February 08, 2021
Business Health Agenda (BHA) 2020 was held virtually this year. A series of employer-only benchmarking calls offered attendees a chance to engage in intimate dialogue, along with the flexibility to participate in more sessions of their choice. The benchmarking conversations explored the ins and outs of engagement platforms and advocacy solutions, how to measure employee engagement efforts, the ways in which technology can help to dismantle mental health stigma, how to infuse mental health into all services and care settings, ways for keeping pace with innovation while managing exceptionally high-cost claims and ways for tailoring benefit design to meet the needs of the modern workforce.
The following is a compilation of themes and key insights that came out of these discussions.
A Look at Employee Experience and Engagement Priorities
There is an increased focus on simplifying the consumer health care experience and enhancing employee engagement with the programs and services that help define that experience.
High Tech vs. High Touch: There’s Room for Both!
The many benefit offerings provided by employers can increasingly become a complex web of programs and services. As this can lead to employee confusion, poor utilization and fragmentation of data, employers continue to explore and invest in ways to streamline and simplify the employee experience. This year especially, the pandemic has placed intensified pressure on employers to invest in (or fine-tune existing) high-tech and/or high-touch solutions to better assist employees with navigating COVID-19 resources and beyond.
Integrated portal/online engagement platforms (“high-tech”) and interpersonal advocacy/navigation (“high-touch”) programs are two channels with different mechanisms for achieving a similar goal – allowing employees to access the right information/support at the right time in ways that are simple and convenient. Employers agree that both high-tech and high-touch approaches are invaluable and that there is a need for both, depending on what an employer is trying to accomplish. Ultimately, there is space in the market for both as employers seek a variety of ways to better support their employees.
According to Business Group on Health’s 2020 Large Employers’ Health Care Strategy and Plan Design Survey, the use of high-touch concierge services increased significantly from 2018-2020 (60% up from 39%). In fact, 21% of employers said that high-touch concierge or navigation was a top health care initiative for 2020. This year’s 2021 survey revealed that as many as 9 in 10 employers will offer navigation support to employees, be it in the form of advocacy, medical decision support/second opinion services or a high-touch concierge offering. As far as engagement platforms are concerned, the 2021 survey revealed that only 23% of employers currently have an engagement platform in place, with an additional 8% making one available in 2021. Another 24% indicated that they will implement in the next few years. Overall, employers are still looking for the personalization capability of engagement platforms to mature.
Are Employee Engagement Efforts Paying Off?
Employers often struggle with determining whether their time and resource investment in employee engagement efforts is paying off. Many have begun to track and measure utilization of resources, with some striving to distinguish meaningful employee engagement from engagement interactions that are simply transactional.
- One employer set out to build an all-encompassing program of their own that incorporates the best aspects of a high-touch advocacy/navigation platform and a high-tech personalized engagement platform. As part of redesigning the employee experience, this employer focused on 1) the marketing of existing programs; 2) providing additional education on benefits and financial well-being; 3) simplifying and improving the architecture and function of a new digital hub; 4) enhanced personalization of preferences; and 5) navigation support. The entire process was informed and supported by an employee feedback loop, which included surveys, focus groups and site utilization testing.
- When asked about the types of approaches employers are currently leaning on (or looking into) for support with employee engagement efforts, the majority of employers on the call (55%) indicated that they have both an integrated portal/engagement platform and an advocacy/navigation program in place. Thirty six percent of employers on the call indicated that they were considering implementing one or both types of programs for 2021/2022.
- By and large, employer engagement measures are based on participation; but many are looking to change that to focus more on sustained and meaningful utilization and outcomes. One employer that currently ties incentives to participation is strongly considering moving to an outcomes-based incentive program.
- One employer shared that it looks at engagement through two different lenses: 1) “Activation,” or an employee’s point of entry into a program (e.g., login, registration) and 2) true “Engagement,” viewed as actions in a program that drive to targeted outcomes (e.g., the number of interactions required for meaningful change).
- A common complaint from employers is that the measurement information that they receive from vendors is too high level. Employers want to go a click deeper on engagement and satisfaction with the tools, resources and programs that are being offered.
Mental Health is Now More Important Than Ever
Today, there is a growing need for employers to proactively address mental health in the workplace and to offer and encourage the timely use of employee behavioral health resources. However, there continue to be challenges to advancing mental health progress, namely uneven and inadequate access (especially for childhood counseling) and stigma, which often stands in the way of individuals seeking the necessary help they need.
A No-brainer: Employers Are Working to Integrate Mental Health into All Services and Care Settings
Disrupting the present practice patterns to make mental health an integral component of a patient’s care journey is no small task, but it is imperative that providers and partners find a way to incorporate mental health support into all appropriate care access points. Employers actively seeking to integrate mental health into their solutions should make it a priority discussion point with their vendors.
