I recently shared the story of Amara, a project manager at a large tech company, whose struggle with severe rheumatoid arthritis and the demands of her regular infusion therapy exemplify the real challenges faced by millions of working people. While Amara’s story was hypothetical, the financial implications for employers are very real. Let's dive in on a real dataset from a current Leap Health client.
The Cost of Infusion Therapy
Amara’s experience isn’t unique within the workplace. Like many of her peers, she requires regular infusion therapy to manage her condition, contributing to the company's substantial healthcare costs. Her company employs over 20,000 individuals across the U.S., nearly 1,900 of whom require infusion therapy, leading to over $10 million in annual healthcare spending. Just as Amara experiences the strain of balancing her treatment with her job, the company feels the financial strain of supporting these infusion patients.
A deeper dive into her employer's claims data reveals that 20% of these infusion patients, like Amara, are responsible for driving 90% of the total infusion spend. This disproportionate cost is primarily due to the high expense associated with hospital-based infusions. In fact, over 50% of the current infusion spend for Amara’s employer is happening in hospital facilities, which are significantly more expensive compared to other settings.
Identifying Savings Opportunities
Just as Amara finds herself exhausted after each treatment, dreading the next session and the toll it will take on her work and personal life, employers face the burden of managing high healthcare costs. However, there’s potential for significant savings and improved outcomes. Leap Health's analysis identified a $2.5 million drug savings opportunity for a company like hers, representing a potential 25% reduction in overall infusion spending.
This opportunity is based on shifting 250 members who are currently receiving care in high-cost treatment centers, to more cost-effective providers. If Amara’s treatments could be administered in a more convenient and less costly setting, she would likely experience less stress and better health outcomes, and the company would see a more efficient allocation of healthcare resources while still providing high-quality care to its employees that is also more accessible.
The Role of High-Cost Drugs
Amara’s treatments are part of a larger issue within the company. The top five infusion drugs account for over $1 million in potential savings. Notably, four out of the top five drugs contributing to these costs are non-oncology medications, underscoring the impact of managing chronic conditions like Amara's rheumatoid arthritis and others like Crohn's disease, multiple sclerosis, and hemophilia.
Beyond Drug Costs: Administration Fees
In addition to the $2.5 million in drug cost reductions, further savings are possible through reduced administration fees. Hospital-based infusions often come with higher administrative costs. These can be mitigated by transitioning to alternative care settings. For Amara, this shift could mean receiving care in the comfort of her own home, alleviating the emotional and physical toll of her treatments, and for her company, it would mean significant cost savings.
The Business Case for Change
Just as Amara dreams of a more balanced life, where her treatments don’t drain her energy and productivity, her employer can also benefit from a more strategic approach to managing infusion therapy costs. By embracing these opportunities, the company could not only reduce its overall healthcare expenditures but also enhance the quality of care provided to employees like Amara.
The transition to more cost-effective infusion settings, coupled with the potential for significant drug cost savings, positions a company such as Amara’s to lead in both employee wellness and fiscal responsibility. This approach supports employees in managing their health without sacrificing their professional responsibilities or well-being.
As the healthcare landscape continues to evolve, companies must prioritize patient-centered solutions that balance cost and care quality. Amara's story underscores the importance of addressing the human and financial impacts of chronic illness in the workplace. By leveraging insights such as those outlined above, businesses can make informed decisions that benefit both their employees and their bottom line.
