Editor's Note: This article is part of a series on benefits technology. All stories in this series can be found here.
Normally, a wise business person wouldn’t support short-cuts on the path to success. But when it comes to benefits engagement, success means making paths to healthcare short. Really short — in some cases, only as long as it takes to walk next door.
In a new era of mobile-accessible benefits technology, gadgetry may seem like the short-cut benefits professionals have been waiting for. Data collection has certainly improved some aspects of wellness, especially as increased use of high deductible health plans (HDHPs) have forced both employees and employers to consider how employees access care.
But while HDHPs have driven consumerism and created better awareness of cost, few employees have the time or energy to research every option available to them — and computers can only help so much.
Now, more than ever, employees need tech-enabled human to human interaction to meet their health goals without breaking the bank. And some are doing it by turning to programs at once newfangled and old-fashioned: A doctor’s office accessible via telephone — or right at the workplace.
Meeting where the need is: Telehealth options
As any benefits professional knows, removing barriers to access is the hard part of the job. Any extra steps an employee might have to take to access their benefits is one more chance they simply won’t engage at all.
Many telehealth options offer employee access to doctors via their phones, which is one way to remove those barriers. But AbleTo’s model focuses on reaching out to high-risk employees, rather than waiting for them to call. A proliferation of healthcare data makes it possible to identify said employees; the trick to getting them to pick up the phone.
“When a healthplan provider reaches out, they think we are calling to collect a bill and don’t want to share details,” Dr. Steven Serra, senior medical director at Aetna, told HR Dive. Aetna partners with AbleTo on a number of plans. “Having an independent tele-behavioral provider is really critical because they aren’t the payer calling, they’re an independent organization.”
“The data is overwhelmingly convincing in that we just need to remove the financial barrier to the patient and the member.”
Senior medical director, Aetna
AbleTo focuses on behavioral health, a key wellness issue that is gaining increased attention in the benefits space thanks to how many health problems are underpinned by depression, anxiety or other mental health issues. AbleTo’s model represents converging ideas in wellness — the focus on mobile accessibility and data gathering, combined with access to connect with actual humans.
But however obvious it may be, money remains a barrier as well. If it has a high-cost up front, an employee won’t use a benefit, so employers have to get creative in how they split the funding and create access.
“CDHPs tend to drive consumerism and create better awareness of cost and necessity of procedures...but deductibles can be a major barrier to care,” Serra said. “The data is overwhelmingly convincing in that we just need to remove the financial barrier to the patient and the member.”
A case study in onsite care center coaching
Telehealth is an important innovation in healthcare that has transformed access in some companies, but some organizations are opting to cut the middle man entirely and bring a clinic onsite.
The City of Plantation in Florida has near 100% participation in their current wellness plan, from both employees and spouses, largely thanks to their onsite program.
“Government sometimes gets a bad rap,” Margie Moale, HR director for Plantation, told HR Dive. “But we are on the leading edge.”
Moale has worked for Plantation for almost 11 years and she took note of her workplace’s “family culture” that has been key to holding down medical costs for their employees. But nine years ago, she noticed that their health insurance costs were “rising significantly,” threatening their ability to provide the rich insurance plan they wanted to offer.
“The controls didn’t seem to be there and we didn’t have much of a wellness program at that point,” she said.
The City wanted a program focused on total well-being, and decided to seek out an onsite vendor for a clinic to serve their employees. They eventually settled on Marathon Health, who remains their partner today.
“It was the total wellbeing,” Beverly Ambrosio, Benefits Manager for the City of Plantation, said of why they opted for an onsite clinic. “Looking at the patient as a total person. Making a point of taking that encounter and taking that to a total health management program. We have definitely seen the results of that.”
Most benefits experts know the 80:20 rule, in which 20% of the population (usually those suffering from various acute health issues) drives 80% of healthcare spend. Since the implementation of the onsite program, the City of Plantation has saved $4 million in healthcare spend overall.
Communication matters no matter what tool you use
One of the reasons Plantation has saved so much money is their reliance on a benefits committee, made up of employees from various parts of the organization. The benefits team explains the benefit situation to the committee, who then can take that information back to their own teams. The committee also brings their concerns and needs to the benefits team in turn. Communication is constant and open.
“The benefits committee helped communicate to our employees that claims equal premiums,” Moale said. That transparency and honesty helped employees understand how they could keep their own costs down by becoming better healthcare consumers. The onsite clinic had a flat fee for all basic care, reducing cost risk to both employer and employee.
“We’re only two people, with 750 employees,” Moale said. “There’s no way we can be there for everyone. There are some people we don’t even see. But the benefits committee does.”
Prior to the clinic, Plantation didn’t have any kind of health reporting in place, Ambrosio said. They occasionally held health fairs and had limited biometric screens with next to no predictive capabilities. But now, they enforce a “three steps to wellness” plan — an online assessment, a biometric screening and a one-on-one total health review with a clinician — that is a combination of powerful technology and human touch.
Teaching employees how to use the right tools
Wellness data tracking remains a problem for a lot of employers, regardless of whether the program relies on onsite caregivers or telemedicine, partly because wellness is often perceived as some vague way of life that can’t be tracked, said Dave Demers, Vice President of Business Intelligence at Marathon Health.
In reality, wellness involves direct interaction with actual medicine.
“I can remember wellness used to be health fairs and brochures and balloons. Well-intentioned soft stuff,” said Demers. “But this is healthcare. It’s a fundamentally different perspective on the role of the patient in the process.”
Metrics have evolved to meet employer need, specifically focused on population health and clarity of data including utilization, basic actuarial cost, visits to primary care physician per person per year, and more. If a wellness program is successful, those stats should change over time, Demers said.
But even helpful tools can become overwhelming if an employer doesn’t consider how they will actually be used. That’s why the coaching, one-on-one aspect of the onsite clinician program can be such a huge boon to employers trying to keep their employees engaged. Having a guide within the system helps employees feel like they can actually conquer it.
“It can be a very cumbersome system,” Mary Meyer, national director of health coaching at Marathon Health, said of healthcare. “There’s not a guarantee that employees can utilize the tools or navigate them. Part of the role is harking back to helping the patient utilize the tool to their benefit. They feel like they are equipped finally and have someone on their side.”
Improved wellness stats should reflect a vested interest of an employer in the total health and wellbeing in its employees — and that means giving employees the time and resources to fully treat their health issues.
“It’s about listening and showing interest,” Demers said. “People don’t get that in healthcare. There’s not true appreciative inquiry going on.”
Ultimately, all wellness tools should allow employees to feel as though they made the change for themselves — empowered to transform their own health. Good benefits tech helps employees set up manageable goals and provides coaching that allows an employee to take the risks they need to take.
“Acute care even can open up the conversation about where they are at and where they aspire to go, and building skillset about behavior change,” Meyer said. “We’re really looking at the long-term vision of that and empowering that patient.”