A ‘How to’ Employer to Achieve Results in Today’s Health Benefits Ecosystem

Addressing the full constellation of health care outcomes through comprehensive, coordinated and accountable care delivery may be the best path forward to fix our broken system. (Photo: Shutterstock)

For most employers before the pandemic, offering a health benefits program was a business necessity. Check the box. Today it has manifested into something far greater. Health care is not only a crucial part of the overall recruitment and retention strategy; Executives of employer health insurance plans spend hundreds of millions of dollars on health care because they see the value in keeping their employees healthy, safe and productive.

But what exactly do employers get when it comes to their healthcare dollars? The United States spends considerably more per person on health care than any other country in the world, but has the lowest life expectancy and some of the worst health outcomes. In other words, our healthcare system is failing and becoming unaffordable for employers. The question facing employers today is how to achieve better results for the few 150 million Americans who are covered by employer-sponsored health insurance.

Related: KFF: Annual family premiums for employer-sponsored health insurance average $22,221

Employers are rightly overwhelmed with how to approach the challenge of providing quality health care to their employees and getting a return on their investment. Fixing our broken health care system must start with primary care. And I’m going to take it a step further and say that a focus on primary care will also come with achieving optimal health outcomes. After all, primary care is the single medical specialty with the greatest potential for improving health outcomes and the only component of health care where a the increase in supply is directly associated with better population health, lower death rates and more equitable health outcomes. Yet primary care is among the most undervalued and underfunded health services in the United States. This is partly due to our entrenched focus on responsive health care versus the value of proactive health.

The Constellation of Health Outcomes

Given the unaffordability of health care in the United States, it’s no surprise that an annual reduction in the total cost of care has become a North Star, especially for those looking to introduce new models of care. However, change will only happen if we look beyond simple cost reduction in the course of the year, as there are many other crucial stars in the constellation of healthcare outcomes that need to be considered – real changemakers factor longer-term cost savings, access, patient experience, employee productivity and retention, and employer satisfaction into their notions of success.

This means for employers that they consider an advanced model of primary health care — one that not only includes primary care, but also extends far beyond it. This model, addressing the entire constellation of health care outcomes, through comprehensive, coordinated and accountable care delivery, is the best path forward to fix our broken system.

Driving change with comprehensive, coordinated and accountable care

Comprehensive care with advanced primary healthcare

First, the fragmentation that exists in the current health care experience is inefficient, costly, and unpleasant for all parties, including, and most importantly, patients. In the post-pandemic era, many organizations are looking to offer various health and wellness services to their employees and have chosen to include many digital health point solutions, such as mental health apps, diabetes management tools and more, in their ecosystem of benefits.

While it is encouraging to see employers begin to strengthen their healthcare offerings, the reliance on point solutions promotes some outcomes more than others. For example, today’s point solutions, many of which are behavioral health solutions, can increase access but do little to improve outcomes. Employers and employees can feel overwhelmed by the amount of benefits in their ecosystem, which can lead to lower than average engagement and satisfaction rates. Often, more is not better when it comes to healthcare solutions for employers.

Instead, employers should seek to bundle services into a comprehensive package, including primary care, but also other high-use functions, such as physical medicine, mental health, health coaching and navigation. cares. As part of this streamlined care experience, employees can access basic services to achieve better health outcomes while minimizing the need for outpatient referrals, and employers can save time and money by working with one provider rather than ten.

Coordinated care with a proactive and technological approach

The second consideration is the importance of a highly coordinated team approach to care delivery, in which primary care, mental health, physical medicine, care navigation, and health coaching providers all work together. to achieve optimal results. A team approach to care management ensures that providers work together across disciplines to achieve the best health outcomes for patients. This approach also relieves the patient of the burden of sharing data and information among dispersed and unconnected healthcare providers.

Picture this: interdisciplinary care teams meeting over coffee each morning, reviewing and determining which of their shared patients should be on their calendars, and proactively reaching out to make sure they check them in.

Additionally, technology must be leveraged appropriately to create the most coordinated care experience possible. Software should be designed to capture as much health data as possible to identify at-risk patients within the employee population to predict health risks before they turn into disease. From there, relationships and technology can create a personalized preventative care experience for everyone.

Another aspect of coordination is connectivity – the ability for patients and care teams to communicate with each other through messaging, alerts, reminders, scheduling and referrals. This applies to care within a client’s benefits ecosystem, as well as care provided outside of the secondary care network. A closed-loop care navigation process built into an integrated primary care model ensures the patient is never alone as they seek to navigate their care journey. The closed-loop care navigation process has, by creating a highly coordinated effort, helped to significantly reduce costs, increase referrals to quality providers, and increase patient satisfaction.

Responsible care with results and a value-driven approach

The topic of accountability is a key part of any conversation about health outcomes. For too long there has been so little accountability in health care, especially when it comes to achieving meaningful results. The fee-for-service structure has ensured this, as the providers and health systems that many employers choose to contract with are rewarded based on visit volume versus health outcomes. Therefore, it’s no surprise that these paid solutions fail to deliver results across the board. Success should not be measured by volume of visits, but by an organization’s ability to empower employees to set health goals and experience their best health.

Employers should seek contracts with performance incentives aligned with the various outcomes noted above (i.e. total cost of care, access, patient experience, employee production and retention). Healthcare delivery organizations should be paid based on their ability to enable patients to live their best lives – that’s health as it should be.

Look forward

As the health benefits ecosystem continues to take shape in the post-pandemic era, employers will be greeted with a grocery list of digital health point solutions. Every solution out there seeks to somehow solve health care problems. However, employers who are truly committed to improving health outcomes across the constellation will invest in Advanced Primary Health. There are no shortcuts here – fixing our system requires a comprehensive, coordinated and accountable approach to care delivery and a commitment from employers to not only improve access, but also deliver health outcomes. complete.

Joel Haugen is product manager at Cross Health, where he is responsible for developing and executing the strategic product roadmap, including scaling the solution portfolio from design and technology enablement to delivery and deployment. optimization. Joel’s expertise in product strategy is reflected in his long history of successful large-scale systems implementations during his 15 years at Optum, with significant experience in aligning customer needs with the right solutions in the provider and payer markets.

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