Brokers: Is it safe to say that,given the tremendous growth of high deductible health plans (HDHPs)that are paired with health savings account (HSAs), many of yourclients have adopted these health care plans for theirorganizations hoping that their employees see that value in theirflexibility?

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And benefits managers: How was implementing the HDHP with an HSAplan? Did employees adopt the plan with excitement, or was thereangst or resistance because it was something new, different, andscary?

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Our guess is the change resulted in mixed results. As more andmore employers offer HDHPs paired with HSAs, there is a perceptionamong employees that you can no longer have a quality health careplan that is also affordable. Employees falsely believe that youneed to compromise one for the other. Because of thisbelief, employees continue to be confused about HDHPs and HSAs andhow to effectively use them.

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As brokers and benefits managers, you can begin to change thisperception.

How to shift behavior when it comes to health careconsumerism

Although many HSA administrators are eager to educate andencourage account holders to become savers – those who save morethan they spend from the account – the reality is that manyAmericans are HSA spenders. They are people who use their accountsto pay for health care expenses as they occur because theymust. Whether it's a chronic illness, medical costs associated withkids, or limited income, there's a reason they aren't savingmore.

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We need to change our thinking about HDHPs and HSAs if we wantto help employees make better spending choices and access healthcare in the right ways. The challenge is that few Americans arewealthy enough to contribute a portion of their paycheck for ahypothetical health care need later in life. The 2018 Year-EndDevenir HSA research report states that of the $34 billion dollarsin HSA contributions, $26 billion dollars were withdrawn, meaningthree-quarters of the total dollars put into an HSA arespent. 

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So why do we continue to categorize HSAs as savingsaccounts and design products aimed at savers when the majority ofaccount holders use them to spend, and the potential toimprove the health care experience is greater if we focus on theneeds of spenders? Because most HSA administrators arebanks – publicly owned institutions that are chartered to focus onassets under management, and have a strong interest in catering tosavers and investors. If we want to change the way our employeessee HSAs, we need to begin to equip them with the tools tounderstand how to maximize theiraccounts. 

Using an HSA to pay for health care now

Spenders are more likely to engage with the health care system.Unless they're using their HSA to buy asprin, sunscreen, and firstaid kits in bulk, it's a safe bet that an account holder who spendsfrom an HSA is a consumer of health care services. Active healthcare consumers play an important part in improving health care inAmerica. By focusing on them and offering support around the healthcare decisions they make with both health care providers and aroundhealth care costs, we can begin to change the perception that aHDHP, accompanied with an HSA, cannot be both high quality andhighly affordable. As with most industries, the educated andinformed buyer pushes providers to be competitive and transparent, bringing costsdown.

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Another reality is that educated and informed spenders can saveemployers money. Insurance premiums are typically dependent on howmuch an employee population will cost the insurance company. Byencouraging employees to pay attention to the cost of health careand select providers and services with the highest value, employerscan improve their rate. Likewise, by encouraging both savers andspenders to contribute to their HSA, employers can lower theirtaxable payroll. But even if an employee can't proactivelycontribute to an HSA, they can still save on their own taxes byfirst depositing their out-of-pocket cost for a medical bill intotheir HSA when they are ready to pay the bill, then paying theprovider from an HSA. 

Empowering employees 

So how do we help employees become savvy HSA account holders?They need expert resources and support as they navigate their HDHP.Providing these resources for employees will empower them to leadtheir health care journey. Employers should encourage theiremployees to start a new health care conversation with theirdoctors, first by telling their doctors they're on a HDHP beforemaking decisions about care. This allows providers to advise on thebest care options, in addition to empowering employees to continuethe conversation with their doctors.

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Equipping employees with additional health care tools can haveimmediate cost saving benefits for employees. For example,employers can communicate that health care providers offer a24-hour nurse line as a low- or no-cost source ofinformation. Similarly, employees can use virtual or onlinehealth care options for common ailments as an inexpensivealternative to costly urgent care visits.

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To put it bluntly, employees have options, but don't always viewhealth care that way. The choices that an employee makes can have ahuge impact on health care costs. By reminding employees they canconsume health care in the same way they consume other things intheir life – by knowing their options and shopping for the bestvalue – they begin to shift they way they view health care. We mustequip employees with resoures on how to lead conversations withtheir doctors so that when their physician recommends a new medicaltreatment, they are comfortable asking whether the treatment isnecessary, if there are alternative options and the cost of theproposed treatment. As employees begin to lead these conversations,they can avoid unnecessary health care expenses and better preparefor future health care expenses. And on the flip side, they can askabout preventative options that can be taken now that will reducecosts down the line. 

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Decision support tools help guide employees to the right carefor them, with the best price option. Similarly, many health careproviders also have resources to compare services, giving employeesthe peace of mind that they are not sacrificing quality for a lowerprice.

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Until we shift the misconception that the value of an HSA is along-term saving mechanism, we are not serving the majority ofconsumers who are looking for resources to make their health careoptions more affordable now. The more resources we can provide tobenefits managers and members, the more confident and empoweredemployees are to take ownership of their health care and seek outthe best options. 

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Matt Marek is Chief Executive Officer and President ofFurther, a national leader in health spending and savings accountadministration dedicated to guiding account holders across the U.S.in saving and spending wisely on their health care. Further serveslarge corporations, small businesses, labor unions, retirees, andgroups in the public sector by providing health savings accounts(HSAs), flexible spending accounts (FSAs), health reimbursementarrangements (HRAs), voluntary employee beneficiary association(VEBA) accounts and commuter benefit services. Visithellofurther.com for more information.

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