Population health considerations for self-insured employers
The majority of Americans receive health insurance through an employer. What’s more is that approximately 60% of individuals who have employer-sponsored health insurance are receiving coverage from a self-insured employer.1
Why choose to be self-insured?
Being a self-insured employer gives your organization more control over your health and well-being benefits and medical spend. This can be immensely helpful as healthcare costs continue to rise, especially in the post-pandemic era. According to Willis Towers Watson, healthcare costs are expected to increase 5.2% in 2022, and being self-insured can give employers the ability to more effectively manage or mitigate this rise in costs.2
However, there are some key barriers self-insured employers face when aiming to manage all aspects of health benefits, improve employee health, and reduce healthcare spending.
- Benefits design: How do I keep up with innovative new benefits trends and technology to attract and retain talent?
- Employee engagement: How do I encourage employees to take an active role in their health?
- Data analytics: How do I interpret my aggregate screening and claims data?
- Showing a return on investment: How do I prove that our wellness offerings are positively impacting our bottom line?
Planning for self-insured success
Focusing on these 4 topics can help employers ensure they are making the most of their self-insured status.
- Program Design:
- Leverage the Triple Aim as a core principle of program design3; all programs should aim to do one or more of the following:
- Improve the experience of care
- Improve the health of the population
- Reduce the per capita cost of healthcare
- Work with vendors who offer clinically guided solutions that evolve as medical technology improves and consumer behavior changes
- Inform your vendors of the different populations within your workforce so they can provide guidance based on the diverse needs of those groups
- This includes breaking down your population by a variety of factors to ensure the offered solutions are accessible and effective based on different demographics
- Focus on chronic condition prevention and management
- Approximately 30-35% of all annual claims for self-insured employers are driven by 1-2% of members with costly chronic conditions; solutions that prevent and manage these conditions can provide a higher return on investment3
- Communications Planning:
- Take the time to make a calendar of all employee communications about benefits and well-being offerings to ensure consistent, clear messaging
- Communication should be spaced out in a way that keeps well-being benefits at the top of peoples’ minds (and inboxes), while not being overwhelming
- Be sure to communicate with employees in a variety of ways (eg, email, paper, in-person)
- Leverage pilot programs, if needed, to gather insight4
- When implementing new offerings, consider a pilot program with a specific group of employees or a specific location to gather learnings to develop a more effective launch strategy for the entire organization
- Program Implementation:
- Don’t take a “one size fits all approach;” leverage screening and/or claims data to funnel the right people into the right care
- Make sure your health and well-being offerings seamlessly link to other related offerings
- Employees do not want to be unsure of their next steps; a lack of connection between getting health risk data, interpreting that data, and receiving clear action steps for addressing any issues illuminated by that data can lead to a drop off in engagement
- Data analytics and review
- Take the time to review aggregate screening and/or claims data, and leverage the expertise of your vendors (including health plans, third party administrators, and wellness solution providers) to help guide you in taking your programs to the next level
- Reflect on the cost avoidance secured through health and wellness benefits to showcase their value to leadership
- For example, hypertension increases an individual’s yearly healthcare costs by nearly 33%5; by illuminating hypertension risk early on, before it becomes costly to treat, this cost increase can be avoided
Getting the support you need
As a self-insured employer, selecting vendors and partners that are committed to helping you improve employee health, increase access to quality healthcare, and lower healthcare spending is essential. A few key things to keep in mind as you evaluate vendors, include:
- Does this vendor offer consultative guidance on program design to meet the unique needs of your employees?
- Are the solutions offered by this vendor clinically based? Is there data to support that the solutions will drive momentum towards at least one goal of the Triple Aim?
- If needed, can this vendor offer communications support to increase engagement?
- Can this vendor provide year-over-year participation and improvement data to help me present a return on investment and value on investment to leadership?
The bottom line
Employers have an eye on the affordability of healthcare, especially as the potential effects of deferred care during the COVID-19 pandemic are unveiled. About 90% of employers have stated that “achieving affordable sustainable costs” for their organization is a top priority in 2022.2 Choosing to be self-insured gives your organization more transparency into healthcare claims and more control over your healthcare spending. It also allows you to take a data-driven approach to tailoring benefits offerings to meet the needs of your most important business asset―your employees.
- Learn more about the Quest Diagnostics 3-pronged approach to employer population health
- Biometric screenings are the foundation for a data-driven population health program. Learn more about the value of yearly biometric screenings>>
Quest Diagnostics has 20 years of experience helping thousands of self-insured employers improve employee health and reduce healthcare spending. Watch this video to learn more.
- Barnett JC, Berchick ER. Health insurance coverage in the United States: 2016. Washington, DC: United States Census Bureau, 2017.
- Mayer, Katheryn. How employers hope to contain rising healthcare costs. HRExecutive. October 8, 2021. Accessed October 23, 2021. https://hrexecutive.com/how-employers-hope-to-contain-rising-healthcare-costs-preserve-care/
- Steven E. Goldberg, Maren S. Fragala, and Jay G. Wohlgemuth. Population Health Management. 2019 .547-554. http://doi.org/10.1089/pop.2018.0184
- Aravamudhan, Rani. How to measure your wellness program’s ROI. BenefitsPro. January 5, 2021. Accessed October 23, 2021. https://www.benefitspro.com/2021/01/05/how-to-measure-your-wellness-programs-roi/
- American Heart Association. Cardiovascular diseases affect employers. Accessed October 23, 2021. https://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_496180.pdf