Healthcare Cost & Quality
| Sep 05 2018

Your CFO May Have a Few Questions about High-Cost Claims

Accustomed to budgeting for a possible healthcare claim that might approach $1 million, employers now have to plan for scenarios in which more than one plan member in a given year incurs healthcare costs closer to $2 million – or even as high as $20 million. Many of the sky-high claims are driven by specialty drugs. There has been a 55% increase since 2011 in specialty drugs spending under the medical benefit, and it is expected that specialty drugs will be nearly half of the total drug spend by 2020.

Your CFO may not want to get into the weeds of health benefit cost management, but with the ultimate responsibility for protecting the company’s finances and mitigating risks, he or she will want to know three things:

  1. What are you doing to proactively review and manage drug spending not just in your pharmacy plans, but also in your medical plans?
  2. How effective are your clinical management programs? Which specialty drugs present the biggest opportunity with better management? What is being done to promote the most effective site of care?
  3. When did the company last review the terms of its stop loss coverage? The use of stop-loss is growing among employers of all sizes – even the largest. Options to explore include stop-loss collectives and captive programs.

I recently joined my colleagues David Dross and Rich Fuerstenberg on a webcast hosted by where we outlined what finance leaders need to consider when assessing risks of self-funded health insurance plans. If you’re interested in learning more about the latest options and best practices in mitigating the risks of rising healthcare costs, watch the webcast on

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