4 ways advisors can support transformative health coverage changes

When I completed my service in Congress in 2014, it was evident that much more work needed to be done to fix the broken U.S.  system. As one of the original authors of the Affordable Care Act, I have a deep understanding of the complexities involved, such as affordability and access for all individuals. Inspired by the May 2015 Call to Action from the American Health Policy, I became eager to collaborate with forward-thinking employers to catalyze a new approach to providing better health coverage to employees, retirees and their families.

Choosing between good health care or inexpensive health care is a false choice. Employers, the largest payers in the U.S health care system can improve health outcomes for its employees by focusing on high–quality care while significantly reducing the cost of care for their employees and their bottom line.

There is no doubt that health coverage and access to quality care are vitally important for the physical, mental and financial wellbeing of our population – and employees understand this reality. In fact, employees are willing to quit their jobs for access to better health care benefits. According to the ERBI Greenwald Workplace Wellness Study of 1,500 employees surveyed in 2023, 83% of employees rank health coverage as extremely or very important when considering job decisions. Of the benefits available to them, 70% of employees say health insurance is the most important benefit in their decision to stay in their job or choose a new job.

As benefits leaders and their advisors shape their strategies, the lessons learned and acted on by your peers at HTA can help these leaders recruit and retain top talent for their respective companies. Among these key lessons:

• Own and know your data
• Develop an understanding of which providers provide high value to your plan members — and which do not
• Insist that carriers and PBMs act as full partners in executing your strategy—you are their customer.
• Deploy effective navigation, so that your plan members find high value providers at the moment when they most need help.

Benefits advisors wield a lot of influence in helping employers find employee health plans that are both better for the business and better for employees. But your influence goes beyond that. As a benefits advisor, you can help shape forward-thinking strategies that prioritize patient wellbeing over cost-cutting measures and influence positive change for the American health care system.

For employers, looking beyond immediate cost savings and understanding the value of investing in robust health care solutions can lead to reduced absenteeism, increased productivity, and overall employee satisfaction and retention. It can also help employers save money. But ultimately, your work as advisors can help Americans live healthier lives. Key steps that benefit advisors can take to support transformative change include:

1. Evaluating provider networks: Select health care providers and networks that prioritize preventive care, chronic disease management, and patient-centered approaches.
2. Implementing value-based care models: Shift from fee-for-service models to value-based care, where providers are rewarded for improving patient health outcomes. Encourage partnerships with accountable care organizations (ACOs) that focus on coordinated and integrated care.
3. Creating personalized health plans: Develop customized health plans tailored to the unique needs and conditions of each employee, enhancing the relevance and effectiveness of care.
4. Encouraging employee engagement: Foster a culture of health within the organization by encouraging employees to take an active role in their health and wellbeing. Offer incentives for participation in wellness programs, health assessments, and lifestyle improvement initiatives.

Some of America’s largest employers have come together with the collective goal of improving people’s lives and making health care more affordable to prove that taking these steps can result in significant cost savings and better outcomes. The result?  They have illustrated the tremendous impact that aligning benefit plans and provider incentives have in improving access and affordability of care – and collectively they have saved over $1 billion annually. 

As a benefit advisor, it can be  transformative to consider the broader impact of your work on employee health outcomes and, quite frankly, our health care system as a whole. It’s not just about finding the most cost-effective plans; you have an important role to play to make the necessary strides towards national health equity for all Americans. 

Robert. E Andrews is the CEO of Health Transformation Alliance.