Empowering patients to make better healthcare decisions

This article originally appeared on BenefitsPro.com in March 2016.

It’s Friday afternoon, and you suddenly remember that you were supposed to make plans for date night. You pull up Yelp to find a restaurant, use Google to locate a movie theater nearby, and maybe browse Metacritic to read reviews and select a film that you and your date will enjoy. In just a few minutes, the tickets are purchased, the reservation is confirmed, and you can feel confident that you’ve made good decisions.

Now let’s consider another scenario. You’re at the park when your child comes running up to you with a bee sting that is swelling badly and appears to be getting worse. You again pull out your phone and hit Google to find the nearest hospital or walk-in clinic. Are any of these providers covered by your plan? Are they good at treating allergic reactions? You have no way to check, so you go to the nearest one and hope for the best.

On the surface, these two scenarios – planning an evening out and responding to an urgent medical situation – may seem unrelated, but they represent two common consumer experiences. The difference between them underscores one of the most important challenges facing American businesses today: empowering individuals to make better decisions about their healthcare.

Businesses are spending too much on healthcare, and they’ve been struggling for years to find a solution. According to a 2015 report by Forrester Consulting, 89 percent of businesses surveyed believe that rising healthcare costs are a crisis. While companies can implement any number of new benefit programs to encourage employees to become healthier and spend less money, it is ultimately up to the employees to decide whether or not to use them.

The problem isn’t that employees are making the wrong decisions or deliberately choosing to spend more money; it’s that they aren’t really making educated, informed decisions in the first place.

The first instinct many employers had to try and address this problem was to shift a greater share of the costs to employees through higher deductibles. The assumption was that, being asked to pay more out of their own pockets, employees would be incentivized to quickly become informed consumers and make more value-driven healthcare choices. Today, nearly one quarter of employees in the United States are enrolled in high deductible health plans, but even with more skin in the game, employee engagement has remained stubbornly low.

The everyday examples above may illustrate part of the reason why this problem has persisted – and also point to the solution. The typical American employer today offers health-related services from over a dozen different vendors – including health plans, clinics, wellness programs, telemedicine, and more – each with their own separate user interface and benefit systems. Keeping track of these benefits, how to access them, and how they relate to each other can be confusing. A recent study from Aflac found that 73 percent of employees didn’t fully understand everything that was covered by their companies’ major medical policies. As a result, when employees find themselves needing to make a healthcare decision, they are frequently overwhelmed.

So what’s the “secret sauce” to solving this problem? From our work with some of America’s largest and most innovative employers, we’ve developed four key elements to successfully driving employee engagement in healthcare benefits.

Curation. As companies offer more benefits and options, employees need to be guided to the ones that will be the most relevant to their needs. In the same way that Netflix offers movie recommendations based upon your past interests, curation requires real-time, data-driven insight into an individual’s needs and programs in order to offer up the right information at the right time — and through the best channel.

Personalization. If you’re only providing generic information and a passive website for employees to access their healthcare benefits, the odds are that they simply won’t engage. Most people don’t think about healthcare until a need arises, and by that time, it’s too late. Instead, the key is to use data-driven, personalized messages to draw in the user proactively and help employees easily identify the best healthcare decision for them.

One-stop-shopping. One of the reasons people like Amazon is that they can order pretty much anything — from books and movies to paper towel and coffee makers — all from a single portal. Employees need a single, integrated location where they can go to easily understand and access all of their health benefits and programs, from medical to pharmacy to third party vendors.

Deliver real value to the employee. If employees are being asked to engage and shoulder more of the cost of care, it’s critical that employers select programs and a health benefits platform that delivers tangible, near-term value to those employees. It can’t just be about overall health or tracking steps. Being able to shop for a medical service or doctor in order find the highest quality care and save money, as easily as people browse for airline tickets and hotel rooms, is a great example of providing clear value to the employee. So is the ability to directly connect with other benefits as easily as a single click.

Addressing the challenge of low employee engagement is essential to reducing healthcare costs, but it goes deeper than that. USA Today studied government records and came to the conclusion that more than 20 percent of all invasive surgeries may be unnecessary, meaning that employees may face high risks and long recoveries for no good reason. Similarly, preventive care can be essential to identifying and avoiding serious health conditions. Substance abuse, undiagnosed mental-health issues, and chronic diseases can all take a heavy toll on employees and workplaces — and most importantly, they’re all treatable if employees can get the right care.

The technology exists to solve these problems today. Employers are already deploying solutions that overcome the complexity and confusion of managing health benefits. This, in turn, leads to increased employee engagement. Ultimately, this delivers what we all want: empowered employees making better healthcare decisions, which leads to better outcomes at lower costs for enterprises and their employees.