Tuesday, Dec 12, 2023

Building Better Hallways for Coordinated Care; Improving Outcomes and Reducing Costs

Nupur SrivastavaChief Product Officer, Included Health

HLTH

Are we easy to do business with?” 


At HLTH, I had the chance to sit down with Juli Galloway, Vice President Global Benefits at AT&T, who shared this quote as a prism for how her team thinks about healthcare benefits. Her belief is that if accessing healthcare and understanding your benefits to get that care is hard, it is unlikely employees will seek that care.


“What is my copay?” 


“Will my virtual primary care physician be plugged into my in-person specialty care?” 


“Where am I supposed to obtain information about my family planning coverage: my health insurance or the company that manages our fertility offering?” 


Navigating healthcare is dizzying and America’s workforce is overburdened by understanding their benefits rather than actually benefiting from them. This rang true in the recently released Included Health’s Workforce Vitals Report, a data-driven analysis revealing insights into America’s workers when it comes to healthcare. Looking across a diverse cross-section of 2,500 individuals spanning job types and levels, industries, demographics, geographies, and company sizes, the analysis showed that:

  • 48% of employees report it is difficult to understand health insurance benefits;
  • 42% say it is difficult to find a high-quality doctor or specialist; and
  • Only 1 in 3 workers say they aren’t confident that they are taking advantage of all their benefits have to offer (31%), or that they know what their benefits cover vs. not (30%).


All of this confusion leads to inappropriate care utilization ranging from under- (doing nothing) to over-utilization (treating the ER like your primary care provider). Which probably explains why over half of the American workforce says they have felt in poor physical (55%) or mental health (57%) one or more days in the past month. 


Many of the employer partners we work with have long seen and felt this pain and are moving away from what we’ve affectionately called “lighting up the tree of benefits.” By taking a more member-centric view and creating a single access point that integrates their benefits, employers like AT&T have made a huge impact on utilization, quality of care and lowering costs. 


Here are a few key principles and assets that employers should put into play when reimagining how they can simplify care.


Make Your Data Work Harder for You

Data plays a critical role in personalizing the experience for members. How, when and what type of communication you receive about your benefit options and potential care interventions can have a tremendous impact on your care journey, experience and ultimately your clinical outcomes. Every employer should be looking at their benefits and navigators to ask “How are you using data to reach the right members at the right time with language that inspires action?” and “Is it clinically-informed?” A clinically-led navigator knows how to leverage medical claims data, hospital admissions and more to intervene in the right way, at the right time, to drive the right decisions.


Clinical Expertise

Clinical expertise is crucial when it comes to healthcare. While obvious on its surface, it is by no means the norm in digital health. Whether it be to maintain a healthy lifestyle or to manage specific conditions having a top clinical expert who practices in a culturally affirming manner alongside you to manage your care leads to better outcomes (ex. Reduced hospital readmissions, hypertension rates, etc.) and lower costs. But what is arguably just as important is achieving trust. Because if someone feels physically and mentally better, saved time and money, and had a positive experience during a trying moment in their life, that individual will more than likely continue seeking care and help from the team that helped them achieve these outcomes.


Integration

The most innovative employers are deeply committed to ensuring their benefits stack maps back to their diverse workforce’s needs. And diverse can mean a lot of different things. Whether it be rural front line workers or a Manhattan-based corporate office employee, or a baby boomer thinking about retirement or a Gen-Zer in their first or second job out of school, employers who service all 50 states understandably need to serve up lots of options. But that can make it challenging to figure out where to go for what and how to access the myriad of benefits offered by an employer, especially without true integration. “Lazy integrating” — links that bounce a member from portal to portal — exacerbates these frustrations and can lead to suboptimal care. Real, meaningful integration that ensures employees only have to enter their information once, no matter which vendor or service they are interacting with. Juli shared during our session that she likes to think integration is an extension of “how we do business.” By minimizing fragmentation, employees can access the healthcare services they need with minimal confusion to live happier and healthier lives. 


Accessing healthcare doesn’t have to be hard. It can and should be simple. It can and should inspire trust. During our HLTH session, AT&T shared how All-Included Care™ is doing just that for its front line workers. Since rolling out this service earlier this year and making it easier for AT&T’s workforce to access care during convenient hours that align with their work schedules, AT&T is already seeing an increase in preventative care utilization and lower avoidable emergency room visits.


By taking a member-centric approach that emphasizes personalization and puts the care back in healthcare, we can simplify the experience in a way that works for everyone. 


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