Workers with employer-sponsored health care often struggle to understand the benefits available to them. They seek support both for choosing appropriate plans and for navigating the health care system with their coverage.
Ill-informed health care decisions drive up the cost of care and are detrimental to employees' health and well-being. Online navigation platforms aim to help employees make better choices.
According to research by Quantum Health, a health care navigation and care coordination company, 88 percent of employers said their workers were confident in understanding their health care benefits but only 35 percent of employees felt it was easy to navigate the health care system. The firm's researchers surveyed 1,001 employees and 250 employers during March and April 2021.
That data is supported by research from Maestro Health, a health benefits third-party administrator. The firm's survey of more than 1,000 consumers earlier this year found that 70 percent felt they don't have the support they need to understand their health care. "Without guidance on which services are covered and which providers are in-network, high-quality and cost-effective, people overpay and put their own health at risk," according to a white paper by the firm.
On the flip side of these findings, companies with effective communication and education about health care can see significant positive results.
Help for HR Departments
Sina Chehrazi, co-founder and CEO of Nayya, a health navigation platform, points to a case study of Pegasus Senior Living's use of a decision-support platform for its 2,500 employees. Using data and artificial intelligence, the platform personalizes the enrollment experience for employees based on their medical history, unique characteristics, lifestyle and financial profile.
Pegasus said it saw a significant decrease in the administrative burden on HR related to employee health care benefits, decreased per-employee medical costs, and increased enrollment of employees in high deductible health plans and critical-illness and accident insurance.
Health care navigation platforms have been around for over a decade, but they are evolving and improving "to help employees make more optimal use of their benefits," said Paul Fetterolf, area vice president with Gallagher, an insurance, risk management and consulting firm.
These platforms, he said, can be used either as part of a benefits administration dashboard or as a stand-alone tool.
Even before the pandemic, Fetterolf said, "employees overwhelmed with information were asking for help in making sense of their benefits and using them in a way that provides them the highest value."
According to Jellyvision, a provider of benefits navigation software, platforms that include a chatbot feature can answer common benefits questions in real time, such as "what is my deductible," meaning less question-answering by busy HR team members.
Marcia Otto, vice president, product with HealthAdvocate, a firm that provides support to help employees navigate the health care system, said she's seen increasing interest in health care navigation systems, but also "a long uptake for [employers] to purchase them and offer them to their employees."
Companies should note, however, that they also benefit when employees make smarter health care decisions.
"When employees are more informed and educated about their benefits, it's a win-win," Fetterolf said. "Employees make better health care choices, and the employer benefits from a healthier workforce and the cost savings that go along with that."
What to Look For
Effective use of health navigation platforms relies heavily on personalization—but the right kind of personalization.
"Personalization of health care information goes well beyond identifying the employee by name upon login or defaulting to a personalized dashboard," Fetterolf said. "Sophisticated systems take data about you—or people like you—to guide and support decision-making."
A platform, for instance, might use individual or aggregated data to suggest benefits packages best suited to the needs of employees and their dependents. Or it might help employees save money on health care by recommending specific programs offered by the employer, such as financial well-being or health care spending accounts.
At the basic level, Otto said, there are systems that simply show employees their benefits options and provide links to them. More-sophisticated systems, she explained, can leverage benefits about the employee based on information they've provided or their health history to customize the experience for them—even the ability to generate reminders or prompts when employees should be making appointments or taking other actions relative to their personal health care needs.
Employers also benefit from aggregated data that helps them track the health of their workforce and identifies prominent health risks that can be addressed through wellness programs, such as high rates of diabetes or pre-diabetes.
Platform features HR leaders should look for include:
- Personal messaging. Look for the ability to reach employees in ways they prefer or ways that have proved effective for improving engagement.
- The ability to connect and exchange data with other key platforms. "If the health navigation tool is not part of a benefits administration platform, interoperability must exist between these two systems," Fetterolf said.
- Mobility. Access through smartphones as well as other devices "is a must-have for any consumer technology," Fetterolf said. "To be successful, you need to meet your employees where they are."
When considering systems, Fetterolf advised employers to define their needs upfront, starting with some basic questions:
- What are employees asking for?
- What employee benefits questions does HR field most frequently?
- What are the organization's requirements for implementing new HR technology?
- What is most important to you in implementing new technology—customer service, ease of use, affordability, return on investment, compatibility with existing tools or something else?
"The American workforce has gone through an extraordinary evolution since early 2020, and employers are stepping up to the plate to provide additional support for employees and their dependents," said Kara Trott, Quantum Health's founder, board chair and senior advisor. When considering navigation solutions, she said, "helping employees break through challenges caused by increasing health care complexity should be a priority."
Communication Beyond Open Enrollment
Finding a solution is just the beginning. Ongoing communication and education are critical to ensure effective use of navigation systems.
"If we learned anything during the pandemic, it's that people just don't care until they care," blogged Jellyvision CEO Amanda Lannert. Employees are "not thinking about their benefits … until their kid breaks an arm, they realize a visit to a therapist is in order, or they're faced with a once-in-a-lifetime pandemic."
Given this situation, she added, software developers are aiming to create "a benefits engagement platform [that] helps employees make smarter decisions in the moments when your benefits are most meaningful to them."
"There need to be communications telling employees that this exists," advised HealthAdvocate's Otto. The platform itself, she said, should also have the functionality to reach out with messaging to employees based on their characteristics, needs and interests.
Lin Grensing-Pophal, SHRM-SCP, is a Wisconsin-based business journalist with HR consulting experience.
Related SHRM Articles:
Health Care Advocates Help Employees Through Serious Diagnoses, SHRM Online, October 2020
Helping Employees Navigate Health Benefits During Open Enrollment, SHRM Online, September 2020
Chronic Care Management Keeps Health Spending Under Control, SHRM Online, November 2019
Data-Driven Benefit-Selection Tools Are Just Getting Started, SHRM Online, September 2019