Drive Better Results Using Best Practices in Health Benefit Management
Every year when we tabulate our survey results, we eagerly dive into the results for jumbo employers (those with 20,000 or more employees) to identify and measure movement in the latest health benefit management trends. The jumbo employers have long been the pioneers driving health care innovation. They cover more people, so more at stake. They also tend to have more resources - people and financial - to devote to the cause. Their focus is not just cost, but also includes the other two components of the triple aim - quality and engagement. How do we know it works? Historically they have demonstrated lower rates of increase in health care cost than the overall averages and at the same time maintained richer benefits (lower deductibles, etc). But the real proof is in an analysis we do of 25 best practices across large employers in three areas – plan design, workforce health, and care delivery – where those in the top quartile for most best practices outperform those in the bottom quartile with about one percent lower trend.
Cost-management best practices
Plan design and delivery infrastructure |
Employee well-being |
Care delivery |
| Contribution for family coverage in primary plan is 20%+ of premium | Offer optional (paid) well-being programs through plan or vendor | High-performance networks |
| PPO in-network deductible is $500+ | Provide opportunity to participate in personal/group health challenges | Surgical centers of excellence |
| Offer CDHP | Offer technology-based well-being resources (apps, devices, web-based) | On-site clinic |
| HSA sponsor makes a contribution to employees’ accounts | Worksite biometric screening | Telemedicine |
| Voluntary benefits integrated with core | Encourage physical activity at work (gym, walking trails, standing desks, etc.) | Value-based design |
| Mandatory generics or other Rx strategies | Use incentives for well-being programs | Medical homes |
| Steer members to specialty pharmacy for specialty drugs | Spouses and/or children may participate in programs | Accountable care organizations |
| Reference-based pricing | Smoker surcharge | |
| Data warehousing | Offer EAP | |
| Collective purchasing of medical or Rx benefits | ||
| Transparency tool provided by specialty vendor and/or used by 10% of members | ||
| Use private health benefits exchange |
While we like to pay attention to what jumbo employers are doing and use it as a lens to predict market movement, it does not mean they are the only employers doing innovative things. Let's take a look at some newer practices that we all could take advantage of:
- Provide access to Accountable Care Organizations. While the ACOs are still very much in the developmental stage, the move from fee-for-service to value-based care is starting to take hold to deliver better care.
- Expansion of the scope and reach of Centers of Excellence (COE) is another emerging trend. While we see the list of conditions for COE expanding, there are two schools of thought about how many facilities are best to offer. Some programs identify a small number of best-in-class facilities nationally and others take a regional best-in-class approach to provide access a little closer to home.
- Use technology to engage employees in caring for their health. Employers are incorporating wearables and mobile apps into their well-being programs to help
- Telemedicine is one of the fastest growing trends. It offers employees a way to access care at a significantly lower cost in the convenience of their homes.
- Onsite services are another way to "meet employees where they are.” Worksite clinics, although not without their challenges, have been implemented by a growing number of larger employers. But smaller employers have new options to consider in this space, like shared or near-site clinics.
Where to start? One of the best practices that has been on our list since the very beginning is access to claims and utilization data in a data warehouse. It is likely not feasible or even practical, to try to do everything. Use your data to identify where the greatest opportunities are to focus your efforts and get you on the right path to tackle the triple aim.