How to encourage school employees to be better medical consumers
By Steve Ott
Americans tend to be savvy consumers of most products and services except when it comes to medical services. Traditional health insurance plans do little to encourage a consumer-focused approach in healthcare spending – participants have no incentive for choosing low-cost providers or shopping for the lowest price prescription drug. Employees either don't know the cost of the care they receive or haven't given much thought to its cost since it was covered and paid for.
This lack of consumerism can create runaway claims that drive premium increases. Experts agree that to reduce costs, organizations must encourage prudent medical spending. According to the Towers Watson 2015 Emerging Trends in Health Care Survey, 66% of employers rated developing or enhancing a workplace culture where employees are responsible for health as their top focus for 2016.
Medical consumerism is a huge shift in mindset for most employees. With support, employees can begin to make daily healthy choices and improve their healthcare decision-making skills when provided with the proper tools, resources and education.
Providing tools and resources
Education is key when encouraging employees to become better medical consumers. Schools may offer resources to employees on their own or team up with their health insurance carrier or consultant. There are a variety of tools and resources out there designed to educate, inform and support employees as they learn how to engage differently with the healthcare system.
Start with the basics when it comes to support and education.
- Define common insurance terms like co-pay and deductible
- Do your employees know the difference between in-network vs. out-of-network and the cost difference between the two?
- Depending on their ailment, do your employees know how to choose the appropriate route of care? (When to see your primary doctor vs. urgent care vs. emergency room)
- Are employees taking advantage of your carrier’s low cost prescription service (if applicable)?
- Are there any other services your insurance company offers that would benefit your employees in either savings or education?
Information can be communicated to employees in a variety of ways including payroll stuffers, enrollment meetings, posters, videos, e-newsletters, benefits fair, etc. Your health insurance consultant is a great resource for these types of materials and events.
- Mobile – Does your carrier have a mobile app? Encourage employees to download it on their smartphone. Members can access their information on the go, when they need it. Members could view their member card, receive preventative care reminders and be able to locate the nearest in-network pharmacy, doctor or hospital. This can be especially helpful if your employees are on vacation and require medical assistance.
- Web – Does your carrier have a website? Employees may be able to get cost estimates for procedures, search for care, view their Explanation of Benefits and claims, use the prescription drug cost calculator or submit questions to a doctor/nurse. For example, if the doctor orders an MRI, an employee can review the facilities, doctors and cost right online. It could help them choose a provider based upon the best quality and lowest cost.
- Call – Does your carrier offer a toll-free number for assistance (often located on the back of the member ID card)? A phone call could help employees gain access to assistance services such as member services, decision support, behavioral health, healthy pregnancy and condition support. A 24/7 nurse hotline can answer questions when employees are not sure what action they should take.
Education based upon utilization
Ask your consultant about your utilization reports. These reports provide an aggregate view of your employees' health including inpatient/outpatient claims, emergency room and office visit utilization and more. You may learn that many of your employees visit the ER but never use urgent care, are smokers, suffer from high blood pressure, etc.
This information can help you decide what sort education avenues your employees may benefit from including:
- Awareness campaigns – Health living, heart disease, stress management, etc.
- Disease management programs – Help your employees manage their diseases/prevent complications
- Wellness initiatives – Provide health education classes, subsidized use of fitness facilities, create internal policies that promote healthy behavior
A supportive workplace will encourage employee engagement which will make them better consumers for their own health in eliminating risky behaviors, embracing a healthier lifestyle and decreasing claims cost.
Steve Ott, Regional Vice President of National Insurance Services, is a licensed insurance agent and registered representative with Series 6 and 63 securities licenses. Steve specializes in Special Pay Deferral Plans and HRAs for school districts, cities and counties in Nebraska, Iowa, Kansas and Missouri.