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The Real Cost of High-Cost Members: Tackling the $150+ Billion Behavioral Health Problem

Health plans are under enormous pressure to control ballooning costs from members who incur high-cost claims.

Estimates indicate that a mere 5 percent of health plan members account for 44 percent of total claims costs.1 In real dollars, that’s more than $500 billion annually across the private insurance industry.2 When you include Medicare and Medicaid plans, that figure exceeds $1 trillion dollars each year.

Spotlight on behavioral health Some of these claims are especially challenging for health plans because the high costs associated with conditions like hypertension, high cholesterol, and obesity can frequently be traced to unmanaged behavioral health conditions.

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