The concept is not new; the wealthy have availed themselves of physician concierge services for many years. What's new is the application to employer health plans. After a decade of battling to contain plan costs, employers are beginning to test concierge services as one solution to costly, and often unnecessary, decisions that their employees make regarding their health.

The range of concierge services covers everything from high-touch human advice to AI-driven apps and platforms, and much in between. Human navigators and AI-infused navigation systems can guide plan members through decisions such as where to have a specific surgical procedure, what their current symptoms may indicate, which health plan best meets their health consumption needs, how to resolve a confusing hospital invoice, and much more.

That they are producing results is borne out by the findings of the National Business Group on Health's 2020 Large Employer Health Care Strategy and Plan Design survey, which revealed a huge uptake by large employers in the inclusion of concierge services in their benefits packages.

For three years, this annual survey has asked respondents whether they offer concierge and related services. For the 2020 survey, 60 percent said they now offered plan members "high-touch concierge services" to help them navigate the health care system and understand their benefits. That's up from 36 percent just two years ago. Three-quarters said they include medical decision support, and employee advocacy tools and services, both up from two-thirds of respondents two years ago.

"One of the most interesting findings from the survey is that employers are focused on enhancing the employee experience," says NBGH CEO Brian Marcotte. "For example, there is a big increase in the number of employers offering decision support, concierge services and tools to help employees navigate the health care system. The complexity of the system and proliferation of new entrants has made it difficult for employees to fully understand their benefit programs, treatment options and where to go for care."

The true value of such concierge services is their availability when a plan member needs the information. The navigators, be they human or machines, "point to the right solution at the right point in time when employees need it," Ellen Kelsay, chief strategy officer at NBGH, told the Society for Human Resource Management in an interview about the survey results.

Accolade is one provider of "high-touch human interaction and advanced technologies" designed to help plan members "navigate the complex health care system to get the right care at the right time." In a white paper, it reports that its large, self-insured employer clients realize savings of more than $10 per plan member per month in year one, compared to the prior year, and that savings reach almost $60 per member per month by year five.

"A few items are needed for plan sponsors to do this well," says Umair Khan, VP of solutions marketing at Accolade. "You need a technology platform that puts together all types of benefits, and breaks down the silos that exist. There is no reason your health plan should be different from the diabetes plan you bought. Thus, you have all files in one place.

"But even if you do that, you need a service experience that sits on top of it, because you must take the time to educate employees and family members about their benefits," Khan adds. "That combination of technology plus the human advisor works really well. It can take all those benefits and bring them to life."

Because so many concierge services are now available to plan sponsors, deciding which ones to add to the benefits package can be difficult. As an evolving service, some have over-promised and under-delivered, often because the vendors miscalculated their own costs. Navigation platforms added to benefits packages are vulnerable to underutilization if plan members don't understand how they work.

Health Rosetta, a for-profit organization that supports health plan innovation and innovative insurance brokers, offers guidelines for evaluating such services.

"The key to an effective concierge experience is integration of information so employees have hassle-free access to simple and actionable guidance on any issue when they need it," Health Rosetta says.

Among the features a plan sponsor or broker should look for:

• The service should demonstrate a deep understanding of the individual consumer—including preferences and health profiles—so that care itineraries are personalized and thus more likely to be followed.
• The service should encompass the suite of benefits the member has access to, understand the individual's plan design, and the individual's current consumption of care (i.e., progress toward their deductible).
• The service should integrate and coordinate a vast array of fragmented solutions into one location, enhancing engagement and optimizing benefit use to lower costs.

"Employees who understand the implications of their consumption decisions are empowered to more intelligently navigate the care system. This means they can avoid unnecessary expense. As consumers use concierge services frequently and stretch their health care dollars further, riskbearing employers, insurers, and providers can accrue savings as well," Health Rosetta says. "Many programs that employers have invested significant dollars in, like value-based primary care or the small number of proper workplace wellness programs, require years to deliver return on investment. Concierge services can deliver savings in year one by guiding your employees away from unnecessary, high-cost care."

Read more: 

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• Expanding access to health care
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