High Cost Healthcare Claimants

High Healthcare Costs Are Caused by High Cost Claimants. If You Are Involved in the Healthcare Budget for an Employer-Sponsored Health Plan, You Need to Think about High Cost Claimants Every Day. 80% of Healthcare Costs are Driven by 20% of the Claimants (typically greater than $25K per Year, per Claimant). 50% of Healthcare Costs are Driven by 5% of the Claimants (typically greater than $100K per Year, per Claimant. High Cost Claimants Generally Fall Into 3 Diagnostic Categories: 1. MSK 2. Cardiovascular 3. Cancer Additionally, there are 3 Claims 'Patterns' for High Cost Claimants. 1. The Explosion--Approx. 50% of High Cost Claimants, Few to Zero Claims Before a Major/Catastrophic Health Event. Examples Include Heart Attack, Stroke and New Cancer Diagnosis. 2. The Ramp-Up--Approx. 17% of High Cost Claimants, Increasing Trend of Claims Costs Over 1 or Multiple Years, Culminating with Very Large Claims Costs, Examples Include Dialysis for End-Stage Renal Disease Secondary to Diabetes and Hypertension. 3. The Continuation--Approx. 33% of High Cost Claimants, Plan Member was a High Cost Claimant the Previous Year and Continues to be a High Cost Claimant, Examples Include Cancer Recurrence/Complications, Congestive Heart Failure, Unsuccessful Spine Surgery or Joint Replacements Needing Revision. .AHealthcareZ is 200+ Healthcare Finance Educational Videos. 💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthca... AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health. 90,000+ Views Per Month Across All Platforms. Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.