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Health Benefits Engagement vs. Experience: know the difference

The term “employee benefits engagement” has become one of the most talked-about topic today in HR today. But what exactly is benefits engagement? How does it differ from benefits experience? And to what extent should benefit leaders be focused on or concerned about it?

Employees’ experience with their health benefits is rooted in emotion, and they own it. They formulate the image of their experience as a result of all the interactions they have with the benefits provided by their employer. It is the cumulative impact of all touch points that determines the overall experience.

Benefits engagement, on the other hand, is each direct interaction that an employee has with the benefits. Contacting a call center for understanding coverage, visiting a doctor, receiving a claim statement are all interactions. All it takes is one negative interaction to damage the memory of the entire experience and the association with their benefits, which ultimately leads to a disengaged employee.

Companies need to think beyond individual interactions and focus on the ongoing journey to improve the ROI of their benefits spend.

Just like a customer’s journey does not start when the customer buys something -it starts when a customer wants something or has a need. The same concept is true for health benefits. The employee’s benefit journey should be an integrated and enduring experience that evolves as the employee interacts with her benefits at every touch point.

Traditionally companies have left benefit interactions to multiple providers, each narrowly focused on their own service or a program. The result – most programs are unused, employees are unaware, and benefits teams are constantly looking for answers.

It is time to take charge. Benefit leaders must recognize and define all aspects of their benefit strategy around delivering great employee experiences across multiple benefits. They need to ensure that every touch point (both physical and digital) is optimized and working to deliver engaging and satisfying experience. They should deploy new technologies to deliver integrated, consistent, contextual, and personalized engagement often to achieve better business outcomes.

While many companies recognize the importance of engaging employees with their benefits, they may find it difficult to know where to start, what to prioritize, and when to act. If you’re interested in learning more about how to improve benefits’ engagement, and elevate every member’s experience – contact us. We are happy to help.

Meeting the Changing Demands of Health Benefits

Working in employee health benefits is a very rewarding experience. There are only a few opportunities in corporate life that offer the ability to positively impact the lives of so many people. However being a benefit leader is a hard job. The complexity and ever-changing landscape can be quite challenging.

The latest challenge is the explosion of new point solutions in the health benefits market. Besides medical, dental, vision and pharmacy, benefit leaders are constantly sifting through voluntary, supplemental, indemnity and many other types of benefits. On top of all this, hundreds of new and innovative digital health benefits are available in the market – each claiming to impact health outcomes and reduce costs. While a thriving ecosystem of health benefits can be a great thing, for many companies it has become a source of aggravation, with growing administrative and technology burden of implementation and engagement.

The expectations of employees from their health benefits are also changing faster than ever before. For several years now, companies have been steadily shifting the cost burden (premiums, deductible and copay) to employees, who have now started to expect personalization and suitability of offered benefits to their unique needs.

How can companies meet the fast changing demands of health benefits, and provide a delightful experience to employees?

They can start by bring all benefits together in a single platform. This is much more than providing links on your intranet. This is about truly integrating benefits – on one website and mobile app. One login to access all benefits, integrated appointment scheduling across providers, integrated health records, claims and a seamless, unified interface for employees.

With such a platform, you can start to monitor what programs are working and fix which ones are not. You can start to personalize programs to meet the specific needs of each employee. You can start to engage employees by presenting them the right care, from the right provider, using the right benefit, at the right time.

There is no doubt that benefit leaders are working very hard to make a difference in employee’s health and well-being. Having a command-and-control system to manage and optimize all benefits will make their life easier and provide them the ability to deliver personalized and complex solutions, regardless of their size.

Leverage mobility to drive employee engagement in health programs

We’re entering an era, where everyone likes their experiences to be immediate and catered to their preferences. That’s why your benefits communication should evolve from intranet-based links to human-centered, year-round mobile interactions to engage employees.

Even though many benefit plans and providers currently offer their own mobile apps and websites – most of these apps are rarely used by employees. Multiple logins, inconsistent, incoherent experience are big barriers to utilization.

It is time for you to have your own fully integrated benefits mobile app. An app that integrates all benefits into a single place and provides a simple, unified, consistent experience to your employees and families.

