As an employer, you understand the importance of providing your employees with quality health care benefits that support their well-being and productivity.
However, rising health care costs can be a significant challenge for businesses of all sizes. That's where care management comes in – a proactive, cost-effective approach to managing healthcare spend while improving the health of your employees.
Care Management: A Proven Financial Strategy
Chronic conditions drive approximately 90% of US health care spending, and the top 5% of people account for 50% of health care spending. In fact, a recent survey found that health care costs in 2026 are likely to be 62% higher than in 2017. This is a concerning trend that requires a strategic response.
Care management is the bridge between cost control and better health outcomes. It is not merely a clinical program; it is a financial strategy that shifts the organization from a reactive, unpredictable spend model to a proactive, controlled one. By identifying high‑risk members early, coordinating care across providers, and preventing costly events, care management delivers tangible savings while improving employee well‑being.
At Blue Cross Blue Shield of Michigan, our care management program, Blue Cross Coordinated Care, uses predictive analytics and more than 30 data sources to identify high-risk members. It focuses on key cost drivers like diabetes, cardiovascular disease, high-risk pregnancies and frequent emergency department utilization.
Coordinated Care Reduces High-Cost Events
Nurse-led care coordination reduces duplicate services, addresses gaps in care and avoidable emergency department visits and admissions. It improves medication adherence, appointment follow-up and preventive care engagement. Blue Cross Coordinated Care has a proven financial impact, with:
- About a $3,660 savings per managed member
- 19% reduction in medical costs for high-risk members
- 25% reduction in inpatient costs for frequent admissions
- 32% reduction in readmissions
- Lower avoidable emergency department utilization and more closed care gaps
Flexibility Drives Greater Savings Potential
The Blue Cross Coordinated Care tiered approach allows employers to scale their investment and target deeper savings opportunities:
- Core: foundational analytics and basic nurse coordination with dedicated high-dollar claimant review ($150,000 spend over 12 months).
- Enhanced: Deeper data integration, expanded care pathways, reduced dollar threshold for claimant reviews to $100,000 with case rate pricing now available.
- Advocate: Higher touch engagement for the most complex cases and reduced dollar threshold for claimant reviews to $75,000.
- Advocate Plus: Premium, fully customized support and reduced dollar threshold for claimant reviews to $55,000.
Investing in Employee Health: A Wise Business Decision
The McKinsey Health Institute estimates that investing in holistic employee health could generate between $3.7 trillion and $11.7 trillion in global economic value. This equates to approximately $1,100 to $3,500 per person, accounting for the effect of reduced attrition, absenteeism and presenteeism, as well as improved employee productivity, attraction and retention.
Care management is a proven financial strategy that can help employers shift from unpredictable, reactive health care spend to proactive, controlled cost management while improving employee health outcomes. By investing in care management, you can reduce health care costs, improve employee productivity and create a healthier, more engaged workforce.
For more information, connect with your agent or Blue Cross representative, visit our Employer site or download our employer guide.
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