Catastrophic injuries cost employers $15B annually

BenefitsPro.com
Full article on BenefitsPro.com

Employers should think about adding care management services for health plan participants affected by serious injuries, both to hold down plan costs and to help workers cope with costly, confusing calamities.

Analysts at Paradigm, an injury care management firm, make that case in a new commentary promoting use of injury care management services.

Employer plans face about 120 diagnoses related to catastrophic health events per 100,000 plan participants per year, according to the Paradigm analysts.

Spinal cord injuries, brain injuries, severe burns and other catastrophes cost commercial payers $15 billion per year, or 1% of annual U.S. employer and employee health care spending.

Employers and their benefits advisors have often assumed that typical plan participants with severe injuries will move quickly into Medicaid plans, but 68% of the plan participants with catastrophic claims in a Paradigm plan claim data review kept their employer plan coverage for at least 12 months.

A patient affected by a catastrophic injury will see an average of about 60 providers over the next year and have an average of about 100 medical and surgical encounters, the analysts estimate.

The typical bill could be $90,000 for a patient with a well-managed case and more than $500,000 for patient with poorly managed care who suffers from infections and other complications, the analysts warn.

Because the family of the patient is facing so much stress and dealing with so many different providers and insurance claims, “the administrative burden often shifts to the employer’s benefits team,” the analysts add. “This can mean fielding calls from employees, contacting insurers, chasing authorizations, and attempting to troubleshoot care gaps.”

The best way to keep management of a catastrophic injury case on track is to use an experienced case manager to develop and implement a carefully designed recovery plan, the analysts write.