Poor health behavior wastes $317 billionNews added by Benefits Pro on May 17, 2012

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Joined: September 07, 2011

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By Jenny Ivy

Benefits managers say poor health behavior is the greatest contributor to health plan costs. Members' decisions led to more than $317 billion of avoidable medical costs in 2011, according to a report from Express Scripts released Thursday.

The fifth annual "9 Trends in Rx Plan Management" states that behavior-driven decisions have three times the impact on costs as health reform, new medications, biosimilars and electronic medical records combined.

"This is a broad acknowledgement of how critical addressing behavior is to reducing health care costs," said Tim Wentworth, senior vice president and president, sales and account management, Express Scripts in a statement. "A vast majority of our clients are now focusing on improving the health behaviors of plan members. This is critical, especially at a time when rising health care costs, waste from medication nonadherence and suboptimal health outcomes are making it harder to provide a robust pharmacy benefit."

Skyrocketing health plan costs and poor health decisions are prompting employers to dramatically boost interest and implementation of wellness programs. In fact, according to Express Scripts, it's the first time in the pharmacy benefit manager's study that wellness programs were cited as "the most effective measure" to control overall health care costs.

The report polled benefits managers from 318 organizations. While only 58 percent of respondents report that they currently use a wellness plan, 81 percent say they intend to offer one in the next two years.

According to the report, integrated pharmacy/medical data is "likely to play an increasing role in identifying members at risk, and coordinating efforts with disease management and wellness vendors. At least three-quarters of respondents say they intend to employ integrated data programs to support these initiatives within the next two years."

Strategies that have worked to influence member behavior:
  • Offering financial incentives for participation - 47 percent
  • Using penalties or disincentives to discourage certain behaviors (e.g., higher premiums for smokers) - 18 percent
  • Offering financial incentives for preferred outcomes (e.g., weight loss) - 11 percent
  • Other - 10 percent
  • None/have not used any - 9 percent
  • Offering nonfinancial incentives (giveaways or recognition) for participation - 6 percent
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