Employers incur approximately $575 billion each year due to their employees’ poor health, and the number of employees who spend at least $100,000 a year on medical care rose by 50% between 2013 and 2021., Much of these costs are driven by fragmented care, improper benefits utilization, and poor health literacy.
Today, members have greater choices regarding where they receive their care. In a single year, they may use an urgent care center, a pharmacy clinic, a retail clinic, a specialist, and a telehealth service. While it is convenient to have so many options, there is no single point of care overseeing the member’s best interest. This can lead to conflicting care plans, duplicate tests, medication interactions, greater costs, and poor outcomes.
A great way to mitigate this type of fragmented care is to engage members in a way that helps them better understand their unique health needs and how best to utilize their benefits for the best outcomes and lowest costs. Doing so also helps improve a member’s health literacy, or “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” High health literacy is essential for proper utilization and optimal outcomes. Low health literacy is estimated to cost employers and insurers $4.8 billion annually in excessive administrative costs.
How to promote member engagement
The word “engagement” is not the same as “touches.” Touches might constitute employee emails or meetings that include information about their benefits or how to develop healthy lifestyles. These are valuable, but they don’t constitute true engagement. Active engagement is when members take action to engage with caregivers, seek education about their unique health needs, and know how best to navigate the healthcare system to get the care they need.
The following five elements are essential to an effective active member engagement program:
- Includes care navigation, case management, disease management, and utilization management
- Provides personal health nurses—registered nurses with diverse clinical experience
- Actively facilitates member-provider engagement to reduce the risk of fragmented care
- Customized to each member’s goals and unique health needs
- Includes assessments of non-medical factors like SDOH
How an active engagement program benefits employers
There are numerous benefits employers can realize by implementing an active member engagement program. These include the following:
- Can lower medical costs by 5.3% and reduce hospitalizations by 12.5% through enhanced support for better decision-making
- Reduce overall medical costs through improved benefits utilization
- Lower absenteeism and presenteeism
- Improve member health and productivity
- Enhance member satisfaction with their medical benefits
According to Healthcare Finance, “Proactive efforts by health plans to engage with members – by providing advice on how to control costs or helping to coordinate care – drive significant improvement in overall customer satisfaction.”
How an active engagement program benefits members
Members who are more engaged in their healthcare journey take greater responsibility for making changes needed to improve their health. Additional benefits include the following:
- Customized care and guidance through personal health nurses (PHNs) for reduced fragmentation and optimal outcomes
- Support for chronic conditions with continuous monitoring, medication management, and guidance for their specific health condition(s)
- More timely interventions to prevent minor issues from becoming major health problems
- Sustainable behavioral change through improved accountability and healthier habits
- Prioritization of preventative care for a better quality of life
Success Story
A multi-national manufacturer implemented an active member engagement program to promote better primary care utilization and to provide better benefits navigation using personal health nurses (PHNs). The PHNs provide an individualized approach that helps members better navigate the care continuum to find the right care in the right setting at the right time. The program included the following elements:
- Dedicated one-on-one collaboration and care planning with a registered nurse
- Interventions that coordinate care, medications, and other benefits and resources
- Technology that prioritizes highest-risk members for outreach and engagement
- Integration with health plans, pharmacy benefit managers, third-party administrators, healthcare provider networks, and other benefit solution vendors
Once high-risk members were identified within the manufacturer’s 40,000 regional workforce, the company implemented a multipronged engagement plan that included:
- Deploying community-based PHNs to facilitate conversations and discover opportunities to coordinate care and eliminate barriers to care access
- Multifaceted campaign to promote program awareness, including print, web, and social media
- Virtual health fairs
- Navigating members to the proper level of care, including bidirectional referrals with behavioral health benefits provider
The results were beyond the company’s expectations and included:
- 85% employee engagement
- 95% employee satisfaction
- 3.13:1 return on investment
The bottom line
It is unlikely that healthcare premiums will come down anytime soon. Therefore, employers need to do all they can to help improve their employees’ health. Employing an active member engagement program is an excellent place to begin.
About Mary Bacaj, Ph.D.
As President of Value-Based Care (VBC) for Conifer Health Solutions, Mary Bacaj is responsible for leading the company’s business unit that delivers population health management and financial risk management services to more than 250 organizations. Conifer VBC is uniquely positioned as a partner to employers and unions, risk-bearing healthcare providers and health plans.
Mary joined Conifer Health in 2014 as Vice President of Strategy to help the company identify and implement solutions that ensure individuals receive the right care at the right time, while healthcare providers are aligned to improve the health of the population. She is a recognized subject matter expert in pay-for-performance programs, hospital and physician alliances, and healthcare reform.
Prior to joining Conifer Health, she was an Engagement Manager at McKinsey & Company, where she worked with senior executives at health systems and health technology companies on strategic challenges, such as population health management, hospital and physician mergers and acquisitions, and risk-based contracting.