The cost of under-utilizing healthcare benefits

These past several years have seen a significant shift to more cost sharing between employers and employees. Specifically, the trend has been to higher-deductible plans, increased co-pays and revamping traditional POS, PPO and HMO coverage in favor of health savings accounts and related  plans designed to help employees and their families manage their health and the cost of care. The good news is that this evolution is helping to control the annual cost of employee premiums for many members, but employees’ out-of-pocket costs now have to be managed differently to compensate for the higher-deductible alternatives.

Reaching that deductible means writing a check, paying cash or swiping a card for covered medical costs like visits to physicians and health facilities, and for tests and pharmacy requirements. Once employees and their covered family members achieve the deductible threshold, more robust insurance coverage — often including tiered pharmacy coverage — kicks in, significantly reducing out-of-pocket expenses.

One of the challenges of these modern benefit payment arrangements is that some people may resist paying for services they don’t deem necessary – like visits to the physicians when they or their dependents are sick or injured, or the purchase of drugs and medicine at retail cost – because of the cash outlay. They also may “horde” medical care, waiting until later in the benefits year when they’ve reached their deductible before seeking costly diagnostic imaging and other tests, or for filling prescriptions.

Fortunately, many benefits such as annual physicals, mammograms and Pap Smears, eye exams, scheduled immunizations, flu shots and more are covered by many plans without a co-payment.  But just because they’re covered doesn’t mean members are taking advantage of these benefits, and relying on insurance providers alone to drive home this utilization message isn’t enough.

Employers share responsibility for ensuring that employees understand their benefits plans, utilize them properly, and have someone to speak with if they have questions or concerns. And while you can’t easily check to see if employees are going to their doctors when they have a cold, or getting their flu shots in the fall, there are steps we can take to address benefit usage and to help ensure understanding and compliance.

These include holding benefits communication meetings or discussing plan coverage at staff meetings, luncheons or during work hours. Your designated human resources person should be available as a resource, and you can consider bringing health screenings for blood pressure, body mass index, cholesterol and sugar levels in-house. Nutritionists, fitness coaches, massage therapists and other health professionals also make “office calls.” Flu shot clinics can be offered at many work sites, and employers can distribute literature, send emails, post information on websites or Facebook pages and text related health-benefit information to employees.

Some companies hold internal contests or challenges to incentivize employees, and engage collaboratively with their health benefits providers, who also often a wide range of supportive communication, outreach and education options relating to general benefits, and to your specific benefits coverage. Many also offer private access to healthcare portals where members can see a confidential record of their benefits usage, get information on appointments, review test results, ask questions and more.

Health plan options and benefits are going to continue evolving as the nation works to get a handle on runaway healthcare costs, the high price of medicine, and clear information about compliance, prevention and warning signs. High-deductible plans aren’t likely to disappear anytime soon, but employers and their benefits providers can work together to help ensure proper utilization, clear communication, and a path to improved health and wellness without adding extra costs.

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If you’re not enjoying the benefits of a wellness program at your company, join CBIA Healthy Connections at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!