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Co-founder & CEO

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Sean Duffy: Sean is certain that behavioral medicine is at an incredible tipping point of innovation, thanks to technology and design. He holds a BS in Neuroscience from Columbia University, was an MD/MBA candidate at Harvard, and formerly worked for Google and IDEO.

COVID-19 Discussion with Omada Health

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Senior Content Development Manager

It&#39;s no secret that employee wellness and benefits engagement are important. A company is only as strong as its employees. However, a robust wellness program that encourages benefits utilization does more than just create healthy, happy employees. Better benefits engagement can also boost the bottom line.  A commissioned study conducted by Forrester Consulting on behalf of bwift surveyed 300 HR and EX professionals in February 2023 and found an increased focus on employee wellbeing and benefits engagement—more than 80% of respondents agreed that improving benefits offerings, awareness, accessibility is a priority. But, overall, utilization is still low. Don&#39;t miss out on <a href="https://marketing.bswift.com/acton/fs/blocks/showLandingPage/a/5166/p/p-0123/t/page/fm/0" target="_blank">the full survey results and insights</a> on what drives a culture of wellness and how to improve employee engagement with benefits. To improve the employee experience, recruitment, retention, morale, and productivity, you need to know how to cultivate a culture of wellness that’s supported by robust benefits engagement. When you promote better employee benefits engagement, you can enjoy better business outcomes. Employers that don’t address the root causes of low benefits engagement risk employee burnout and other issues that hurt retention and ultimately hit the bottom line.  The causes of low benefits engagement Seventy-one percent of the survey respondents agreed that their employees underutilize employee benefits. Low engagement is concerning, but HR can take proactive steps to improve things. However, before we can solve the problem, we need to understand it. Forrester identified these as causes of low benefits engagement:<ul><li>Lack of a &quot;wellness culture&quot;: When wellness is not part of the fabric of an organization, it can set off a downward spiral. Employees are less likely to engage their benefits. Poor engagement leads to decreased employee retention and the loss of top talent. </li><li>Limited benefit awareness: Many HR and EX leaders pointed to educational barriers to benefit participation. Simply put, many employees are just unaware of all the benefits available to them. This is a missed opportunity to improve employee wellness through better benefits engagement.</li><li>Inadequate communication, education, resources: Even when employees are aware of their benefits, organizations struggle to effectively communicate value and purpose. Poor messaging, education, and awareness keep employees from fully understanding how these benefits can positively impact their wellbeing.</li><li>Struggling with benefits tech: Clunky user experiences and inaccessible benefits platforms discourage employees, too. So, even if everything else is running smoothly, bad tech hinders benefits utilization and undermines the effectiveness of otherwise great wellness programs.