Navigating health care post-COVID: 3 ways to help hold the line on costs

Inflation appears to be calming down, supply chain snarls have eased and the pandemic is over (or is it/?). Even so, employers will have their hands full as they attempt to offer a package of employee benefits that is attractive and affordable.

“Make no mistake – COVID is still with us,” said Dr. Monte Masten, chief medical officer for Marsh McLennan Agency. “We are still seeing in the United States 120,000 new cases of COVID-19 each week. We are seeing 1,700 deaths and 2,000 hospitalizations in the United States each week, and only 17% of the population is up to speed on their boosters.”

Masten participated in “Navigating Health Care Costs in an Uncertain 2023,” an April 11 webinar sponsored by MMA. In addition to the lingering effects of COVID, shifting employment trends, deferred utilization and pressures on unit costs are driving health care inflation. Six in 10 people have experienced health care cost increases that have outpaced inflation in the past 10 years.

Patients who deferred care during the pandemic may soon see the bill coming due, often at a higher cost.

“During the height of the pandemic, around 2021, there was an 80% decrease in people getting colonoscopies,” he said. “There was a 70% decrease in women getting cervical cancer screenings or pap smears, and there was almost a 55% drop in mammographies. So the big question still out there that is going to impact everyone from a benefits perspective is if we are going to see over the next few years more late-stage cancers being diagnosed, which are going to be more difficult and expensive to treat.”

Related: Top 3 post-COVID workplace concerns: What employers need to pay close attention to now

Generational shifts also likely will affect costs. More people are choosing to work past age 65, when health care needs often increase. Somewhat surprisingly, however, millennials tend to be more frequent utilizers of health care than preceding generations.

“This may have to do with how they have grown up in the U.S. health care system,” Masten said. “They have grown up with telemedicine and urgent care. Access has been improved for the younger generation.”

Demand for behavioral health services increased exponentially during the pandemic.

“Even as we are exiting stage left from COVID, it’s still a challenge,” he said. “We are seeing suicide rates go up. We see accidental overdoses from drug use going up. Depression, stress and anxiety in the workplace are going up. When people are socially isolated from their coworkers, I think there is a big tie-in to the behavioral health trends we are seeing in the workplace. People in HR are really struggling with this.”

Advances in gene therapy and pharmaceuticals also are driving costs. Currently, more than 1,000 therapies are in the development and approval pipeline worldwide. The global cell and gene therapy market is projected to reach more than $21 billion in 2026.

“They are accomplishing some amazing things, but it puts a lot of financial pressure on the employer,” said Rick Kelly, senior vice president of employee health and benefits. “In the last three years or so, the number of claims of $1 million or more has increased by 50%. That’s all claims, not just gene therapy, but gene therapy is starting to be a really big driver of it.”

And then there is the cost of drugs, which he put into perspective.

“If the price of gas were to increase at the same rate as brand and specialty drugs over the past 10 to 12 years, we would all be paying $11 a gallon at the pump,” Kelly said. “What is even more scary is that the expectation is that the cost of pharmacy for brand and specialty drugs is going to triple between now and just 2030.”

He suggested three ways to help hold the line on costs:

• Biosimilars. FDA-approved biological drugs that share similarities in safety and quality as other biological drugs are continuing to enter the market.
• Stop-loss solutions. Stop-loss insurance provides protection against catastrophic or unpredictable losses, such as a costly gene therapy claim.
• Pharmacy calculators. There may be opportunities to save on a pharmacy plan with changes to the pharmacy benefit manager Use the prescription calculator to estimate possible savings.

“While we have passed the height of the pandemic,” Masten said, “I am almost positive that we are still going to see the impact of COVID-19 on health care trends from an employee benefits perspective, certainly in 2023 and possibly even beyond.”