Having been involved in worksite marketing in one role or another for the last 17 years, I have benefitted from having strategic conversations with worksite insurance professionals and brokers during this time. These conversations have allowed me to surmise there is an age-old problem in the workplace that needs to be addressed - how can employers continue to manage the rising cost of health care and balance employee needs while recruiting, hiring and maintaining the best possible workforce?
An innovation solution to the retention problem exists; in fact, more than one solution is possible. Several key areas need to be addressed: benefit challenges, traditional solutions, broker problem, and innovative solutions.
According to MetLife's 13th annual Employee Benefit Trends Study, employer's top employee benefits objectives are retention, and controlling health and welfare benefit costs.1 Offering cost-effective benefits to employers and employees can be challenging.
Annual premium increases coupled with limited cost containment tools create frustrations during benefit renewals. After raising deductibles or co-pays and cutting benefits, what strategies are still available for employers (fully insured or self-insured) to cut costs and add more value to their employee benefits package?
Wayne Drye, CEO of World Insurance Association, Inc., Atlanta, Georgia, has indicated rising health care costs often force his client companies into a fragile balancing act to provide competitive benefits, manage cost, and still remain compliant with current health care regulations. He asks, "How long can employers maintain the status quo and still survive?"
Traditional Retention Solutions
We have all heard the saying, "doing the same thing over and over again expecting different results is the definition of insanity," yet frustrated brokers and employers continuously turn to the traditional solutions to solve this age-old problem. For Fortune 500 employers and small businesses alike, rising health care costs make it harder to retain employees, more expensive to add new employees, more difficult to maintain retiree coverage, and harder to compete in the global economy.
Relying on insurance-based strategies involving raising deductibles and co-pays or cutting benefits or integrating voluntary benefits that are employee paid don't completely solve the problem. While these strategies have been successful to a degree, there is only so much cost shifting an employee is willing or able to take on. It's time to look outside the insurance paradigm to non-insurance products.
Although non-insurance products and services have been in the marketplace for years, they haven't been sold for widespread use in the workplace. Below is a summary of several products and services currently available to use in the employer marketplace that can deliver higher employee satisfaction and a remarkable ROI if strategically positioned.
Medical Bill Negotiation Services
From emergency room visits to complicated hospital stays, this advocacy and bill negotiation service is designed to help the employee understand complicated medical bills to ensure they pay only what is legitimately due a provider. Employers benefit by reducing the reliance employees place on human resources within the company to help explain complicated medical bills.
These services help simplify medical expense management for employees, increase satisfaction and engagement and save employees money. In addition, the amount charged against the health plan claims is reduced.
The Kaiser Family Foundation and Truven Health Analytics calculate prescription drug spending at 10 percent of the total national health expenditures. An even more shocking statistic is drug spending alone in employer health plans tops out at a whopping 19 percent of total expenditures.
Employers should be concerned about the double-digit rise in the cost of medication and should consider steps they can take with medication management partners to implement specific programs for employees who take multiple medications for chronic illnesses.
This can have a substantial impact on their bottom line. The New England Health Institute (NEHI) estimated that nonadherence to medication along with suboptimal prescribing, drug administration, and diagnosis could result in as much as $290 billion per year in avoidable medical spending.
Medication management programs are focused on driving improved outcomes through medication adherence. They can provide individualized care that is proven to improve the lives of chronically ill patients. By improving medication adherence hospital admissions are greatly reduced, benefitting the employee's health, and reducing claims against the employer's health plan2.
As an added convenience, medications are often sorted, labeled, organized, and delivered to the member's home at no additional cost. Usually 12 to 15 percent of an employer group has a chronic illness. This is designed for employees with chronic conditions such as:
- Ulcerative colitis
- High blood pressure
- High cholesterol
- Infectious diseases (HIV, Hepatitis) Arthritis
- Congestive heart failure
- Crohn's Disease
Telemedicine provides the convenience of 24/7 access to U.S. board-certified, state licensed doctors who can consult, diagnose, and prescribe medication for common and acute illnesses via phone or video. Substantial cost savings are achieved when claims are redirected from the health plan and driven to a telemedicine provider.
