An employer 'How to' for driving outcomes in today’s health benefits ecosystem
Employers are overwhelmed with how to approach the challenge of providing quality health care and get a return on their investment.
For most employers pre-pandemic, offering a health benefits program was a business necessity. Checking the box. Today, it has manifested into something far greater. Health care is not only a crucial component of the overall recruitment and retention strategy; employer health benefits leaders are spending hundreds of millions of dollars on health care because they see the value in keeping their employees healthy, safe and productive.
But what exactly are employers getting when it comes to their health care dollars? The U.S. spends dramatically more per person on health care than any other country in the world, but has lowest life expectancy and some of the worst health outcomes. In other words, our health care system is failing and is becoming unaffordable for employers. The question facing employers today is how to achieve better results for the approximately 150 million Americans who are covered by employer-sponsored health insurance.
Related: KFF: Annual family premiums for employer-sponsored health insurance average $22,221
Employers are rightfully overwhelmed with how to approach the challenge of providing quality health care to their employees and get a return on their investment. Fixing our broken health care system must start with primary care. And I’ll go a step further and say that a focus on primary care will also come with achieving optimal health outcomes. After all, primary care is the single medical specialty with the greatest opportunity to drive health outcomes and the only health care component where an increased supply is directly associated with better population health, lower mortality rates and more equitable health outcomes. Yet, primary care is among the most undervalued and underfunded health care services in the U.S. That is in part because of our ingrained focus on reactive sick care versus seeing the value in proactive health.
The constellation of health outcomes
Given the unaffordability of health care in the U.S., it is not surprising that an annual reduction in the total cost of care has become a North Star, particularly for those seeking to introduce new models of care. However, change is not going to happen unless we look beyond just in-year cost reduction, as there are many other crucial stars in the health care outcomes constellation that need to be tended to — real changemakers are factoring in longer-term savings, access, patient experience, employee productivity and retention, and employer satisfaction into their notions of success.
What that means for employers is looking at an advanced primary health model — one that is not only inclusive of, but also extends well beyond, primary care. This model, by addressing the entire constellation of health care outcomes, through comprehensive, coordinated and accountable care delivery, is the best path forward toward fixing our broken system.
Driving change with comprehensive, coordinated & accountable care
Comprehensive care with advanced primary health
Firstly, the fragmentation that exists in the current health care experience is inefficient, costly and unpleasant for all parties, including and most importantly, patients. In the post-pandemic era, many organizations are looking to offer various health and wellbeing services to their employees and have chosen to include many digital health point solutions, such as mental health apps, diabetes management tools and others, within their benefits ecosystem.
While it is heartening to see employers begin to bolster their health care offerings, a reliance on point solutions favors some outcomes more than others. For instance, the point solutions of today, many of which are behavioral health solutions, may increase access but do little in the way of improving outcomes. Employers and employees alike can feel burdened by the amount of benefits in their ecosystem, which can yield subpar engagement and satisfaction rates. Oftentimes, more is not better when it comes to employer health care solutions.
Instead, employers should seek to consolidate services under one comprehensive offering, inclusive of primary care, but also other highly utilized functions, such as physical medicine, mental health, health coaching and care navigation. Under this streamlined care experience, employees can access foundational services to achieve better health outcomes while minimizing the need for outside referrals, and employers can save time and money working with one vendor rather than ten.
Coordinated care with a proactive, tech-enabled approach
The second consideration is the importance of a highly coordinated team-based approach to care delivery, in which primary care, mental health, physical medicine, care navigation, health coaching providers all work together to achieve optimal outcomes. A team-based approach to care management ensures providers are working together across disciplines to achieve the best health outcomes for patients. This approach also relieves the patient of the burden of sharing data and information among dispersed, unconnected care providers.
Picture this: interdisciplinary care teams convening over coffee each morning, reviewing and determining who of their shared patients ought to be on their calendars, and proactively reaching out to ensure they get them on the books.
Additionally, technology should be leveraged appropriately to create the most coordinated care experience possible. Software should be designed to capture as much health data as possible to identify at-risk patients within the employee population in order to predict health risks before they develop into illness. From there, relationships and technology can create a personalized, preventative care experience for all.
Another aspect of coordination is connectivity–the ability for patients and care teams to communicate with each other via messaging, alerts, reminders, scheduling and referrals. This applies to care inside a client’s benefits ecosystem, as well as care provided outside in the secondary care network. A closed-loop care navigation process embedded within an integrated Primary Health model ensures the patient is never alone as they seek to navigate their care journey. The closed-loop care navigation process has, by creating a highly coordinated effort, contributed to significantly reduced costs, increased referrals to quality providers and increased patient satisfaction.
Accountable Care with Outcomes and Value-Based Focus
The topic of accountability is a key component to any health outcomes conversation. For too long there has been so little accountability in health care, especially when it comes to driving meaningful outcomes. The fee-for-service payment structure has made sure of this, as the providers and health systems many employers have chosen to contract with are rewarded on the basis of visit volume versus health outcomes. Therefore, it is not surprising that these fee-for-service solutions fail to drive outcomes across the board. Success should not be measured on visit volume but on an organization’s ability to enable employees to set health goals and live their best health.
Employers should seek out contracts with performance incentives that are aligned to the various aforementioned outcomes (i.e. total cost of care, access, patient experience, employee production and retention). Health care delivery organizations should be paid based on their ability to enable patients to live their best health–this is health as it should be.
Looking ahead
As the health benefits ecosystem continues to take shape in the post-pandemic era, employers will be met with a grocery list of digital health point solutions. Every solution out there seeks in some way to solve health care’s problems. However, those employers who are truly committed to driving health outcomes across the entire constellation will invest in Advanced Primary Health. There are no shortcuts here–fixing our system requires a comprehensive, coordinated and accountable approach to care delivery and a commitment on behalf of employers to not only improve access but deliver comprehensive health outcomes.
Joel Haugen is chief product officer at Crossover Health, where he is responsible for developing and executing the strategic product roadmap, including scaling the solutions portfolio from design and tech enablement to delivery and optimization. Joel’s expertise in product strategy is seen in his long history of successful large scale system implementations during his 15-year tenure at Optum, with significant experience in aligning client needs with the right solutions across the provider and payer markets.
Read more: