Curb the Loss Leaders of Your Clients' Health Plans

In the current economic environment, it seems like the cost of everything is going up. Inflation is high, cost of living has increased and individuals and businesses alike are feeling the pinch of tightening budgets. 

Healthcare is no exception. Experts predict we will continue to see healthcare costs rise in 2024. Not only is this a concern for employers whose budgets are already strained, but it’s a concern for individual employees and their families as well.

Read on to see what you can expect from healthcare in 2024, and how benefits consultants can help their clients combat rising costs by reimagining their benefits strategies. 

Healthcare costs are continuing to climb

Benefit consultants predict employer healthcare costs will jump up to 8.5% in 2024 due to medical inflation. Remarkably, of this 8.5% projected increase, 1 percentage point is said to represent the increase in demand for weight-loss drugs alone. 

This means employers will be looking to their benefits consultants to help with cost containment more than ever. HR teams must find effective ways to strike a balance between reducing healthcare spend and keeping employees engaged by providing high-quality benefits experiences. 

And HealthJoy is here to help. 

How HealthJoy lowers costs for high-cost claimants by 21%

At HealthJoy, we utilize several strategies to lower healthcare costs while still providing a streamlined, simple and personalized benefits experience for enrolled employees. 

We recently conducted a study to understand the effect of our care navigation platform on the top 5% of claimants to determine whether individuals who were engaged with HealthJoy generated lower claim amounts than individuals who did not activate HealthJoy.

We are pleased to share that high-cost claimants who activate HealthJoy see a 21% reduction in healthcare spend compared to those who do not activate HealthJoy–a win-win for the employee and the employer. 

Here are specific strategies we utilize that contribute to this reduction in healthcare spend.  

Redirect employees to high-quality, affordable care 

Oftentimes, when an individual has a healthcare need, they go to the closest medical facility or they go wherever they can be seen the quickest. While being seen promptly and conveniently is important, it doesn’t always result in the highest-quality or the most affordable care option. 

Our care navigation platform helps match members with providers that meet their unique needs, are in-network and affordable and ensure that they are highly rated. 

Our Impact of Care Navigation on High Cost Claimants study revealed that 44% of the healthcare savings from HealthJoy come as a result of steerage towards more affordable providers and services as well as proactive redirection. 

Specialty networks

For employers, a majority of the healthcare spend usually comes from a smaller group of employees. This is likely true for many of the clients you serve. One of the more costly claims employers see that drives up healthcare spend is elective surgeries.

Cost containment is a critical focus of almost every employer’s benefits strategy for this year, but how can large claims like surgeries be reduced? At HealthJoy, we recently announced a new partnership with Employer Direct Healthcare. HealthJoy will integrate SurgeryPlus® into HealthJoy’s navigation experience to provide members with dedicated support and superior access to surgical care. 

SurgeryPlus is the market leader in driving savings, providing employers with 60% lower surgical spend. This reduces healthcare spend for employers, and out-of-pocket costs for employees.

Additionally, SurgeryPlus is the most accessible and largest network compared to similar centers of excellence. The average driving distance to a SurgeryPlus facility in the US is 29 miles. This is crucial because employees have the ability to drive to a location near them, instead of having to fly to a specialist for surgical care. This leads to strong utilization – 5x higher than independent Centers of Excellence.

They have a rigorous vetting process – resulting in a complication rate of less than 1% compared to the industry average of 8-15% – ensuring that members receive the highest quality and most specialized surgical care. 

This partnership will give HealthJoy’s employer clients – many of whom have fewer than 10,000 employees – seamless access to this specialty network, which has historically been limited to enterprise accounts.

Virtual care solutions

Another way HealthJoy helps employers with healthcare cost containment is through offering high-quality, virtual care options. These services are available 24/7, and allow employees to be seen by a provider without leaving the comfort of their home. 

This is particularly important for members without an established primary care physician. Nearly one-third of Americans have little to no access to primary care, meaning they are far more likely to seek out healthcare services at an urgent care or emergency room, which significantly increases the cost for care. 

