While health benefit plan partner selection remains predominantly in the benefits domain, human resources professionals have a stake in the decision-making process as well. Benefits and finance-related decisions tend to center around networks, discounts, administrative fees and claim adjudication. But, for the organization seeking to optimally leverage their health plan relationship to support larger organizational imperatives such as values alignment, engagement, productivity and longer-term workforce sustainability, HR can add an additional perspective.
The following highlights several areas where the HR value-add can be incorporated into the requirements definition and selection criteria during the health plan “RFP” and evaluation process. Not all will be applicable — or even a consideration — in every instance. And larger employers — especially larger self-funded employers — will have the greatest amount of leverage to include these added opportunities during the negotiation process.
- In addition to looking at access, disruption and the discounts, can we determine the opportunities for us to best align our plan members with value-based network providers, high-performance networks and centers of excellence?
- How effective is the potential service provider in delivering on not only physical health care but also emotional health needs, including employee assistance plan services, mental health and substance abuse as part of our overall emotional and social well-being efforts? If we are considering multiple partners in this area, what assurance can we get on their ability to effectively integrate and coordinate with other entities to help assure a seamless member experience?
- In our major locales, do we have members who face limitations in accessing — or barriers to receiving — care? Can we offer greater support to those facing limited transportation capabilities, insufficient health resources, cultural barriers or family constraints? If so, what help can the health plan offer to overcome these social determinants of health (SDoH) via their relationships and
support from community services or other resources? Can they demonstrate analytics that would help us leverage these capabilities?
- Can we leverage the health plan to reinforce our organization’s brand, values and desired employee experience through an aligned health-care experience supported by concierge-style support, navigational tools and decision assistance?
- Can we obtain a specific Net Promoter Score (NPS) for our group to gauge member satisfaction with the healthcare experience?
- Is reporting available that will contribute to our reporting efforts for Environmental/Social/Governance (ESG) and Sustainability Accounting Standards Board (SASB)?
- Beyond the opportunity to manage direct health-plan claim costs, are there opportunities to align with a partner that can better support managing indirect costs through better preventive care, chronic condition management and oversight of complex care beyond just paying claims?
- Can the health plan provide predictive modeling and risk profiling of the covered members and recommend plan design or care management opportunities that will aid in our efforts to demonstrate continued value accretion via a healthy and engaged workforce?
To optimize the potential for more efficient, higher-quality care that will support well-being efforts, helping keep people on the job, and, when treated, enable them to return to productive work as quickly as possible.
To position the involved health plan resources effectively within the broader employee well-being portfolio especially as it relates to physical and emotional health to maintain or improve well-being, productivity and return to work.
To improve the well-being and access to care for at-risk population segments and to help assure their ability to be healthy and productive on the job. This is especially a need in economically challenged urban areas as well as rural areas.
To further branding and the employee value proposition through the health plan and enable concierge-like assistance from point-of-need through an episode of care and through to recovery and return to work.
To effectively and empirically track member satisfaction with the health plan and contribution overall to the organization’s employee satisfaction metrics.
To provide a foundation for ongoing program improvement, maximize opportunities for proactive management of emerging conditions and support reporting to investors for ESG and SASB purposes on workforce well-being and longer-term sustainability of workforce productiveness.
Indirect cost savings include the reduction in lost time, a more rapid return to work and increased productivity value that arise when conditions are better managed, care is more efficient and higher in quality and outcomes are improved. Studies have suggested that this value can be 1.5x to 2x the cost of the actual direct medical claim.
As data becomes more robust and as machine learning enables deeper insights into complex data, health plans are increasingly able to profile future health risks and members at risk, enabling better planning and budgeting and more effective outreach to help keep workers productive and on the job.
Putting It All Together
The health plan is a critical player in HR efforts to improve employee wellbeing, optimize on-the-job performance and sustain a healthy, productive workforce for the future. The traditional components of health-benefit plan evaluation remain as important as ever, but even greater value can be obtained to support larger organizational goals by incorporating the type of elements suggested here. Each organization will need to consider what matters to them, and, as noted, the greatest opportunities to achieve these broader value-adds favor the larger self-funded employer. That being said, employers of all sizes can consider how they could leverage certain points.
The bottom line is this: HR input beyond the traditional benefits focus is a valuable contribution from planning to actual selection of a health-benefit plan service provider. Anything less risks missing out on potential added value.
Randall K. Abbott is senior strategist emeritus, now retired, from Willis Towers Watson.