Open enrollment in an opening-up America: What employers should consider and employees may expect
Here are four categories to consider when evaluating health plans.
Of the many learnings that emerged from the pandemic, the impact of the digital health revolution stands out as one of the most important for employers.
While health care technology startups already were offering online and digital services to consumers, health plans, and providers prior to the pandemic, the explosion and adoption of these services since January 2020 has transformed the way people embrace tech-driven solutions for health care.
As employers plan for an opening-up America, what should they consider about the health plans and innovative solutions they offer employees to support their health, lifestyle, and choice? In the “new normal” work world, many employees will have flexible options for onsite, remote, and hybrid ways to work. What will these employees expect for high-tech, high-touch options to help them manage their personal and family health?
Here are four categories to consider when evaluating health plans.
Access: High-tech, high-touch avenues
Telehealth and virtual care have grown dramatically throughout the pandemic. How will your employees use these new tech-based channels compared to seeing providers in person? Will it be different across geography and populations? And what will the cost impacts be of different channels for employees and employers across co-pays, reimbursements and other related health care expenses?
One thing is clear. People want choices. They will continue to seek coordinated care with their trusted providers and specialists, so it is important that employer health plans offer robust, high-performance provider networks that can serve employees in their communities. But many employees value new ways of handling health care issues that complement traditional care. Whether it is on-demand services through telehealth services or lifestyle-health solutions through digital app options, giving employees the flexibility to mix and match their approach to health care will produce the best outcomes for everyone.
Chronic condition management and prevention management
According to the Centers for Disease Control and Prevention (CDC), six in 10 U.S. adults have a chronic disease and four in 10 adults have two or more chronic diseases. They include diabetes, heart disease, and cancer. For employees – or their family members – with chronic conditions, having choices in the types of chronic disease-management programs, tools, and support available, and how they access them, is increasingly important.
As an example, if employees can choose home-care solutions that complement (and do not replace) the services they receive from their regular doctors and specialists – such as in-person house calls from medical professionals or online medical advice and guidance, peer support, and educational resources – they will be able to navigate their health journey more confidently.
Often, these unique services are provided to members through innovative partnerships between health plans and technology-based firms that specialize in solutions for health issues. They may focus on specific illnesses, or they may leverage the power of members’ lifestyles to help promote general well-being, or reverse and prevent some chronic conditions. These collaborative efforts bring decades of scientific research and the latest technology to health plans, which can then offer new, flexible choices for members that can be scaled quickly, based on need and demand.
Mental health for adults, teens, and children
One health care issue that emerged during the pandemic and its accompanying period of social unrest has been mental health. It is now widely recognized as an increasingly important area of need for adults, teens, and children.
Employers play a critical role in supporting mental health services for their employees and their families. Recently, the Mental Health Index Worker Edition reported improvement because of the positive effects of mental health services.
Telehealth services for mental health and innovative mental health programs are growing rapidly, and employers should remember that there is not a “one-size fits all” mental health solution. As a result, health plans must provide employees different channels for mental health support – office visits, telehealth sessions, and digital platforms that are accessible at any hour for personalized support. Additionally, health plans should deliver solutions for family members such as teenagers, many of whom still suffer the effects from the pandemic lockdown and isolation. Additionally, at-risk populations such as pregnant women with serious maternal health issues may require specialized support.
Social determinants of health are a known contributor to mental health issues. Stress created by food, housing, and transportation disparities impacts many people, especially more vulnerable, marginalized populations. Some health plans are addressing these issues by introducing geographically targeted community-health programs, funding local grants, while also collaborating on other services provided by respected nonprofit organizations.
Values, mission, actions: The Brand
Consumers today increasingly want to know what the corporate “personality” is for the businesses they support, and that’s true for health plans. Research has shown that customers are more likely to buy from a brand that demonstrates traits they admire and support. Employers are increasingly asking how their health plan partners improve life for the communities they serve – beyond just paying for care. They are evaluating its social giving, community involvement, and volunteer activities. They want programs that focus on diversity, equity, and inclusion for its own company as well as the community.
Ultimately, employers are facing tough decisions when it comes to health plan partners, especially as the pandemic continues. However, employers of all sizes are looking beyond just benefits. They want a corporate partner that leans into innovation and holds hands with its community. As we move into 2022 you can bet that these “wants” will increasingly become “demands” of all health plans.
Daniel Prettyman is vice president of commercial markets with Blue Shield of California.
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