April In-The-Know

In-The-Know

Understanding Care Acuity: Why It’s A Key to Your Clients' Healthcare Costs

In this issue

Care acuity refers to how much care and attention a patient needs at a given time. It goes beyond a diagnosis and considers factors such as chronic condition burden, symptom severity, functional limitations, risk of hospitalization, need for clinical monitoring, and the amount of coordination needed across providers. In simple terms, care acuity helps answer the question: how much care does an individual need right now?

For benefit consultants, understanding care acuity can provide a more meaningful view of what is driving healthcare costs across a client population. Acuity affects quality, outcomes, safety, cost, and workforce productivity. When acuity is assessed accurately, patients are more likely to receive the right level of care at the right time, reducing avoidable complications, unnecessary utilization, and gaps in care. When clients can better identify members with rising or high-acuity needs, they are in a stronger position to guide people to the right care setting, support chronic condition management, reduce avoidable utilization, and make more informed benefit strategy decisions. This insight helps move you beyond plan pricing and utilization trends to become a strategic advisor to clients.

Right Care, Right Place

One of the most common drivers of unnecessary healthcare spending is when members receive care in a setting that is more intensive and expensive than their condition requires. A common example, using the emergency room for a non-emergent issue that could be treated in primary care, urgent care, or virtual care.

A review published in the Emergency Medicine Journal found that in some cases, up to 36% of patients in high-cost emergency settings could have been treated elsewhere. Tools that help members understand where to seek care can support better decisions and improve alignment between need and care setting. This creates an opportunity for you to assist clients with benefit design and communication strategies that steer members to appropriate, cost-effective care.

Chronic Disease: A Pathway to High Acuity

Unmanaged chronic diseases, such as diabetes, obesity, or high blood pressure, push people toward higher acuity and cost. If these conditions aren't identified and managed early, members are more likely to experience complications and hospitalizations.

Research consistently shows that the earlier a client can identify an at-risk population and intervene, outcomes improve and high-cost episodes can be avoided. As a consultant, this means helping clients with programs, incentives, and care models that can prevent risk from escalating.

How You Can Help Your Clients

Managing healthcare today means shifting the conversation from paying claims to managing health complexity. You can help your clients take a more proactive approach by focusing on these strategies:

  • Spot Risks Early: Use claims data to identify members whose care needs are growing so you can help them before a crisis occurs.
  • Promote the Right Care Setting: Design plans that encourage members to use the most appropriate (and cost-effective) care locations. Digital tools, like Health Action Council’s AI-powered symptom checker on www.findtherightcare.org, can help steer employees to the right place for care.
  • Manage Chronic Conditions: Encourage investment in programs that focus on prevention, condition management, and healthy behavior change.
  • Remove Access Barriers: Support plan designs that make it easy and affordable for members to get preventive and primary care.

Take Action

You can help your clients move from being reactive to being strategic. Start by reviewing population data to understand how many members are in rising or high needs categories, where care is being delivered, and whether avoidable emergency department or hospital utilization is occurring. Health Action Council can help you think more strategically about the quality, cost, and value of healthcare.

To learn more, contact Jennifer Lahtinen at [email protected] or 714.917.9199.

Email Jennifer Lahtinen

Sources

Ready to take control of your employee healthcare & benefits costs?

Contact Us

We use cookies and similar technologies on our Website to ensure you the best browsing experience. Read about how we use cookies and how you can control them in our Privacy Statement. If you continue to use this site, you consent to our use of cookies. Go to Privacy