</li></ul> How to cultivate a culture of wellness: Boost benefits engagement  Employers must review and enhance benefits, foster active employee listening, and evaluate and optimize benefit program implementation, management, messaging, and maintenance—including technology, UX, and employee communications. Improving employee wellness means getting employees to engage with their benefits. Here’s how:<ol><li>Regularly evaluate employee benefits: Conduct a comprehensive audit of your current benefits program to ensure it aligns with evolving needs and expectations. Assess the relevance and impact of benefits and consider making changes to enhance benefits engagement. </li><li>Actively listen to employee feedback: Employee feedback was the number one metric for 81% of directors and manager-level survey respondents. Create channels for employees to provide feedback and concerns regarding benefits. Use this feedback to identify areas for improvement and better benefits solutions</li><li>Bridge the knowledge gap: Make sure your employees know the benefits available to them. Over 50% of survey respondents said they’re already expanding messaging and education on employee benefits. Consider creating comprehensive messaging campaigns to help highlight the value and purpose of each benefit. </li><li>Invest in user-friendly benefits technology: An intuitive and easy-to-navigate benefits platform that seamlessly integrates with core systems and partner platforms can enhance benefits engagement. That’s probably why more than 70% of surveyed decision-makers are investing in new employee benefit platforms, improving the user experience of existing platforms, or both.</li></ol> Build a business case for better benefits engagement Engaging employees with benefits is crucial for both employee well-being and business success. However, many companies overlook the role HR plays in achieving this.  Poor benefits engagement can lead to burnout and stress, impacting both operational efficiency and company culture. To prioritize employee well-being and benefits engagement as critical business imperatives, HR professionals need to build a strong business case.  Some key considerations include:<ul><li>Improved business health: Poor benefits engagement can lead to increased burnout and chronic stress levels, ultimately burdening both operational efficiency and company culture. Prioritizing employee well-being and benefits engagement can help to reduce the risk of burnout, improve employee morale, and create a more positive workplace culture.</li><li>Talent acquisition and retention: In today’s fluctuating job market, employees have more diverse employment options. They’re less willing to accept burnout and unhealthy work environments. By prioritizing employee well-being and benefits engagement, organizations can differentiate themselves from competitors and attract and retain top talent.</li><li>Increased productivity: Engaged and healthy employees are more productive, creative, and innovative. Investing in employee well-being and benefits engagement can improve overall productivity, drive business growth, and enhance the bottom line.</li><li>Lower healthcare costs: Engaged employees are more likely to participate in the programs you invest in and in turn less likely to experience chronic health conditions and require costly medical interventions, meaning lower healthcare costs for both the organization and individual employees.</li></ul> Benefits engagement is essential for employee wellbeing and organizational success A culture of wellness isn’t just a nice-to-have. It’s critical not only for improving the employee experience, but also business success. Ignoring that reality risks impacts on talent acquisition and retention, productivity, and healthcare costs. A robust culture of wellness is driven by strong benefits engagement. Employers that want to see that engagement need to take proactive steps. They need to review and enhance benefits, foster active employee listening, and optimize their benefits program implementation and technology to effective employee communications. That’s how HR can translate employee wellness into tangible, bottom-line benefits for the organization.  [<a href="https://marketing.bswift.com/acton/fs/blocks/showLandingPage/a/5166/p/p-0123/t/page/fm/0" target="_blank">I WANT A COPY OF THE STUDY</a>] Don&#39;t miss out on the opportunity to improve your company&#39;s benefits engagement and bottom line. Visit bswift.com to learn more.

