Actionable Employee Health Trends For 2023

In a webinar, our team of data scientists and clinicians sat down to share the trends and analysis findings that shaped the 2023 Employee Health Trends report. Below are some highlights from their conversation.

Watch the replay here.

Surges in Cost of Cancer Treatment

‍In our first analysis, Janet Young, M.D., Lead Clinical Scientist led the discussion. Janet has an M.D. degree from Yale University and has amassed more than 30 years of experience providing clinical expertise and oversight to the development of healthcare analytics, guiding clinical content development of new models, methods and applications. Her findings indicated that we were able to identify five types of cancer that account for about 60% of employers' spending in our book of business for cancer. Those include breast cancer, leukemia, lung cancer, multiple myeloma, and lymphoma.

To understand what services drive treatment costs, we broke down spending for these top five cancer types using the Springbuk service type classification method. As expected, there's some variation in the services used depending on the type of cancer, but in all five cancers, the main driver of costs was specialty drugs.

Biosimilars are one tool that helped provide necessary care at a lower cost. There are actually several cancer drugs that have biosimilars, and there's a complete list in our 2023 Employee Health Trends report.

Place of service is also very important. When feasible, it's typically much less costly to treat commercially insured patients in an office setting compared to an outpatient hospital. We found an $8,000 savings when the most common dose of Keytruda, which is the most common drug used in chemotherapy, is administered in an office setting rather than an outpatient hospital.

As we wrapped up this section of our analysis, Jennifer Jones, Enterprise Practice Leader, provided some key takeaways and action items for employers to apply to their benefits strategy. Jennifer has over 20 years of multi-faceted experience as a clinical dietician, certified well-being expert and employer health benefits advisor. At Springbuk, she focuses on population and employer health to guide our clients toward achieving a greater impact on health outcomes. She shared that the last key takeaway here for this section really becomes the emphasis on cancer prevention. We certainly still see a lot of employers with large percentages of their populations that are non-compliant in preventive screenings, like mammograms and colonoscopies. So it's going to be important, and really essential, to be able to identify and track those members, continue to educate them, and connect them with the right type of care and when those screenings are appropriate.

Increase in Specialty Drug Spend

We know that specialty drugs have become an integral part in the treatment of many conditions, often improving quality of life, but at the same time, they've been driving up healthcare costs. It's likely that we'll continue to see more members on these drugs. So I think employers are faced with the challenge of ensuring that members who really need these drugs have access at the lowest possible cost.

Humira has remained far and away the top drug by spending and all of the last three years, accounting for over 12% of specialty drug spending. But we are expecting some relief from spending on Humira this year because several biosimilars for Humira are entering the market.

Even if the adoption of biosimilars has been slow, they've had a major impact on cost. When used, they save about $700 per claim.

I think there are always so many nuances, especially when we are speaking about specialty drugs. As you think about the impact and how to best control costs going forward, many of these cost-saving opportunities will be dependent upon you working with your PBM and your consultant to really understand what's offered through your current plan and formulary, and then what they expect to do when these new biosimilars are released.

We've seen where a lot of education is important to members around biosimilars as far as what they are and their efficacy, but that tends to be a gap for many individuals. So that is a critical point as far as education. The last piece here, from an employer standpoint, is being able to evaluate the top conditions that are utilizing specialty drugs in your membership.

Within our application, our users know they can just click on specialty drugs when looking at our Condition Groups page. And that will be able to show you, by condition, that specific breakdown as far as what's coming from the pharmacy channel and what's coming from the medical channel. And knowing those conditions allows you to be very prescriptive with considering lifestyle management programs or more holistic programs that, ideally, will help address those conditions and specifically speak to members before they have to go on a biosimilar or biologic.

‍Updates on Telemedicine & COVID-19

Our third subject matter expert that we heard from was Chris Gagen, Sr. Director of Professional Services here at Springbuk. For over 20 years, Chris has developed, implemented, and enhanced predictive models within the employee health benefits industry. Chris has deep experience in collaborating with business leaders, data scientists, and developers to define and solve healthcare business problems. 

He highlighted that on the positive side, we've noticed a significant decrease in low-acuity ER visits. And in fact, we've seen this trend continue – low acuity ER rates are around half of what they were in 2019. When we say low acuity, we're referring to things like sore throats, sinus infections, headaches, those types of conditions. At the same time, we see low acuity telemedicine rates increasing, suggesting that some of these needs are being met in a lower-cost, more appropriate setting.

In 2019, only 1% of mental health encounters were done virtually, we're flipping that a little bit. Now we see it's nearly 30%. And we believe this is a positive trend for a number of reasons. 

• Telemedicine is great for high-frequency, low-intensity care.
• It's convenient. Members can do this on their terms from their homes, minimizing the amount of time away from work.
• Access to traditional in-network mental health care providers, especially for children, can be challenging.
• And providers like it. They can often make deeper connections or new observations or make what are essentially virtual house calls.

To read the full analysis of each trend, head over to springbuk.com/eht23 to download the 2023 Employee Health Trends report.

‍