Employers represent a critical market segment for most health systems’ strategic growth plans.
Increasingly, employers are recognizing the importance of providing a streamlined, integrated experience for employees accessing the health care system. By developing a better understanding of how employers think about this “experience,” health systems can tailor their strategies to effectively capture an increasing share of employer business.
According to recent research from Willis Towers Watson, 78% of employers are prioritizing improving the health care experience for their employees.1 This focus on the experience is not surprising, as additional research conducted by Willis Towers Watson shows that employees who get their benefits from their employers give the health and welfare initiatives provided by their employers a –52 Net Promoter Score.2
Importantly, employers are increasingly expecting some element of risk- or value-based design in health plans, particularly in services administered by health systems. A critical way for health systems to capture the value created through these value- or risk-based arrangements is to provide members a thoughtful and seamless experience that does not have roadblocks that might push members toward suboptimal routes in pursuing care. Clearly, as health systems increasingly target the employer segment, creating an integrated “experience” will be a key success driver.
Defining “experience”
To start, health systems must recognize that an individual’s health care experience has multiple facets, which are related but may differ in complex ways. For simplicity, “experience” can be segmented into three parts with respect to employer health care.
- Employee experience: Employers are usually the starting point for most people’s health care experience. This is where an employee will enroll in his or her employer’s benefit plans and receive information about additional programs that an employer may offer, such as wellness programs, price transparency tools or onsite clinics.
- Member experience: Once enrolled, the employee becomes a “member” of the health insurance plan in which he or she has enrolled. As a member of a health insurance plan, typical issues the individual needs to deal with include who’s in and out of network, deductibles, balance bills, prior authorizations, and other financial and administrative items.
- Patient experience: Once an individual needs to use his or her health plan to address a medical condition, that individual becomes a “patient.” This facet is where many health systems initially focus their efforts, as it has been their traditional purview. Focus here is typically on such items as appointment scheduling, referrals and accessing test results, as well as the core provision of clinical services.
Anyone with U.S. employer-based health insurance has experience that simultaneously touches on each of these facets. Unfortunately, the various stakeholders involved in providing each experience do not consistently coordinate and integrate to deliver a seamless overall health care experience. Noted below are a few representative examples:
- An employee accesses an employer’s care management vendor for support to manage a chronic condition, but the vendor provides clinical advice not fully aligned with the employee’s primary care physician.
- A specialist determines an employee needs a minor medical procedure and refers the patient to an outpatient facility. Though the specialist is “in network,” the outpatient facility is not, generating significant additional costs for both the employer and the employee.
- An individual in a physician’s office asks questions about the cost of a procedure and refers to pricing information in a phone app provided by the employer. Neither the provider nor the office staff can confirm that the information accurately reflects what might be billed.
These and many other situations generate a tremendous amount of confusion, frustration and worry among individuals, even if their employer and the health system have the best intentions. With this perspective, the factors behind the negative net promoter score noted earlier begin to become clear.
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The importance of employee experience is exemplified by two case studies from a “mystery shopper” exercise recently undertaken for a health system’s employee population. Both highlight the complexities of navigating health benefits and why it is critical for health systems to support employers’ employees to enable a better experience. 1. An “employee” (mystery shopper) on the recommendation of her orthopedic specialist sought a chiropractor. The employee first confirmed chiropractic care was covered by visiting her employer’s benefit website, but no chiropractic providers were listed. Next, she accessed the online provider finder tool on her health insurance carrier’s website to search by ZIP code and specialty, but no results were found. Finally she called the “concierge” line for her employer’s health plan (managed and staffed within the health system); the representative provided vague guidance about the availability of the one in-system chiropractor and directed the employee back to the employer’s benefit website to complete a form for approval for care outside of the health system’s domestic network. Overall, the process took the employee a considerable amount of time and ultimately resulted in the employee seeking care outside of the health system. 2. An “employee” requiring a knee replacement surgery wanted to find within the health system’s domestic network an orthopedic surgeon with significant experience. He first went to the health system’s public website to use the provider finder tool, where he was presented with dozens of orthopedic surgeons, but it was not clear which surgeons specialized in knee replacements. He noted that there was no option to search by condition or service; instead, the only option was the wider clinical specialty. His next step in his search for a knee specialist was to sign in and search his employee health plan website, managed by the health system. The employer provider finder had more features than the health system’s public website’s provider finder, allowing him to find surgeons in a “map view” and to specify language preferences, but again there was no option to search by condition or service. Neither provider finder helped him identify the “best” doctor for his needs. |
The role of the health system
A lack of clearly defined roles and accountability are the biggest causes of experience difficulties. In the past, each of the key players in the health care “ecosystem” had well-defined roles in providing the employer, provider and member experiences. As the ecosystem is evolving, those roles are changing, but the blueprint for providing an integrated experience has not kept pace.