The Business Case for Boosting Benefits Engagement: Improving Employee Wellness, Retention, and the Bottom Line

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Senior Manager

Managing Director, National Health Care Transparency Leader

Amid the growing importance, involvement, and influence of patients in health, price transparency is becoming a front-burner issue for health care systems, health plans, employers, and other industry stakeholders (see <a href="https://www2.deloitte.com/us/en/blog/health-care-blog/2021/new-and-future-transparency-rules-could-push-health-plans-and-he.html" target="_blank">New and future transparency rules could push health plans and health systems to collaborate</a>). Unlike virtually every other consumer market, the prices for health care products and services are typically shrouded in mystery and often presented months after care was provided. As a result, prices can vary widely among hospitals—even those that are in the same geography. Moreover, negotiated contracts can mean every health plan pays different prices for identical services at the same facility performed by the same clinicians. Negotiated rates are not necessarily tied to outcomes or value; they tend to reflect which entity (the health system or health plan) was most successful at the negotiating table and had greater leverage in the market. Deloitte’s work with hospital and health plan clients reveals largely positive intentions in caring for a patient’s financial health, in addition to their physical health, and helping them navigate the often-challenging requirements of a fragmented health care delivery and financing system. Further, our experience with these clients gives us unique insight into the challenges of health care price transparency and what it’s going to take to achieve a fair and equitably transparent market.   Despite the challenges to achieving transparency in health care markets today, we believe that transparent health care markets are a critical accelerator to what Deloitte sees as <a href="https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/future-of-health.html" target="_blank">Future of Health</a> in which the consumer is at the center of the health care ecosystem and empowered to own their health care journey.  We call this future “360 Degrees of Transparency”: an ecosystem in which pricing and cost data are accessible and easy to understand for the consumer; standardized quality metrics are utilized in conjunction with pricing data to gauge overall provider value; all stakeholders are actively participating and interacting with the available data; and provider prices are highly affected by consumer sentiment and payer/public data interpretation. This future has implications across all health care stakeholders. For example: <ul><li>Decisions factoring in the service-level cost of care could impact hospital volume and employee benefit plan selection.</li><li>Innovative benefit design could influence hospital volume and drive patients toward higher-value (low-cost, high-quality, accessible) care. Employers could look to make changes to network or switch health plan carriers. </li><li>A mutual understanding of what is in the hospital- and health plan-disclosed pricing data is becoming the starting point for negotiations.</li></ul> Federal government as catalyst for change  The US government has taken a number of actions to advance 360 Degrees of Transparency. On January 1, 2021, the Centers for Medicare &amp; Medicaid Services (CMS) began requiring hospitals and health systems to display negotiated prices for “shoppable services” in a user-friendly format. A similar rule, which went into effect July 1, 2022, requires health plans to post the rates they have negotiated with clinicians, hospitals, health systems, laboratories, imaging companies, and other entities. Health plans will also be subject to additional requirements—such as providing members with online tools to enable price shopping—in 2023 and 2024 (see our 2021 report on <a href="https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-health-plans-face-market-disruption-andstrategic-opportunities-03102021.pdf" target="_blank">The Transparency in Coverage rule</a>). The price transparency regulations have twin intentions: (1) to boost market competition among hospitals and health systems and, ultimately, drive down prices; and (2) to provide consumers with the information needed to make informed decisions. Fundamentally, the regulations pull back the curtain on prices that providers and payers have long considered to be proprietary. More recently, regulators have enacted a law that builds upon the hospital transparency requirements and Transparency in Coverage final rule. The No Surprises Act (NSA) is a federal law that became effective January 1, 2022, and requires providers and payers to provide information about the cost of health care services scheduled in advance. The law is intended to prevent surprise billing of patients and increase decision making in health care by mandating proactive measures that providers and payers must take to communicate anticipated costs to patients before they receive care. NSA provisions require immediate changes for most providers and payers in order to comply in a way that provides financial transparency to patients. While imperfect, hospital pricing data is currently available nationwide. Almost all hospitals have provided some level of price transparency, but there is significant variation in the level of functionality and information disclosed. Of the hospitals we analyzed:<ul><li>71% either did not update their previously posted CDM file or posted a new file without any form of negotiated rates</li><li>1 out of 3 posted files required some form of additional scripting or data manipulation (e.g., python, SQL) to view</li><li>29% posted a file with some version of payer-specific negotiated rates. Of these files, 95% included information on national commercial plans; the other 5% only included information on managed government plans or smaller regional plans.</li><li>26% of providers we analyzed posted some version of cash/self-pay rates in their disclosure. Self-pay rate discounts ranged from 10% - 70%.</li><li>Among the files with payer-specific rates, 76% displayed inpatient rates at the DRG level, 28% displayed some version of outpatient or inpatient case rate information, </li><li>88% displayed outpatient rates at the CPT/HCPCS level, while the remaining 12% summarized rates at the APC level</li><li>51% included some version of drug rates, while only 26% included rates at the NDC level.