Five chronic conditions cost employers $2.5 billion over two years, study shows

Companies spent $2.5 billion to treat employees' asthma, diabetes, hypertension, mental health and substance abuse and back disorders over the course of two years, according to a new study.

UnitedHealthcare reviewed all claims issued by the Health Action Council's 57 nationwide employer members—which are responsible for coverage of 281,000 individuals—to find that more than 60% of workers struggle with at least one of these chronic conditions, making them the top cost drivers in employer healthcare. By studying which populations are most impacted by which diseases, Craig Kurtzweil, vice president of UnitedHealthcare's Center for Advanced Analytics, said he aims to help employers and payers lower their overall health spend by structuring targeted benefits packages to meet the needs of these workers.

"We see healthcare as an asset to a business, not just an expense item. If done right, if we truly can work together to identify populations that need to improve their health, we think we can lower healthcare costs," Kurtzweil said. "A healthier workforce is a more productive workforce."

Researchers found asthma was 20% more prevalent among Black employees than those of other races. Black individuals were also more likely to require asthma treatment than white respondents, with 71% of Black respondents suffering from flare-ups that required hospitalization, emergency department or office visits compared to 56% of whites. While Black children and adults generally needed more treatment, they were less commonly prescribed inhalers—86% of Black children were prescribed inhalers compared to 93% of white children.

Asthma rates also varied by individuals' location and income class in the study. Workers located in suburban Maryland, northeastern Pennsylvania and Philadelphia, San Antonio, Dallas, Phoenix and Ohio had the highest rates of asthma in the nation. Lower-income patients were less likely to be prescribed inhalers and more likely to require treatment—56% of those in the lowest income bracket required treatment, compared to 33% of respondents earning the highest income.

Health Action Council CEO Patty Starr said employers should create targeted advertisements for asthma screenings and prevention programs based on employees' location, and make sure marketing campaigns are representative of the populations they aim to engage.

"Instead of sending out a message to everybody about a specific subject, now we're able to say, here's our targeted audiences, by gender, by ethnicity, by region, or location of our operation," Starr said. "We're able to look at our benefits designed to say, 'How should we cover a specific class of medications? Are there a specific class of procedures they should have?'"

Although Asian individuals make up 3% of Health Action Council's covered lives, the study found that they have the highest rate of diabetes claims. Diabetes was prevalent in 43% of Asians studied. This study echoes the findings of a 2014 Harvard University and National University of Singapore report that found Asians' diet, high rate of smoking and urban living all increase their risk of diabetes.

In addition to having the highest rate of diabetes, the Health Action Council report also found that Asians had the highest rates of diabetic testing and treatment. Researchers were unsure exactly why Asians were most able to effectively manage the disease, saying it could be due to provider treatment or cultural or educational differences.

"Going beyond the surface-level view of population health into the nitty-gritty details around the world, we see some targeted opportunities to fund research to do as well," Kurtzweil said.

The study also found that men were more likely to be prescribed drugs to manage hypertension than women. Although women were "sub-optimally treated with evidence-based medications" to fight heart disease across all age groups, senior women were least likely to be prescribed hypertension medication. There was a 20 percentage point difference between younger women and those over the age of 60 who were prescribed therapies for the disease.

Starr said that employers should work with third-party administrators and medical professionals to ensure there aren't disparities in care.

"A study like this really arms an employer with the needed data to really provide employees with the type of benefits needed to improve their overall health," Starr said. "Not only does it do that for today in their current working population, but based on their relationships within their communities, those collaborators can also look at the health within a given region to actually impact the workforce moving forward."