Program Showcase: Screening/Early Intervention

DMEC Staff@Work

Health Matters: The Bottom Line on Preventive Health Behavior

By Case Escher, Alexa Galluzzo, Robin Halverson, and Karla Thommen

Health & Productivity Team
The Partners Group

Every year, employers analyze the previous year’s cost data and find that 5% of the insured population drove 50% of plan costs. Often, 1% of insureds are responsible for 25% of total costs!1 What is driving their need for healthcare services? What can be done to manage their medical costs, while maintaining or even improving their treatment and outcomes?

Identifying large claims is standard practice in the healthcare industry, but rarely does it have a significant impact on managing future costs. It is a reactive, rearview mirror look to assess the size of the pothole you just hit. Typically, the top 5% of health plan costs can be attributed to catastrophic accidents and new cancer diagnoses. While employers take measures to manage the cost of continuing treatment for these hardships, initial costs have already been incurred. Future interventions have limited impact.

If you want new outcomes, you need new solutions. How can we keep an ardent eye on the windshield to avoid the next rut up the road? And even if employers can predict the future, how can they change it?

Stay Ahead of the Curve

How much can early detection improve outcomes and cost from a cancer diagnosis? Survival rates are as low as 53% for some stage III colon cancers and only 11% for metastatic stage IV.2 Mean per-patient cost in the first year after diagnosis for stage I is less than half the first-year cost of colon cancer diagnosed at stage IV, a savings of almost $60,000.3 Detecting and treating cancer at an early stage can and does save lives, as well as money (Figure 1). Considering that one in 22 U.S. men will develop colon cancer this year, the cost savings of early detection are significant for any health plan budget. Savings for early diagnosis and treatment for breast, prostate, and lung cancers follow the same pattern. These cancers, along with colorectal cancer, were the most frequently occurring in 2017.4

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