In order to recruit and retain the best workforce possible, you need to provide a health benefit that serves everyone based on their individual needs. (Image: Shutterstock)
Employers are taking monumental steps to promote diversity, equity and inclusion across their benefit programs and workplaces. Even as I feel optimistic about the significant effort and progress being made, I offer candid caution about the structural roadblocks that could undermine your hard work.
Some of the most common elements of insurance design, like high deductibles, have been found to act as barriers to care and exacerbate health disparities. Moreover, "one-size-fits-all" health plan design is inherently inequitable because it treats all employees as if their health journeys, care needs, and financial resources are similarly situated.
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The health insurance industry is ripe (one may even say overdue) for new and innovative solutions that provide employers and employees rich, affordable and inclusive health benefits. Plan design must meaningfully evolve to reflect the growing diversity of America and today's hyper-personalized, consumer-driven economy. We can no longer tolerate the status quo because – if for no other reason –you can't deliver on a commitment to an inclusive workplace without inclusive benefits.
It's time to put some new thinking and personalized plan design strategies to work. Here are 5 ways to start:
1. Take affirmative action and set subsidization strategies to improve known health inequities.
Smart subsidization is the cornerstone of inclusive benefits. Most health plans offer an equal level of coverage for all employees. For example, an employee who makes $35K a year, and another who makes $350K a year, have the same deductible, coinsurance and out-of-pocket maximum. That's not equitable, and this "one-size-fits-all" design perpetuates health disparities.
Inclusive benefits, on the other hand, adjust subsidy based on factors like income level, known disparities, social determinants of health (SDOH), and clinical performance of the underlying care. Inclusive, equitable health plans lower the cost of treatments, providers and medications known to be effective in treating certain conditions for certain people. Race and age, for example, can have a significant impact on the effectiveness of certain treatments. If a health plan doesn't consider these personal factors for the subsidization of those treatments, it's not optimized to promote inclusion.
2. Make health insurance accessible and understandable.
It can feel like health insurance is its own language. Most people don't speak it well. In fact, only 4% of Americans can correctly describe the terms deductible, copay, coinsurance and out-of-pocket maximum. And 26% have avoided care because they don't know what their health plan covers.
Inclusive health plans use intuitive apps/websites and clear language, not industry jargon, to make every element of the plan easy to understand and use. Your employees need to be able to understand what is and isn't covered, what their options are, and exactly how much care will cost them, in advance. When they don't, they lose opportunities to use the benefit that you and them pay good money for—and, more importantly, they're not able to own their health.
3. Provide cost certainty and eliminate financial barriers.
Affordability and lack of cost certainty are significant barriers to accessing care. Thirty-four percent of people with employer-sponsored health insurance skipped medical care within the last year because of cost. Furthermore, many people don't feel comfortable going to the doctor and seeking care because they don't know how much it will cost until weeks later when the bill arrives. Many people in this situation skip or postpone care. Growing evidence also shows an association between high deductible plans and disparities in access to care.
Deductibles and coinsurance simply must be eliminated from health plan design. With these barriers removed, employers have more flexibility to change subsidization of coverage connected to various income levels of employees and their SDOH.
4. Support and personalize whole-person needs.
Truly inclusive plans are designed around whole-person health. This means taking into account socioeconomic factors that contribute to health disparities at a structural level and enacting workplace policies to fight them. Providing personalized coverage for SDOH and whole-person needs – including coverages for mental health, nutrition, and other nonmedical activities proven to improve health and wellbeing – is the future of health insurance.
Finally, your health benefits should allow your employees to easily make health care decisions that are best for their individual needs, without arbitrary requirements like a prior authorization for routine care or gatekeeping by a primary care physician.
5. Focus on conditions and treatments by personalizing care navigation.
A health benefit that makes it easy to search for treatment options by conditions and health issues, allows people to make informed choices for their specific needs and preferences. Designing insurance in this way instantly changes how employees engage with their health. Their health plan becomes their wellness platform, prevention platform and condition-management platform. This condition-first approach is how people think about their health. They think: "I have this condition or health need, and I want to know what treatments and providers can help me solve it, effectively and efficiently."
Health plans should also offer information about provider diversity and offer a wide and diverse network of high-quality, low-cost providers, as well as clinical advocacy and support experiences – from call centers to care navigation – that help members find appropriate care reflective of a wide range of unique needs (e.g. racial, cultural, ethnic, LGBTQ+, etc.).
Building better for everyone
Again: you can't deliver on a commitment to an inclusive workplace without inclusive benefits. And we know that inclusive workplaces – those in which employees feel respected, trusted and valued – demonstrate higher productivity, achieve greater innovation and recruit and retain better talent. In order to recruit and retain the best workforce possible, you need to provide a health benefit that serves everyone based on their individual needs. And, more importantly, it's the right thing to do. Who's with me?
Marcus Thygeson, MD, MPH has served both sides of health care – as a treating medical doctor and health plan executive. As the Bind Benefits Chief Health Officer, he ensures Bind plan design aligns with research-backed, quality care.
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