your employee base signficantly, and needs themselves are evolving.  You’ll need a refreshed and keen understanding of the workforce’s needs, utilization patterns, and engagement preferences.

Let’s assume you made solid decisions around health plans, plan administration, programs and policies.  Now, get the most out of these choices and proactively drive to the highest level of value possible.

Key TIP:

Offset increases in costs by optimizing plan performance.

Eliminate guesswork.  Use health data to get the most out of partners and programs.

2. Market and industry disruption continues.

Disruption, disruption.

We’re watching the pandemic accelerate the adoption of virtual care and at-home care. We see business investment and digital innovation compliment longstanding desires for an increasingly streamlined, affordable system with improved care access and health equity.

Providers and carriers continue to explore and innovate business models. Value-based care options and accountable care organizations are growing.  There are countless new market entrants in the wellness and point solution space.

What this means for employers as plan sponsors:

New health programs and options may offer interesting visions, yet leave employers with many unknowns.

What to do:

Build a repeatable model that lets you easily pilot new approaches and comparably measure results. Find a partner to do the heavy lifting around data sourcing and management.  Focus your precious internal resource time on using insights with leadership and making strategic decisions.  Choose business partners with seasoned consultative and analytic specialists to track and compare cohorts.  Create holistic views that show associated impacts and connected costs.  Lean on your partner’s expertise to define metrics and analytic views in ways that support decisions around program expansion, change, or termination.

Key TIP:

Create a data-driven program and repeatable model that lets you pilot new strategies or programs and compare measured results.

For example, pilot and analyze: Which joint replacement care approaches have the shortest associated disability duration, fewest average physical therapy visits, and lowest prescription costs?

3. DEI and SDoH command the spotlight.


Show me the data.

Survey results* that report statistics like 83% of U.S. organizations reported implementing diversity, equity and inclusion initiatives in 2021 and political activity like The Improving Social Determinants of Health Act of 2021 (S. 104/H.R. 379)**, illustrate the magnitude of momentum.

Read more about it here* and here**.

What this means for employers as plan sponsors:

2022 invites enormous opportunity to drive change by partnering with emerging DEI leaders who bring passion and creativity to evolving program design in ways that accommodate a broader set of needs. The very qualities that make us unique and special and our social environments (both home and at work) influence what works well for each of us when it relates to health. Employers that can measure what’s working for whom are set up to make smart and responsible benefits design decisions tailored for their population.

What to do:

Create a data-driven, measurable DEI and SDoH framework around your benefit offerings. This could be looking at traditional metrics by salary range or race, incorporating third-party regional SDoH data, or even looking at variances in condition prevalence based on job types. Look at a minimum of 2 years of baseline data and prioritize equity gaps and key drivers. Host small group lunches to ask employees for context around what you see in the numbers. Engage with health plan- and community-based resources alternatives. With analytic rigor surrounding your efforts, and a multi-disciplinary approach, you’ll see an impressive impact.

4. Health is top of mind for more individuals.

Show me the data

Literally. The need for mental health services is increased, and mental health has a known influence on physical health and overall health costs. A Kaiser Family Foundation (KFF) study* found that during the pandemic, about 4 in 10 adults in the U.S. have reported symptoms of anxiety or depressive disorder, up from one in ten adults who reported these symptoms from January to June 2019. One insurance company published mental health claims increased by 25% in 2020.

See the data here*.

What this means for employers as plan sponsors:

Recognize your ability to support the whole person through benefits design. Hit the streets and ask your employees what’s important and what is needed.

What to do:

It’s a great time to listen to what people say, and measure what they do. In addition to adding mental health benefits, pilot environmental changes. How do a blend of policy updates (e.g. mandatory meeting-free lunch-and-wellness hour?) and benefits expansion (coupled with a wellness program with fitness incentives) associate to employee satisfaction survey data and business goal measurement? The data exists. It’s just a matter of analyzing it.

5. AI, ML and predictive analytics foundations bloom.

Innovation acceleration

Artificial Intelligence (AI) and Machine Learning (ML) are being applied for clinical innovation in areas like medical imaging, drug discovery, and to predict disease early. These are areas beyond an Employer’s realm. But these same technical innovations are useful in population health management – for planning, resource management, and targeted communications.

What this means for employers as plan sponsors:

You’ll see more and more talk about health Big Data being used to define health experiences that personalize care, address diverse needs and preferences, and icrease engagement.

As an Employer, you are set to take a leading role in putting health data to work using AI, ML, and predictive analytics. You have access to significant data, control of working conditions and environment, and a trusted relationship with individuals.

Creating a culture that grooms healthier people, invites short-term and long-term advantages:

– increase health
– lower health costs
– improve employee retention
– increase productivity

What to do:

Right now – use AI, ML, and predictive analytics to plan resources, build business continuity and forecast costs more accurately. Next, dig into rising risk groups. Identify actions that influence a more positive outcome. Work with vendors that embrace these technological opportunities – and ask them to articulate how their strategies drive savings for you, as a payor.

Where do I even start?

Choose a flexible analytics technology that will let you analyze results across different plans, evolve over time, and bring in point solution data.

Work with an established vendor whose core vision is in line with providing health analytics to employers, like yourself.

Health Big Data is complex. It requires highly specialized skill sets and domain expertise.


Key business trends in healthcare – and what these mean for Employers