Comorbidities are driving up health care costs—here’s how more specialized care management can control them

Health care costs in the United States are rising at unsustainable levels. The past two years have brought the highest consecutive cost increases in a decade, and that trend shows no signs of slowing down as employers prepare for another 9% increase in health care costs through 2026. There is increasing pressure for health plans to control costs and provide greater value.

A major driver of rising costs is the increasing prevalence of comorbidities. Today's patients present with more complex, interrelated conditions that increase severity, prolong recovery, and require more expensive interventions.

To bend the cost curve, we need a smarter, more integrated approach to care management—one that addresses rising upstream cost drivers while still delivering high-quality, patient-centered outcomes.

How comorbidities accelerate cost spirals for health plans and members

Currently, 6 in 10 U.S. adults live with at least one chronic disease, and 4 in 10 live with two or more chronic conditions. Not surprisingly, nearly 90% of the country's $4.9 trillion in annual health care spending is related to chronic diseases (such as heart disease, diabetes, and cancer) and mental health conditions.

In fact, comorbidities are at the root of many of today's biggest cost drivers. For example, expensive specialty drugs, such as GLP-1 drugs to treat diabetes and advanced oncology therapies, are driving a sharp increase in pharmacy spending. At the same time, demand for behavioral health care and substance abuse treatment continues to increase, increasing utilization and driving up health care costs across the system.

For health plans, comorbidities compound the challenge of managing costs and ensuring high-quality outcomes. Increased acuity makes it more difficult to predict risk, and the fragmentation of care in addressing multiple conditions creates inefficiencies that strain budgets and erode member satisfaction.

Unlike single conditions that can be treated independently and often increase costs incrementally, comorbidities can increase the complexity of health care and create cascading needs that make services and costs higher at every step of the patient journey.

This burden is particularly evident during catastrophic diagnoses and recovery from injuries such as spinal cord injury, traumatic brain injury, amputation, severe burns, and polytrauma.

For example, a patient with Type 1 diabetes who suffers multiple traumas from a car accident will experience a different recovery trajectory than a patient without the same underlying condition. They are at greater risk for delayed wound healing, infection, cardiovascular complications, and slow recovery from surgery due to poor tissue perfusion.

There is often a domino effect: one complication leads to another, and the condition quickly spirals out of control. That's why every phase of care, from wound healing to medication management, involves higher risks and more complex care considerations. Without a comprehensive approach to recovery management, complications can increase, recovery times can be longer, and costs can quickly escalate.

For patients, more complex recovery can bring greater physical hardship, as well as mounting medical bills and longer time away from work, which can undermine financial stability. At the same time, health plans must contend with rising costs from escalating claims and unmanaged comorbidities while working to maintain quality of care and support their members’ expectations.

Care management efforts have traditionally focused on utilizing management, prior authorization, and case-specific siled plans to limit costs. But this approach is no longer sufficient to address the complexities of today’s healthcare consumers.

Instead, we must move beyond traditional care management and cost containment strategies to better support payers and the members they serve.

5 Ways to Improve Care Management

Traditional care management systems are not designed to accommodate comorbidities. Effectively addressing these issues requires a proactive, comprehensive approach that considers the whole person and their unique health needs.

Professional care management strategies provide a results-driven approach to patient care. In practice, there are five key elements of professional care management that help improve care delivery and manage costs:

1. Prioritize early intervention – Early intervention is an effective way to prevent dramatic increases in medical costs. Care management programs that encourage preventive medicine and strengthen connections with primary care providers can help patients address the root causes of health problems before costly crises occur. If a catastrophic injury or diagnosis does occur, stronger patient-provider relationships also lay the foundation for more effective coordination, ensuring patients don't start from scratch when they need care most. Risk stratification and predictive analytics are powerful tools for identifying members most at risk of costly disease. Data insights reveal hidden vulnerabilities and ensure the right resources and support are in place from day one.

2. Taking a multidisciplinary approach – Coordinated, multidisciplinary care models that focus on the full range of a person's needs—physical, behavioral, and social—are critical to addressing comorbidities. Behavioral health, in particular, has become a key overlay. Decades ago, many health care plans underestimated the impact of behavioral health on chronic disease. But today, it’s clear that addressing behavioral and physical health issues is critical to improving outcomes and reducing costs. Multidisciplinary care with a holistic health approach helps improve medication adherence, reduce readmissions, and address real-world challenges that impact health outcomes.

3. Leverage a highly specialized team – When complex, high-cost conditions arise, a general approach cannot account for the additional impact of comorbidities. Rather, expertise ensures that co-occurring conditions and health needs are comprehensively managed. This helps prevent recovery roadblocks, improve recovery outcomes, and prevent costly mistakes. Health plans need care management programs that bring together experts with specialized knowledge to handle complex needs. This may appear to require a multidisciplinary team of surgical specialists, rehabilitation specialists, home care, and behavioral health providers to address overlapping challenges. Involving the right specialist at the right time can help patients cope with a variety of situations and make the recovery process smoother from the start.

4. Improve care coordination – Care is often interrupted when patients move between providers, treatments, or care settings—disparities that increase costs and worsen outcomes. Effective coordination connects the dots, ensuring the team shares information, adjusts treatment plans, and works toward the same goals. Not surprisingly, 79% of organizations said better coordination of integrated care teams is one of the top actions to improve the quality and impact of care. Rather than focusing on limiting care, smart coordination strategies prioritize the delivery of more effective care, ultimately reducing delays, duplication, and conflicting advice.

5. Empower members with health literacy—— The ability to navigate care options and make informed choices about surgery, treatment, and recovery paths is just as important as the ability to get care in the first place. Strong health literacy helps members avoid unexpected complications and unnecessary use that often occur when comorbidities are not controlled. Health plans can enhance health literacy by providing decision support tools, providing clear educational resources, and creating opportunities for members to engage with trusted care guides. Even small steps—such as streamlining medical information or enhancing preventive care—can help members become more confident and empowered health care consumers. Enhancing health literacy about comorbidities helps members recognize their risks and take proactive steps to improve their health. When people recognize how conditions like diabetes or depression interact with other health challenges they may face, they can make more informed decisions and achieve better outcomes.

A smarter way to manage healthcare costs

As the complexity and cost of care in the United States continues to rise, the most sustainable path forward is to reimagine how health plans help their members access care, manage recovery, and reduce costs.

Adopting a more specialized approach to care management offers health plans the opportunity to both control costs and improve patient outcomes. This approach points to a healthier, more resilient future for health plans, their members, and our entire health care system.

Photo: OsakaWayne Studios, Getty Images

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