With COVID-19 as an accelerant, digital healthcare delivery solutions are on the rise, serving as a tool for boosting employee morale, productivity and even critical retention during the ‘great resignation.’
by Tom Starner
While the state of healthcare delivery and outcomes in the United States certainly has its historical success and consistent upsides, it can do better. Apparently, much better.
For example, according to CEOWORLD magazine’s Health Care Index for 2021, South Korea has one of the best healthcare systems in the world, with the U.S. ranked a distant No. 30. The Index ranks 89 countries based on several factors that contribute to overall health.
According to some experts, one key problem in the nation’s overall healthcare performance is that current access to the healthcare landscape remains fundamentally complex, making it difficult and often confusing for consumers–whether they receive care through employer-provided benefits or not.
Courtney Stubblefield, senior director, Health & Benefits, at WTW says the current state of consumer healthcare ineffectiveness can be attributed to many factors. For one, she explains, the nation’s healthcare sector is fragmented and bureaucratic, often architected primarily to facilitate payments across a disjointed supply-side–rather than to ensure the quality and effectiveness of patient outcomes or a smooth patient experience.
“Today, things like unclear starting points, high costs, a mix of insured/non-insured, access issues and other factors make care uneven and disparate in different locations under different conditions,” she says.
Taken together, she explains, these factors often force patients and consumers to self-navigate a web of supply-side resources that at its most basic makes finding a provider or service difficult and at worst can be direct barriers that prevent the right care from being delivered at all.
Stubblefield notes that just under half the country–over 150 million people, according to Kaiser Family Foundation data–receive their healthcare coverage as part of their employee benefits package.
“In the US, we’ve created a system of employer-sponsored health coverage that is a significant source of access to healthcare,” she says. “However, many issues lie beneath the surface that affect variability in that access and delivery.”
No ‘quarterback’ to coordinate care
Candice Sherman, CEO of the Northeast Business Group on Health (NEBGH), a New York-based employer coalition, says that in America another factor in successful treatment outcomes is too few people have primary care physicians who can provide care and act as “quarterback” in making the appropriate referrals and providing care coordination.
“Health plans providing coverage for employer-sponsored healthcare are well aware of the difficulties with finding the right care at the right time,” she says. “Nurse lines, help lines and online navigation services are becoming the norm, as a result.”
Employers are also aware of the issue of overly complex healthcare access, she adds, and many large employers provide healthcare navigation services through other vendors that help with finding care and facilitate second opinions from centers of excellence for complex illnesses such as cancer.
“Even on a good day, the healthcare system is more often than not complicated to maneuver,” says Eric Weil, medical director, primary care, Care Medical, the dedicated medical clinic for Amazon Care. “Consumers have to work their way through scheduling systems. They have to work their way through a language quite different from the language that they speak on a daily basis–and that’s the language of healthcare.
“They have to move back and forth between different providers who may or may not be in the same system and, in and of themselves, may or may not have access to the same information about the patient or their family member,” he explains.
On top of that, in the current environment, healthcare consumers don’t even necessarily have the ability to visit their physicians or nurse practitioners in person all the time because of COVID-related constraints, which are driving long appointment wait times.
“That combination is very challenging for even those who have good access to the healthcare system and information and have access to transportation or can afford to take a day off from work,” Weil says. “Imagine a person who works 10-12 hours a day and doesn’t have the luxury of taking time off, and maybe English isn’t their first language. These additional variables make it even harder for some to access the fundamental level of healthcare that everybody deserves.”
Improve outcomes, deliver value
With that as context, WTW’s Stubblefield says employer benefits that simplify the healthcare ecosystem for patients can drive outcome improvement and deliver value, adding that the ideal scenario for both employees and employers is to truly impact some of the difficult dynamics of the healthcare sector with emerging types of technology-driven and patient-focused solution features including:
Personalized care advocacy models informed by more complete data. Aligning patients with direct-care services, in an integrated way, that they need based on as much applicable data as possible, including health data and social determinants data, such as transportation/housing stability, education, economic status, literacy, and numerous others.
Navigation tools that help patients access care more efficiently. This may mean single-click access to virtual primary care, offering new forms of care continuity by connecting programs or on-demand convenience and scheduling services.
Options for adding newer data points like quality and patient preferences to enable better diagnostics, reduce waste, and improve patient acceptance and compliance with care.
“There are several models being explored to deliver a better member health experience,” she says.
One such solution, she explains, called the overlay model, allows employers to contract with a vendor or set of vendors to provide data and integration services without changing underlying health plans and insurance carriers.
“This approach aims to leverage much of the new technology available to connect members through apps and notifications and deliver content virtually,” she says. “While these require less change at the onset, the challenge is to build sufficient levels of integration and connectivity with health plan functions and data to support patients fully.”
Stubblefield says healthcare benefits also are a key factor in employee experience and in attracting, retaining and satisfying talent–particularly high-performing talent.
WTW’s employee data captured through its annual Global Benefits Attitudes Survey, in fact, found that pre-pandemic 2019, 43% of US employees agreed/strongly agreed that healthcare benefits play a role in attraction and 54% said the same for retention. Fully 70% replied that their health plan met their needs.
WTW data also shows that employees care deeply about price/cost reductions (39%) and more generous healthcare coverage (36%), though a number of emerging areas such as services that help direct to the best care options (29%), greater access to emerging care solutions (24%), and access to on-line/virtual visits (20%) are on the rise.