</li></ul> The major national health plans posted their machine-readable files the first week of July 2022, and the file sizes and usability are proving to be the biggest challenge in analyzing the underlying data. The average health plan file size is 100-1000X larger than average hospital file sizes, and the largest group of plan files’ size (so far) is 20 terabytes, across ~4,500 employer files. Our analysis of the machine-readable files also reveals that the data provided by health plans is inconsistent, and often inaccurate or incomplete. In working with one health system, we determined that prices submitted by one of its health plans—for one service line—were up to 10 times the actual negotiated rate. Additionally, only a portion of the services they had negotiated were included in the file. These are issues that should be identified and resolved in the monthly reporting required of health plans under the Transparency in Coverage rule. Finally, patient-facing tools do not yet meet customer expectations. Our consumer survey found that a majority of people would use a tool that aggregated their likely out-of-pocket costs for health services. However, such a tool would need to be contextualized with quality, conveniency, coverage, and user reviews. For example, when asked about accuracy of liability tool estimates, 42% of consumers responded that they expect estimates within a 10% or less accuracy range and 5% responded that they did not expect a liability estimate tool to be very accurate. In practice, it could be several years before consumers are able to comparison shop. We expect the transparency rules, along with new interoperability rules, could eventually lead to less price variation among health care providers, improvements in market differentiation, and shift to value-based care, outcomes that line up with <a href="https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/future-of-health.html" target="_blank">Deloitte’s vision for the Future of Health</a>. Preparing for 360 degrees of transparency Given the state of pricing transparency—and the clear market forces driving increased competition and appetite for informed decision-making by employers and patients—many health systems and health plans are making a series of no-regret moves to prepare for a possible future of 360 degrees of transparency in which pricing and cost data is accessible and easy to understand for the consumer; standardized quality metrics are utilized with pricing data to gauge overall provider value; all stakeholders are actively participating and interacting with available data; and provider prices are highly affected by consumer sentiment and payer/public interpretation of data. These moves include:<ul><li>Understanding price position. Analyzing the price transparency disclosures to understand price relative to provider or health plan peers.</li><li>Evaluating pricing strategy. Developing a pricing strategy that sets price relative to value and is consistent with business requirements and mission.</li><li>Engaging with stakeholders. Building value communication and engagement strategies to help stakeholders understand and engage with the newly transparent data.</li><li>Pursuing technology investments. Digitizing the patient financial experience to surface liability estimates ahead of service and support patients in financing their care. </li></ul> To make these moves, Deloitte’s MyRateFinder™ data framework has been designed to use extensive domain knowledge and proprietary analytics to extract meaningful insights from hospital and health plan pricing data and surface estimates for transparency-related use cases.  In one client example, a nationally recognized academic medical center encountered non-standard completion of machine-readable files among hospital peers and health plans due to ambiguous CMS guidance. The implications of the data in the market were unclear and competitive business use cases were undefined. We developed a five-year sustainable, enterprise-wide strategy to help our client prepare for the accelerating evolution of price transparency, achieve federal compliance, and maintain its desired position in the market.  We expect the transparency rules will dramatically alter the competitive landscape over the next couple of years. While there are clear challenges with implementing the new reporting standards, we are energized by the breadth and depth of this data. With unit prices now available for institutional and professional services across all sites of service (and paired with utilization data), we can begin to compare total cost of care and, ultimately value, within and across markets to improve decision-making for all stakeholders in the health care ecosystem.  While price transparency remains in its early stages, we are already seeing organizations taking steps toward the envisioned 360 degrees of transparency. Tech start-ups are aggregating pricing data and reporting in a consumer-friendly interface to enable price shopping. Employers are hiring health benefit firms or accessing online tools, and analyzing the cost of their network and the value they’re receiving from their health plan partner’s price negotiations with providers. Health care payers and providers are integrating transparency data into their pricing strategy for negotiations but, in a new era of consumerism and patient-centricity, they will need to do even more to embrace 360 degrees of transparency and unlock value in market share and profitability.  As used in this document, “Deloitte” means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see www.deloitte.com/us/about for a detailed description of our legal structure. Certain services may not be available to attest clients under the rules and regulations of public accounting. This communication contains general information only, and none of Deloitte Touche Tohmatsu Limited, its member firms or their related entities (collectively, the “Deloitte Network”) is, by means of this communication, rendering professional advice or services. Before making any decisions or taking any action that may affect your finances, or your business, you should consult a qualified professional adviser. No entity in the Deloitte Network shall be responsible for any loss whatsoever sustained by any person who relies on this communication. Copyright &copy; 2022 Deloitte Development LLC. All rights reserved

