In Part 1 of our series on navigating healthcare, we touched on the high-level problems—around rising costs and diminishing outcomes—employers face when it comes to helping guide employees and their families, (collectively “members.”) on their healthcare journey. In Part 2, we delve more deeply into why the numerous and varied solutions employers have implemented aren’t working as well as they could.
Existing Solutions Are Not Enough
Employers face a challenging healthcare environment in the U.S. Years of healthcare financing and plan design changes, such as higher deductibles and narrower networks, helped flatten out healthcare utilization since 2013.1 These same plan design tactics also contributed to two new challenges: (i) hospital systems, providers and pharma companies raised prices by 17% overall since 20131,2 in order to offset the volume losses, and (ii) members delayed necessary care in response to the cost shifting initiatives.2
New Solutions, New Challenges
To address rising costs and your members’ tendency to delay care until it’s too late, employers have implemented all kinds of solutions aimed at improving health outcomes and driving down cost. Based on research conducted by Grand Rounds, over 50% of HR leaders rely on vendors other than their medical carrier for a range of health benefit solutions3 that include everything from disease management programs and telemedicine to cost-transparency tools and engagement platforms.
Though these healthcare solutions can prove helpful, employers are finding that their benefits programs as a whole aren’t getting members to the right healthcare as quickly and effectively as possible.
- Too much information leads to confusion and indecision. Employers are deploying an ever-growing number of point solutions—like diabetes management tools, well-being apps or expert medical opinions—in an effort to better support their members. However they typically each blast them with their own set of outreach and engagement emails, mailers and reminders. Members are overwhelmed with too much information and are subsequently unable to make a decision—some completely ignoring the outreach altogether.
Lack of an integrated approach. Many members are dealing with not just one condition, but a set of related conditions that also bring with them various behavioral health challenges—for example, a member can be suffering from heart disease and high blood pressure while also battling anxiety and depression due to their declining health. It’s no wonder then that the success of point solutions, which only address a specific health need or issue, is limited. The lack of an integrated solution that looks at the member as a whole person not only leads to a negative, disjointed experience, but it also contributes to diminishing outcomes and rising costs.
According to a recent study, people with 1–2 chronic conditions and highly fragmented care were 13% more likely to visit the ER.
- Little clinical and care guidance. A quarter of members, including almost half of those between ages 18–29, don’t have a primary care provider (PCP) to coordinate care. And even if they do have a PCP, those providers can only allocate 15 minutes of time for Q&A and won’t know about the relevant benefits available to the member.4 When members do look for a new doctor, their health insurance company surfaces over 40,000 search results, making it almost impossible to understand which doctor is high quality and right for them. Given this, it’s unsurprising that 88% of adults do not have proficient health literacy.Members don’t have the care and clinical guidance that tie together and optimize the entire healthcare ecosystem, including choosing the most clinically appropriate benefit and finding a high-quality in-network doctor. These members are at risk of choosing incorrectly and making decisions that send them down a clinically inappropriate and wasteful path.
An Example: How Healthcare Delays Impact Members
Take the example of a member suffering from diabetes, for instance. If that member has some questions about side effects from their medication, they need guidance and clarity. Instead, they’re given multiple options: enroll in their diabetes management program, talk to a doctor ASAP via telemedicine, or talk to their endocrinologist during their next check-up, or some combination of the above, or none of the above. These options, implemented with the objective of solving a specific problem, have unintentionally compounded it, by introducing more complexity and making it harder for members to know what they need—or what options are available to them, causing them to further delay care.
In our final installment of this blog series on navigating healthcare, we go over how having the right healthcare navigation solution can significantly improve employee engagement and their overall health.
1 Health Care Cost Institute 2017 Annual Report
2 American College of Physicians
3 GR market research
4 Medscape Physician Compensation Report, 2017