“The surge in the use and acceptance of virtual care through 2020+ has been astounding, with nearly half of employees using virtual visits and 80% reporting them as effective as face-to-face visits,” Stubblefield says.
She notes that employees with mental health issues, in particular, report they are more likely to get the help they need through virtual care, and this increases as pay level goes up. Stubblefield says the adoption of member experience-based solutions is setting the new standard and expectation for a competitive, attractive employee health care offering.
Along those lines, she adds that digital “consumer-friendly” apps, often referred to as point solutions, have a wide and still growing adoption rate. According to WTW’s 2021 Benefit Trends Survey, for example, point solutions are in use in different forms by most employers. The current critical areas of focus for these solutions are measuring their impact and integrating the member experience across them.
Sherman adds that care navigation and care advocacy are key to creating a more consumer-friendly healthcare experience, explaining that “new flavors” of managed care–which place consumers at the center of a constellation of easily accessible primary care and specialist providers that have shared access to patient information–can be extremely effective in simplifying access to care and eliminating the need to “shop around” for in-network providers.
“Consumers want to be able to locate geographically convenient healthcare providers, see their reviews, know which insurance coverages are accepted, make appointments in the time frame needed, fill out forms and communicate with providers–all from their phones,” she says. “The extent to which employers are able to offer such consumer-friendly platforms through the vendors they work with can provide a ‘leg up.’ ”
According to Amazon’s Weil, most healthcare systems work hard to improve access in one fashion or another. Most healthcare systems also make it a priority to offer a wide range of services. However, outcomes remain somewhat unpredictable.
“It’s in an employer’s best interest to ensure that team members get what they need, when they need it and where they need it,” he says. “And it’s much too rare that you get all three of those outcomes delivered.”
COVID: A telehealth proving ground
Looking back over the past two years, Weil says the COVID pandemic has uncovered many aspects of the healthcare delivery world that dovetail with the critical objective he mentions above. One clear lesson learned stands out: telehealth works.
“It streamlines access to healthcare providers in general,” he says, adding that telehealth also highlights the fact that care can be delivered in many ways besides a face-to-face, in-person visit.
“COVID has been a force factor in making us realize that there are other ways to deliver care, that it’s justifiable to pay for that care and that outcomes can be improved with those tools,” he says. “It eventually would have happened without COVID, but it probably would have taken much more time to really get traction.”
Weil says people suddenly realized that it was doable and effective. There’s also a learning curve with making this change, and it may be more challenging for medical professionals who have been practicing exclusively face-to-face for 25 or 30 years.
“COVID is not going to go away any time soon, and there are always going to be scenarios where we may have decreased access for one reason or another,” Weil says, citing natural disasters that mean people can’t leave their homes but require care that can be delivered remotely.
“There are always going to be other reasons why people can’t come into an office for face-to-face care,” he says. “So, it’s always going to be beneficial to have this alternative mechanism to offer.”
To be clear, Weil does not claim that telehealth is the solution for every problem. The need for in-person care will always exist. But telehealth can replace some of that need.
“Part of the challenge and part of the excitement is figuring out which parts it can effectively replace in a meaningful way and how we can push the envelope on that,” he says. “The technology is constantly advancing and our capacity to deliver care in the home will change and grow over time. We will change and grow in the process, learn how to do more, and learn how to push those boundaries as the industry continues to evolve.”
There’s also a cultural change required from healthcare providers, Weil explains. As the country enters a new phase of healthcare, the people who deliver that care also face a learning curve. That means a “new breed” of clinicians, physicians, nurse practitioners and nurses are training in a world where telehealth will simply be another tool in their medicine bag.
“It is, as they say, meeting people where they are, quite literally,” he says, noting that having a good healthcare experience is critical, and sometimes providers can do that by allowing people to better engage. “If they have a better experience, it merely gives us an enhanced opportunity to take care of their high blood pressure or their diabetes or their depression.”
The telehealth trend also appeals to employers because it can help improve the general health of all of their employees without the employees even knowing it, Weil explains, merely by engaging with the type of tools being made available.
“Healthcare, medicine, can often be intimidating and scary,” he says. “The idea is to turn healthcare delivery into a non-threatening experience at a level that anybody can digest. It’s not about catering to people with PhDs; it’s about catering to everyone.”
Creating a happy, loyal and productive workforce
In the end, employee health and wellbeing are critical to building and maintaining a happy, loyal and productive workforce, according to NEBGH’s Sherman. She adds that employees want to know their employers are willing to invest in their health and wellbeing–and the kind of healthcare benefits offered can be an important signal to that end. She explains that making healthcare benefits accessible and affordable to all employees can make it clear that an organization’s values are in line with those of employees.
“In a period during which there are many more job openings than people willing to fill them, healthcare and other types of benefits can make a big difference in evaluating one employer vs. another,” she says.
Stubblefield concludes that one thing the pandemic has made even more obvious is that employers and their advisors must continue to build and deliver improved healthcare strategies to better support the workforce.
“Perhaps no time has been greater for the focus on the holistic needs of all employees to connect them to their employer,” she says. “There is a clear belief in place that organizations who get this right stand to benefit through reduced resignations, higher engagement, increased productivity and better overall employee wellbeing.”
