How Employers, Payers Can Pursue Integrated Health Care Benefits

November 24, 2020 - Employers are gravitating toward integrated health care benefits to improve member engagement and patient experience as well as lower healthcare spending, according to a report commissioned by Anthem.

As employers are increasingly taking charge of their employees’ health insurance, new strategies are emerging to streamline care and coverage. As of 2013, ten percent of employers had dropped healthcare coverage entirely, largely due to costs. Those who continue to provide health insurance may be scrambling to meet employees’ needs in an affordable way.

One of the main drivers behind employer activism is rising healthcare costs. As the price tags on healthcare products and services continue to increase, employers want to bring employee healthcare spending under control. By taking a more active role in their employees’ health insurance, they can implement more targeted strategies to rein in spending.

Another factor that pushes employers to captain their employees’ healthcare coverage is the desire to improve coverage and care quality. They may leverage centers of excellence or high-performing provider networks to facilitate high-value care at a lower cost.

Integrated health care benefits are a united solution for both of these motivations.

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An independent research firm fielded four studies for Anthem, one every two years from 2014 through 2020. The studies observed 300 employers' behaviors, experiences, and reactions as they pursued integrated health care.

Not only have integrated health care benefits strongly attracted employers’ interest, but those who engage with this solution are seeing positive outcomes on their member engagement, member experience, and healthcare spending, the studies’ results demonstrated.

What are integrated health care benefits?

Integrated health care itself is not new to the healthcare industry. Care coordination and whole-person care have played a significant role in moving the healthcare system towards value-based care.

However, integrated health care is also an employee benefits strategy, not just a clinical strategy.

Integrated health care interweaves pharmacy, ancillary, supplemental health, and other benefits data into the employer’s health plan to facilitate smoother communication between employees’ providers.

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This employee benefits strategy might also include an employee assistance program, disability benefits, and absence management.

In 2020, the most popular products to integrate were vision (75%integrating) and pharmacy benefits (73% integrating). Dental and disability benefits followed the pair. Also, 64 percent of employers were integrating employer assistance programs, and 62 percent were integrating supplemental health products.

“Actionable data is shared among doctors and other health care providers so they can better diagnose and treat members, detect coverage gaps, and guide employees toward prevention and care management,” the report explained.

Provider collaboration is key to this strategy. Three key methods for facilitating provider collaboration included connecting all providers through an EMR, establishing automatic reminders about extra dental cleanings, and sending health-related reminders to employees. Employers also leveraged AI and apps to connect employees to their benefits.

Employer interest in this solution has increased significantly in the last four years alone.

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In 2016, only 33 percent of employer study participants were in the process of integrating their healthcare benefits, and another 27 percent were actively considering this course of action. In 2020, 56 percent of employers were integrating their healthcare benefits, and an additional 23 percent were considering it.

Only four percent of the employers who participated in the study rejected integrated health care benefits.

Large employers are more likely to pursue integrated health care benefits.

In 2020, cost-effectiveness was the primary factor that motivated employers to pursue integrated health care benefits (83 percent), followed by improving employee health (82 percent).

How can companies, payers pursue integrated health care benefits?

Employers typically follow a three-phase model for implementing integrated health care benefits.

The first phase is development. In the development stage, employers set their objectives, analyze the costs and risks, and put together an operating plan.

Phase two is implementation. Employers in this phase will select a payer or carrier and identify necessary vendor partners.

Most employers (71%) chose to integrate their health care benefits using one payer. Over 70 percent of employers considered integrating vision and dental benefits using a single payer.

Once these components are in place, employers will put their integrated health care benefits plan into action, educate their employees on the solution, and engage their employees with the platforms.

The final phase is post-implementation. Employers will report the outcomes and evaluate their integrated health care benefits strategy, measuring its progress against their success metrics.

Over half of employer participants defined success by employee engagement (51 percent), while another 29 percent measured success by return on investment.

One of the key ways in which employers measured return on investment results was through payer data. Payers can partner with employers by making integrated health care benefits data available.

What are the results of integrated health care benefits?

Most employers indicated that integrated health care benefits achieved positive employee experience and patient outcome goals.

“Employers strongly agree that IHC plays an integral role in human capital management. IHC results in happier, more productive employees, provides more personalized benefits, and contributes to employees’ emotional health, an area that is coming to the forefront,” the report stated.

Study participants’ responses regarding integrated health care benefits typically related to improved employee happiness, reduced healthcare spending, increased member engagement, improved quality of care, and improved patient experience.

“Employers also see the implementation of IHC as key to attracting and retaining talent, and helping to keep their companies competitive,” the report added. “Employers indicate they will expand their IHC benefits strategy to include more benefit lines in the future.”