Affordability is one of the biggest issues facing employers and employees when it comes to health care. The rising cost of health care benefits threatens companies’ ability to attract talent and compete in the global marketplace.
According to the U.S. Census Bureau, the majority of Americans -- 56 percent -- have employer-sponsored health care plans. And the costs for those plans continue to rise. The total average annual cost of health care benefits exceeds $12,000 per employee.
In the past, companies depended on health plans and carriers to negotiate good rates, negotiate the payment of those rates and facilitate claims of adjudication.” says Alice Shade, CEO of Sentry Health. “They also expected them to provide some care management, to take care of their employees.”
The problem for employers is that they’re just not seeing this happen, she says. “We’re facing a bigger, broader delivery problem than just a cost problem.”
Employers are tackling this larger problem by more actively playing a role in controlling employee health care costs through employer-led initiatives designed
enhance the employee experience and reduce barriers to care.
Here are some strategies employers can consider to help control their employee health care costs and improve their employees’ overall health.
Solving Delivery Problems through Network Innovation
One popular strategy with employers is improving access to care by reducing barriers to health services delivery or through network innovation.
On-site or near-site clinics can reduce barriers to care for employees by locating necessary health services at or near work sites. “These efforts to bring health care closer to the work site are focused on building a better culture around health and the way health care is delivered by making it more convenient for employees,” Shade says.
Narrow networks and centers of excellence are some common examples of this strategy, says Dan McMahon, a principal in the
Center for Health Innovation at Mercer. “But new entrants into space are developing networks based on core philosophies like only including providers that are practicing evidence-based medicine or providers that have been rigorously tested for their outcomes by relying on deep data sets,” says McMahon.”We’re changing networks from your traditional, broad-based standard network to these finely tuned, more narrow networks.”
Building an Advocacy Model
We’re shifting to a more holistic, relationship model of care for both members and their families, says McMahon. “Gone are the days of traditional style customer service, where a member might call in and say, ‘Hey, I lost my benefit card,’ and the health plan representative would say, ‘Great, one's in the mail. Talk to you next year,’” says McMahon.
“Now, when a member calls in for their benefit card, the person asks, ‘Hey, that probably means you have a health event coming up. Why don't you talk to me about it?," says McMahon. “Quantum and Accolade have had a lot of success with this holistic model by building relationships and asking what's going on with both the member and the family to understand what their broader health care needs are.”
The cost-saving benefits of this model come from earlier identification of potential problems down the road, McMahon says.
Christopher Lee, a health care consultant and clinical solutions marketing manager at
Family Health Centers of San Diego, says that this kind of model is crucial for helping employees understand their benefits and what resources are available to them. “We all have busy lives where most of us don’t know 100 percent of what's in our insurance benefit plans until a need comes up,” he says. “It is critical to have some sort of advocate, case manager or care coordinator to inform patients about benefits and engage them in taking better care of their health.”
Identifying Digital Solutions
With the advancement of machine learning, AI and data analytics,
digital solutions to health care are expanding at an exponential rate. For employers, this can mean even more access to solutions to help control employee-health care costs.
“Virtual health care solutions are growing rapidly, particularly in behavioral health,” says McMahon. “It's not just a phone call. It's FaceTime. You can develop a relationship with that doctor. On top of that, you have a wealth of new apps-based care in areas like physical therapy,” he says.
These kinds of digital solutions can really reduce barriers to care, says Lee. “For a lot of people, they find it difficult to schedule an appointment to see their doctor when they want to. They may have to take a half the day off or the whole day off to go to see their doctor.” Digital solutions allow patients to access care without having to miss work or disrupt their daily lives.
