At open enrollment time HR professionals are losing sleep, but mostly over their to-do list. Outside of open enrollment, the above image is a heat map of what HR professionals responded was most concerning to them. Let’s break down the top three and talk about how HR professionals can sleep more easily.
1 - Engagement
By far, engagement in benefits is the biggest concern, and rightly so. Benefits managers spend the year determining the best strategic benefits package for their employees and want to realize the fruits of their labor. The benefits outside of major medical that most are adding this year are cost containment tools. Without engagement, the best laid plans will not realize results.
As the central point of all benefits, First Stop Health has found that engaging employees to make better healthcare decisions is hard. It takes work and a one-sized fits all approach will not provide the same results between different industries. The best approach is a customized, co-branded engagement campaign to ensure that all employees know when, why and how to use their benefits. Anytime you can use real claims data to target groups of employees that may need extra assistance in making good decisions, the more engagement will drive better health outcomes and lower claims costs.
2 - Controlling Costs
Regardless of what the incoming Trump Administration does to ACA, there is little chance healthcare or pharmaceutical costs will actually go down. Cost containment strategies are playing a significant role in self-insured companies’ benefits plans going forward. These can take the form of a transparency solution, concierge medicine, health advocate, telemedicine, or all of the above. The key to successfully containing costs is two-fold: avoid generating unnecessary claims and make sure employees shop around to understand price differentials for procedures.
Telemedicine is the only benefit that will divert healthcare claims, if it is provided separately from the carrier. Price transparency is the other cost containment solution that is getting a lot of interest these days.
Both of the solutions can bend the cost curve of healthcare claims, but only if these solutions are utilized at a high level by employees. And high utilization will only occur if there is a high level of engagement.
3 - Specialty pharmacy
High drug costs are the largest contributor to overall increases in healthcare costs for employers in the past five years, and they increased 22% on average in 2015 alone. Employers have implemented measures to try to reduce the use of more expensive drugs by mandating step therapy, whereby employees have to use less expensive drugs prior to more expensive, specialty meds.
Some companies have created penalties for purchasing drugs at retail pharmacies, or mandated mail order for certain medications. Some have even excluded certain medications from their plans, created tiered pricing models or separate deductibles for prescription drug plans.
As with much in life, the best laid plans can fall short if implementation and engagement are not up to par. So, it makes sense that engagement is the biggest concern of HR professionals. By better engaging employees in their benefits programs, utilization goes up and costs are better controlled -- and that includes in the procurement of drugs, which has an enormous impact on overall increases in healthcare costs for employers. First Stop Health has cracked the code on high engagement. By driving the highest utilization rates in telemedicine, we have achieved cost containment in the diagnosis and treatment of episodic healthcare needs of our clients.