Are CFOs Targeting their High Cost Medical Events?

CFOs for self-insured businesses know their expenses to the penny – for example, what it costs to lease office space. But, for one of their highest costs – healthcare for their employees – they may be flying blind.

Unlike the predictability of leasing, healthcare costs vary widely. The cost of the exact same procedure might differ based on region, provider, and negotiated rates. Faced with the out-of-control nature of healthcare costs, CFOs of large organizations are finding ways to cut costs.

According to a 2021 survey by the Business Group on Health, the top three cost-cutting measures for the coming year are:¹

1. Implement more virtual care solutions | 53%
2. Expand access to mental health services | 36%
3. More focused strategy on high-cost claims | 31%

“High-cost claims are clearly one of the issues that keep employer health plan sponsors up at night,” said Mercer’s Jean Moore, senior director of health specialty practices.

According to Segal Consulting Group, 25% of all stop-loss claims of $1 million or more come from neonatal infant care.²

“Fortunately, there are ways employers can improve the experience of employees and family members dealing with serious conditions while also managing cost, ” Mercer’s Jean Moore said. “This can be done by helping to ensure that patients are receiving the right care, delivered in the right place at the right time.”³

CFOs shoulder a fiduciary responsibility to their organizations that requires close control of the levers that drive healthcare costs, particularly as dollars shift from traditional fully-insured to self-insured programs.

ProgenyHealth is a targeted solution for managing high-cost and complex NICU claims

As the only national company dedicated to NICU Care Management, ProgenyHealth provides specialized utilization management, case management, social determinants of health management, and payment validation and assurance. ProgenyHealth’s integrated approach delivers consistent cost savings of 2:1 or better for its partners.

CFOs should discuss these risks with their benefits consultant, broker, or health plan administrator to ensure that NICU care management is built into their plan design.

Learn how CFOs can better contain their most-costly claims

Download and share the white paper, CFOs: Are You Targeting the High Cost of Complex Medical Events?

1. Business Group on Health. 2021 Large Employers’ Health Care Strategy and Plan Design Survey. August 2020. Available at: www.businessgrouphealth.org/resources/2021-large-employers-health-care-strategy-and-plan-design-survey
2. The Segal Consulting Group, 2019.
3. www.mercer.com/newsroom/mercer-survey-reveals-managing-high-cost-claimants-is-employers-top