About WISHRM

By Mike Roche, Member Services Manager, The Alliance
 
When you look at where employees are spending your health care dollars, sometimes you just have to sigh.
Here are two examples:

• Employee A goes to the emergency room on a weekday for a problem that could have been treated at the doctor’s office. When the employee gets the bill, he complains to Human Resources about the size of the bill – and his out-of-pocket cost.
• Employee B ignores flyers and posters about reasonably priced MRIs at a free-standing facility and instead gets an MRI at the hospital. Again, the bill proves eye-opening to the employee.

These employees paid higher out-of-pocket costs for unnecessary care. They also cost your health plan more money than it needed to spend.

Self-Funding Can Help

Self-funding gives you tools that you can use to encourage employees to do the right thing for their health and their pocketbooks. To have the greatest impact, aim for “win-win” strategies that benefit the employee while saving money for the health plan.

Ideas worth pursuing as part of a self-funded health benefit plan include:

• Design steerage programs that guide employees to high-value health care. For example, The Alliance offers the QualityPath program to guide employees to high-quality care that saves money for the employer and employee alike. That’s a win-win.  
• Use value-based insurance design (VBID) to reinforce smart choices. A VBID approach to caring for chronic conditions might lower the cost of medications for diabetic patients, for example. The goal is to help employees care for their condition now so they can avoid the costly problems that occur if the disease advances.
• Create consumer-driven health plans that combine high-deductible health plans with health savings accounts (HSAs). The employer can help fund the HSA to create an incentive to switch.
• Educate employees about their options. Cost and quality vary wildly. Give your employees insights about quality and access to cost estimates that help them compare providers. Introduce tools like Choosing Wisely to help them understand the impact of health care decisions.
• Give employees access to care via telehealth. With the right provider and the right promotion, telehealth can help you expand access while encouraging employees to access the right level of care for minor problems.
• Nurture a culture of health. Tying your wellness program to the health plan can reduce absenteeism, alleviate “presenteeism” and boost morale and engagement.

Every one of these ideas offers a “win” for the employee as well as the employer. The goal is to help employees and covered dependents save by helping them make better choices. Instead of avoiding care, you’re helping employees pick the right care at the right time in the right place.

Partner for Success

The right partners can help you make consumerism part of your self-funded health benefits. It’s worth noting that self-funding vendors often have a greater interest in pursuing consumerism. That’s because their reward comes from helping the employer succeed.

As you work with vendors who support self-funding, seek out partners who share a commitment to consumerism. This goes beyond simply offering options to providing a toolkit of communication materials to persuade employees that consumerism is in their own best interest. 

So your telehealth partner should not just link employees to caregivers; they should also offer tools and information you can use to persuade employees to adopt it.

Likewise, your network partner should go beyond simply listing in-network providers to help you educate employees about how to decide where to go for fairly priced care.

Data Matters

Health plans may claim to give you some or all of these tools, but it’s rare that they can match self-funding’s ability to target your employees’ needs and health care usage. Self-funding lets you address issues at a deeper level because you have access to your health plan’s data.

That data helps you identify where your health care dollars are going, which spending represents potential waste or overuse, and where you can find opportunities to guide employees to high-value care. For example, The Alliance offers reports that help employers analyze utilization and its impact on costs.

The goal is to refine your health benefits program to obtain more health for your employees and dependents, not just more health care. In a self-funded benefit plan, consumerism helps you enlist employees so they become a vital part of that strategy.