Mention the words “open enrollment meeting,” and some people might immediately tune out. Or maybe they start twitching and checking the calendar. We tend to think about what an opportunity these meetings are to make a positive change in the lives of members.
Open enrollment meetings and employee benefits are important in the lives of members. That's why it is so vital that we do all we can to help encourage members to utilize their benefits. Improving utilization is a powerful way for client managers, HR leaders, and brokers, to help reduce costs for clients and members while empowering members to improve their health outcomes.
Pop quiz! Without looking it up, which costs employee plans more: a visit to a primary care physician (PCP) or a visit to the emergency room? And of the two, which is a more painful experience for the member? Obviously, it’s the emergency room. Nobody wants to be there, and nobody wants to pay the bills that come out of those visits. The key is prevention. Preventing a problem is always going to be preferable to treating a problem. By utilizing preventive medicine, like regular PCP checkups and tests, members set themselves up for better health outcomes down the road.
According to a 2019 analysis[1] shared by the Healthcare Financial Management Association, an “estimated $8.3 billion is spent each year on emergency department (ED) care that could be provided in another location.” The findings were based on a study where an independent primary care delivery service company was contracted by the employer to provide access to a single on-site primary care clinic at the firm’s headquarters and 15 near-site primary care clinics in the same commuting zones as the firm’s company locations. It reported on visits to the emergency room made by patients with just six chronic conditions, including behavioral health, diabetes, and hypertension. By focusing on preventive care and proactive management, patients and providers may be able to reduce the severity of symptoms for these chronic conditions as well as the costs of later radical interventions.
Investing in prevention can deliver huge benefits for members and employers, and utilization management (UM) programs are a powerful tool in steering members to preventive care. UM programs can draw on data to identify members who will benefit from extra intervention and help them find the care they need. Employee education tools can help empower other members to seek out primary care providers. We can help employers tailor their messages and strategy to reach their people.
We can help you design and implement an employee wellness program, with incentives and education. For employees who work from a central location, a wellness fair is a great way to reach a large number of your people at once. For geographically disparate populations, walking/wellness challenges can inspire healthy competition between teams. These wellness programs are usually a great bet for employers. According to a survey[2] of Society of Human Resources Management members, approximately three quarters of their members offered a wellness program, and more than two-thirds of those who offered wellness programs said their efforts were “somewhat effective” or “very effective” in reducing the costs of health care. What’s more, the Rand Corporation studied these efforts, and found[3] an ROI of $1.50 for each $1 spent on wellness programs, according to SHRM.
Employers who can offer on-site primary care options for their populations may also see positive results. The researchers found that among members who utilized the employer-sponsored primary care vs the control group, total spending was 45% lower per member per month. According to the report, “The lower spending was associated with lower spending on non–primary care services, such as emergency department … and hospital visits … despite higher spending on primary care … and mental health.”
Client managers also play a vital role in improving utilization during our annual plan reviews with clients. As a TPA, we can sit with employers to look at the data and dig into ways to reduce cost. We look at what has been utilized through the year and check in with the client about their plans for the coming year. Are they expanding, or implementing a wellness program, or bringing employees back to the office, or making some other big change? We make sure we’re aligned on their goals for the coming year and then figure out how to support utilization.
In February 2023, the National Association of Community Health Centers released a report[4] on the state of primary care in America, and they found that more than 100 million Americans do not have access to primary care due to a shortage of providers in their community. As a nation, we have a long way to go in improving healthcare utilization. And as a trusted partner for our clients, we have an enormous opportunity for improving the lives of members while reducing the cost of healthcare. Connect with us and let’s get started today.
Open enrollment meetings and employee benefits are important in the lives of members. That's why it is so vital that we do all we can to help encourage members to utilize their benefits. Improving utilization is a powerful way for client managers, HR leaders, and brokers, to help reduce costs for clients and members while empowering members to improve their health outcomes.
