Member Participation: Develop Strategies to Reduce Non-Engagement


Installment 1 of 6: “Empowering Employers in 2024: Strategies for Effective Employee Health Management and Financial Optimization”

Empowering Employers in 2024 Series

Installment 1
Member Participation: Develop Strategies to Reduce Non-Engagement

The cost of providing healthcare for employees has risen dramatically, evidenced by the proliferation of high-deductible health plans and the attempt to better share the cost burden among all stakeholders. The average employer cost of providing healthcare insurance in 2022 was $6,584 for an individual and $16,357 for a family—a 43% increase over the previous decade.1

$575B – Annual employer expenses incurred due to employees’ poor health.2

individuals spending >$100K each year on medical care rose 50% between 2013 and 2021.3

50% of healthcare spending comes from just 5% of the population.4

In theory, higher out-of-pocket healthcare costs should result in individuals taking better care of themselves to avoid paying more. However, greater financial responsibility leads many to delay or skip care altogether, which can ultimately lead to poorer outcomes and higher costs—quite the opposite of the intended goal.4

The Impact of Chronic Disease

Adults in the U.S. with a Chronic Disease chart
Adults in the U.S. with a Chronic Disease chart

By 2028, more than a quarter of the U.S. workforce will be 55 or older.9 Since older adults typically have more chronic conditions, the economic impact on employers could be significant.

Chronic diseases are the leading cause of disability and death in the U.S.5 The Centers for Disease Control and Prevention (CDC) estimates that 60% of adults in the U.S. have a chronic disease and that 40% have two or more.6 Conditions like heart disease, diabetes, hypertension, and obesity have increased exponentially. In addition to higher healthcare costs, chronic conditions such as these have led to significant employer costs related to absenteeism, presenteeism, and reduced productivity.

  • $1T is the annual economic impact of unaddressed chronic disease among employees.7
  • $36.4B is the annual cost to employers from reduced productivity due to unaddressed chronic disease.8

The Growing Obstacles to Participation in Healthcare

Non-participation drives nearly $300 billion in avoidable healthcare costs annually.13

Managing chronic diseases often presents challenges, including instances of non-participation in prescribed care. This can involve difficulties in completing medication courses, adapting to lifestyle changes, or attending wellness and follow-up appointments. Various factors, such as affordability of medications, side effects, work commitments, or childcare responsibilities, can impede adherence to care plans. This non-participation, often resulting from these and other complexities of life, can lead to worsening conditions and increased healthcare usage, impacting both employers and employees.

The Epidemic of Participation Challenges

50%

of patients do not follow their prescribed care plan.10

30%

of prescriptions for chronic conditions are never filled.11

50%

of medications for chronic conditions are not taken as prescribed.12

Addressing Non-participation

Research shows personalized health and wellness programs yield better results than standard one-size-fits-all programs.14

A solution lies in adopting strategies that assist members in utilizing their health benefits more effectively. By providing additional benefits and resources, employers can play a supportive role in enabling members to better understand and manage their health conditions, navigate the healthcare system, and make the most of their health plan benefits.

Risk stratification. Claims data can be used to identify utilization patterns and trends that impact medical spending, ensuring the highest-risk employees receive the proper attention and support.

Personal health nurses (PHNs). Using a holistic approach, PHNs educate individuals about their unique health needs and provide support to get the care they need. This includes connecting members with primary care, specialists, and local support resources.

Targeted Engagement. Personalized programs developed by PHNs focus on guiding employees through the complexities of managing their chronic conditions. This targeted engagement approach helps identify and address unique health challenges, providing necessary resources and support.

Success Story

A 55-year-old individual with a medical history marked by significant health challenges such as obstructive sleep apnea, narcolepsy, osteoarthritis, and a history of back surgery, was hospitalized due to a pulmonary embolism. Upon discharge, he received new instructions for oxygen use but continued to face difficulties with both breathing and mobility upon returning home.

No follow-up appointments were arranged for the member, and to exacerbate matters, his insurance plan no longer covered the high-cost medication prescribed to him. Despite numerous attempts to communicate these concerns, the individual and his family experienced distressing difficulties in reaching anyone for assistance.

How Conifer Helped

  • The PHN proactively reached out to the member’s pulmonologist to raise concern that the high-cost medication being prescribed wasn’t covered by his insurance. This resulted in the pulmonologist prescribing an alternative medication which was covered, reducing the member’s out-of-pocket costs and ensuring he took the medication.
  • The PHN reviewed the member’s treatment plan, addressing concerns including diagnosis, new equipment and the member’s discharge.
  • The PHN played a vital role in educating the member, addressing queries related to oxygen safety, blood thinners, the consequences of non-participation, proper utilization of non-medical pain treatments, and the safe use of over-the-counter medications.

Member Results

  • Thanks to the outreach efforts of Conifer’s PHN, the member comprehensively followed through with his post-discharge treatment plan.
  • In short order, the member transitioned to breathing room air, no longer requiring oxygen support.
  • Employing ice and an over-the-counter pain reliever for pain management, the member successfully returned to work approximately six weeks after undergoing surgery.

A Win-Win for All


Care plan non-participation is a complex issue with far-reaching implications that impact the nation’s healthcare costs and an employer’s bottom line. Benefits managers must develop more proactive solutions that address member participation challenges in a way that lowers employer costs and provides a holistic experience for their members. Partnering with Conifer Health can help.

Through the intervention of Conifer’s personal health nurses, members are empowered to take control of their health while employers can take control of their costs. Partner with Conifer Health and let’s win together!

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