The goals of your mobile app should be global availability, simplicity, personalization, and a one-stop shop for all benefits.

With your benefits experience mobile app, your employees can access and utilize all benefits in a way that works best for their family. To further the impact, you can provide them a simple way to check coverage, view medical records, tests, Rx history, claims and even make payments using integrated HSA account.

The personalized digital experiences delivered through your mobile app can make benefits’ support immediately accessible to any employee, anywhere, and at any time. This will increase utilization of your programs and improve employee engagement and satisfaction.

Leverage these touchpoints to improve outcomes & employee engagement

When most benefit administrators focus on employee engagement, they think about open enrollment. Of course choosing the right coverage is an important step, but it’s only one piece of the puzzle. It is equally important for employees to know how to find and use care included in their coverage.

Why? Because care and coverage go together and when employees are engaged to improve their health and wellness, they are more likely to take positive action and change behaviors.

Employee engagement can be improved by creating a positive and consistent experience across her journey. This requires a systematic approach of orchestrating touchpoints — a touchpoint being any interaction between the employee and her health plan.

The key is coordinating and integrating the touchpoints so that they seamlessly meld together.

Here are some touch points longitudinally mapped throughout the employee journey, and you can leverage each touchpoint to support the others in the journey.

Open Enrollment

Reaching out to members during enrollment is a great way to start the communication. This opportunity should be used for explaining plan design, options and answering coverage specific questions for each member.

New Member Welcome

Post enrollment (after the member has signed up) is an opportunity to determine satisfaction and understanding of the plan collateral, design and customer service for future improvements. During this interaction, be sure to track responses that require timely follow up for members needing additional assistance.

Health Risk Assessment

Many employers provide incentive to employees for completing assessments. Use this touch point to engage members, enhance wellness programs, segment your population for better targeting and determine the appropriate follow-up plan for each segment.

Preventive Care Outreach

Employees aren’t used to seeking preventive care – they may be confused about which tests to ask for, may view preventive care as costly and aren’t aware of the free benefits provided under the ACA. This issue leads to members avoiding care until the last minute or using the most expensive option available. Use the right timing to reach members for preventive care.  Calls scheduled on the employee’s birthday can be very effective.

Care Gaps

If your plan design include VBID elements, and it reduces the out of pocket costs for members to use high quality services, you can use this as an opportunity to not only explain the gaps in care , the impact of this gap on member’s health, but also what services are needed to close the gap, the costs and the right providers to help close the gap.

Care Plan Adherence

The adherence to the plan of care is important in improving health outcomes and reducing overall cost of care. Start with a proactive reminder, and follow-up with calls to determine root causes and identify reasons for non-adherence. The overall approach should be to inform, educate, and assist members with adherence challenges.

ER Over-utilization

ER is expensive. A number of visits to ER are unnecessary or avoidable, and majority of such visits are taken  by a small segment of members. Identifying such members and helping them locate in-network providers in alternative cost-effective setting can reduce costs for employers as well as employees. You can use this touch point to educate them on appointment scheduling, video visits, nurse line etc.

Care Transition

Appropriate care transition from one setting to another can have a significant impact on employee’s understanding and compliance, readmission status, and overall satisfaction. It should however be done in a  timely manner (within 48 hours of discharge) to ensure the continuity of care.

We understand that most benefit teams are simply not naturally wired to think about the member’s journey through out the year.  For teams that master it, the reward is cost reduction, better outcomes, higher employee satisfaction and loyalty. It is well worth it.

Member Segmentation for better outcomes in self-funded plans

The health care delivery model is changing.  New models like ACO, PCMH, COE have evolved in the last few years. The payment structure in these models is typically aligned to quality measures, but the metrics and the operational processes required to achieve them are driven by large carriers (and CMS) or health systems or both. Even though self-funded employers contribute significantly into their revenue, they have largely been left out from the discussion.

