Reports and Surveys | January 10, 2024

Key Factors Impacting Health Plan Cost Trends

As a health plan sponsor, you keep abreast of cost trends and are interested in the primary drivers.

We’ve created an infographic on key findings about health plan cost trends based on data from Segal Health Analysis of Plan Experience (SHAPE), our proprietary health data warehouse.

Get the Infographic

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What you'll learn

The infographic includes trend data on:

  • The effect of COVID-19 on medical cost trend
  • How the cost trend for mental health compares to overall medical cost trend
  • How the cost trend for cancer treatment — typically a major driver of costs for most health plans — compares to overall medical cost trend
  • The recent acceleration in prescription drug trend that’s mainly attributable to high utilization of glucagon-like peptide-1 receptor agonist (GLP-1) drugs used to treat diabetes and for weight loss

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You'll also learn:

  • The three main drivers of medical cost trend
  • The five conditions that are the main drivers of mental health cost trend
  • The five types of cancer that are driving costs related to cancer treatment
  • The three other conditions that, in addition to diabetes and obesity, are also major drivers of prescription drug expenses

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There's more data in the infographic! You'll get:

  • The percent of all mental health-related visits that are done virtually
  • The percent of all virtual visits that are related to mental health
  • The 78 percent increases in the gross allowed cost per member per month (PMPM) for anti-diabetic GLP-1s (e.g., Mounjaro®, Ozempic® and Rybelus®) between the first quarter of 2022 to the second quarter of 2023
  • How the gross allowed cost PMPM for anti-obesity GLP-1s (e.g., Saxenda® and Wegovy®) roughly doubled in each of the first two quarters of 2023

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How do your plan’s medical and prescription drug trends compare to this data?

Do you know what’s driving those trends?

Analysis of your data can reveal your cost drivers — information you need to focus your cost-management strategies for maximum impact.

About SHAPE and it can help target your cost-management efforts

SHAPE includes information from large health plans across the United States representing a range of industries and organizations. Collectively, they cover more than four million lives.

You can use SHAPE data to benchmark your plan’s experience and performance.

Interested in mining your own health plan data and/or benchmarking it?

Let’s have a conversation.

Get in Touch

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This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.