Cardiovascular conditions now the second-highest reimbursement category, Sun Life says

Dive Brief:

  • Cardiovascular conditions — including congenital heart defects, heart failure, stroke and hypertension — moved into the second spot for stop-loss reimbursements in 2023 for the first time, an analysis of claims data from 2020-2023 from insurance provider Sun Life found.
  • Falling just behind cancerous tumors, cardiovascular conditions surpassed blood cancers for the first time in the four-year view, Sun Life said. Members spent just under $1.2 billion over four years on the condition, and cost is up 33% — “higher than we would expect given medical inflation,” the company said.
  • Heart failure led among cardiovascular subcategory claims, at 16.1%, with an average member age of 54; acute myocardial infarction and coronary atherosclerosis followed in the second and third spots, Sun Life found. Cardiovascular disorders were the fourth-highest medical category for the number of $1,000,000 claims.

Dive Insight:

Cardiovascular disease (CVD) “makes a significant impact on the health of employees, and the financial health of a self-funded business,” Sun Life concluded from its study.

According to a 2023 fact sheet from the American Heart Association, heart disease and stroke cause more deaths each year in the U.S. than all forms of cancer and chronic lower respiratory disease combined. They also accounted for 12% of total U.S. health expenditures from 2018 to 2019, “more than any major diagnostic group.”

Sun Life noted the relationship between CVD and other conditions, pointing to recent research showing that long-term complications of cancer may increase the risk of CVD. Cancer survivors had a 37% higher risk of incident CVD and a 52% higher risk of heart failure compared to the rest of the population, a study published in the Journal of the American College of Cardiology showed.

Research also suggests that incident CVD may be linked to COVID-19 infections. 

A range of lifestyle factors can heighten the risk of CVD, including poor diet, physical inactivity, tobacco use and alcohol consumption, according to the World Health Organization. Chronic stress also contributes to the condition, research shows. 

Employers can play a role in encouraging healthy behaviors and reducing workplace stress to address the prevalence of CVD. While these actions can take the shape of well-being benefits like access to therapy or gym memberships, cultural change is just as, if not more, important for worker well-being, employees have said. This looks like liveable wages, true work-life balance and sustainable work practices, according to one expert.

Beyond malignant neoplasms and CVD, blood cancers (leukemia, lymphoma and multiple myeloma), newborn/infant care and orthopedics/musculoskeletal conditions rounded out the top five high-cost claim categories. Meanwhile, COVID-19 dropped all the way down to No. 29 in 2023, compared to spot No. 11 in 2022.