New AHPI Study Highlights Private Sector Initiatives for Reducing Costs of High Cost Claimants

Federal Health Care Reform

The American Health Policy Institute this week released "High Cost Claimants: Private vs. Public Sector Approaches," a study in collaboration with Leavitt Partners that compares and contrasts high cost beneficiaries—defined as a beneficiary who costs $50,000 or more in a year—in the private and public sectors.  In order to better understand the burden of high cost claimants' costs to employers' health plans, AHPI surveyed 26 large employers on their claims data.  The study found that while 1.2 percent of members are high cost claimants, they account for 31 percent of total spending.  This amounts to $122,328 annually per high cost claimant, 29.3 times as much as members on average.  Dr. Tevi Troy, Chief Executive Officer of the Institute, said, "Both the federal government and the private sector need to take a careful look at high cost claimants.  Employers, for their part, are developing innovative approaches to high cost claimants and are in a unique position to establish programs that address this group."  These initiatives include:

• Mining health data to target certain chronic conditions;
• Engaging beneficiaries to be active plan participants;
• Implementing wellness programs with a clinical orientation;
• Developing predictive biometric health screening profiles; and
• Using care management to target the costs of particular diseases or procedures.