Cost advantage of comprehensive primary care

Cost is the first and most obvious consideration that comes up as you think about what services should be covered in the plans you're putting in front your clients. Although the evidence linking the ability to bend the cost curve" to investments in wellness and prevention has not been conclusive, we do know that preventative care and wellness programs help individuals better control chronic disease, prevent new illness, and reduce the incidence of emergency care. But in order to effectively turn these health improvements into a cost advantage, we have to stop thinking about preventative care as a category of services that are bolted onto a health plan and start thinking about it as a spectrum of options embedded into the plan's primary care coverage. It's important that we make services available that resemble those of a custom health plan – not in the insurance sense, but rather a "plan for health" shaped by the primary physician who knows the individual best. And to be effective, this plan cannot result in additional out-of-pocket costs to the individual.Another often overlooked cost benefit of providing primary care at no out-of-pocket cost is that it reduces unnecessary specialist visits, imaging and labs. With a deductible plan, individuals often try to save money by bypassing their primary physician and engaging with a specialist directly, because they think they'll end up getting referred anyway. This often ends up costing them and the plan more, as the issue could often have instead been addressed by their primary provider.

The concepts described above provide complete coverage on common health care services, including primary care, urgent care, specialist visits, labs and imaging, generic prescriptions and online care – anything that ensures the employees get the care they need as early as possible. It's what's best for their well-being, and with cost offsetting advantages and clever underwriting, it can often save employers money. Helping clients understand the cost advantage of comprehensive primary care should always be a part of the plan selection conversation.

Understanding the needs and wants of consumers

Another consideration when thinking about which services and care should be incentivized through coverage is thinking about an individual's health more holistically. As a society and an industry, we know a lot about the integration of physical health, mental health, social health and beyond. Comprehensive primary care coverage should include specialists who can help employees address mental health concerns, provide options for alternative medicine, and support their wellness goals.

With the proliferation of information available on the internet and social networking, individuals are increasingly learning more about their own health and now have sophisticated ways of thinking about their diet, wellness and beyond. And they want their health plan to provide the right portfolio of choices. As an industry, it's our responsibility to know which services promote well-being, but it's also an opportunity to give consumers the options to pursue care in the way they want it.  Whether acupuncture, chiropractic care, Eastern or Western medicine, virtual or in-person care, "big box," boutique or at-home fitness solutions, the evolution of health benefits will require leaning into the ways that today's individuals want to pursue health and offer options that stand out as truly unique and reflect their wants and needs. Health care and the pursuit of well-being is no longer "one-size-fits-all," so the same should be true of coverage options.

As professionals in the employee benefits industry ramp up their 2021 sales and renewal efforts, they'll need to be both educators and listeners, bringing new ideas, and helping clients grasp the value of what various benefits may have to offer, while at the same time amplifying the voice of the customer we're ultimately serving – the individual employees – and keeping their needs and wants top of mind. Increasingly, employees are asking for comprehensive primary care coverage that empowers them to take charge of their health in a way that truly fits their individual needs, without the confusion and stress that comes from the financial uncertainty of deductible health plans.

Marek Ciolko is the CEO of Gravie.