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3 ways employers can drive healthcare innovation

Proactive companies are leading the way in improving health and reducing costs. Here's how to get started.

It’s the ultimate healthcare paradox: U.S. employers spend nearly $700 billion on healthcare each year, yet remain frustrated with the system’s complexity, quality and rising costs.

As major funders of healthcare more proactive executives are using their market power to take charge. From Haven, the newly named Amazon, JPMorgan and Berkshire Hathaway venture, to Walmart, Boeing and GE, companies are tackling rising costs and looking for ways to improve the benefits experience for employees.

Haven has specifically identified three key focus areas: improving primary care, making insurance simpler and reducing pharmacy costs. However, companies of all sizes can use this framework to improve their programs. We’ll break down each of these key focus areas, provide insight into each one and give actionable steps companies can take now.


Improve access to quality primary care


Why it matters: 

Proper primary care offers employees a comprehensive “medical home” from which all other healthcare utilization is coordinated. These strong primary care physician (PCP) relationships can improve health and reduce waste.


What companies can do now:

Start by understanding if and how your workforce is under-utilizing primary care. Visibility into claims and spend by place of service will offer a good starting point. Other indicators like emergency room visits for non-emergent care can also indicate a lack of primary care utilization or access.

An innovative approach gaining traction is employer-sponsored direct primary care, where physicians provide care for designated employer groups. According to the DPC Frontier Mapper, there are already more than 1,037 direct primary care clinics in the U.S., presenting an opportunity for employers to take advantage of a model consumers already trust.

There are also ways to encourage primary care utilization within your health plan, such as $0 or reduced copays. You can also consider incentivizing utilization through your wellness program, including annual physicals or preventive care indicators in order to qualify for premium reductions or other rewards.

Clear employee communications can also help. Remind workforces of the convenience and cost advantages of visiting their primary care doctor instead of the emergency room for non-life-threatening issues. And when evaluating health plan partners, ensure their customer service team prioritizes helping employees find in-network primary care doctors.


Make insurance simpler and easier to use


Why it matters:

Simplifying the complex healthcare system benefits everyone; a clear and engaging health care experience helps employees use benefits correctly, keeping employer spend down and workforce satisfaction high. But attempts at consumerism without the right employee support can lead to under-utilization and more confusion.


What companies can do now:

Enter the concept of concierge healthcare, where employees have navigators or advisors available to walk them through every step of the healthcare system from open enrollment to understanding billing after a procedure. These programs, like Healthgram’s Connect service, align employees with dedicated advocates who proactively guide employees through each stage of care and finding cost savings in the process.

Note that these don’t have to be new or additional vendors. The most comprehensive health plan administrators have these concierge and advocacy programs built in.

Start by asking your HR team about common questions they get from employees and consider an employee survey to better understand the pain points of your unique workforce. Then evaluate your health care partners by their ability to provide support in those areas without adding more layers or confusion to your team or employees.


Make prescription drugs more affordable


Why it matters:

According to Mercer’s 2018 National Survey of Employer-Sponsored Health Plans, 68% of employers say that managing specialty pharmacy is “important” or “very important.” Pharmacy costs have a significant impact on both employees and companies’ spending, so it’s no surprise that existing and future employer-led strategies will aim to reduce the burden.


What companies can do now:

  • Conduct a detailed review of your pharmacy contracts. Look for and ensure aligned interests with your PBM by requesting revenue breakdowns over the life of the contract.
  • Seek acquisition-based pricing for mail and specialty claims. Contracts based on a discount off AWP results in huge revenues for the PBM that only increase as specialty drug costs rise.
  • Require independent, clinically-focused prior authorization. PBMs lack incentive to provide the detailed oversight required to produce savings for employers. Find an independent entity to conduct prior authorization in line with your financial interests.
  • Educate members on highest-value pharmacies. With transparent pricing at retail, grocery and discount stores like Walmart and Costco, drugs may be significantly less expensive than other drug stores.


As more employer-led strategies begin to take shape, like-minded companies can take note of solutions that have already proved successful in reducing costs and improving employee experience. Starting with these three areas, companies of all sizes can make headway now towards a better healthcare solution for their workforce.


Healthgram’s proven model helps companies achieve better financial and physical health while cutting the confusion and frustration that traditionally accompanies employer-sponsored insurance. See how we’re making a difference and how we can help your company discover a new approach to care.


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