Man facing a maze In many ways,we have fundamentally lost sight of the purpose of insurance andthe role of consumers in making informed choices about how theyobtain and pay for care. (Image: Shutterstrock)

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Employer-based health insurance was the answer to a perfectstorm of post-World War II problems. A clever scheme to circumventwage freezes and labor shortages gained a political foothold thathas been nearly impossible to dislodge. For employers andemployees alike, the mid-20th century model has become too costly,too rigid, and too confusing for today's consumer-driveneconomy.

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The COVID-19 crisis will force hard economic choices. How can weprovide health benefits and still defend the bottom line? How canwe attract and retain good employees? How can weimprove employee health care?

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Related: The start of something big

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The pandemic has created a new sense of urgency, but thesehealth insurance questions have existed for decades.

The status quo is not okay

Health care operates by its own rules. There is virtually noother industry so removed from the power of the marketplace and thecontrol of the consumer. Employers and employees have been caughtin an unnecessarily adversarial fight over who will pay exorbitantcosts. In many ways, we have fundamentally lost sight of thepurpose of insurance and the role of consumers in making informedchoices about how they obtain and pay for care.

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This is not employers' fault. Poor insurance design has forcedemployers to choose between meeting budgets and providing anexpensive benefit to employees. This is not employees' fault. Theyhave been forced to surrender control over their own health caredecisions, and in the process have lost the consumer power thatdrives product improvements and lower costs in most otherindustries.

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It's time to change the equation and build health insurancearound the idea that employers and employees have a common goal: agreat benefit that controls costs and provides a choice amongproviders of high-quality care. We need a new plan design thatcreates an intuitive fit between people's health insurance and theway they actually use health care.

Highlighting clear treatment paths

Nearly overnight, COVID-19 brought extreme focus to one specificcondition. We have seen the entire industry stand up to thechallenge, delivering care with compassion, relieving costbarriers, and adapting to new practices in telemedicine, testing,and treatment with imagination and discipline.

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When the crisis abates, which it will, we must apply the samecondition-based approach to all of health care. Imagine reducingcosts by design, not just happenstance, or providing incentivesthat reward employees for following established standards of care.That would fundamentally change the employee/consumer experience ofcare for everyday conditions that affect millions ofpeople—diabetes and hypertension, heart conditions and joint pain,pregnancy and wellness care.

Eliminating the deductible

COVID-19 forced many insurers to modify their plans to ensurecompliance with federal mandates that eliminated cost barriers togetting tested or evaluated for the disease. Without thesemandates, many employees would have been required to pay for thosetests and evaluations until they hit their deductible. It was clearthat relief from deductibles was essential to the public policy aimto allow unfettered access to testing and treatment protocols forthe greater good.

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Why can't the same logic apply across all conditions—not justinfectious diseases? Look at diabetes. Cancer. Early-stage kidneydisease. Do we really want employees to avoid care due to fear ofcost? When these diseases are caught early and managed well, we canslow or prevent their escalation to later stages where quality oflife declines, morbidity rates increase, and the cost of care risesdramatically.

Using value as the new cost-sharing mechanism

Artificial intelligence and medical research are unlockingtremendous opportunities to reduce the cost and improve the qualityof health care. We have ever-growing data sets to analyze andpinpoint which treatments are the most effective and efficient fora wide range of conditions.

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With that knowledge, we have the ability to change how employersand employees share in both costs and benefits value. Whenemployees see their treatment options in advance of care, they alsohave the option to choose more effective and efficient treatments,lowering costs for both parties.

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A health insurance plan that provides choice with incentives forfollowing clinically-proven standards of care empowers employees tochange consumer behavior. They become informed consumers of healthcare with greater potential to choose more effective and efficienttreatments.

Changing where we seek care

Out of the COVID-19 crisis has come another long-soughtinnovation: consumers are utilizing telehealth and remote-caretools at a higher rate, such as online symptom checkers and virtualvisits. There is no going back. A study from the University of California San Francisco found thatbefore COVID-19, two percent of UCSF's visits were virtual. Now,well over half are, and researchers don't see the trend reversingwhen the pandemic is over.

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Mental and behavioral health is another area innovating in lightof the current crisis. Though changing, the perception is thatthese services have historically been fragmented and difficult toaccess. Telehealth and virtual visits have unlocked counseling andtreatment opportunities to meet a wide variety of needs.

Better design is possible

As you evaluate plan designs for 2021, will you continue toprovide incentives to encourage employees to try virtual carebefore going to a clinic? Will your plan provide choices and guideemployees to effective, efficient care?

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The risk of maintaining the status quo is so much greater now.Better plan design enables people to get the care they need in theright place, at the right time, at the right price. We can't goback to how things used to be. The way forward is a health planthat provides benefits to both employers and employees.

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Jodi Hubler is president ofBind andbelieves innovation and certainty are the keys to insurance design.A veteran health care executive, investor, and former CHRO, she hasa unique perspective on what makes good business, good policy, andhigh-quality employee benefit programs.


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