Health & Welfare Consulting at Marsh McLennan Agency

Marybeth Gray

I may date myself with this analogy, but medicine in 2024 is akin to what we saw on the Jetsons TV show when we were kids. Healthcare benefit programs are more like The Flintstones. We need to change this and the only entities that can do so are the employers in the U.S.  If we wait for the very “slow to adopt” insurance carrier partners, we are doomed. I sit in utilization meetings with our carrier partners and hear “We have 300+ diabetics in our population and we have 16 members enrolled in the disease management programs.” This is an epic failure.  We need to do better for our members and our bottom line!

The top concerns in healthcare facing employers in the US, whether you are seated in Human Resources or Finance, are the rising costs of care and how to maintain competitiveness without breaking the bank. We are sitting in a fascinating time in healthcare. We will see more change in the next 5 years than we have in the past 50 years. When the Human Genome Project, an international research project to decode the human genome ended in 2003, we finally had a map. The U.S. scientists partnered with scientists around the world to further understand how our genetic makeup affects our health. What they found over the next decade was fascinating.   We now see that many diseases that we have lived with for generations are mutations in our genome. 

As a child, I watched the Jerry Lewis telethon for muscular dystrophy every Labor Day. Today, scientists can identify and correct the genetic errors causing muscular atrophy using molecular scissors. This involves fixing the genes in a lab and then reintroducing the corrected genetic material to the baby during a 23-day hospital stay. If treated early, the child may avoid wheelchair confinement and enjoy a significantly improved quality of life.

However, this gene therapy costs upwards of $2.3M per baby. Similarly, gene therapy for Hemophilia costs $2.9M per patient. With over 55 gene therapies in the FDA pipeline, the high costs pose a major challenge for employers and the stop-loss carrier market. Balancing the affordability of benefits while covering these expensive, life-altering therapies is increasingly difficult for employers in the US. The concern is that these million-dollar treatments may become more common and financially burdensome.

When I speak with employers, we discuss leveraging new medical breakthroughs to enhance benefits and reduce costs. I'm not a fan of high deductible plans that shift costs onto employees, hoping they will become better consumers. Instead, we should focus on using new medical technology for prevention rather than treatment. For instance, cancer is the top cost driver for employer health plans in the U.S. Understanding advancements at major cancer providers is crucial. Employers should implement Center of Excellence strategies in cancer care, as where you get your cancer care matters.

In 2016, Congress approved the 21st Century Cures Act, funding the Cancer Moonshot initiative with $1.8B in grants over seven years. The NIH directed these funds, primarily to leading cancer research centers like MD Anderson, Dana-Farber and Memorial Sloan Kettering. These institutes have advanced beyond traditional treatments like radiation and chemotherapy to precision medicine, immunotherapy and genomic mapping. Pharmacogenomics ensures patients receive effective medications, addressing the FDA's estimate that 75 percent of cancer patients are on ineffective drugs. Employers should embrace this technology and cover genomic testing to enhance treatment efficacy, improve care quality and reduce costs.

I'm excited that over 50 new companies are offering blood tests to detect cancer. With one in two men and one in three women facing cancer in their lifetime, and rising rates in younger people, this is crucial. Currently, there are only five preventive cancer screenings for over 50 cancer types. Three out of four new cancer cases and deaths are from cancers not covered by these screenings. Employers can offer blood tests that detect cancer biomarkers with 88 percent accuracy and identify the cancer's origin, enabling earlier detection. Since 90 percent of cancers are treatable if caught in stage 1, this approach can improve outcomes and reduce costs. Additionally, a simple mouth swab can reveal genetic cancer risks, aiding in preventive screenings and cost management for employers.

We are quickly moving from treating diseases to preventing them in the new world of medicine.

In addition to cancer, we are seeing a tsunami of costs with the following issues mounting to name a few:

1. Cost of care and inflation in the U.S. is surging post-pandemic due to a lack of preventive screenings and the hospital providers' demand for higher wages and better work-life balance. During the pandemic, hospitals had to shut down their primary sources of revenue during the almost two plus yearlong pandemic–same-day surgery, outpatient care to a large extent and imaging to name a few. They are now negotiating contracts with the insurance carriers and asking for large per diem increases–some upwards of 150 percent.

2. According to the CDC, six in 10 adults in the U.S. suffer from a chronic illness and four in 10 have multiple chronic illnesses. In 2022, diabetes was costing an estimated $412.9 Billion annually according to The National Institute of Health. The new-to-market GLP-1s are a class of drugs that treat diabetes. Recently, they have been remarkably effective in weight loss. With recent social media attention, and the Oprah Winfrey special, national attention has been drawn to the breakthrough and has driven employees' desire for coverage of these expensive medications. While one could argue they would have a return on investment, with obesity driving so many chronic conditions being treated by other medications, they are over $1200 per member per month in some cases. I think much of this noise will dissipate with the GLP-1 medication in the FDA pipeline for approval which will cost approximately $200 per month as a non-injectable pill form of the medication that is showing greater efficacy and promise.

I am optimistic about the future of healthcare. My mission is to help employers understand they are the change agents in the U.S. healthcare system. They are driving the bus.  No one has more power than employers to create and demand changes to our complicated and costly healthcare systems on behalf of our members and their families. We need a better path to higher-quality healthcare in the U.S. Together we can do this!