This evolution is particularly important for health systems to consider as they formulate and execute growth strategies to engage employers. For example, health systems creating direct contracts with local employers will have a major stake in establishing a compelling, coordinated and integrated experience in order to capitalize on the value proposition for the employer. In this strategy, ensuring the experience enables the desired behavior; supports effective engagement with the system’s care management functions; and provides consumer-grade operational elements like online, same-day appointments will be paramount.
For those systems whose strategy focuses on a center of excellence approach, clinical coordination with an individual’s local care team (likely at a different system), clear communications with the patient and perhaps family members, and seamless integration with insurance and billing matters will be of utmost importance.
Of course, the health system does not and cannot “own” all elements of the experience; however, as the health system is developing its employer segment strategy, it can and should proactively work with its chosen partners to establish an integrated approach to the experience employees will have. This integrated approach may include:
- Setting clear expectations
- Establishing roles and responsibilities
- Defining individual and shared metrics
- Mapping the necessary technology and process connectivity
- Aligning communications
An integrated approach will naturally have to contend with varying levels of maturity among the key players, such as their relative level of technology sophistication. While these constraints will undoubtedly complicate the strategy, addressing these considerations up front will increase the downstream success of any strategy being deployed.
Getting started
Incorporating an effective experience element to a health system’s growth strategy may seem like a daunting task, and it is. One practical way to jump-start the development of a great experience is to begin with a set of guiding principles. Since the role of providing clinical care is at the heart of what health systems do, they have the “high ground” in establishing experience principles that ultimately support the provision of cost-effective, high-quality care.
Health systems can share these principles with their partners: insurance carriers, technology partners and, most importantly, the medical practitioners within the system who are core to the experience. Each may need to address these principles differently depending on their role, sophistication, business model and other factors. By establishing a common “true north,” a health system can lead the charge to deliver a consumer-grade, integrated experience to the employees and families of their employer clients.
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Experience guiding principles for health system employer segment strategy Focusing on these guiding principles will be an important first step in aligning on the myriad operational, financial, technical, clinical and other elements that ultimately make up the overall employer segment strategy and corresponding individual experience. |
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Principle |
Description |
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Progressive consumer-grade experience |
Overall, individuals access a modern, simple, streamlined, personalized solution comparable to other consumer experiences (e.g., Amazon, OpenTable, Uber) when they seek care |
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Multi-platform capabilities |
Support for individuals is provided seamlessly across multiple platforms, including phone, web and mobile/text solutions based on member preference |
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Comprehensive network inventory |
Individuals have access to an accurate and up-to-date listing of network providers across all care settings (hospital, PCP, specialist, clinics) and across all access paths (phone, web and so on) |
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Member-driven search |
Individuals can search for providers/care settings across dimensions that are most important to them, such as location, gender, experience, quality, cost or other factors |
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Optimized recommendations |
As part of seeking care, individuals can get recommendations on the optimal provider/care setting based on objective criteria that they choose, such as proximity, objectively measured quality and cost |
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Practical communications |
Communications to individuals regarding their care is integrated and practical, including appointment schedules and reminders, pre-authorization information, referrals and other elements of care delivery; clinical information is communicated in easy-to-understand, patient-centric language |
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Virtual delivery of care |
Where appropriate, certain elements of care can be delivered directly via telemedicine or other virtual capabilities directly integrated with the platform individuals use to seek and access care |
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Financial transparency |
Individuals are provided with all relevant financial information to support their decision making when seeking care, including cost for care, deductible/out-of-pocket maximum impact, health reimbursement arrangement/health savings account usage and out-of-network costs |
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Secure and compliant solution |
The entire experience for individuals in accessing information and support on utilizing care employs current privacy and security protocols and is fully compliant with applicable laws and regulations; security and privacy is transparent and clear to the member |
In summary, health systems must have a focused, integrated experience strategy as part of any employer segment strategy. Depending on their specific strategic initiative, health systems not only need to consider the “patient” experience, as they have in the past, but also the “member” experience that has typically been the role of an insurance carrier. They also need to be aware of and influence the “employee” experience, in terms of how their particular strategy is communicated to employees. Providing a great experience is no longer a “nice to have,” but rather it is a critical path to initially penetrate the employer segment and subsequently influence the individual behaviors required to deliver on the strategy’s value proposition.
References:
[1] “Survey highlights,” High-performance insights — best practices in health care, https://www.willistowerswatson.com/en-US/insights/2017/01/full-report-2016-21st-annual-willis-towers-watson-best-practices-in-health-care-employer-survey
[1] 2017/2018 Global Benefits Attitudes Survey, p. 19 (North America). https://www.willistowerswatson.com/en/insights/2017/11/2017-global-benefits-attitudes-survey-benefit-preferences