Tuesday Morning With Justin: Healthcare, Leadership & Life
Tuesday Morning With Justin: Healthcare, Leadership & Life
Multi-Million Dollar Claims are up 50% over last 4 Years
We break down why 1% of employees drive a third of healthcare costs and how multi‑million dollar claims are rising. We show how site of care, quality data, and smart incentives can cut spend without cutting outcomes, including a $72k infusion savings case.
• 1% of employees driving a third of spend
• Multi‑million dollar claims rising 8% year over year and 50% over four years
• High‑cost conditions including neoplasms, NICU, cardiovascular, sepsis, leukemia, lymphoma, multiple myeloma
• Inpatient stays as the biggest cost driver
• Traditional cost shifting failing to control trend
• Site of care strategy for specialty drugs and infusions
• Transparent imaging and surgical steerage with $0 options
• Using infection rates and outcomes to build trust
• Designing benefits that guide members to high‑value care
Drop a comment, shoot me a text, let me know your thoughts.
Music by Alex Lambert.
Contact Justin via text 740-525-5259 or via email JFutrell@TrueNorthCompanies.com
I welcome the opportunity to hear your feedback from this episode!
Thanks again to my musically gifted friend Alex Lambert for the music. Also thanks to Kevin Asehan for the edits.
Welcome to another Tuesday morning with Justin. I'm Justin Futrell Benefits Advisor at True North. Today, we're going to start with two headlines and then expand on both of those. The first, just 1% of employees drive nearly a third of all healthcare spending. 1% of employees a third of all healthcare spending. The second headline, multi-million dollar claims rose 8% this last year and are up 50% over the past four years. That's according to the Kaiser Family Foundation, the first article by Benefits Pro. Now, what are the top conditions? Because both of these headlines are talking about large high-cost claimants. What comes to mind for you? Here's the answer: neoplasms, newborn care. Think about when babies have to go to the NICU, cardiovascular problems, sepsis, leukemia, and lymphoma. So think blood cancer, and lastly, multiple myeloma. Now, what contributes the most with all of those claims across the board? What's your guess? The answer: inpatient hospital stays. Long inpatient hospital stays are going to rack up facilities charges that are going to end up with a really hefty bill when we're all said. So that begs the question. With um the quote from Benefits Pro is this matters to employers who have spent decades trying to control rising health care costs. Employers have tried changing plan designs, shifting cost sharing, and exploring new delivery methods for care. But despite those efforts, the cost of providing health care benefits has outpaced inflation almost every year for the past 40 years. That tells me that benefits advisors like myself are not doing a good job across the board because there are ways that we can solve these problems. Let me give you two examples. And then I'm going to ask you to think about how you would react. First, drug infusions. We had an employee, a client with an employee this year who was diagnosed with MS, multiple, multiple sclerosis. Now, when you go to the emergency room when something happens like that, it's completely out of the blue. What's going to happen? That hospital is going to take care of you, solve the immediate need, and then schedule you to come back to their infusion center. Why? They can mark up the cost of that drug. So this example specifically that I've seen with my own eyes is$150,000 was going to be the annual cost for infusions for this drug. By outsourcing this drug, same exact one, same exact dosage, we can get it$78,000 just by changing the delivery of care. That's a$72,000 difference. For what? Just solely the fact that it's not being given inside these hospital systems walls. It's outrageous. Second example, proactive. We've talked about how we can incentivize people to go to different places of care. For example, we talked about diagnostics and imaging. What if we said, hey, go anywhere you want to, but it's zero dollars if you go to one of these handful of places around you that are transparent with their prices? So I want to ask a rhetorical question and also drop a comment, shoot me a text, let me know what your thoughts are. What would you be willing to do in regards to changing where you were getting care done? Let's say you had a knee surgery and your primary care doctor said, hey, go here. What if you were told, hey, if you want to go there, you can, but if you choose to go to one of these three places, you don't have to pay a dime. How would you feel? Personally, well, at first I might think it's a scam, right? I would want to see reviews, right? I want to know what other people say about this. It seems too good to be true. I would also want to know what the quality measures are. Like, okay, if people like this doctor, that's great. That checks one box, but I also want to make sure this is a legitimate doctor with good quality care. We can we have access to that data. We can see infection rates on certain surgeries. So now that I can check that box and feel comfortable with that decision, what would keep you from pulling the trigger on being able to save money for yourself and going to a high quality, reasonably priced place of care? Let me know. Till next week.
