The Future of Employer-Sponsored Health Insurance

By Terry Rowinski

The COVID-19 pandemic has upended the status quo in American healthcare, and its results will be felt for years to come. More than 36 million Americans have filed for unemployment since March 2020. Because of these record-high layoffs, an estimated 25 million to 43 million will lose their health insurance. 

After seeing the effects of the COVID-19 pandemic on people’s health and the economy, consumers have even more reason to question the current state of healthcare. One of those questions – by no means a new one – is whether it makes sense to have health insurance tied to employment status. Some are looking for greater consumer advocacy and more options, while others want to deconstruct the entire system.

As stakeholders rethink the future of healthcare, employers, providers, brokers and TPAs must do more to provide a quality healthcare experience. That means not just focusing on cutting costs, but instead doing more to empower consumers by helping them to better understand and utilize their benefits.

Provide a Strong Consumer Experience

Consumers expect the same digital options they interact with elsewhere, like in retail, to be available in healthcare; so far, the industry has been woefully behind. Borrowing customer experience best practices from other industries will help consumers better understand and access their healthcare. 

Some of the tools that can help improve the customer experience include:

• Secure, private communications such as messaging and video conference apps
• Self-service portals for completing simple transactions like making payments
• Easy online options for claims management or other services
• Customer support services available through a variety of methods, including chatbots, email and phone

Simplify the Payment Process

Many of the frustrations with the current system come down to the high cost of healthcare.  A majority of insured adults who had a recent major medical bill experienced higher-than-expected charges, confusing statements and/or “surprise” bills. Amid a pandemic and the resulting economic recession, billing practices that aren’t consumer-friendly will increase frustration with the current health insurance model, leading to dissatisfaction both with the provider and the system. 

One way to help consumers understand the payment process is to simplify billing. Some of the ways that the healthcare industry could simplify medical billing include:

• Sending patients a simplified statement that consolidates all of an individual’s or a family’s explanations of benefits (EOBs) and medical bills for an entire month
• Creating a network of providers offering bundled payments
• Offering flexible payment plans 

Become a Partner in Healthcare

Consumers are unhappy with the current healthcare system in part because they don’t see the value. Their employers are making decisions seemingly based on cost and in the best interest of the company, not the employee. 

Health insurance is an incredibly important part of a person’s life, and yet the current system often relegates it to a line item on a company’s books. What people need isn’t just a sponsor, but rather a trusted partner who can help them make the best decisions about care.  

Customer advocacy should exist throughout the consumer’s interaction with the system, from getting all the information they need to pick a plan, to asking a provider about coverage, to contacting the insurance company for payment options. At each of those steps in the process, consumers should be greeted with a partner, not a drone – or worse, no one at all. 

The value in employer-sponsored health insurance lies beyond the plan itself. When employers and other healthcare stakeholders demonstrate how they want to help consumers, holistically and with compassion, the experience will improve. At the heart of our work is the desire to improve the human condition. 

Terry Rowinski is President & CEO, Health Payments Systems, Inc.