The changes to the health care system brought on by the COVID-19 pandemic are creating a new set of risks and opportunities for health care purchasers and plan sponsors, some of which are not yet fully known.
In their article “Charting a New Course: Implications of the Pandemic for Health Plan Sponsors” in the November issue of Benefits Magazine, authors Jeff Levin-Scherz, M.D., and Julie Stone identify nine actions that health plan sponsors should take amid this uncertainty to maximize the value of care available to their plan members while maintaining affordability.
Levin-Scherz and Stone are leaders in the Willis Towers Watson health and benefits practice. Levin-Scherz is also an assistant professor at the Harvard T.H. Chan School of Public Health and a faculty advisor for the Harvard Medical School Evidence, Insight and Strategy for Optimizing Health Benefits program for the International Foundation of Employee Benefit Plans.
1. Consider a Range of Scenarios When Planning for 2021 and Beyond
Health care costs could go up between 0.5% and 5% in 2021 depending on the course of the pandemic. Health plan sponsors should build this uncertainty into their financial planning, monitoring both internal health care utilization and market trends.
2. Remember That All Health Care Is Local
Plan sponsors should promote high-value networks, since cost differences among providers are large and are not consistently related to quality. By carefully reviewing discounts and access, health care sponsors can be sure to maintain the aggregate value of any narrow network offering.
3. Build on a Broad Virtual Care Strategy
Plan members have become more comfortable with telehealth services during the pandemic. Plans can offer initial triaging through digital solutions and telemedicine and then direct patients to the most cost-effective care. Plan design can also encourage virtual care through lower cost sharing and as a substitute for in-person care.
4. Design Mental Health Programs to Meet Expected Increased Needs
Plan sponsors can build upon the experience of the pandemic to incorporate app-based and virtual care to meet the growing need for behavioral health care interventions. Plan members with severe mental illness and substance abuse will still require in-person care.
5. Recognize That Health Care Affordability Will Be a Growing Challenge as the Economy Recovers
Health plan purchasers and sponsors can carefully review their plan design to be sure that low-wage workers are able to afford premiums and do not face out-of-pocket costs that would lead to financial insecurity.
6. Review Existing Health Plan Offerings Critically
Some existing programs may no longer provide perceived benefit to members. For example, research has called into question whether some traditional wellness programs improve health outcomes or lower health costs, and some employees are turned off by these programs. Sponsors can evaluate the value of such programs and can redeploy funding to provide more comprehensive well-being programs or lower the total cost of health care.
7. Address Social Determinants of Health
By using culturally inclusive messaging, plan sponsors can attend to the needs of their diverse populations. They can collect and store race information in human resources information systems to share with health plans and data warehouses and identify disparities in care and outcomes, while respecting both regulatory requirements and privacy.
[Related Reading: Signs and Symptoms of an Employee Struggling With Mental Health]
8. Keep an Eye on New Health Plan Designs and Vendors
Health insurance carriers are offering plan designs that decrease out-of-pocket costs for high-value services, often combined with a narrow network, navigation services and restrictions or higher costs for low-value services. It’s important to check that these plans have affordable premiums and costs at the point of care and full transparency on coverage inclusions and exclusions.
9. Measure Results
Plan sponsors can make better informed decisions about their plans if they measure the impact of their programs. They should seek objective evaluation of offered programs and be willing to alter or even eliminate programs that fail to reach objectives. Plan sponsors should carefully analyze the impact of virtual care to ensure that it is a substitute for, but not incremental to, in-person care.
“While we can’t foresee all that lies ahead, we know that getting in front of the coming changes is an important key to success,” Levin-Scherz and Stone write. By following these nine steps, “purchasers can smartly position their health care programs to not only create value today but also adapt to a new world of health care use and delivery.”
Kathy Bergstrom, CEBS
Senior Editor, Publications at the International Foundation of Employee Benefit Plans
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