Member segmentation is one such example – Large health systems and carriers serving diverse populations are trying to follow different risk stratification models including ACG, HCC, ERA, CCC, Charlson Comorbidity Index, MN Tiering etc. While these models may serve their interests, not necessarily yours. For example, Medicare uses HCC (Hierarchical Condition Category) model that assigns a risk score based on chronic or serious condition and demographics, which works for 65+ population they cater to. HCC model may not be suitable for your population.

Similar to large health systems, PCMH providing primary care to your employee populations are also trying different methods for their risk stratification including primary , secondary, tertiary prevention and terminal care. Again, these models may not exactly work for your employee population.

The employee and dependents population in mid-large employers is typically spread out in multiple geographies often served by multiple health systems. If the metrics and processes are not defined by the employer and left out to the systems or carriers, employers will end up facing the same issue that they currently face with PPO models: Data inconsistency and limited insights into overall plan performance.

As you start thinking about about 2017 benefit design, start looking at segmenting your employee population. For each segment, you can define the right care models, incentives and discounts on copayments for your employee population and align the payments to your provider partners to meeting those metrics.

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Why wellness should be a part of value-based plan design

According to RAND corporation, about 80% of large employers in U.S. offer wellness programs. Despite a significant spend (over $8 billion annually) by employers on these programs for over 20 years, participation by employees as well as the program’s ROI remains poor.  We can think of three possible reasons:

  1. Lack of targeting
  2. Lack of evidence
  3. Lack of accountability

Lack of targeting

Wellness programs typically are not geared towards demographics of specific employee population. Plans based on VBID (value-based insurance design) are targeted for specific populations affected by specific conditions.

For example, free gym-membership is great for employees who are motivated to stay healthy and can take out time to exercise, not so much for someone who is struggling with chronic conditions, commuting for hours to get to work and feels the pressure of higher out of pocket costs. For such individuals, a plan that offers a lower out of pocket costs for certain evidence based services (and medications) goes a long way in reducing barriers to better health.

Lack of evidence

Karen Pollitz at Kaiser  summarizes it well –  “For a lot of things companies do, it’s all about being evidence-based. But with workplace wellness programs, it’s faith-based: A telling finding from our survey is that most employers who offer wellness programs don’t collect data on whether they work.”

On the other hand, VBID design is based on reducing barriers for high value services offered by providers who follow evidence based guidelines.

Lack of accountability

There are so many factors that go into helping an employee or dependent get “healthier”. Most wellness programs act like silos and provide a very nichy service, which makes it hard to determine if any improvements are a result of a specific program or something else.

VBID plans on the other hand are outcomes based that use clear metrics, incentives and payments design for enhancing access to preventive services as well as improving health outcomes by reducing barriers to effective treatments.

We believe that the impact of workplace wellness programs can be significantly improved if these are incorporated into an overall value-based plan design.


Narrow network and value-based-care are not the same thing for employers

Narrow networks have been in the news for the last few years. A number of carriers have started to offer this to employer-sponsored health plans as well as to individual marketplace. This concept is marketed differently than what it really is.

Narrow network is essentially a higher discounting method based on an assumption that a provider will offer more concessions when their competitors are excluded from the network. The higher discount is supposed to bring down the overall cost of the care for self-funded employers. Typically layered in tiers, narrow network becomes Tier 1 and broad PPO network is offered at a higher cost.

This is no more than a short term fix because it does not address the basic problem of accountability. By becoming part of a narrow network, a health system is not declaring that they will be accountable for the care they provide to your employees, that they will report on the outcomes that are important to you, that they will align their payments to meeting your quality measures or they will provide more visibility and better experience to your employees and their families. None of that. All they are promising is a better discount. Given the lack of transparency and huge variability in healthcare costs today, that does not mean much.

Even if the agreement between the carrier and network is value-based, employer don’t gain much from that. If the provider delivers on the promise of reducing costs in a risk-reward model, provider and carrier split the savings, employers not so much. If that does not happen, providers don’t make more in incentives, but the employers still pay for the higher costs.

In other words – Heads I win, tails you lose.

This approach will work only if the employers themselves are part of the equation, have full control over what benefits they require from the ‘narrow network’, what outcomes are important for them and what contractual arrangements will make sense to get value for the care.