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High-cost claims have become the single fastest growing issue for employers in the last several years and have been highlighted as the “most significant threat to employer-sponsored healthcare.” Since 2016, the number of health plan members with claims $3M+ has doubled, heightening sustainability concerns.

Mitigating High-Cost Claims

Addressing a Rapidly Escalating Challenge

The management of high-costs claims is diverse and complex with various stakeholders increasingly conflicted and less motivated to work with self-insured plan sponsors. Market solutions exist in some areas but are unevenly deployed. 

The National Alliance is amplifying the employer/purchaser voice through collective action and creating momentum through its high-cost claims initiative. It brings together coalitions and employers from across the country to address emerging issues and challenges.

High-Cost Claims Resources

Cancer treatments, heart disease, live birth and perinatal conditions, and blood infections are among the costliest claims, while 53% of healthcare spending for high-cost claims is for chronic conditions, and 47% is for acute conditions, according to the American Health Policy Institute. Learn more and take action with these resources.

Action Brief

New Directions to Better Manage High-Cost Claims

High-cost claims have become the single fastest-growing healthcare cost for employers in the last decade; a significant threat to employer-sponsored healthcare benefits. This Action Brief includes steps employers and other plan sponsors can take to mitigate high-cost claims while improving health outcomes.

Rethinking how Employers Address High-cost Claims

This report offers insights and action steps to help employers mitigate the effect of high-cost claims.

Mitigating High-Cost Claims

Elimination of annual and lifetime maximums through the Affordable Care Act and the dysfunction of the reinsurance market has made high-cost claims a top priority for every employer, purchaser and market.
Action Brief

Mitigating High-Cost Claims: A Closer Look at Hemophilia

Although hemophilia is a rare disorder affecting about 25,000 people in the US, it ranks among the highest-cost healthcare conditions. Vendor strategies may result in the lowest total cost of care, but conflicts can increase employer costs unnecessarily.
Press Release

Healthcare Affordability

Healthcare affordability crowds out wages and price transparency, driving employer concerns and fueling action.

Coalitions In Action

Membership in the National Alliance is a catalyst for state and regional coalitions and their employer/purchaser members to advance key initiatives. Together, they leverage their collective influence to drive health, equity and value.

High-cost claims are a highly credible threat to employer-sponsored healthcare coverage. Unified employer action will drive risk mitigation.
Shawn Gremminger, President & CEO
National Alliance of Healthcare Purchaser Coalitions

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