What you need to know

What are the top cost drivers that consumers are most susceptible to?

Employee demographics and claims experience reveal that the top five diagnostic categories are typically the same for any organization: orthopedics, cardiac, diabetes, respiratory, and behavioral health—the important thing is to choose the major categories that are most manageable and have potential for impact by a comprehensive health and wellness program. The following table is an example of the top health risk issues and claim cost drivers a company might have over the course of a year, ranked by cost—highest to lowest.

Most companies with more than 100 employees can get a report from their health insurance carrier that outlines all of their claims from the previous year, and employers with fewer than 100 employees can use company demographics (age, sex, family size) to predict their overall health risk issues and claim cost drivers. You may have someone in-house who can analyze these reports, or you may want to consult your Benefits Advisor. Identifying your top health risk issues and claim cost drivers will help you understand the most significant health issues plaguing your workforce and driving up your health plan costs.

Armed with this information, your health plan and/or Benefits Advisor can help you design and implement a worksite wellness program specifically tailored to your health risk issues and claim cost drivers—and they can help you create a culture of wellness at your company. For example, in our experience, the top five health risk behaviors that typically need to be addressed are:

  1. Lack of physical activity
  2. Ineffective stress management
  3. Unhealthy eating habits
  4. Unsuccessful weight management
  5. Tobacco use 

Coaches' Takeaway

Biggest consumer cost drivers are prescription medications and use of the emergency room for non-emergency situations.

Tools & Resources

CDHPCoach’s Storage Facility, where the Coach has organized and compiled a vast amount of tools and resources for you to access.


Housed here are key components and information within the book, Bend the Healthcare Trend which was the impetus behind the CDHPCoach.


What you need to know