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Balancing cost containment and quality in medical coverage

Stay ahead of the curve with Health Trends 2024. Explore strategies for optimizing employee benefits, containing medical costs, and leveraging digital health services. Gain valuable insights to navigate the changing healthcare landscape.
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03/14/2023 · 5 minute read

While employers and insurers focus on cost containment for 2024, inclusivity and quality remain key considerations

General inflation has been top-of-mind globally for the last two years.  It has affected individuals’ cost-of-living, as well as businesses in terms of increased pay demands, higher prices, and challenging operating environments.

As medical inflation rates tend to be run higher than general inflation, related insurance pricing is inevitably effected, according to Mercer Marsh Benefits Health Trends 2024, our global insurer research report. After end-of-year results are analysed, we expect premium increases in 2023 to be higher than in 2022.  

Given this anticipated trend, employers face a difficult balancing act. Skills shortages are constraining growth in many sectors; attracting, retaining, and engaging employees with good quality benefits provision will continue to be a priority. At the same time, our research indicates that around one- third of markets with double-digit percentage increases in the cost of cover. This will put pressure on HR teams to rein in the scope and breadth of coverage.

Cancer is a major source of claims

Understanding and addressing drivers of costs is vital. Health Trends 2024 shows that cancer continues to be a major source of claims, both in terms of per-dollar value and frequency.

What were the top causes of claims in 2022 based on your book of group or overall business?

Source: Mercer Marsh Benefits Health Trends 2024

Developing clear strategies that address cancer prevention, diagnosis, treatment, and putting into place practical work supports for impacted employees can directly mitigate costs. These approaches can have relevance for other non-communicable diseases (NCDs). Providers recognise the need to innovate and extend services to support treatment of cancer and other NCDs, with over a quarter (27%) planning to add communications about cancer prevention (61% already do so) and 30% considering adding genetic testing as part of their offering.

Employer supports for individuals with health conditions

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Physical inactivity, tobacco use, alcohol consumption, unhealthy diets and air pollution increase risk, but employers can help mitigate the impact of these factors

Ensure benefits encourage and provide preventive care, including health screenings

Often, individuals may not be aware they have a condition, in part due to unaffordable testing and limited access to care

Evaluate barriers to accessing care; consider care navigation and advocacy services to refer members to high-quality care as well as mental health and community support

The employee experience related to treatment is often sub-optimal due to complex systems, lack of coordination and outdated models of care

Consider various benefits coverage gaps including plan maximums, case management, prescription drugs, income continuation

Employees who are unwell need varying levels of job supports as they perform or return to their duties

Create accommodation policies and make sure managers are trained on supervision of known or invisible conditions, including supporting a return to the workplace after a leave of absence and promoting anti-stigma team dynamics and communication

Source: Mercer Marsh Benefits Health Trends 2024

Healthcare is transforming

Broadening the definition of cancer support is one example of how healthcare is transforming, often by leveraging digital health. In most of the world’s regions, our survey findings reveal a perception that public health services have deteriorated and health service provision has declined since the onset of COVID-19. On the flipside, private healthcare is improving in both scope and quality.

Select digital health services, including telemedicine, are now well-embedded in most private health insurer offerings. Other digital solutions offer great potential for the next five years, including AI-driven tools that permit remote patient monitoring and offer first-line diagnosis and pharmaceutical developments.

Cost-containment is a priority

While there may be major shifts in the way that healthcare is structured and delivered in the longer term, cost containment remains a primary focus for many employers. 

Percentage of employer plan sponsors aiming to reduce plan coverage to manage costs

Source: Mercer Marsh Benefits Health Trends 2024

Affordability is a significant issue, with 42% of respondents globally saying that private healthcare affordability is worse now than before the pandemic. That has implications for inclusivity of care as well as breadth of included services that address gaps in need in the workplace.

Affordability of public and private healthcare

Source: Mercer Marsh Benefits Health Trends 2024

Research shows that, insurers’ response to the need for cost control is most effective when employers work with them. It is vital to check that insurers have updated medical cost sharing, deductibles, and limits. This is not always done proactively. Again, AI has the potential to improve cost containment through algorithms that detect fraud, identify waste or abuse, as well as direct people to centers of excellence for high-quality care.

Inclusivity gaps need further action

Providers have sharpened their focus on broader aspects of inclusivity, for example making sure that communications are inclusive and accessible. There has been progress in expanding cover for diagnoses, learning supports, and occupational therapy to support neurodiversity. Although there is progress, the research highlights that insurers are less engaged with ensuring diversity in their own medical provider networks and in using member demographic data to proactively address health care gaps and needs. Significant care gaps remain, especially around women’s/reproductive health and mental health support. 

Women’s/reproductive health benefits present a mixed picture. Cover is patchy across regions. For example, support during pregnancy is limited, with just 21% of insurers globally saying that they support high-risk pregnancies.

Mental health remains a workplace and societal challenge. Insurers across all regions, except Middle East and Africa (MEA), identify emotional and mental concerns as a top-five risk factor for medical claims. Providers are exploring additional areas of support, notably around coverage of targeted services for children, teenagers, and parents. Health Trends 2024 research shows this is valued highly by employees.

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69%  - Coverage for psychological and/or psychiatric counseling sessions (outpatient)

62% - Inpatient treatment

57% - Coverage for prescription medications prescribed for mental health (outpatient)

35%  - Virtual advice via chat, powered by artificial intelligence (no human involved)

35% - Coverage for targeted services for children, teenagers and parents to assist with mental health, socialization and learning issues faced by youth

33% - Training to recognize and address own and others’ mental health challenges

Source: Mercer Marsh Benefits Health Trends 2024

Cover for psychological and/or psychiatric counselling sessions remains ripe for improvement. Over half (52%) of surveyed insurers cover 10 or fewer counselling sessions, which may not be sufficient to address need, especially for more complex mental health issues. Employers need to be aware of these limitations and either anticipate additional costs or discuss opportunities to extend support.

Conclusion

Insurers are optimistic that over the next two years inflation will ease and medical trend rates will begin to stabilise. In the short term,  employers and providers will need to weather the storm of higher premiums. Employers will need to explore cost-containment opportunities while continuing to offer employees the scope and quality of health insurance protection they need. Doing so will help meet the business goal of attracting and retaining scarce high-quality talent.  

About the authors

Nicole Cohen

Nicole Cohen

Strategy and Planning Lead Specialist Mercer Marsh Benefits

  • United States

Elizabeth Sherer

Elizabeth Sherer

Director of Health and Wellbeing Innovation Mercer Marsh Benefits Multinational

  • United States

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