Most employers announce annual enrollment for health care benefit plans, give employees two weeks to decide which plan to enroll in, and then expect them to understand how the program works for the balance of the year, says Robert J. Dorsey, Vice President of Consulting at Benefitdecisions, Inc.
Open enrollment is no longer just an annual event. Companies should work with employees or give employees the tools to help them understand health care options throughout the year which will help them become informed and better consumers — saving money for the employee and employer, Dorsey says.
“Typically most employees use the health care system and don’t understand how their benefits apply until 30 to 45 days after the service, when the explanation of benefits arrives at their home. That approach is backward considering that the majority of services are scheduled. Employees need to better understand how their benefits apply before they get the services,” Dorsey says.
Smart Business spoke with Dorsey about how nurse advisory programs work with health care plans to enable better consumer decisions and reduce costs.
How would having more information in advance help when scheduling health care services?
In the Chicago area, prices can vary significantly depending on the health care services provided. For example, a brain MRI can range from $1,500 to $8,000; that’s a pricing variance over 400 percent, which is after the in-network discount is applied. Employees and their employers will find this kind of pricing variance for many scheduled services like X-rays, CAT scans, colonoscopies and mammograms, but neither knows how to evaluate such pricing. We need to provide members with access to pertinent pricing and quality of care information before the services are rendered. We are asking employees to be better consumers yet we don’t provide the services or tools to allow them to succeed.
Benefit plans today try to steer employees to make better decisions through higher deductibles and HSA type products.
However, they become better consumers by having access to health care professionals who can assist employees in better understanding their benefits prior to receiving services, the pricing options for those services and even assist in scheduling the appointment with the provider. Strong nurse advocacy services really empower members to be better consumers.
What can be done to get employees this information?
About five years ago, there were only a few companies in the country that provided nurse advisory services. Today, there are many, not including those offered through major insurance companies. Employers can also contract with nurse advisory firms outside of their health plans. There are some very good ones that assist employers in educating employees about costs, outcomes and alternative services. Typically, the cost of these services range from $3 to $10 per employee, per month, and yield a reduction in claims of roughly 5 to 8 percent. On average, about 50 percent of an employer’s health care claim costs are for discretionary, non-life threatening scheduled services. Nurse advisers can help employees become better consumers by giving them the right information before services are scheduled.
What is the employee response to these programs?
Employers are finding that employees are looking for help with plan selection, scheduling appointments with providers, evaluating cost and quality of care information, and prospectively understanding how the benefit plans will work at the time of service. Employees are an employer’s greatest asset, so connecting them with a trusted health care adviser improves productivity, lowers claims, lowers turnover and reduces absenteeism. Employees love it. Everyone wins.
Cost shifting strategies through higher deductibles, large out of pocket maximums, payroll deductions or confusing HSA products do not flatten an employer’s health care cost, and, worst yet, have the unintended consequence of really frustrating the employee and employer. A successful strategy is one that includes a nurse advisory program and education, working with employees throughout the plan year.
