Strategies for HR Managers to Help Employees Master the Changing Healthcare Landscape
by Andrew Ceccon, A.D.A.M.
Just as astronomical gas prices are forcing us to pursue alternative energy sources, healthcare inflation has forced U.S. companies to find alternative health plans. Consumer-driven healthcare (CDH) seems to be the only option gaining real traction.
In the CDH vision, employers offer programs that give employees real incentives to consume medical services wisely. People seeking medical care would have a wealth of comparative data at their disposal, just like anybody shopping for a consumer good. Armed with data, they could buy the best brand (doctor, hospital, lab, etc.) at the best price for their situation. The forces of capitalism would compel insurance companies and doctors to find a reasonable balance between quality of care and cost to please consumers and plan sponsors.
Not all of the puzzle pieces have fallen into place yet. To this day, the delivery of medical care simply ignores the rules of free markets. If doctors often don't know how much they actually charge for their services, how can patients--that is, rank and file employees--act as rational buyers?
Let's consider what an employee needs to succeed under a new healthcare paradigm: comprehension of their plans; decision support to enroll in the right plans; better health and lifestyle to minimize the need for medical care; financial smarts to manage money; convenience and confidence; and, organization of personal information. This is a long punch list indeed.
When you boil it down, there are seven major steps employees must climb to become true healthcare consumers:
- Get educated about their health plans
- Get support making plan decisions and enrolling
- Educate themselves on health and wellness
- Manage their health proactively
- Manage their health accounts prudently
- Evaluate the quality of healthcare providers
- Know what things costs in advance and negotiate when appropriate
As you see, the onus is on the individual. Let's examine these steps and see how employers can construct the handrails needed to help the workforce ascend.
Step One: Health Plan Education
At the bottom of the staircase is "Health Plan Education." The goal is to create enough awareness of how medical plans work to allow people to use them wisely.
What's required?
- Plan rules and costs
- Summary plan descriptions and other compliance documents
- Forms and links
- Frequently asked questions
What's desired?
- Multimedia education
- Communication articles
Step Two: Decision Support and Enrollment
The next step is to help employees choose their plans and elect them efficiently during enrollment events.
What's required?
- Plan comparisons so they can evaluate plans.
- Change communications to explain new plans or modified plan rules.
- Enrollment forms or links to complete enrollment.
What's desired?
- Web-based enrollment. The ultimate in convenience and simplicity for the employee. That is, they go to your portal and walk through a process that filters out only what they are eligible to elect.
- Personal guidance: Grasping the moving parts of a high deductible health plan (HDHP)/health savings account (HSA) plan has proved challenging. Companies need to conduct face-to-face meetings with employees to prepare them for the new world of CDH. They should offer personalized and interactive planning tools online to model scenarios.
Step Three: Health and Wellness Education
These days health information is coming from everywhere, but not enough comes through the workplace. The goal of making health and wellness information available is to give access to reliable, unbiased health information in context with benefits planning.
What's required?
- Trustworthy information on conditions. At the bare minimum, the healthcare consumer must be knowledgeable about symptoms or conditions they face.
- Education on wellness is also critical to prevent such conditions and enjoy a higher quality of life.
What's desired?
- Visuals and videos. There are millions of Web pages filled with medical content, but images and videos are much more instructive teaching tools. Employers should seek to connect employees to highly visual health education.
Step Four: Health Management
Learning facts about health and wellness on demand is a great start, but health management makes such information actionable on a personal level. The goal here is to encourage employees to actively manage their own well being.
What's required?
- Health risk assessments (HRAs). Online HRAs generate information about potential risks that may lead a person to seek proper care.
- Symptom checker. Symptom checking software can list potential culprits and maybe save a doctor's visit.
What's desired?
- Comprehensive guidance on conditions and wellness. Interactive guides about specific topics, such as asthma, diabetes, and weight loss, can provide an in-depth understanding of the condition, treatments and lifestyle changes.
- Medical decision support. Patients aren't always aware that they have choice in medical matters. Tools like decision checklists can educate them about the pros and cons before they pursue expensive surgery.