Virtual Primary Care is a solution to this problem. Within the HealthJoy app, users receive recommendations for virtual care options, and this helps drive utilization. Our research shows that 16% of the healthcare savings that HealthJoy generates for employers comes from telemedicine. 

Chronic condition management

The CDC reports that 6 in 10 adults in the United States are managing some type of chronic disease, and 4 in 10 are managing 2 or more. These chronic conditions can be physically, emotionally and financially debilitating and represent a large portion of employer healthcare spend. 

At HealthJoy, we simplify the process and reduce the cost of managing chronic conditions such as diabetes, pre-diabetes and hypertension. And that’s why we've partnered with Teladoc Health to revolutionize chronic care. 

HealthJoy’s Chronic Care powered by Teladoc Health lightens the burden of managing chronic conditions by providing a unified care experience for employees who are managing one or multiple chronic conditions. 

This partnership helps employees from multiple angles–to best manage their symptoms and get the care they need, whether it’s a clinical solution, lifestyle or behavioral factor, or even holistic care. With so many people battling chronic conditions, this is an excellent benefit offering your clients can provide to their employees. For example, Teladoc Health reports that of those who have been diagnosed with pre-diabetes, their chronic care solution reduced the incidence of a diabetes diagnosis over three years. 

Musculoskeletal condition management

Roughly half of Americans suffer from some form of musculoskeletal (MSK) condition. With the prevalence and chronic nature of these conditions, it’s no surprise that MSK is the most common cost-driver for healthcare spend in the U.S. Employers spend an average of $7,800 per employee struggling with an MSK issue. 

HealthJoy’s Virtual MSK Therapy provides convenient, effective and inexpensive exercise therapy for individuals struggling with virtually any type of back and joint pain throughout the body. Our Virtual MSK Therapy program comes at a low cost to the employer and is free to the employee. This program provides life-changing pain relief and is a better care option than a costly and (potentially) ineffective surgery. 

And employers love the cost savings as well. On average, our clients see around $2,572 claims avoided per participant, and members experience an 82% reduction in pain with 85% function improvement.

Rx Savings 

Prescription drugs account for roughly 20% of employer healthcare spending. According to our latest Member Health Goals data, 45.5% of enrolled employees are paying for at least one prescription medication. 

We use a unique combination of smart navigation technology and human intervention to ensure that employees take advantage of cost savings on their prescriptions. JOY, our virtual assistant, prompts members to input their medication information and can alert them to savings options or pass the information along to our medication specialists, who can provide even more personalized service and recommendations. 

This multi-faceted approach to Rx Savings helps reduce out-of-pocket costs for employees and reduces healthcare spend for employers. Our data shows that HealthJoy’s Rx Savings provides an average savings of $132 per request, which adds up to substantial savings when you consider every enrolled employee.  

Healthcare consumerism in 2024

“Healthcare consumerism” is a relatively new concept that was born out of quickly rising healthcare costs. Not only is the cost of healthcare rising, but the cost of health insurance as well. 

This combination has led individuals, known as the new “healthcare consumers”, and employers to explore alternative options. According to the American College of Healthcare Executives (ACHE), rising out-of-pocket costs are turning passive healthcare consumers into active ones. 

This is where HealthJoy comes in. Our care navigation solution can take that burden of finding the highest-quality care for the lowest cost, off the shoulders of employees and HR teams. We provide personalized recommendations – adapting to unique wants and needs – producing cost savings for the employee and their employer. The result – healthier employees and a healthier bottom line.

Additionally, at HealthJoy, we collect proprietary data through our Member Health Goals survey during the onboarding process, which allows us to understand each member’s unique wants and needs. We can then use a combination of technology and automation, and human interaction and service to provide a highly personalized healthcare experience to employees, while providing significant cost savings for employers. 

Learn more about how HealthJoy can reduce employer healthcare spend.