Dismantling Stigma: Technology Is Leveling the Playing Field
Beyond integration of services, employers are tackling mental health perceptions and misconceptions. Fortunately, technology has offered a pathway for connecting employees to mental health resources while simultaneously playing an integral role in the fight against stigma. Anti-stigma campaigns are becoming more popular with assistance from web-based intervention, online discussion groups and virtual resources and apps. The goal is to keep behavioral health resources at employees’ fingertips while normalizing mental health dialogue.
- One employer overhauled its approach to behavioral health to provide on-demand access to behavioral health coaching, video therapy, video psychiatry and self-guided therapy. The goal was to have a solution that would be accessible to all employees, including those outside the U.S., at any hour.
- Some employers are looking into digital well-being platforms that provide fitness, mindfulness, nutrition and sleep videos – on-demand resources that offer personalized support for employees and normalize the mental health conversation, thus helping to mitigate both access and stigma concerns.
- Another employer has partnered with internal employee resource groups (i.e., groups that champion different ethnicities, cultures, sexual orientations, female empowerment and young professionals) to better reach and connect employees with the behavioral health resources being offered.
- In an effort to enhance male engagement with behavioral health resources, one employer has held male-only sessions and has enlisted support from male leadership (e.g., messages, videos). This employer also continues to provide information on community resources in case employees are less comfortable participating in employer-provided mental health resources.
- Some employers have seen an increase in EAP utilization, particularly for child-care/summer camp placement assistance. One employer has found that promoting ancillary services of the EAP, in essence, encourages employees to become more comfortable with the mental health aspect of it.
- Employers are pushing their vendors hard for more mental and behavioral health service integration. They are increasingly trying to get their carriers to see and address the gaps that exist when it comes to mental health and are working to achieve a more holistic approach, focusing on prevention, resilience and treatment.
- Many employers have newly emphasized the training of front-line managers, with a goal of enabling them to identify potential behavioral health issues and direct employees to appropriate resources. Often, this training is built internally (working with risk and organizational development teams), while leveraging external experts on mental and behavioral health for guidance.
Tailoring Benefit Design to Meet the Needs of the Modern Workforce
Today, employers are increasingly tailoring their benefits to the next generation of employees who value flexibility and choice. Employers discussed the various ways in which they’ve sought to personalize their benefit offerings. However, with COVID-19 as the backdrop, this conversation naturally gravitated toward work/life balance and ways to support employees in a virtual environment.
- One employer has gone to great lengths to understand how its benefits offerings are working at the individual level. Through a 6-month exercise (benefits portfolio assessment), this employer looked into how well their benefits were helping associates to take care of themselves and their families. This involved empathy interview conversations and an all-associate pulse survey. The company also conducted empathy research to try to understand why health care was simply unaffordable for lower-wage earners.
- Some employers are rethinking the traditional PTO structure and making changes that acknowledge the diversity in their workforce.
- There was a general consensus from employers that, given the virtual world we are now living in, employees are struggling with separating work and home and with taking time away in general. This employer instituted “Thank You” days off (e.g., extra time off during the holidays) to promote more balance.
- Another employer put restrictions on how early and late meetings can start. This employer also implemented “summer hours” and “holiday hours,” where the company shuts down for a 2.5-day weekend.
High-cost Claims: Keeping Pace with Innovation
The high-cost treatment pipeline, especially in the genomic innovation space, has put unprecedented pressure on the system and thus plan sponsors. These days, employers are challenged with keeping pace with innovation (i.e., providing coverage for new treatments) while simultaneously holding down costs.
- As many newer, especially high-cost drugs are administered and paid for under the medical benefit, traditional utilization management solutions are no longer enough to manage the cost impact of emerging specialty drugs and gene therapies.
- To date, the prevalence of gene therapy claims has been small, as they target a small number of patients impacted by severe conditions. However, this may change as the pipeline expands to address more mainstream, even chronic, conditions.
- Employers struggle most with the inability to forecast the cost impact of these exceptionally high price tags. While they try to work with their vendors throughout the year to secure pipeline updates, for the most part, this information is coming to them through a single annual meeting.
- Many employers feel as though they need to explore new ways of managing risk and are looking to solutions like stop-loss, financing and risk-pool models to change the way they pay for these new, especially high-cost drugs.
- One employer shared that its organization has had conversations about whether the company would even cover these drugs at all – not how, but if.
- Employers also discussed the importance of addressing the knowledge gaps that exist and stand in the way of asserting the true value of these drugs (i.e., questions concerning administrative burden and long-term durability/effectiveness of treatment).