National Study by Employee Benefits News Finds 37% of Employers Are Offering Healthcare Navigation Platforms to Address Rising Healthcare Costs

Only 22% of employers fully trust that digital health tool vendors are acting in the employer’s best interest when sourcing better information and guidance for making health benefits decisions.

DUBLIN, OHIO, April 10, 2024 – Employer Benefits News (EBN), a primary media resource for decision-makers in the world of employee benefits, human resources and workplace culture, announced today the findings of its State of Healthcare 2024 study, sponsored by Quantum Health, the industry-leading healthcare navigation and care coordination company to over 500 self-insured employers and supporting over 3 million active members on their healthcare journeys.

The study, conducted by Arizent, EBN’s parent company, researched both employer and employee perspectives on healthcare costs and the benefits navigation process. The study sampled 501 employees and 181 employer benefits decision-makers. Employees were balanced to the U.S. employed population (in gender, age and race), and employers comprised of organizations with at least 10 employees and from a wide range of industries and job levels/roles.

For employers, 63% reported that cost is among the most important factors in building their benefits packages. 89% are taking one or more actions to lower their healthcare costs, and for 37% of respondents, one of those actions includes offering healthcare navigation services to make sure employees are accessing the right care. With more than half of employees feeling their total healthcare costs are too expensive, health-related benefits are often cited by employees as the most important benefits employers can offer.

With the demand from employees for new virtual care options and tools, employers have increasingly made digital health point solution tools (for management of chronic conditions) available for their employees (82%) to drive efficiency and cost reduction. However, EBN’s study found that, of employers using digital health tool providers/vendors as a source for benefits decisions, only 22% fully trust that these vendors are acting in the employer’s best interest. Instead, the study insights point to utilization data as the most trustworthy source: 90% of employers that use utilization data to make benefits decisions either fully or mostly, trust this resource to provide information that serves the best interest of the company. 

With employees feeling the crunch of high healthcare costs, 42% reported that their medical expenses went up because their health plans got more expensive within the past year. Among the respondents who experienced a decrease in household medical expenses, 20% reported that their family sought out less specialist care and 18% less preventative care. For their part, employers don’t see the future of healthcare changing much, with 79% of companies expecting next year’s overall costs of healthcare benefits to be higher than this year, and 70% reporting being concerned about their company’s ability to afford health coverage.

Kerry Gross, director of Research Intelligence at EBN, notes, “Based on our findings, costs are a clear factor for both employers and employees, and costs will remain a critical issue that employers will need to manage as they look to continue to offer well-considered benefits plans.”

To better manage costs and clinical outcomes, employers are taking action against higher benefits costs. They see healthcare navigation platforms as a means to support and drive employee engagement and manage digital health point solution utilization across their populations.

The study found that only 44% of employees are confident they understand how much healthcare will cost using their insurance. This gap points to a need for more clarity, education and guidance around healthcare. While employees feel relatively confident in their overall coverage and are most confident about finding a doctor in their network (67%), they are less confident about other aspects of insurance, including costs and coverage details.

“Going beyond just finding an in-network doctor and answering coverage questions, Quantum Health’s navigation platform intersects the member, the provider and the payer in the natural benefits flow to administer preauthorizations, provide claims support, and integrate member support with clinical care specialists and other care-specific point solutions offered through the member’s benefit plan,” says Veronica Knuth, chief people officer of Quantum Health. “Utilizing our proprietary Real-Time Intercept® model (initiated by a member’s first contact with us through their benefits card) our Healthcare Warriors® proactively and directly engage with members on their healthcare journey to get them on the right healthcare path, advocating for them and mitigating ineffective or costly claims. Overall, we help improve clinical outcomes and provide the support HR benefits teams need to take on the hard stuff of benefits management.” 

The study revealed that even employees who know something about their health insurance or coverage still go to HR first with their questions. Even younger workers (Gen Z) report turning to HR first when they have questions about their health insurance. This need for “human” support can put an increased burden on HR and benefits teams, already in pressured roles handling significant and intensifying shifts in workplace operations and cost benefits management.

Learn more about EBN’s State of Healthcare 2024 study here.