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Cracking the Code on Managing Healthcare + Benefits Costs

Prashant Srivatava May 15, 2019

In my previous post about the rising costs in healthcare and benefits, I asked you to imagine a pie chart that shows your company’s total expenditures, and how much of that chart was taken up by healthcare and benefits spending.

Chances are, that slice of the pie has been getting larger over the past couple of decades. On one hand, healthcare spending has been increasing at rates significantly higher than inflation; on the other hand, various types of benefits—from student loan repayments to gym discounts—have been added to keep attracting the best talent, particularly in tight labor markets like the present. And while you may have purchased a number of programs to help encourage smarter healthcare spending, such as incentives and higher cost sharing with employees, the upward trend continues.

Most people would like to save money, get healthier, and take full advantage of their new work/life benefits—but they need the right guidance. They need tools with the intelligence to help them reduce their out-of-pocket spending and get more value out of their benefits packages.

What large employers need is a platform that addresses these exact points. When employees make smarter healthcare and benefits decisions, they not only get healthier, they spend less (as does their employer) and stay more loyal to their companies.

Low-hanging fruit: Better plan selection

Guidance begins with the first interaction with benefits, and it recurs every year: open enrollment.

Many people tend to stay in the same health plan year after year, even if their spending circumstances have changed or will change in the coming year. Employers need a tool that fights this status quo bias, which commonly kicks in when people are faced with an overwhelming amount of information and choices.

Evive Plan Choice breaks that bias. It applies relevant claims data to guide people toward the optimal plan for them—often, one that will save them money. It allows employees to easily compare plan options with clear breakdowns and visualizations of the details involved, so they can ultimately make an informed selection.

Let’s say an employee, Lucy, is enrolled in her company’s PPO plan and provides coverage for her daughter. She pays high premiums but appreciates the low cost sharing, as she and her daughter occasionally visit the doctor for common colds or versions of the flu that go around at her daughter’s school. When open enrollment comes around, she falls prey to the status quo bias and doesn’t intend to change—even though she could save a good amount of money by switching plans.

Enter Plan Choice: When Lucy logs in to enroll this time, she sees her total expected cost of care with each plan option based on her past utilization pattern, as well as information on which of her doctors are in-network with each plan. She can add an upcoming procedure or another type of anticipated care to recompute her options, if she so chooses. Before receiving this easy-to-digest information, she hadn’t considered how she could save money by choosing a different health plan.

Her results from Plan Choice show that her optimal selection would in fact be the high-deductible health plan (HDHP), and the clearly communicated information helps her understand why it’s a logical choice for her circumstances. Lucy enrolls in the new plan, seeing that she’s going to save money, can open an HSA to budget for the expected out-of-pocket costs, and gets to keep her in-network doctor.

By receiving personalized guidance, Lucy keeps a bit of extra money in her paycheck for day-to-day living expenses and can save for future healthcare expenses appropriately.

Putting that plan to use

When an employee chooses a high-value health plan, that’s a win for them and for their employer. But when it comes to actually using those health benefits, how can people ensure they’re doing so in the most cost-effective way?

Providing guidance in healthcare consumerism can be difficult, as the experience is more nuanced than other consumer experiences. While cost matters, convenience and quality can be just as important—if not more so—which often leads people to choose more expensive options to avoid the risk of poor care.

Evive Best Match takes those factors and mirrors intuitive consumer experiences to help people connect with trusted sources of care at a fair price. Let’s revisit Lucy: Now enrolled in the HDHP, she’s worried and cost-conscious when she starts experiencing back pain and needs to get an MRI. Using Best Match, she inputs her priorities, reviews all of her options (sorted by quality first, with accompanying cost and location details), and ultimately settles on a high-quality facility that’s an extra mile away from her office but less expensive than procedure prices at the closest one.

After the MRI, she receives a message from her MyEvive app (our digital navigation platform) to try a musculoskeletal disorder program. The program can help her with a personalized exercise regimen, give her hints and tips for reducing pain, and enable access to a health coach. She signs up with a single click and manages her back pain with confidence over the next six months without needing additional treatment. Ultimately, this saves her even more money by avoiding unnecessary medical care and pain-management prescriptions.

By piecing together this fragmented information into one personalized experience, employees can get the guidance they need to cut down on wasteful spending. They’re able to find lower-cost options with trusted quality scores, reducing the risk of costly complications and the need for further care.

Where savings and benefits engagement meet

Opportunities for cost savings across health, financial security, and work/life success are abundant in MyEvive, powered by the intelligence of eOS. From nudging an employee to take their allergy meds on a high-pollen day, to connecting them seamlessly with an FSA to fund their child’s daycare, to reminding them of their employer’s gym discount, a solution like this is key to guiding people toward better decisions in their everyday lives.

These solutions are what keep that benefits-spending portion of the pie from growing out of control, and they bring more value to the benefits experience. When people choose the right health plan to begin with, engage with those benefits in an informed manner, and get relevant nudges for healthier lifestyles all the while, smarter spending and lower costs can result for employees and employers alike.