The cost of healthcare in the United States has risen every year for decades. This trend will undoubtedly continue, at least in the near-term.
In response to rising healthcare costs, many employees have opted out of their employer-sponsored healthcare plans to maximize their take-home pay. If you want to maintain, or even increase participation this open enrollment season you’ll want to help your clients understand what matters most to their employees when it comes to their healthcare plans. Help them consider the commonsense strategies they’ll need.
Low participation is problematic for employers who need to compete for talent. They need healthy employees to participate in order to keep costs from spiraling upwards for the general workforce.
What employees care about
Simplicity: Nobody likes surprise expenses. Employees want to understand very clearly what is and is not covered by their benefits plans.
Access: Employees’ attitudes about managing their lives and activities virtually have obviously shifted. They want virtual or virtual-first care options too, so they don’t have to work or personal family time when they or their family needs medical attention. Meaningful virtual-first and in-office access to care is now table stakes for health plans.
Affordability: If employees have a serious medical event, they need to have deductibles at an amount they can actually pay. Out-of-pocket costs that exceed personal savings is a major source of concern for many workers.
Financial sustainability: Year-over-year rates need to be predictable so employers can feel confident they can afford the benefits their employees will need next year and the years after.
To prioritize employees’ care, also prioritize cost controls
Good health care is less about offering insurance, more about getting people the healthcare they need at an affordable price. With inflation on the rise, you can expect both your clients and their employees to be concerned with the cost of healthcare over the next year.
Cost controls that don’t compromise quality will be more valued this year than in past. Using an ERISA self-insurance plan will give you the flexibility you’ll need to add the cost control measures your clients need. Fully insured plans probably won’t offer the flexibility you’ll want. Most healthcare costs for employees will be standard sick or injury care. Before raising deductibles, consider carving out some of the very expensive services your employees rarely need, and have a secondary plan for these services if you know there is desire for them.
Ensure easy and $0 copay access to primary care – both virtual-first and in-office. Further, build into your clients’ plans effective population health, care navigation and steerage to ‘right-priced’ and quality facilities, referral management and pre-authorizations. Eliminating unnecessary activity and spending will always be the first step for containing costs.
Increase employee engagement and participation
Companies that are thoughtful about offering plans their employees can actually afford to buy and use will gain an advantage. This is especially true for employers competing for top talent and healthy employees.
Optimizing participation requires the basics:
- Keep costs down. Employees making normal wages are already at the limit of what they can afford, and there are often no funds left at the end of the week after shelter, transportation, and food. Nothing else can help participation more than lower costs.
- Communicate well. Keep out-of-pocket costs and coverage simple and clear. Smart plan design helps, and a good broker earns their keep here. Care navigation and steerage to ‘right-priced’ and quality healthcare facilities helps employees connect with providers who do a high-quality job at the lowest cost.
- Explain the trade-offs and why they matter. Not every benefit will matter the same to everyone. However, everyone can get most of what they need to lessen the burden of wondering if healthcare will be accessible and affordable if they need it. Working together thoughtfully is needed more now than ever.
Widespread change is coming to employer benefit programs. Benefit strategies like effective population health, efficient care navigation and referral management are the new norm for employer health plans. Eliminating unnecessary activity and spending will always be the first step for controlling costs. Benefit advisors and brokers that do not think differently about their clients’ health plans are already losing ground in our inefficient healthcare system.
Dr. David Berg is President and Co-Founder of Redirect Health.