Seventy percent of all doctor visits can be handled by telemedicine providers. The most common consult fee for a non-embedded telemedicine plan is zero dollars. It is important to partner with a provider that can deliver reports defining breakeven points, deliver a strong ROI and one who has processes in place to help drive employee utilization.
Word of caution: Many health plans are beginning to embed a telemedicine component in the health plan at a low cost to the employer. The patient then pays a $35.00 - $50.00 consult fee. When the consult fee is higher than a copay for a doctor office, or blocks the convenient use of the service, employee satisfaction is thwarted.
The health plan provider has no incentive to help drive utilization. When utilization is one to two percent, it is just money thrown away. Be sure to partner with a service provider that has a low to zero dollar consult fee and a communications plan to drive employee utilization.
This is the real opportunity to drive utilization and achieve high ROI. Telemedicine is designed for employees with any of the following:
- Acid reflux
- Cold and flu
- Joint aches
- Ear infection
- Bacterial infection
- Insect bites
- Fungal infection
- Pink eye
- Sore throat
- Sinus conditions
Medical & ID Theft Protection
Medical and identity theft is constantly in the news. Identity theft can be a difficult crime for a victim and is on the rise. Once a person has been targeted, it can place a tremendous burden on a victim's finances and time and bleed over into the workplace in terms of lost productivity due to lost concentration and absenteeism. Early detection is the key to avoiding the expense and time to undo damage to an employee's digital health.
The Broker Problem
With the Affordable Care Act in place these last few years, health insurance brokers need the tools to help advise their clients on how to solve their problems and stay abreast of constant changes in the compliance driven world of employer health care.
While health care costs continue to rise, regulations continue to grow and commissions continue to shrink, health insurance brokers need new solutions to solve the continuing problems employers face in the employee benefit arena. As a worksite marketer over the years, I've always tried to position myself as a resource to the health care broker by delivering the broker products and services they could take to position themselves as expert problem solvers to their clients.
I did this by delivering enrollment platforms, supplemental insurance products that delivered employees a vast number of choices and the means to communicate the information needed for employees to make good choices about those products and services.
Employers still need these services. However, the results of the MetLife 13th Annual U.S. Employee Benefit Trends Study indicate the top two employers' benefit objectives are retaining employees (41.1% and controlling health and welfare benefit costs (37.3).
Using a mix of non-risk based, non-insurance products can offer innovative solutions to the age-old problem" the rising cost of healthcare, balance employee needs while recruiting, hiring, and maintaining the best possible workforce. Using non-risk based product and services is the next evolution in employee benefits. The smart broker will partner with a non-insurance based company that:
- Understands the employee benefit world and its inherent challenges
- Benefits that reward high utilization and shift costs away from the employer
- Has a portfolio of group non-risk based products and services
- Employs a communication strategy to drive utilization and customer satisfaction
- Has an enterprise level administrative system to service the broker and broker's clients
Recruiting, hiring, and retaining the best employees while controlling health and welfare benefit costs have been two of the leading concerns of employers and therefore a big concern for benefit brokers to help solve. The traditional solution of increasing premiums, raising deductibles or co-pays or just cutting benefits makes it difficult for the employer to recruit, hire and retain the best employees.
In addition, premiums are rising at a pace beyond the willingness and ability of the employee to pay. This can negatively affect employee retention. Adding a new perspective of operating in the paradigm of non-risk based product and services to solve the "Age-old Problem" can set you apart as an innovative problem solver in the employer benefit arena.
To become a forward thinker, we only need look to successful people and how they are solving the same problems your clients have, that of recruiting, hiring, retaining the best employees while controlling health and welfare costs. Brokers can add value to their consulting and brokerage services by shifting paradigms and look to the next innovation in employee benefits.
- Insights from Metlife's 13th Annual S. Employee Benefit Trends
- "Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Adherence for Chronic Disease." NEHI 2009
- Average cost for level 1 non-emergency visits. com
About the Author
Dr. Rick Dumas is National Sales Director for MedCareComplete, responsible for the overall administration, operation, sales development, and distribution. MedCareComplete is a compilation of non-risk based products and services to protect the physical, financial, and digital health of its members.