Health insurance doesn't necessarily protect members from incurring
An estimated 92% of the U.S. has
First, employers have to identify the problem, says Ashok Subramanian, co-founder and CEO of Centivo.
Read more:
"Most human resource executives who make these decisions generally assume that their employees are satisfied," says Subramanian. "And we're not going to move forward until employers are a little bit more self-aware and have empathy for what their employees are going through."
According to Centivo, employers felt that 83% of their workforce was satisfied with their health plan — but the employees reported that just 61% were satisfied. It's the difference between a B and D grade, and many employers do not know they're failing, stresses Subramanian. He notes that since executives generally are towards the top of their company's pay scale, benefit leaders may not fully understand just how little disposable income the typical employee has each week. One in three Americans cannot afford an unexpected expense of $400 or more, according to Centivo. If they need to see a specialist or get tests done, poor coverage may mean financial hardship.
Subramanian advises employers to assess whether their health plans make care affordable. This means looking into the utilization of the health plan — analyzing claims data, and seeing just how often employees engage with their plan — as well as identifying whether employees have a primary care physician. If employees are using their health plans sparingly, and for urgent care or emergency room visits, then employers might have a problem.
"The reality is most services a person needs over the course of the year can be handled by a primary care physician," says Subramanian. "And if a specialist is needed, it's best if it's guided by a primary care team so that you can actually get to the person who is most qualified for your need. For example, you may not get the right orthopedist for your condition if it's a hip issue versus a knee issue."
Read more:
Primary care is not only cheaper but is often the first step in identifying illnesses or conditions before they become severe. And the earlier you catch the problem, typically the less expensive it is to treat it, explains Subramanian. That's why low primary care engagement usually translates to higher medical costs down the line.
However, the underlying red flag is that employees find primary care too expensive to access in the first place. If a primary care physician feels out of reach, then how can the rest of the health plan be affordable? That can lead to employee health deteriorating.
"If you don't change the oil in your car, you're going to end up paying for that mistake later," says Subramanian. "If I'm skipping doctor visits because of big deductibles and coinsurance, then you're more likely to end up in an emergency room for a condition that may have once been easily solved through medication."
Read more:
Subramanian believes the key to an affordable health plan is low premiums (ensuring workers sign up for the health plan in the first place) and free primary care.
"The way that we've worked to lower the cost of care is by empowering every employee to have a relationship with an advanced primary care team," he says. "Typically, we find that there's about a 20% to 30% savings opportunity."
Subramanian underlines that infrequent use is not a sign of a good health plan, and the sooner employers assess the affordability of their plans, the sooner they can improve them.
"People are yearning for change," he says. "The more employers start to realize that gap in satisfaction, the more likely they are to embrace new approaches to their healthcare."
