U.S. residents who have employer-sponsored coverage used fewer or the same amount of medical services in 2016 as they did in 2015—but their spending spiked, driven by increasing medical prices, according to a new Health Care Cost Institute (HCCI) report.
For the report, HCCI analyzed claims data for about 39 million U.S. adults under age 65 with employer-sponsored coverage from 2012 through 2016. According to the report, the data set represents about 26% of the U.S. population who receive health insurance through their employer.
Overall, the report found total health care spending for individuals with employer-sponsored coverage reached $5,407 per person in 2016—up 4.6% from 2015. According to the report, that 4.6% growth rate was the highest increase observed over a five-year period.
However, according to the report, health care utilization was not a contributing factor to the spending increase: Health care utilization rates either fell or remained unchanged during the study period. Instead, the researchers found price increases accounted for nearly all of the uptick in spending.
For instance, the researchers observed that price growth rates across nearly all medical service categories outpaced growth rates for the utilization of those services. According to the report:
- Prescription drug prices—which Axios' "Vitals" notes did not account for insurer rebates—rose by 27% from 2012 to 2016, while utilization grew by 1.8%;
- Prices for inpatient services rose by 24.3% from 2012 to 2016, while hospital admissions declined by 12.9%;
- Prices for emergency department (ED) visits rose by 31%, to $1,917 per visit, while ED visits increased by 2%;
- Prices for inpatient surgeries rose by 30%, to $41,702, while inpatient surgical admissions fell by 16%; and
- Prices for outpatient surgery rose by 19%, to $4,722, while outpatient surgery use fell by 6%.
However, the report found that patients were somewhat shielded from the price increases, with out-of-pocket spending (not including insurance premiums) growing at a slower rate than total per-person spending. That said, the researchers found out-of-pocket costs rose across all categories, except for prescription drugs, which saw out-of-pocket spending per person fell by 15% from 2012 to 2016.
When looking closer at health utilization data, the researchers found PCP office visits fell by 18% from 2012 to 2016, while specialist visits saw a bump. However, they said the study did not explore why the shift from PCP to specialist visits may be occurring (Johnson, "Wonkblog," Washington Post, 1/23; Thielking, "Morning Rounds," STAT News, 1/23; Baker, "Vitals," Axios, 1/24; Health Care Cost Institute report, 1/23).
Create a super-utilizer program
Every population health manager develops a strategy to manage high-risk, high-cost patients. Many of these super-utilizer programs start small, but as they expand, leaders take the opportunity to re-evaluate program design—from appropriate patient recruitment through graduation.
This guide offers a blueprint for implementing a super-utilizer program and measuring success across six steps.