High-cost Claimants: Is the Affordability of Your Benefits Plan at Risk?

High-cost Claimants: Is the Affordability of Your Benefits Plan at Risk? For most employers, prescription drugs, doctor fees or an unexpected visit to the emergency room is top of mind when considering high-cost claimants and their benefits program. The last thing is usually a cancer diagnosis.

But with more people being diagnosed with cancer every year, preparing your benefits program for the possibility of a cancer diagnosis is essential. A 2023 Global Oncology Trends report shows that over the past five years, the number of patients treated for cancer has increased annually by about 5%.

Furthermore, The American Cancer Society shares that for the first time, the amount of new cancer cases in the United States is expected to be over 2 million in 2024. Creating almost “5,500 cancer diagnoses a day.” A staggering number that highlights the urgency for businesses to consider the possibility that someone in their workforce could be diagnosed with cancer any day. 

Being proactive doesn’t have to be expensive. 

While the cost of cancer treatment varies widely depending on a number of factors, costs can easily—and quickly—reach tens of thousands of dollars. Sometimes hundreds of thousands. Per patient.

Employers need to take a deep dive into their benefits programs to ensure the coverage they provide supports their workforce and protects their business—before a crisis occurs. If strategies aren’t in place, employers may have to prioritize premium payments over wage increases or hiring new staff, which can negatively impact retention and recruitment efforts.

Solutions don't need to be complicated or require upfront costs. For example, implementing cancer screening programs, along with education about the importance of cancer screenings is just one way employers can prepare. Keep in mind that screening programs should be offered for all ages, not limited to those workforces with aging employees as the incidence of cancer in young people continues to climb.

Protect your people.

It’s not only important for employers to think about the management of high-cost claims, but also the quality of care and wellbeing of those going through treatment. Ongoing cancer treatments, specialist consultations and corresponding loss of income due to missed work can take an emotional toll on patients and their families.

Ensuring employees receive the right treatments and care—when they need it—can help alleviate stress and reduce costs for those affected. For example, cancer treatments that require infusions are usually done in hospitals. Infusions in this setting can be costly. To help lessen the cost, employers could consider sourcing outpatient cancer facilities in their area. Not only can this reduce the financial burden for employees, but it could also present an opportunity for patients to be treated closer to home.

While changing physicians may be required, creative solutions can generate cost savings that could be utilized elsewhere in the program, including adding more support programs, implementing paid time off, and providing a flexible work schedule or financial assistance.

Don’t wait. Discuss your benefits with a trusted consultant today.

Management of high-cost claims due to illnesses like cancer can be complex, but you have options. With the support and knowledge of a benefits specialist, strategies can be put in place to help mitigate the effects a high-cost claimant can cause. For both your business and your people.

Is the affordability of your benefits plan at risk? Reach out to a consultant today to discuss your program in detail.