- Personal health records. People can electronically organize information on their providers, conditions, treatment, medications and more. Having a thorough medical history can lead to better doctor interactions and health outcomes.
- Wellness programs. A Forrester study showed that 57 percent of respondents have some form of wellness program today and 23 percent intend to within the next 2 years. There are a variety of wellness programs designed to help people quit smoking, lose weight, exercise, etc. The best ones integrate a personalized online resource with human support.
- Health coaches. These are nurses, dieticians, social workers, and others trained in motivational interviewing techniques. They help plan members become more knowledgeable about their conditions and gently remind them to follow up regularly with their doctors.
- Disease management. Disease or case managers guide care choices for patients with chronic illness. Over half of employers have disease management programs now.
Step Five: Account Management
Now it's time to address the financial aspects of "Account Management." This pertains particularly to HSAs where the consumer now has an account to spend. The goal for HR is to make it easy for participants to manage their money prudently.
What's required?
- Education on how to use plans. Linking the banking aspects with the insurance aspects can be tricky for even well-informed individuals. Here lots of education in the form of FAQs and instructional videos can alleviate the confusion.
- Online access to account balances. It should be easy for people to track their accounts with online tools. It's even better when the tools are integrated into the employer-sponsored portal because now you are connecting the benefit plan, health management and financial management in one place.
What's desired?
- Calculators to estimate medical expenses. Admittedly it's hard for anyone to predict medical needs, but a good calculator can at least assist an employee in ballparking conservatively for purposes of deciding how much to save in their accounts.
- Financial modelers. Savvy folks see HSAs as tax-advantaged ways to build assets for healthcare in retirement. Calculators can help with financial planning, especially if HSAs start doubling as investment vehicles.
Step Six: Provider Quality
If we ask employees to be consumers, they have to know the products they are buying--that is, the doctors, hospitals, pharmacies, drugs, health plans, and procedures. The reality is that there is scant data that the average person can decipher to help them.
What's required?
- Intuitive, unbiased quality ratings. We have seen some good tools to evaluate hospital and health plan quality, and employers can make these available through employee portals.
What's desired?
- Standard system for assessing doctor quality. We are still a ways off from having a convenient means to compare doctors in a fair, user-friendly way. Fortunately, social networking shows some promise. Some websites are gathering patient feedback on providers, though it will take some time for these to amass enough data to be useful.
Step Seven: Cost Negotiation
The final step to consumerism is to know what medical services cost. The goal is to empower patients to predict and negotiate medical costs in advance.
What's required?
- Education on the economics. Few but the insurance cognoscenti understand how the healthcare system works. In the co-pay days, employees were not so driven to scrutinize doctor bills and insurance payments. Now they must pay attention.
What's desired?
- Price transparency. Lack of transparency is a major impediment to true consumerism. One of the most interesting examples of transparency at work is LASIK surgery. Because it is rarely covered by health plans, it has acted like a commodity. Practitioners openly advertise prices which have steadily gone down while quality has been driven up. Indeed, anticipating costs may not be easy for many procedures; nevertheless, clarity is imperative to assist the consumer.
Today, HR can guide the willing employee up about five of the seven steps. Central to your strategy should be a cohesive set of Web-based resources that the employee and their family members can access whenever they need to. When it comes to provider quality and cost negotiations, greater market forces are at play. Insurers, providers, and government have to collaborate on solving these tough issues.
HR departments who use portals to assist employees in their journey to consumer-driven heaven enjoy gains such as appreciation and smarter utilization of company's programs, reduction in HR distractions, a paperless environment, improved perception of HR's service and a healthier, more productive workforce.
About the Author
Andrew Ceccon is the chief marketing officer at A.D.A.M., a provider of healthcare content and benefits tools for employers, health plans, and healthcare organizations. He was a key architect of Benergy&TM;, A.D.A.M.'s health and benefits portal for employees currently used by over 5,000 organizations. For more information, please visit www.adam.com.
