How new trends help brokers build self-funded plans
As we settle into our next normal, brokers will need to advise their self-funded clients to build plans that meet their employees’ new expectations while keeping costs low.
The past year completely altered everything we knew about health care — especially the way it’s managed. The health care industry is still changing, leaving self-funded employers more confused than ever.
Clients rely on their benefits advisor to help them navigate the unknown and plan for the future with some level of predictability. As we settle into our next normal, brokers will need to advise their self-funded clients to build plans that meet their employees’ new expectations while keeping costs low.
The new landscape
Health services spending was down roughly 2.7% (based on seasonally adjusted annual rates) as of December 2020 compared to December 2019, according to the Peterson-Kaiser Family Foundation Health System Tracker. Despite the dramatic decline in the early months of the pandemic, the health care industry has largely returned to its pre-COVID numbers.
This data not only reflects the population’s increased comfort with returning to their provider’s office — and the changing policies allowing them to do so — but also a new way in which patients will be accessing care in 2021 and beyond.
Incentive programs that reflect the next normal
The way consumers accessed (or didn’t access) their health care varied dramatically as a result of the pandemic. To comply with regional ordinances and provider guidelines, patients either chose to forego elective care completely or found new ways of accessing care.
With the exception of avoiding preventive care altogether, which could harm self-funded employers in the long term, these alternatives to care proved to be more cost-effective for employers. Encouraging your self-funded clients to build a plan that incentivizes cost-saving methods for accessing care will be a win for everyone.
Preventive care
While consumers have grown more comfortable returning to their provider’s office than in the first months of the pandemic, the numbers are still lower in December 2020 than they were in 2019. This varies by type of care. According to the Health Care Cost Institute, colonoscopies are 10% to 15% below their normal rate year over year; however, prostate screening tests and mammograms have surpassed their 2019 levels.
These types of screenings are critical to keeping employees healthy and ultimately lowering employer health care costs. Employers may need to add extra incentives to their health care plans in order to convince employees to once again seek preventive care; for example, offering insurance premium discounts to employees (and any covered dependents) who receive a preventive care screening at the beginning of their coverage.
Primary care physician
While you’re encouraging clients to incentivize preventive care, it’s also a good time to talk about requiring all plan participants to name a primary care physician. Mandating all participants to have a PCP ensures they’ve identified a trusted provider who can help them with preventive care or acute or chronic health concerns. According to a 2019 Journal of the American Medical Association study, people who received primary care had a better overall experience with their health care.
You can help employers encourage plan participants to see a PCP by requiring them to name one as a condition of their coverage. Many employees may not know where to start when looking for a provider, so providing them with a list of quality, in-network providers is a great way to ensure they know who they can call for preventive care or should a health issue arise.
Telehealth
Telehealth is the most common example of a new health care delivery method patients tried during quarantine. In the first weeks of the pandemic, telehealth usage skyrocketed, with 46% of the population using the tool (up from 11% in 2019).
Telehealth wasn’t always a covered option within health care plans; if it was, patients were unfamiliar with how it works. While the major insurance carriers announced that they were waiving co-pays and fees for telehealth during the pandemic, employees of self-funded health insurers — many of whom have their claims processed by major carriers — were confused as to why they were still getting charged.
Telehealth saves employers money if employees are empowered to turn to telehealth first when appropriate. A concern that might have once had an employee in the ER could be quickly addressed with a (much less expensive) virtual visit. In addition to building benefit plans that make telehealth an affordable option, encourage clients to educate their employees around when and how to use telehealth services.
Onsite health clinics
This may apply to only your larger clients, but for those who are able, onsite health clinics are an excellent opportunity to provide more care opportunities at a lower cost. Despite the disruption from the pandemic, many larger employers have plans to expand their onsite clinics. Currently, 72% of large employers either have a clinic in place or will by 2023.
For clients who do have an onsite clinic, it may be incentive enough: nothing beats convenience, especially when coupled with other incentives like those for preventive care. If a client is considering adding onsite care, share the cost-saving benefits: an onsite clinic ensures employees are seeing in-network, cost-effective providers, who can then recommend off-site specialists meeting the same standards.
Mental and behavioral health care
While focusing on ways to incentivize different types of care and ways to access that care, encourage clients to include mental and behavioral health incentives as part of that plan. The impact of poor mental health has been in the spotlight in the past year as we collectively dealt with isolation, disruption and anxiety. As we return to a new normal, encourage clients to help their employees seek the care they need.
Helps clients provide quality, cost-effective care
As you’re helping clients implement changes for their health plan to increase cost savings, keep in mind how changes in health care utilization and the ways we access care will continue to evolve post-pandemic.
While incentives are a great way to encourage utilization, one of the best ways to design a cost-effective, self-funded benefits plan is to focus on the in-network health care providers. Identify high-value providers, and design a benefit plan that encourages employees to use these providers first.
Also: Virtual primary care: Relational care without geographic boundaries
Examples of high-value providers include providers who offer bundled care or providers who have demonstrated being more cost-effective. For clients with onsite care, design a plan that encourages employees to use the onsite primary care physician, who can recommend other in-network, high-value care providers.
No one could have predicted the events of 2020, but as we begin returning to our pre-COVID routines, we’ll need to pay even closer attention to the trends to ensure people are receiving the health care they need. Brokers will have an even more important role as a key advisor in 2021 and beyond to help clients identify trends and build coverage that’s both quality and cost-effective.
Terry Rowinski is president at Health Payment Systems, Inc.