Mini-White Paper: Lower Costs And Clinical Programs
Employers are continually looking for ways to control costs and improve the quality of healthcare for their employees. Using a Total Cost of Care approach, better clinical program management can result in significant savings.
Help your organization lower costs by ensuring employees get the right care from the right provider at the right place and time. Get a clearer picture of how clinical programs are a key component of an effective Total Cost of Care strategy with the mini-white paper below.
Together with your health plan partner, you can use a Total Cost of Care approach to deliver better results for your employees and your organization’s bottom line.
Optimizing Total Cost of Care through clinical programs
Employers are continually looking for ways to control costs and improve healthcare quality for their employees. By utilizing advanced and better managed clinical programs, your organization could achieve substantial savings through a Total Cost of Care (TCOC) approach.
Total Cost of Care: the big picture
Total Cost of Care refers to the total amount an organization spends on healthcare and health benefits for employees and their dependents. There are four key components of TCOC:
network and benefit design, member engagement, clinical programs, and cost protection.
By viewing it all through a Total Cost of Care lens, you can gain a clearer picture of potential solutions that can make a meaningful impact on the health of your workforce and your organization’s bottom line. Let’s dive deeper into clinical programs to learn more.
Why are the right clinical programs important?
Effective, data-driven clinical programs ensure employees are getting the right care from the right provider at the right place and time, particularly those with chronic or high-cost conditions. Given that 90% of annual healthcare expenses are attributed to people with chronic and mental health concerns, employers can achieve significant savings through improved care management.1 This approach can lead to fewer emergency room visits, lower hospitalization rates, increased preventive screenings, and other savings.
The cost of hospital stays and related services increased by 4.2% last year.2 Clinical programs can help mitigate the rising costs of condition management.
Whether it’s integrating medical and pharmacy benefits, implementing care management, or bringing behavioral and physical health together, there are several ways to achieve more effective clinical programs.
Clinical programs in action
By implementing effective clinical programs supported by employee engagement, you can optimize the benefits for both your workforce and your organization's bottom line.
Here’s an idea of how the right pieces come together:
Engage your health plan partner
Here are a few questions to ask your health plan partner in order to gain a better understanding of your current clinical programs:
- What can we do together to drive better engagement and more effective use of clinical programs?
- What programs do you offer to encourage collaboration across pharmacy and clinical programs?
- How are you using data to drive better outcomes?
- What new solutions are being offered to help better integrate and manage the care of my employees?
Questions? We’re here to help. Contact your account management team, broker, or sales representative for more information. Together, we can determine the right Total Cost of Care approach for your organization’s needs.
1 Centers for Disease Control and Prevention: Health and Economic Costs of Chronic Diseases (accessed July 2023): cdc.gov.
2 Peterson-KFF Health System Tracker: How does medical inflation compare to inflation in the rest of the economy? (accessed July 2023): healthsystemtracker.org.
3 National Library of Medicine: Waste in the US Health Care System: Estimated Costs and Potential for Savings (accessed July 2023): ncbi.nlm.nih.gov.
4 Journal of Managed Care + Specialty Pharmacy: Medical Costs and Health Care Utilization Among Self-Insured Members with Carve-In Versus Carve-Out Pharmacy Benefits (accessed July 2023): jmcp.org.
5 Modern Healthcare: Behavioral health patients spur 57% of commercial healthcare spending (accessed July 2023): modernhealthcare.com.