Smarter health care consumers requires stronger benefits education initiatives – BenefitsPro

While shopping around for care is critical to reducing out-of-pocket costs, it can feel overwhelming for those not used to doing it. (Image: Shutterstock)

With health care costs continuing to rise, today’s consumers need to make smarter health care decisions to ensure they receive the care they need at a price they can afford. Unfortunately, most American consumers lack an understanding of health care, their own health plans, and how to effectively “shop” for health care coverage and services. This inability to make educated choices costs employees—and their employers—millions in unnecessary costs each year.

Related: Health care consumerism and price transparency tools: Are your employees equipped?

Consumers are increasingly turning to their employers for guidance on how to make the right health care choices. And that’s a good thing–too often, according to DirectPath’s 2021 Consumer Report, employees are learning health insurance terms and concepts from family (24%) and friends (14%) or self-conducted research (34%) rather than from benefits professionals. Further, friends, family, and the internet lack knowledge of the employee’s personal situation and the employer’s plan offerings—putting employees at risk of receiving incomplete, if not faulty, information.

Prioritize benefits education

To help their employees, employers should focus their efforts on several key areas: basic terminology and concepts of health care, the specifics of available benefit offerings, and how to apply that knowledge.

To start, employers need to reteach (or, in some cases, introduce) the basics of health care and how to use it. By focusing on core terminology such as premium, deductible, copayment, coinsurance, and out-of-pocket limit, as well as concepts such as network and out-of-network and preventive care, employers can help their employees understand how they share the cost of their care. Further, communications should explain fundamental concepts like procedure (i.e., what services they need) and provider (e.g., hospital, physician, outpatient clinic, pharmacy) so that employees have a contextualized understanding of how to then put their benefits to use.

Smart health care decisions start with smart benefits selections, as an employee’s health care coverage heavily influences the care they choose. It’s essential that employees are aware of all the plans and programs available to them—not just their health care coverage itself, but wellness programs, supplemental programs offered by the carrier and other vendors to help address specific health needs, and transparency tools.

As with any form of education, this content should be shared in a variety of formats (e.g., using both digital, print, and “in-person” channels), as everyone learns and accesses information differently. That said, studies have shown that consumers overwhelmingly prefer personal interactions, which offer the opportunity to have their specific concerns and circumstances addressed, often in a one-on-one setting.

Not every organization has the bandwidth to create and maintain a robust, year-round benefits education program, which is where partnering with brokers and consultants can help. Operating as an extension of the HR team, these professionals can help craft and execute a benefits education program and pull in external resources to help.

Teach employees how to shop for care

Sometimes, consumers make the wrong health care choice because they don’t know there are alternatives. In that same DirectPath survey, 55% of respondents admitted to not knowing they can compare treatment or services costs before choosing where to get their care. Care costs are not fixed across the board. For instance, traveling to a nearby town across the state line can result in significant cost savings. Similarly, employees should not assume that the care provider they have been visiting for years will always be the best option, as plan terms can change year to year. Despite this, over half (57%) of consumers only check if a provider is in-network when they plan to visit a new provider or facility, and 25% only do so when their health plan changes.

While shopping around for care is critical to reducing out-of-pocket costs, it can feel overwhelming for those not used to doing it. To make the task easier, employers can introduce tools like websites such as GoodRx and FairHealth that employees can use to compare prices online, though it is important to note that these sites do not consider specifics like employees’ plan provisions or deductible status. For a more personalized cost estimate, employees can consult carriers’ websites, which typically factor in the employers’ health plan provisions. Slowly but surely, more hospitals are making tools available on their websites as heightened transparency regulations take effect.

Still, even employees who are comfortable using online tools might find these comparisons confusing. To increase employees’ confidence, employers can also offer them consultations with advocacy services. For example, if an employee needs help deciding where to receive a medical procedure, an advocate can create a side-by-side comparison of providers that accounts for the cost and quality of each. Year-round access can ensure employees can get the information they need –when they need it — without overwhelming HR teams.

With health care costs on the rise and many consumers facing uncertain finances as the pandemic wears on, employers can do their part to help employees take control of their finances. By prioritizing benefits education and connecting employees with the resources they need to make sense of health care costs, employers can help employees—and, in turn, themselves—save on care and stay healthy.

Kim Buckey is vice president of client services at DirectPath.

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