How Total Cost Of Care Drives Savings Through Clinical Programs
Aug 17,2023
Read Time 4 Minutes
Infographic: Clinical Programs And High-Quality Care
Effective clinical programs ensure that employees, especially those with chronic or high-cost conditions, are getting the right care from the right provider, in the right place at the right time. This approach can lead to fewer emergency room visits, lower hospitalization rates, higher adherence to preventive screenings, and cost savings for employers.
By implementing programs that encompass population health management, care management for at-risk employees, integrated medical and pharmacy benefits, as well as behavioral and physical healthcare, you can pave the way to a healthier workforce.
View the infographic below to learn how you can use a Total Cost of Care approach to discover strategies to help manage your clinical programs more effectively.
Total Cost of Care
Drive savings 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.
What is Total Cost of Care?
Total Cost of Care refers to the total amount an organization spends on healthcare and health benefits for employees and their dependents
Why choosing the right clinical programs is just what the doctor ordered
Effective clinical programs ensure that employees, especially those with chronic or high-cost conditions, are getting the right care from the right provider, in the right place at the right time. This approach can lead to fewer emergency visits, lower hospitalization rates, higher adherence to preventive screenings, and cost savings for employers.
90% of annual healthcare costs are for people with chronic and mental health conditions.1
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Population health management Support employees’ whole health and drive engagement with data-driven clinical decision making and integrated care. |
Lack of care coordination accounts for $27.2-$78.2B in wasted healthcare spending each year.2 |
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Care management for at-risk employees Better manage at-risk employees with a team-based partnership approach to achieve early and targeted interventions. |
$147B in annual productivity losses are due to chronic conditions like heart disease and stroke.1 |
|
Integrated medical and pharmacy benefits Use real-time prescribing data to improve care management for your employees, driving better outcomes that can lead to a healthier, more productive workforce. |
4% lower annual medical costs, with an associated average medical cost savings of $148 per member per year — specifically, $3,601 with carve-in versus $3,749 with carve-out or a separate pharmacy benefit.3 |
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Integrated physical and behavioral healthcare Integrating physical and behavioral healthcare can lead to improved health outcomes and cost savings. |
57% of commercial healthcare spending is driven by behavioral health patients.4 |
|
Population health management Support employees’ whole health and drive engagement with data-driven clinical decision making and integrated care. |
|
Care management for at-risk employees Better manage at-risk employees with a team-based partnership approach to achieve early and targeted interventions. |
|
Integrated medical and pharmacy benefits Use real-time prescribing data to improve care management for your employees, driving better outcomes that can lead to a healthier, more productive workforce. |
|
Integrated physical and behavioral healthcare Integrating physical and behavioral healthcare can lead to improved health outcomes and cost savings. |
|
Lack of care coordination accounts for $27.2-$78.2B in wasted healthcare spending each year.2 |
|
$147B in annual productivity losses are due to chronic conditions like heart disease and stroke.1 |
|
4% lower annual medical costs, with an associated average medical cost savings of $148 per member per year — specifically, $3,601 with carve-in versus $3,749 with carve-out or a separate pharmacy benefit.3 |
|
57% of commercial healthcare spending is driven by behavioral health patients.4 |
Clinical programs can pave the way to healthier employees and organizations
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:
Meet Sara. Sara has diabetes and COPD, and her doctor recommends that she lose weight.
Timely. Using data, we are able to identify Sara’s care gaps and health risks in order for her care providers to deliver more timely service.
Appropriate place. Sara is not feeling well and needs to determine where she should go to get the care she needs. Through member education tools, Sara is directed to the right clinical setting.
Right care providers. Once Sara determines that she can be seen in an outpatient setting, she contacts her insurance company to assist in finding the right care providers.
Comprehensive care. By integrating Sara’s care and having real-time access to data, her care team has a fuller picture of her health to ensure that her unique needs are met.
When strong clinical programs are integrated your benefits strategy, you can help employees like Sara achieve better health outcomes at a lower cost.
Ask your health plan partner
- Are pharmacy benefits integrated so that clinical teams have a full picture of each employee’s health?
- How are you using data to drive better health outcomes?
- What programs do you offer to encourage collaboration across pharmacy and clinical programs?
- What new solutions would help me better integrate and manage the care of my employees?
Take a Total Cost of Care approach to control spending
Together with your health plan partner, you can use a TCOC approach to deliver better results for your employees and your organization’s bottom line. Contact your account management team, broker, or sales representative for more information. We can help you determine the right 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 National Library of Medicine: Waste in the US Health Care System: Estimated Costs and Potential for Savings (accessed July 2023): ncbi.nlm.nih.gov.
3 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.
4 Modern Healthcare: Behavioral health patients spur 57% of commercial healthcare spending (accessed July 2023): modernhealthcare.com.
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