By Cathy Hartman, Chief Healthcare Solutions Officer, Paradigm

Healthcare costs in America are rising at unsustainable levels.

The past two years brought the highest back-to-back cost hikes in a decade — and the trend shows no signs of slowing down as employers brace for another 9% increase in healthcare costs in 2026. For health plans, there is mounting pressure to reel in costs and deliver greater value.

A major driver of these rising costs is the growing prevalence of comorbidities. Today’s patients are showing up with more complex, interrelated conditions that increase acuity, prolong recovery times, and require more costly interventions.

To bend the cost curve, we need a smarter, more integrated approach to care management — one capable of addressing rising upstream cost drivers, while still delivering high-quality, patient-centered outcomes.

How comorbidities accelerate cost spirals for health plans and members
Six in 10 U.S. adults currently live with at least one chronic illness, and four in 10 have two or more. It’s no surprise that nearly 90% of the country’s $4.9 trillion annual healthcare expenditures are tied to chronic diseases (such as heart disease, diabetes, and cancer) and mental health conditions.

In fact, comorbidities are at the root of many of today’s largest cost drivers. For example, costly specialty drugs, such as GLP-1 medications for diabetes and advanced oncology therapies, are driving steep increases in pharmacy spending. Meanwhile, heightened demand for behavioral healthcare and substance use treatment continues to increase utilization and push healthcare costs higher across the system.

For health plans, comorbidities compound the challenge of managing costs and ensuring quality outcomes. Rising acuity makes it harder to predict risk, while care fragmentation that occurs when addressing multiple conditions leads to inefficiencies that strain budgets and erode member satisfaction.

Unlike single conditions, which can be treated on their own and typically increase costs incrementally, comorbidities multiply healthcare complexity and create cascading needs that spike services and costs even higher at every step of the patient journey.

This burden is especially pronounced in recovery from catastrophic diagnoses and injuries, such as spinal cord injuries, traumatic brain injuries, amputations, severe burns, and multiple traumas.

For example, a patient with Type 1 diabetes who sustains multiple traumatic injuries from a car accident will experience a different recovery trajectory than someone without the same preexisting condition. They face increased susceptibility to delayed wound healing, infection, cardiovascular complications, and slower surgical recovery due to poor tissue perfusion, among other risks.

There is often a domino effect: One complication triggers another, and conditions can quickly spiral out of control. That is why every stage of care, from wound healing to medication management, involves heightened risk and more complex care considerations.

Without an integrated approach to recovery management, complications increase, recovery times are longer, and costs quickly escalate. For instance, the average cost of a catastrophic case is roughly $90,000, but unmanaged cases can escalate to more than $500,000.

For patients, a more complex recovery can bring greater physical hardship as well as mounting medical bills and extended time away from work that can undermine financial stability. Meanwhile, health plans must grapple with escalating claims and rising costs from unmanaged comorbidities, while working to maintain the quality of care and support their members expect.

Care management efforts have traditionally focused on utilization management, prior authorizations, and siloed condition-specific programs to limit costs. But this approach is no longer sufficient to address the complexity of today’s healthcare consumer.

Instead, we must look beyond traditional care management and cost-containment strategies to better support both payers and the members they serve.

5 ways to improve care management
Traditional care management systems are not designed to accommodate comorbidities. Addressing them effectively requires a proactive, integrated approach that accounts for the entire person and their unique health needs.

Specialized care management strategies offer an outcomes-driven approach to patient care. In practice, there are five key elements of specialized care management that help improve care delivery and manage costs:

1. Prioritize early intervention
   Early intervention is an effective way to prevent healthcare costs from spiraling. Care management programs that encourage preventive medicine and stronger connections to primary care providers can help patients address root causes of health concerns before they become high-cost crises. Stronger patient-provider relationships also establish the foundation for more effective coordination if a catastrophic injury or diagnosis does occur, ensuring patients are not starting from scratch when they need care the most. Risk stratification and predictive analytics are powerful tools to identify members most at risk for costly conditions. Data insights surface hidden vulnerabilities and ensure the right resources and support are in place from day one.
2. Adopt a multidisciplinary approach
   Coordinated, multidisciplinary care models that look at the full spectrum of a person’s needs — physical, behavioral, and social — are essential to addressing comorbidities. Behavioral health, in particular, has emerged as a critical overlay. A few decades ago, many healthcare programs underestimated the impact of behavioral health on chronic conditions. But today, it’s clear that addressing behavioral health alongside physical health conditions is vital to improving outcomes and reducing costs. Multidisciplinary care that takes a holistic approach to health helps improve medication adherence, reduce rehospitalizations, and tackle the real-world challenges that shape health outcomes.
3. Leverage highly specialized teams
   When complex, high-cost conditions arise, a generalist approach cannot account for the added impact of comorbidities. Conversely, specialized expertise ensures co-occurring conditions and health needs are managed holistically. This helps prevent barriers to recovery, improves recovery outcomes, and prevents costly missteps. Health plans need care management programs that bring together specialists with the expertise to handle complex needs. This might look like engaging a multidisciplinary team that combines surgical experts, rehabilitation specialists, home care, and behavioral health providers to address overlapping challenges. Having the right experts involved at the right time can help patients navigate multiple conditions and make for a far smoother recovery process from the start.
4. Improve care coordination
   Care often breaks down as patients move between providers, treatments, or care settings — gaps that drive up costs and worsen outcomes. Effective coordination connects the dots, ensuring teams share information, align treatment plans, and work toward the same goals. It is no surprise that 79% of organizations say better coordination of integrated care teams is one of the top actions to improve the quality and impact of care. Rather than focusing on limiting care, smart coordinated strategies prioritize delivering more effective care, ultimately leading to fewer delays, duplications, and conflicting recommendations.
5. Empower members with health literacy
   The ability to navigate care options and make informed choices about surgeries, treatments, and recovery paths is equally as critical as the ability to access care in the first place. Strong health literacy helps members avoid unexpected complications and unnecessary utilization that often arise when comorbidities go unmanaged. Health plans can strengthen health literacy by offering decision support tools, providing clear educational resources, and creating opportunities for members to engage with trusted care guides. Even small steps — like simplifying medical information or reinforcing preventive care — help members become more confident and capable healthcare consumers. Strengthening health literacy around comorbidities helps members recognize their risks and take proactive steps to improve their health. When people recognize how conditions like diabetes or depression interact with other health challenges they may face, they can make smarter decisions and achieve better outcomes.

A smarter way to manage healthcare costs
As the complexity and cost of care continue to escalate in America, the most sustainable path forward is to reimagine how health plans can help their members access care, manage recoveries, and reduce costs.

Taking a more specialized approach to care management offers health plans the opportunity to both contain costs and improve patient outcomes. The approach points to a healthier, more resilient future — for health plans, their members, and for our healthcare system as a whole.