The healthcare system can be confusing to employees, and too often their questions and concerns get lost in the shuffle of changing benefits, new providers and varying deductibles. Confusion and low satisfaction fuel an expensive cycle for employers: field employee questions, overpay, renew. A new approach replaces low expectations with cost-saving programs powered by data, where employees have the guidance they need to make smart healthcare decisions. A look at the current ecosystem:
Employees struggle to understand health benefits
A Harris poll found that although they may have been involved in electing their plan, as many as two in five insured Americans did not have a good understanding of the services actually covered under those healthcare plans. Not only does this breed confusion, but employees who don’t know what their plan will cover may avoid necessary care or over-utilize expensive services.
Employees receive medical tests, treatment, and procedures they don’t need
Because there is little guidance and transparency, members are often directed towards unnecessary care. According to a report by the Institute of Medicine, waste accounts for 30 percent of healthcare spending in America. This waste—three-fourths of a trillion dollars a year—is more than we spend on all elementary and secondary public education in the U.S.
Members go to the emergency room when they don’t have an emergency
Members often enter the healthcare system when in need of urgent care, quickly making decisions based on fear and anxiety. In the mind of a panicked employee, rushing a child to an emergency room because of a sore throat may seem like the best option. Truven Health Analytics examined more than six million emergency department visits and found more than half could have been avoided. People with private insurance were as likely to overuse emergency departments as the uninsured and those on Medicare and Medicaid.
Employees lack education on price variance
Costs for medical procedures can vary by over 1,000% in the same ZIP code. When employees are kept in the dark about procedure costs, they lack the tools to make wise choices.
An emerging model involves employees in the proactive management of their healthcare. It puts them at the center of every healthcare decision and connects providers, employers and members seamlessly. According to the J.D. Power 2017 Member Health Plan Study, Health plans that utilize an integrated delivery system outperform traditional health plans on every factor measured in the study, including member satisfaction and coverage. Characteristics of an employee-centric approach:
Employee-centric care is built around the needs of each individual. It is not a one-size-fits-all model, but takes into consideration the employee’s benefit plan, medical needs, lifestyle, and level of understanding of the healthcare system. Members receive personalized guidance from live, knowledgeable experts they trust.
This approach gives employees the right information at the right time, often before they know they need care, and connects members with the right providers for their needs and benefits plan.
Because members are educated on high-value providers, overspending is avoided on necessary care. At the same time, preventive care that helps avoid the occurrence of advanced chronic conditions, inappropriate ER use and inpatient hospital stays benefit both employee and employer.
It values education
Keeping employees in the dark about their benefits or the true cost of procedures ultimately hurts the employee and perpetuates a broken healthcare system. An employee-centric model puts a premium on transparency and invests in guiding employees towards the best decisions based on quality and cost. Communication about health benefits is clear, frequent, and inspires action.
Members share in financial rewards
Here’s an example of how a cost-effective strategy pays off: let’s say an employee is overdue for a colonoscopy. An email is sent out through the member’s secure dashboard to remind her to call her advisor, their independent guide to the healthcare system. The advisor educates the member on the price variance of the procedure in her area (the average range is between $710 and $3200, a 450 percent difference), and helps her schedule an appointment with a fair price provider. By using the fair-price facility, the member receives a cash reward.
Is your company stuck with the symptoms of the traditional care model? See how your company can benefit from a better approach.