Beth Roberts, senior vice president for commercial business at Harvard Pilgrim Health Care
For years, consumers have faced difficult and often confusing choices while operating in a complex healthcare system, making them feel overwhelmed, uncertain and even unheard during healthcare interactions. However, a sea change in the approach to benefits was happening. Today, experts say the COVID-19 pandemic has ramped up this process exponentially.
“Healthcare has been transforming and evolving for quite some time now,” says Dr. Elizabeth Coté, Chief Mission Officer at MyHealthMath, a Portland, Maine based company that helps consumers choose health plans based on their best interests.
“Now the trend is magnified, because the entire country is experiencing a major healthcare episode,” Coté says. And because leadership hasn’t been consistent in managing the pandemic (and its impact on healthcare), it’s created more ambiguity than ever before and a hunger for answers.
Citing a “blanket of exhaustion settling on the nation,” she says the solutions that offer more transparency and clear answers will win the day for consumers seeking more direction and engagement. Beth Roberts, senior vice president for commercial business at Harvard Pilgrim Health Care, agrees, noting that transparency should be “a journey” throughout the healthcare decision-making process.
It starts when an employer chooses a plan by ensuring they understand the benefits design and cost so they can make the best decision for their employees.
Roberts says it’s also important for employees to be “empowered and educated” at the time they select their healthcare plan. From there, having a navigation system to help them shop for cost-effective healthcare can play an important role and potentially provide them with a financial incentive when they opt-in for lower cost options.
“Sharing in the reward helps change behavior down the line,” says Roberts.
Enhancing virtual care
Changes are occurring from a practical standpoint too, with providers and carriers quickly enhancing the virtual experience to increase access to combat the isolating nature brought on by the pandemic. One report says more than 66% of employers see virtual health and wellbeing offerings (e.g., telemedicine, therapy) becoming permanent fixtures in the workplace.
Roberts adds that the industry is at a “tipping point” due to the rising costs of health insurance and that the insurers who can help consumers navigate and make healthcare decisions in their best interests, such as opting in for preventative care, and ensure that any barriers to access are removed by offering members different options to receive this care, will be the companies that stand out. “It’s important that no matter where a consumer is on the healthcare spectrum, they are able to access the care they need,” Roberts emphasizes.
Accountability — that is, insurers playing an instrumental role in helping consumers understand their cost of healthcare in advance — will also be a stark differentiator, adds Coté. This is because both employees and employers want to know the value of their healthcare dollars.
Consumers “deserve to have this accountability and know what they are purchasing with their dollars,” she says.
According to Roberts, insurers are driving accountability through even more transparency in cost and access.
“It’s incumbent on us (as insurers) to make sure people understand how to engage with their healthcare plan and what to expect both when they are healthy — and when they require assistance navigating the system in a time of need,” says Roberts. “We need to find more ways to be a good partner to give members the very best outcomes.”
Health insurers and employers can be invaluable allies during this crisis to help improve the consumer experience in an evolving healthcare environment.
Learn more as Beth Roberts and Dr. Elizabeth Coté continue this important conversation in the recent podcast series, The Path of Transformation & Change: Health Benefits in 2021, sponsored by Harvard Pilgrim Health Care.