At the halfway point in a calendar year, HR and benefits teams begin to seriously ponder what’s next. Which plan designs will we take forward, and which should we leave behind? Is it time to partner with a center of excellence for cancer treatments or musculoskeletal disorders? What more can we do (and afford) to support mental health, caregiving, family building or members with chronic conditions?

Given myriad options for “remodeling” a benefits offering, it can be easy to overlook a critical feature: the front entry to your employee benefits experience.

For many employers, next year’s health benefits front door will look and function much the same as today’s: Rely on the carrier’s call center to handle members’ provider search, coverage and claims questions. Update the benefits enrollment website with the latest plan details. Assume members will contact the HR and benefits team if they fail to get answers and satisfaction from either of those other two sources.

But is this traditional approach to benefits access, education and guidance still a sound strategy? Recent research suggests at least five reasons why it’s probably time for an independent, more value-adding type of benefits navigation and healthcare advocacy type of solution  ̶  one that combines digital access and information self-service tools with people-powered, concierge-level benefits education and clinical support.

1. Younger generations aren’t feeling the digital love

Some employers rely heavily on a benefits website and virtual health services as members’ main points of benefits answers and care access. Why? First, these solutions are relatively economical to adopt. Second, as employee populations grow younger and more digitally native, they’ll be more inclined to self-serve online for answers to benefits questions and access to care.

That’s the theory. An early 2024 survey by Employee Benefit News, in collaboration with Quantum Health, asked 501 employees across four generations (Gen Z, millennials, Gen X and baby boomers) how confident they are about understanding health insurance and care utilization. Consistently, Gen Z and millennials reported feeling less confident than their older colleagues when it comes to finding an in-network doctor, knowing what insurance covers, determining how much a service will cost, and working their way through other healthcare literacy and decision-making basics.

Survey says: Younger employees are less confident about using health benefits than older colleagues  ̶ and more likely to wish they had a navigation or advocacy service.

Younger employees also were less likely to look to a benefits portal or other online tool for answers about health insurance, and more likely to turn to the HR team. By contrast, when asked to pick benefits they wish were offered by their employers, younger workers were even more likely than older ones to choose access to a navigation and advocacy service as one of their preferences.

2. Cost control plus an enhanced employee benefits experience

The EBN-Quantum Health survey found that 83% of HR leaders and benefits professionals who responded said their organizations’ overall cost of providing health benefits increased in the past year. In fact, 70% expressed concern about their employers’ continuing ability to afford healthcare coverage for employees, with the greatest level of concern among those that self-insure.

Based on those concerns, nearly 90% of respondents said they are taking one or more actions to lower healthcare costs. When asked which of several strategies they are pursuing, offering healthcare navigation or advocacy services ranked in the top three, along with increasing preventive care and wellbeing programs and offering less-expensive options to in-person primary care (e.g., telehealth).

Survey says: Employers rate cost savings the No. 1 positive impact they get from working with a navigation or advocacy service.

The larger the employer, the more likely respondents were to name navigation among their top strategies for lowering healthcare costs. By contrast, only 15% of respondents said they are managing costs by reducing the quality of benefits and doing more cost sharing with employees.

Interestingly, an effective independent navigation solution acts as a catalyst for respondents’ two top cost-control strategies. It helps ensure health plan members keep up with preventive health screenings. It also educates members, in real time, on making cost-aware decisions about care options, including choosing among ER, urgent care or virtual health services.

3. Adoption of independent navigation is growing

In another recent survey, this one conducted by Quantum Health in late 2023, 600 benefits HR leaders and benefits managers shared their views on navigation, care coordination and advocacy services. Respondents divided evenly by their employers’ number of employees  ̶  from small and midsize to large and “jumbo” (50,000-plus). All 600 respondents worked for organizations that self-insure for health benefits.

Jumbo and large employers were the most likely to already offer  ̶  instead of a carrier’s member services model  ̶  an independent healthcare navigation, care coordination or advocacy/concierge service, with 43% reporting they offer such a benefit. Among the respondents whose organizations don’t currently offer a navigation and advocacy service, 85% said it’s “highly likely” they will within the next two years.

In the EBN-Quantum Health survey, 37% of all respondents said they currently offer healthcare navigation to their employees, with that number approaching half, 48%, among the largest employers in the survey.

Survey says: More than half of benefits consultants guide their self-insured clients to an independent navigation solution versus a carrier member services model.

A 2023 survey of 100 benefits consultants by Med City News and Quantum Health also found momentum building for adoption of navigation. More than half of respondents (53%) said they guide self-insured clients to an independent navigation solution versus a traditional carrier member services model.

4. The bigger they are … the more value they expect and get

The Quantum Health employer survey asked respondents to rate on a 100-point scale how much the value brought to their organizations by a navigation or advocacy service has increased since implementation. Jumbo and large employers averaged 90 and 88 with their ratings, respectively. Asked to rate the value increase they expect from navigation and advocacy in the future, all respondents, regardless of workforce size, gave ratings 83 or higher.

5. Benefits education and health literacy improve

The 2023 employer survey also asked respondents to identify ways their navigation, advocacy or concierge service is having a positive impact. Tops on their list was “saving our organization money,” followed closely by “improving employees’ understanding of their health benefits,” “improving health outcomes,” and “improving awareness and utilization of point solutions and tools.”

Given those sorts of impacts, it pays for HR and benefits pros to ask the question sooner rather than later: Is it time to remodel the entryway to our employee benefits experience?

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