Health Reform WK-EDGE Integrating medical, pharmacy, and behavioral benefits can save $7,400 annually for enrollees with complex conditions
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Thursday, January 23, 2020

Integrating medical, pharmacy, and behavioral benefits can save $7,400 annually for enrollees with complex conditions

By Lauren Bikoff, MLS

The integration of employee health care benefits can lead to substantial savings for employers, according to a study from Cigna.

Employers that integrate medical, pharmacy, and comprehensive behavioral benefits see meaningful savings in total medical costs as compared to employers with medical and basic behavioral coverage, according to recent research from Cigna. The Value of Integration study examined 2.3 million claims over a two-year period and found that on average, employers with fully integrated benefits:

  • saved $207 annually per customer and $867 annually per individual with an identified health improvement opportunity (about 16 percent of the population);
  • saw annual medical cost savings of $7,372 for individuals with conditions requiring a specialty medication, such as multiple sclerosis or rheumatoid arthritis; and
  • showed savings of more than $11,679 for customers with an oncology diagnosis and 24 percent lower oncology in-patient costs.

The survey found that enrollees with integrated benefits are more engaged in their health and well-being, are more likely to stay in-network for their care, and are more informed about their care options. On average, the 2019 study showed:

  • A 17 percent higher customer engagement in Cigna programs, such as counseling for conditions like diabetes and heart disease; lifestyle or wellness coaching to help with weight management and smoking cessation; and personal case management for more complex conditions like rheumatoid arthritis or cancer.
  • Thirty-two percent lower mental health readmission rates, and 18 percent fewer out-of-network behavioral claims.
  • Five percent higher utilization of in-network high-performing providers and four percent lower out-of-network claims.
  • Improved outcomes for individuals in need of treatment for opioid misuse—with a 15 percent higher rate of receiving misuse treatment and 30 percent reduction in subsequent overdoses when experienced one year prior.

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