Today’s workforce is very different than it was 10 or even five years ago. What employees are looking for in terms of benefits continues to evolve as their needs and expectations change. Making sure your clients' organization’s benefit offerings are able to meet these changing needs and expectations can have a significant positive impact on your client's ability to recruit and retain in a competitive talent marketplace.
The primary change in the benefits market is one of focus. Benefits used to take the wide view, providing standardized offerings communicated to employees via standardized, mass mailings or emails. Service and support were provided by large call centers, where employees were all treated the same way. From the employer perspective, one of the major focuses of benefits plans, especially health plans, was to contain costs.
But as employees have become more involved and informed partners in their healthcare, what they’re demanding from their health insurance benefits has changed. Rather than a standardized set of benefits offerings and a generic service and support experience, they seek more targeted, personalized options.
Medical opinion and decision support services can play a key role in providing employees with both the personalized information and support they want and the evidence-based information they need to make informed medical decisions. In addition, these services also can help address employer concerns about healthcare costs by guiding employees to the most appropriate care and best healthcare providers, which lowers the risk of costly medical errors, duplicative and unnecessary diagnostic testing and inappropriate treatment. Employers and organizations also benefit when employees receive the most appropriate care because both absenteeism and presenteeism are reduced, which decreases the costs associated with lost productivity and hiring temporary or permanent replacement employees to cover for those who are ill or injured and unable to work.
When expert medical opinion and decision support services were first developed, they were primarily delivered through insurers and administrators in the form of case management or mandatory second surgical opinion programs. These services were structured primarily to save the insurer money in claims payouts and employees quickly figured this out. Many viewed these services with skepticism and suspicion, feeling that the goal of cost containment was not necessarily in the best interest of their health and wellbeing.
In response, an industry of third-party medical opinion and decision support services emerged. These firms sought to provide an independent and comprehensive solution that delivered unbiased reviews of a diagnosis or treatment plan and recommendations of physician and facilities that were best suited to provide the needed care. Most of these services worked by referring employees to a physician or facility in their database and many are handled entirely online.
While these services do provide some valuable information and support to employees, they don’t offer the personalization employees want and need to navigate an increasingly complex health system and the overwhelming amount of medical information, some of it accurate, but much of it questionable, available on the internet. So now employers are looking for resources and partners that can improve and personalize the employee health experience. The 2017 Willis Towers Watson Employer Trends in Health Care Survey found that 96% of the large employers who responded to the survey view the improvement of the employee health experience as a top priority over the next two to three years. Respondents cited improved employee engagement, increased employee satisfaction with their health plan, an improved employee value proposition, and a direct positive impact on long-term healthcare costs as the reasons they’re working to improve employee health and wellbeing programs.
What the next generation of healthcare decision support services looks like
Moving forward, both employers and employees want a champion — someone who can deliver a deeper, more personalized healthcare experience for employees, which in turn builds both employee satisfaction and loyalty to the employer and helps ensure that employees get the care and support needed to stay healthy and on the job.
To achieve these goals, what employers should look for in the next generation of healthcare decision support services is:
· Personalization: The employee and his or her needs and wants are the central focus. Support and services should be provided by an experienced, dedicated adviser who not only provides referrals to curated physician experts and centers of excellence, but also works with and supports the employee from end to end, providing the latest evidence based information and support to help employees make healthcare decisions.
· Rapid response: Diagnosis and care plan review, research and facilitated access to healthcare providers should happen within days, not weeks.
· Coordinated communication: The healthcare decision support team should coordinate all communication and referrals between the employee, healthcare providers, health plans, TPAs, EAP and other health benefit vendors. Coordinated communication helps lower the risk of misdiagnosis and delayed diagnosis, medical errors, inappropriate care, missed follow-ups on test results and treatment plans, and unnecessary testing and treatment.
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