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Medical inflation is a significant challenge that impacts the affordability and sustainability of global health systems, employee benefit programmes and the total cost of care for patients.
It is influenced by various factors, including the current economic climate, the rise in complex and chronic conditions, declining public healthcare accessibility in certain regions, healthcare workforce shortages and the overuse of high-cost drugs.
To more effectively manage this industry challenge, a transformative approach to employee health benefit plans could be considered.
Instead of a reactive model that focuses on addressing health issues after they arise, a proactive and multifaceted approach has the possibility of significantly reducing medical costs and improving overall employee wellbeing.
This approach would involve optimising clinical systems to ensure efficient and effective care, promoting lifestyle medicine to prevent chronic conditions, enhancing pharmacy management to optimise medication use, and making telehealth a central component to provide flexible and accessible care options.
This shift in mindset from reactive to proactive care has the potential to lead to a healthier workforce, reduced medical expenses and more sustainable benefit programmes that not only address immediate health needs but also foster long-term health and productivity.
Four strategies to help control medical costs
- Clinical systems can help reduce healthcare spending. Benefit plans that use patient data and analytics can help identify at-risk employees. With the right clinical systems in place, patients receive compassionate, personalised care. Companies that prioritise claims analysis data are in a better position to understand population health trends and support targeted, as well as measurable interventions.Plans with care management programmes provide diverse health support, including proactive outreach, nurses and case managers, making patients’ path to a healthier life smoother, potentially lowering medical costs.
- Lifestyle medicine is a specialty that offers patients the tools and resources to help prevent or reverse chronic conditions. Providers help patients understand heart disease, diabetes, hypertension, mental health issues and other noncommunicable diseases. By educating patients on the six pillars of lifestyle medicine: nutrition, exercise, adequate sleep, managing stress, avoiding toxic substances and community connection we can understand and address the root causes of these conditions.UnitedHealthcare Global utilises the My Wellbeing platform to support its members in managing a healthy lifestyle. This platform offers a centralised hub and mobile app, enabling members and dependents to track their daily activities and habits. They can also engage in various wellness journeys and challenges, and access personalised content and coaching. Additionally, the platform provides access to the employee assistance program (EAP) for emotional support.
- Pharmacy benefit management ensures a balance between what is prescribed, at what cost and for how long, to combat fraud, waste and abuse. High-cost drugs and the overuse and overprescribing of medications is a challenge due to the fluctuation in prices globally. As drug costs and use rise, many employers and insurers are passing these expenses on to consumers. A pharmacy management programme can optimise medication use to better manage healthcare resources with clinical and scientific knowledge.Patients realise better health outcomes when clinical pharmacists work with providers to review medication for more personalised care. It also gives patients better access to alternative, non-pharmacological treatments, like lifestyle medicine and social prescribing, which connects people to activities, groups and services in their community. Implementing wellbeing initiatives can help manage expenses by promoting the use of preventive care that can help avoid more costly treatments later. It also helps maintain employee engagement in their health, potentially reducing stress-related exacerbations of other conditions.
- Telehealth can help expand and transform the efficiency of various medical services, including primary care, specialist consultations, prescription drug fulfilment, mental and behavioural health programmes and care navigation for acute illnesses. Telehealth accessibility supports proactive, preventive care that reduces the long-term costs that encumber health systems. Telehealth visits give providers insight into health data that can identify risk factors early. It also continues to enhance global healthcare delivery and reduces reliance on costly urgent care services.
UnitedHealthcare Global provides a range of health support services, including programmes for physical, behavioural, social, and financial wellbeing. Our offerings encompass virtual and in-person wellness initiatives, mental health services, digital health tools and wellness tracking.
Managing healthcare affordability
Implementing one or all of these initiatives can help providers reduce medical inflation rates by facilitating more precise and efficient care, identifying and addressing high-cost areas, and optimising the use of resources through targeted interventions and real-time data analysis.
Working together, these tools help improve care transitions and outcomes by intercepting and proactively engaging members with high and rising risk or use patterns, ensuring more appropriate and cost-effective care. Such efforts ensure that healthcare remains affordable and efficient.