Rationale of Level-Funded Health Plans for Women in US

OBJECTIVES: Level-funded health plans enable an employer to provide affordable healthcare to the employees while simultaneously having the potential to receive benefits in terms of refunds and better access to employees’ claims data. Women in the US have a higher average per capita healthcare spend than men. The present research aims to explore if level-funded health plans directed specifically towards women employees in the US can help in better management of costs for the employer and health outcomes for women.

METHODS: The study adopted the following methodology: 1. A secondary review of literature – using publicly available information on several platforms including PubMed, NIH, and CMS – of level-funded health plans. 2. A focused group discussion with clinicians and health insurance experts on drivers of the high cost of care among women. 3. Real-world data analysis – using Optum’s de-identified Clinformatics® Data Mart Database – of medical and pharmacy claims for women by age groups and states to identify the drivers of cost and volume of claims. This information was used to identify if women segment met the criteria for being good candidates for a level-funded health plan – favorable demographics and relatively healthier or with diseases/ conditions that are easily measurable, targetable, and when managed properly, drive down costs.

RESULTS: A total of 20 diseases/ conditions were identified that were important from both cost and clinical care standpoints. Women-specific conditions, like pregnancy, menstrual problems, and female infertility are among these 20 conditions. Women under 45 years are likely to benefit from level-funded plans with specific programs for these conditions, while older patients are more likely to benefit from programs targeting lifestyle diseases and cancers. The analysis is ongoing.

CONCLUSIONS: Women employees and their employers are likely to be benefited from level-funded plans devised specifically to meet women’s health needs.