Healthcare Consumerism

Consumerism and transparency will be the key to controlling benefit costs. Employees have been encouraged to consume healthcare with little concern for the cost or incentive to negotiate services. The solution will be to create a partnership with employees to manage benefit utilization and cost. Our unique process reduces the fear and increases the enthusiasm through continuous education and providing empowerment tools so your employees can make better healthcare and personal financial decisions.

Empowering employees to make better healthcare decisions can reduce claims costs by as much as 25%. Employers may combine the power of healthcare pricing transparency with patient advocacy to drive lower cost, higher quality health decisions.

Through a proactive planning system you can create a benefits strategy that supports your broader business goals. Our process is ongoing and includes:
  • Establish annual benefits objectives
  • Analyze performance of current benefit plans
  • Provide competitive benchmarking analysis
  • Provide insight into the impact of legislative issues on your plan
  • Introduce new and creative benefit concepts
  • Explore all available cost control strategies
Benefits plans are of little value unless clearly communicated and understood. We work closely with our clients to develop custom, high quality and professional communication tools including:
  • Open enrollment announcement
  • Benefit highlight brochure
  • Online enrollment portal
  • Real time online access to benefit information, eligibility and costs
  • Links to provider networks, claims and customer service
  • Online benefit summaries
  • Benefit eligibility reports
  • Monthly wellness letter
  • Links to carrier wellness benefits including nutrition and health club services
  • Links to Rx data and costs comparisons
Helping employees be better consumers for their health care benefits
Encourage employees to approach benefit shopping the way they would car shopping. Then give them the tools to do so.

  • Suggest they compile their yearly healthcare costs—such as the estimated number of doctor visits, special procedures, and prescriptions—and run side-by-side comparisons in their benefits administration platform to determine what their actual costs will be. Remind your employees that a higher cost plan doesn’t always equal a better-quality plan.
  • Link to your insurance carriers from your intranet so that employees can view benefits easily.
  • Suggest online tools to compare costs and features of different plans.
  • Provide tools that help decipher the costs of service at different providers, as well as prescription cost calculators.

If an employee needs treatment for a condition, encourage a consultation with your company’s employee advocacy support representatives to find out which healthcare providers have the best outcomes for certain procedures.
The upshot: Understanding that employees may need help digesting benefits information is key to ensuring that they’re are able to take full advantage of their insurance options. Giving them the tools to ease this process not only helps ensure healthier employees with higher morale, it helps contain costs for the company.

Skin In The Game For The Employee
The emergence of public and private health insurance exchanges, as well as the ongoing shift toward placing more responsibility on workers for health plan decisions, is creating a new normal for employers and employees alike.

As the Affordable Care Act’s public health exchanges boasted roughly 8 million enrollees during its first signup period, and the Small Business Health Options Program marketplaces are expected to be fully operational by year’s end, the introduction of choice to employee populations is a “major disruptor,” says Paul Lambdin, a director at Deloitte Consulting.

Along with the state and federally run public exchanges, and the evolving private exchange marketplace, choice-oriented insurance markets are shifting the onus on employees to make key cost decisions. High-deductible health plans and consumer-driven health plans have been a fundamental component of the health care industry as employers have moved away from assuming full responsibility for employee health care.

There is more “skin in the game for the employee and the individual,” says Lambdin.

The ACA requires improved transparency among health care quality and price data, components that are projected to allow consumers to make better choices. According to Susan Novak, senior manager at Deloitte Consulting, this will ultimately lead to the “unleashing [of] a more efficient market system.”

She explains that the increase in the availability of cost data, and overall data in general, will allow employee populations, and individuals for that matter, to make more informed decisions.

Out-of-pocket spending on health care, meanwhile, has increased for all age groups, including more than 40% for millenials, Gen Xers, baby boomers and seniors over the last 12 months, according to Deloitte data.

More importantly, more individuals are refusing to use the benefits of their plan coverage to manage these escalating costs. For instance, 33% said in a prior Deloitte survey that they used home remedies or over-the-counter medicines to treat their illness rather than visit their physician.

Even more astonishing is the active nature many millennials are taking with regards to their health plan coverage. Deloitte finds that those born between 1982 and 1995 were more likely to look up costs and negotiate prices with their providers, indicating an area where insurance companies and benefit plan sponsors should consider directing more attention.

“As the consumer is taking on more costs, I think they will be searching and demanding more quality care,” says Novak.

In theory, more choice and more data to support choice should improve decision-making by the general population. In practice, we know that a small percentage of the population is in fact able to make effective use and decisions based on the data. The reality is that most people stop making effective choices at all — they are simply overwhelmed by the information and the inherent complexity of analyzing it. Think 401k plans vs DB Pensions, Energy Service Companies vs. the regional electric provider, etc. Transparency of data and choice are an inherently good thing, but most consumers are no where near prepared to analyze it – and education (a critical complement to information) is rarely taken advantage of. Those who gain the most are people with the resources to hire experts or people with the time and inclination to self-educate. As a rule, this leaves the majority of the population feeling helpless – either throwing up their hands (watch 65 year olds trying to make decisions about a Medicare plan on their own) or acting on poorly informed recommendations. In the end, we need to develop ways to help people make decisions which take advantage of the data, but don’t require them to become experts in it’s analysis. We need to combine data, behavioral psychology, and human insight in ways that guide people through the choice process — in short, help them objectify their own situation and the solutions that are best aligned with that situation. People can make good choices about complex conditions – but only when they don’t have to become experts (or rely on them) to sort through the clutter.