Breaking the health benefits congestion cycle: What really matters?
The post-COVID benefits-review cycle is an opportunity for managers to make choices that matter to employees.
There was a transportation study done once that corroborated what drivers knew from the frustration of being struck in traffic: despite claims to reduce traffic, building more highways actually creates more congestion. For every percentage increase in highway capacity there is an equal increase in the amount of traffic. Complexity did not deliver simplicity.
I used to think about that when I was a corporate benefits manager reviewing RFIs and RFPs during the annual cycle to select health care vendors, whose offerings ran the gamut from comprehensive care management to point solutions, from clinical intervention to wellness regimens. I worked for a large Midwest self-insured company that employed several hundred thousand people, and the span of our health care needs did feel as vast as the L.A. freeway system. The challenge to provide better health care for a population that ranged from executives living in mansions to line workers who were sometimes homeless was daunting. Every spring, I struggled to navigate the multiple lanes, cloverleafs and ramps of vendor noise that created more congestion in our benefits programs, when what we needed was a simple, straightforward ride. Yet, simple was nowhere on the map. Every year it was the same. 2021, however, can and must be different.
Related: Unraveling the complexity of our health care billing system
The employer experience of the COVID-19 pandemic has been profound, affecting health care benefits, consumption and utilization, and forcing existential questions about post-COVID choices. On a personal level, benefits managers have also experienced those upheavals and understand their impact — how the well-being of you and your family dictates priorities. This is the moment to reflect on what’s important and what you need, to externalize your values post-COVID, using your understanding of “What we really need” as the guide to your decisions. The noise doesn’t matter. This is not a space in which offering more is going to get you the results you seek.
What is the post-COVID plan?
Three key principles emerged from the COVID experience that are helping me make sense of what the role of benefits should be after the pandemic ends, whether or not employees return in-person to the workplace.
Improving health improves business. The priority to reduce costs is real, and budget savings will always be top of mind. Benefits managers whose sole interest was cutting costs are still vivid in my memory. However, decisions must be guided by the commitment to improving members’ health. It’s the reason members have benefits. But, we often lose sight of how better health benefits the bottom line. When I worked in benefits, we conducted a multi-year study with an external research organization that found improving wellbeing did help drive revenue. Improving health care isn’t just a worthy thing to do; it’s smart for business.
Stop making benefits planning and rollouts so complex. The siloed nature of the “highway” cycle doesn’t allow for focussed thinking. It shouldn’t take seven months to create an enrollment booklet for four plans. It’s also much too confusing to offer Members 27 plans. Stop trying to boil the ocean. Ask yourself two questions: What do employees need? How do I make it simple?
Start by working from the outside in. It may feel antithetical to representing your members’ needs, but individualism forces you to lose the grander vision that you need in order to simplify large systems and deliver the greatest benefit for the greatest number of members. Think of your target population as the belly in the bell curve rather than the narrow limbs on the ends. For companies of any size, but certainly for larger ones with the greatest range of demographics, pursue the goal of improving the populations’ health broadly rather than individually.
Use the experience from the last year to implement what employees want. COVID presented the biggest proving ground in the history of benefits. Companies adjusted and responded in ways that members actively utilized in historic numbers. That behavior reflects consumer choices that should drive benefits decisions. Shift dollars to support what Members actually want for their health and well-being.
For example, the soaring numbers for telehealth should be eye-opening. Allocating resources to make telehealth access easier would embolden members’ choices. The focus on mental health and its high utilization, as a result of the stresses of the pandemic, should be part of “the whole population” approach. Other emerging innovations, such as at-home urgent care, can help meet the overall goal more than existing underutilized benefits. And, certainly, anything that can simplify the user experience and offload their navigation nightmare, including guide services and other resources, should be given prominence. As with the bottom-line benefits of improved health, directing Members to appropriate care will help meet both clinical and budget goals.
Listen to what you’ve learned and act
We are still in a crisis, and let’s seize this opportunity to adjust the way we strive to improve employee health and well-being. As benefits leaders, we must focus on what employees truly need. Through the pandemic, your people have told you through their actions what matters most to them. Listen to that.
Now is the time in the benefits cycle for an internal audit in which you ask yourself one simple question consistently regarding every existing and proposed benefit, aligned with the goal of improving the population’s health: What does this actually do? It’s the most important measurement. If you can’t stand back and say, “I know that by doing this we’re improving the population’s health,” get rid of it. What benefit will have the most impact?
We’re all on the road to getting sick, and prevention at the broadest level will have the greatest chance for improving the health of the population. This complex, confusing, frustrating system can be made simpler. You know what matters. Focus on that.
Read more: