Benefits navigation programs enable employers to cut health care costs without shifting the financial responsibility to employees, while also increasing their overall health care experience.

Health care costs are growing at an alarming rate, and managing these costs is one of the biggest struggles employers face today. With the cost of employer-sponsored health care benefits expected to approach $15,000 per employee in 2019, the search for a solution is a top priority among employers. As a result, many employers have turned to high-deductible health plans (HDHP) to cut costs which offer lower premiums to employees in exchange for significantly higher deductibles. In effect, a large portion of the health care financial responsibility is shifted to employees.

While this may help employer costs, it leads to greater employee frustration and a poorer health care experience. Employees are now required to pay more out-of-pocket costs for the same health care they were receiving before the switch to HDHP plans. When managing an unexpected health event, a larger-than-anticipated bill makes an already overwhelming experience even more distressing for employees.

Related: Employers not listening effectively on health benefits

More than simply causing employees to become upset with employers, the higher costs associated with HDHP plans can potentially impact employee health by discouraging the use of health benefits. When faced with more out-of-pocket costs through HDHPs, employees are expected to shop around for the lowest cost health care options. But "shopping around" in this industry isn't nearly as easy as it sounds, and causes some employees to forgo their health care benefits altogether. In fact, 39 percent of employees have chosen not to go to the doctor to avoid costs.

But avoiding the doctor's office can actually lead to higher costs for both employees and employers. By skipping wellness checks or leaving an illness to go untreated, employees inevitably face more costly health problems in the future.

With more expensive procedures comes more cost for employers—and more employee absences. Employees in poor health have double the number of absences of their coworkers, and productivity losses from missed work cost employers $1,685 per employee, each year.

Not quite the cost savings employers were hoping for.

HDHPs aren't the only option for employers hoping to reduce health care spending. Benefits navigation programs enable employers to cut health care costs without shifting the financial responsibility to employees, while also increasing their overall health care experience.

improving the employee health care experience

Without a benefits navigation program, employees are forced to navigate the health care experience on their own, often under distress. Studies show that employees are increasingly confused about their plans, leading to an overall negative health care experience and employer resentment. In addition to increased stress, these decisions made while battling overwhelming health care information frequently lead to increased cost. In fact, nearly 1 in 5 inpatient admissions include a claim from an out-of-network provider—a common mistake when under pressure.

Because benefits navigation programs have a full understanding of an individual's health care benefits, plan details, and resources available, they're able to provide the information, guidance, and support that the employee needs. Instead of requiring employees to piece together disparate information given by insurance providers, clinicians, etc., benefits navigation programs give employees one person to call to receive a complete overview and understanding of their options. When employees are satisfied with their health care experience, employers benefit. In a recent survey, 56 percent of employees indicated their satisfaction with their health care plan is a key factor in deciding to stay at their current job.

Reducing health care costs

In one study that examined overtreatment, doctors reported on average that 20.6 percent of all medical care was unnecessary, and some experts estimate that at least $200 billion is wasted annually on unnecessary testing and treatment.

Instead of simply shifting these unnecessary costs to its staff, employers can enlist a benefits navigation program to help prevent overtreatment and wasteful spending. Two of the most commonly cited reasons by physicians for overtreatment were patient-requested services, and difficulty accessing medical records leading to duplicate tests. Benefits navigation programs are uniquely positioned to combat both of these overtreatment causes due to their comprehensive insight on an employee's medical records and plan benefits.

For example, instead of simply providing an employee with information on in-network specialists, the coordinator is able to confirm the employee has seen a primary care physician to verify the diagnosis. If the specialist request was spurred based on a self-diagnosis, the coordinator can gently steer the employee toward the correct health care starting point. Similarly, benefits navigation programs can prevent redundant tests to reduce avoidable costs. Coordinators work directly with doctors to understand a patient's medical history and benefits coverage, flagging test that have already been conducted. Through early intervention, unnecessary expenses are avoided before they occur.

A win-win solution

Instead of stripping plans or shifting costs to save money, employers can take a consumer-centric approach to solving their health care challenges. Benefits navigation programs are rooted in empathy and compassion, designed to reduce complexity and create a better health care experience for employees. At the same time, the services they provide help reduce employee health care spending—good news for employers and employees alike.

Shannon Skaggs is the president of Quantum Health.

Read more: 

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• High-touch, high-tech advocacy means lower-cost health care
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