Pulling Back the Curtain: Health Care Price Transparency Expected to Boost Market Competition, Support Patient Decision-making

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Senior Vice President Clinical Innovation

Discover key connections to your mission and community Advancing diversity, equity and inclusion across every community is an urgent and imperative goal for many organizations. It’s essential to connect advocacy groups to health organizations, health employees to the mission of health, and consumers to services that have historically been out of reach.  To shape a more equitable health picture, leaders can collaborate with community groups to improve data collection, pinpoint local needs and take action. They can also project the impact that social determinants of health and bias within the community have on their organization. Pairing with community-based organizations  Health organizations are thinking about health equity in new ways. They’re working with community partners to share data, build whole health consumer profiles, create value-based care avenues that address inequities, and assess performance metrics. Leaders should identify local community groups that are strong potential partners. By building trusted relationships with these entities, health leaders can assist them with the support they need to implement solutions and scale. To that end, the community may already have developed possible solutions that haven’t yet been explored at a broader level. Together, health and community-based organizations can work together to finally empower the scaling of community-originated ideas.  There are many ways to approach cementing these community-based partnerships. Health organizations can financially support nonprofits. Health leaders can also serve on their boards. Additionally, they can invest in programs that serve the community needs around food, transportation, housing and other basic life needs. It can be more cost-effective for health organizations to support community work that is already serving their members through a whole-system approach. Health foundations and Medicaid health plans are also channels to fulfill members’ holistic health needs. Half the battle lies in some of the basics. Using technology to address social determinants of health Technology is an indisputable asset in supporting a patient’s health journey. It empowers a person to have more information at their fingertips, allowing them to better take charge of and manage their condition around their life, rather than their life around their condition. Technology also adds value to the greater health care ecosystem by combining important contextual information from an electronic health record — such as a patient’s health history, medications, allergies and social determinants of health — with a computerized version of best practice clinical guidelines. As a result, a more complete health picture allows providers to offer a more personalized recommendation, and that can lead to a more equitable outcome. Technology supports value-based care management through remote monitoring, patient mobile apps, artificial intelligence, automated scheduling and more. These tools also help overcome transportation- and cost-related challenges to improve access to the physical and behavioral health services people need.  Digital therapeutics further personalize the health experience by pulling together a person’s background, preferences and mental health symptoms and then matching them to an app that would fit them best.  However, it’s important to keep in mind that technology will not solve health equity on its own. For instance, access to technology itself is a social determinant of health. Those living in rural areas may not have internet or mobile service coverage that is powerful enough to enable a person to use electronic technologies for digital health. They may also lack the funds to afford these services.  Charting health equity with outcomes in mind  To identify people who are affected most by health disparities, organizations can construct a data-driven map of communities at risk. Connecting data points also provides insight into the ways social determinants, health literacy, bias and other inequities affect health outcomes. For example, a person experiencing homelessness may be driving high health care utilization rates, yet the data point that they are unhoused may not be recorded anywhere in the patient’s records. If information from multiple sectors connects these facts, then the community, public health system, homeless shelters and health organizations may be able to combine forces to assist the person in securing housing. The same structure applies to other SDOH, such as food and transportation. Health care is a major part of a community and of an ecosystem, yet there are other vital factors at play too. In fact, medical care contributes to just 20% of a person’s health outcomes, while where one lives, works and ages can have more impact on their health than any other factor. Ensuring products and services serve consumer needs Racial, ethnic and language diversity often isn’t reflected in products and service offerings. There’s no clearer business case for growth than increasing the access of products and services. Improving and simplifying readability for people with low literacy is one example of supporting an approach of diversity and inclusion. Other aspects to consider are whether your products and services can be delivered in rural areas, what your consumers’ needs are for communicating, whether a population’s primary language is English, whether products meet their needs, and if your customers understand how to use them. Serving every person, everywhere, through technology is the best business case. By thoughtfully determining how you can weave health equity into every aspect of your business, you can reach all the different dimensions of the American consumer. Listen here to explore more strategies for reducing disparities and improving health equity.

Health Equity Paves New Pathways for Integration

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