A Solid Investment
Pop quiz! Without looking it up, which costs employee plans more: a visit to a primary care physician (PCP) or a visit to the emergency room? And of the two, which is a more painful experience for the member? Obviously, it’s the emergency room. Nobody wants to be there, and nobody wants to pay the bills that come out of those visits. The key is prevention. Preventing a problem is always going to be preferable to treating a problem. By utilizing preventive medicine, like regular PCP checkups and tests, members set themselves up for better health outcomes down the road.
According to a 2019 analysis[1] shared by the Healthcare Financial Management Association, an “estimated $8.3 billion is spent each year on emergency department (ED) care that could be provided in another location.” The findings were based on a study where an independent primary care delivery service company was contracted by the employer to provide access to a single on-site primary care clinic at the firm’s headquarters and 15 near-site primary care clinics in the same commuting zones as the firm’s company locations. It reported on visits to the emergency room made by patients with just six chronic conditions, including behavioral health, diabetes, and hypertension. By focusing on preventive care and proactive management, patients and providers may be able to reduce the severity of symptoms for these chronic conditions as well as the costs of later radical interventions.
Investing in prevention can deliver huge benefits for members and employers, and utilization management (UM) programs are a powerful tool in steering members to preventive care. UM programs can draw on data to identify members who will benefit from extra intervention and help them find the care they need. Employee education tools can help empower other members to seek out primary care providers. We can help employers tailor their messages and strategy to reach their people.
Programmed for Success
There are no one-size-fits-all solutions in benefits. We say that a lot, and we mean it. For clients who want to improve member utilization, the best place to start is with your client manager. They already know your population and can help you find programs that will inspire and empower your unique population.We can help you design and implement an employee wellness program, with incentives and education. For employees who work from a central location, a wellness fair is a great way to reach a large number of your people at once. For geographically disparate populations, walking/wellness challenges can inspire healthy competition between teams. These wellness programs are usually a great bet for employers. According to a survey[2] of Society of Human Resources Management members, approximately three quarters of their members offered a wellness program, and more than two-thirds of those who offered wellness programs said their efforts were “somewhat effective” or “very effective” in reducing the costs of health care. What’s more, the Rand Corporation studied these efforts, and found[3] an ROI of $1.50 for each $1 spent on wellness programs, according to SHRM.
Employers who can offer on-site primary care options for their populations may also see positive results. The researchers found that among members who utilized the employer-sponsored primary care vs the control group, total spending was 45% lower per member per month. According to the report, “The lower spending was associated with lower spending on non–primary care services, such as emergency department … and hospital visits … despite higher spending on primary care … and mental health.”
Client managers also play a vital role in improving utilization during our annual plan reviews with clients. As a TPA, we can sit with employers to look at the data and dig into ways to reduce cost. We look at what has been utilized through the year and check in with the client about their plans for the coming year. Are they expanding, or implementing a wellness program, or bringing employees back to the office, or making some other big change? We make sure we’re aligned on their goals for the coming year and then figure out how to support utilization.
In February 2023, the National Association of Community Health Centers released a report[4] on the state of primary care in America, and they found that more than 100 million Americans do not have access to primary care due to a shortage of providers in their community. As a nation, we have a long way to go in improving healthcare utilization. And as a trusted partner for our clients, we have an enormous opportunity for improving the lives of members while reducing the cost of healthcare. Connect with us and let’s get started today.
[1] “Preventable ED Use Costs $8.3 Billion Annually: Analysis.” Healthcare Financial Management Association, https://www.hfma.org/payment-reimbursement-and-managed-care/payment-trends/63247/
[2] “The Real ROI for Employee Wellness Programs.” Schaefer, Jennifer. SHRM, 2015.
https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/real-roi-wellness.aspx
https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/real-roi-wellness.aspx
[3] “Do Workplace Wellness Programs Save Employers Money?” Rand Corporation, 2014.
[4] “Closing Primary Care Gap: How Community Health Centers Can Address the Nation’s Primary Care Crisis.” NACHC.org, 2023. https://www.nachc.org/wp-content/uploads/2023/02/Closing-the-Primary-Care-Gap_Full-Report_2023_digital-final.pdf