How You Can Support Your Team with the Rise of Health Care Costs: Medical Cost Savings Programs

September 11, 2024

We’re back with part two in our cost saving series. (Click here to learn more about pharmacy saving programs)

As a recap, we know the upward trend of health care costs is expected to continue, impacting employers and individuals alike. High drug prices, increases in outpatient procedures, and more members needing high-cost care are challenging health plans, employers, patients, and the entire health care system.

So how can you make sure your employees are being taken care of, and what is Excellus BlueCross BlueShield doing to help improve quality of care while combating these costs?

In this post, we’re talking about our cost saving medical programs including outpatient surgeries, supporting members with high-cost conditions, and the importance of preventive care programs. 

Hips, knees, and other musculoskeletal (MSK) conditions

First, we’re talking about increases in outpatient surgeries, especially on hips, knees, and other musculoskeletal (MSK) conditions. These conditions are one of the leading drivers of health care expenses in the U.S. and consistently one of the top three highest costs for our health plan. In 2021, there was an estimated 9.5 million visits to the emergency department across the US for MSK conditions.1 And in 2021, we spent $800 million on MSK-related costs .2 This continues to be a trend in 2024. In fact, an additional $57 million on outpatient surgeries – including hip and knee surgeries – through the first five months of the year compared to the same time last year.

Costs aside, this can also have a big impact on businesses in the form of employee productivity: Nationwide, it has been found that musculoskeletal disorders account for an average of eight days away from work.3

So, what is being done to address this?

Many MSK conditions can be effectively managed or even improved with physical therapy (PT).4 We analyzed our data and saw that in 2021-2022, adherence to PT was low. For example, of our members who were facing back pain and were prescribed physical therapy, 18% completed only one PT visit.2

We knew we needed to make it easier for our members to access and adhere to their PT plans to help improve their outcomes. That’s why we now offer digital musculoskeletal (back, neck and joint) health care and PT services with our plans through our partner, Vori Health.* Support from Vori Health can help:

  • Increase physical therapy engagement, resulting in better quality of care.
  • Increase ease and speed of access to care, resulting in better compliance with treatment.
  • Reduce unnecessary invasive treatments and trips to the emergency room, resulting in lower overall costs.
  • Reduce absenteeism, resulting in higher work productivity.

Plus, Vori Health can help your employees get back to their lives faster with access to:

  • Convenient video visits.
  • Medical evaluation and diagnosis.
  • Personalized treatment including physical therapy and more.
  • Non-opioid pain medication and imaging if needed.
  • Support to help manage pain, regain strength, and enjoy life.

Even better, Vori Health visits are provided at no cost to members on many of our health plans (subject to deductible, where applicable). This service can be the first step in addressing MSK conditions to support traditional PT but does not replace your local Physical Therapist.

Download our MSK Savings Toolkit >>

High-Cost Conditions

Next up, we’re going to focus in on how we’re supporting members with high-cost conditions. We have found that more of our members are receiving care for severe and high-cost conditions that add up to more than $100,000.

A relatively small number of members – only about 1% –often drive a large majority of a plan’s health care costs. These are usually members with chronic or complex conditions, and oftentimes they are managing multiple health concerns at once.

Once a potential high-cost individual has been identified, the next critical piece of the strategy is to ensure that support is being tailored to their unique needs. At Excellus BCBS we have care management teams available for all members who want help managing their care or just staying healthy. Those with chronic conditions typically benefit the most from our care management teams to ensure they have the full range of care and support required to manage their conditions. Our care management team can help members in a variety of different ways:

  • Customize an outreach and engagement plan for members.
  • Educate them on the importance of following their doctor’s care plan and help them adhere to it by encouraging follow-ups with their specialists.
  • Assist members with interpreting their benefit package and claims history to identify potential solutions or ways to control costs.

Download our Care Management Toolkit >>

Preventive Care

Lastly, prevention is key when it comes to health care. We want all our members to be as healthy as possible, and it’s the key to good health and reducing costs.

Preventive care consists of services that help catch potential issues early before they develop into more serious health conditions. Things like routine checkups, screenings, and immunizations can fall under preventive care. And preventive services are covered in full by our health plan. Here are some ways your employees can get the most value out of their plan.

  • Know where to go for care – A primary care provider, telehealth, urgent care, or emergency room have different costs. It’s important to use the most appropriate arena for the care you need to make sure you’re not overspending.
  • Shop around – Use our cost estimator tool to compare costs at different providers.
  • Use our pharmacy price check tool to connect with a pharmacist, check drug prices and more.
  • Make sure your doctor is in network – Use our Find a Doctor tool to check. Care usually costs less when received from an in-network provider.
  • Treat health concerns early – Take advantage of services like physical therapy to keep conditions manageable and hopefully without costly surgery.
  • Take advantage of our care management support and free 24/7 nurse call line. We can help you understand your options and navigate the health care system – at no additional cost.
  • Download the Wellframe® app which gives you instant access to a dedicated care manager, dietitians, nurses and other health care professionals to help you meet your health and wellness goals.

Download our Preventive Care Savings Toolkit >>

Actions you can take to help control costs:

  1. Download our cost savings toolkits where you can access more information, resources, and prewritten emails for sharing with your employees. These toolkits will support you in opening a dialogue with employees as well as sharing ways employees can navigate the health care system, understanding what care is right for them, and help improve outcomes.
    1. MSK Savings Toolkit
    2. High-Cost Claimant Toolkit
    3. Preventive Care Toolkit
  2. Please don’t hesitate to contact your account manager or broker for more information on these programs.
  3. For more helpful content to educate and engage your employees in their health care, visit ExcellusForBusiness.com.

1 Estimates of Emergency Department Visits in the United States, 2016-2021, Centers for Disease Control and Prevention [CDC].

2 Work-Related Musculoskeletal Disorders and Ergonomics, Centers for Disease Control and Prevention [CDC], 2019.

3 2021-2022 Health plan data

4 Musculoskeletal Pain: Current and Future Directions of Physical Therapy Practice – PMC (nih.gov)

Vori Health is an independent company that offers virtual musculoskeletal (back, neck and joint) health care and physical therapy services to Excellus BlueCross BlueShield members[MD6] .

Wellframe is an independent company that provides a health and wellness support mobile app to Excellus BCBS members.

Excellus BlueCross BlueShield is a nonprofit independent licensee of the Blue Cross Blue Shield Association.