To cut health plan costs, many employers are moving toward a self-funded plan that provides transparency into claims data. But gaining access to data won’t magically cut costs overnight. Even a 500-employee self-funded group that spends time analyzing data, implementing drug carve-outs or limiting a primary care network may not immediately see the needle move toward more efficient healthcare.
Employers can make plan design changes and educate employees throughout the year, but the best way to reduce healthcare costs is to reduce healthcare costs at the source — that is, to help employees use healthcare as efficiently as possible.
Medical and prescription plans are complicated and difficult to use; so is the healthcare system. Helping employees consume benefits efficiently means guiding them to appropriate behaviors when they are actually using their benefits. Health events tend to be emotional situations that employees and their loved ones must navigate — it’s a situation that’s rife for potential errors in judgment. But benefits managers and other benefits advocates can guide employees to the right care and provide resources to help them use their benefits effectively.
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Benefits advocacy becomes a first-to-call resource for plan participants. Rather than reaching out to an insurance carrier first — whose issue resolution success is measured based on the call time — employees contact their benefits advocate, who is trained to answer questions, deal with insurance claims and support them on their medical journey.
The advantages of connecting plan participants with a benefits advocate are many. Benefits advocates can deliver information that plan participants request and take extra time to educate them on how to efficiently use their benefits. If an employee calls to ask what their emergency room visit deductible is, for example, a benefits advocate will provide that information and also educate the caller on when it’s appropriate to go to the emergency room versus using urgent care. Urgent care often provides a better patient experience, a lower out-of-pocket cost for the member and can ultimately lower claims for the employer.
The same goes for prescription benefit questions. Benefits advocates educate plan participants on the difference between generic and name brand medications, and when it may save the individual money to turn to a mail order pharmacy versus a retail pharmacy.
Benefits advocates become an extension of the benefits communication platform, helping to educate participants when plan changes are made. This sort of education has proven to be helpful for employers switching to high-deductible health plans that require more financial responsibility on the part of the participant.
With the help of a robust benefit advocacy program, employees and participants can more easily make decisions about their care.
Cost savings also comes in the form of time saved for employees, who can focus on their jobs and their families while a benefits advocate helps them get the right care or resolve complicated and confusing health insurance claims.
The employee is healthier and happier — and the employer has created a pathway to more efficient benefits utilization and engagement.
