Most people with experience in designing health benefits or managing an organization’s finances are familiar with the 90-10 rule: Out of 100 people enrolled in a health plan, about 10 of them with complex and chronic needs will generate roughly 70% of the spend.1 The other 90% of employees typically use their plan only a few times a year — for an annual physical or to fill a prescription.
Given the dramatically different health care needs of these two populations of employees, an important question arises: How should we create plans and benefits strategies geared toward each group and tailored to their unique situations?
We want healthy employees to stay that way, and we want to help those with more serious needs receive more effective and efficient care to drive positive outcomes and improve their health, which in turn may reduce costs. Failing to build strategies that account for the starkly different needs of these two groups of employees risks further widening health disparities that exist today.
This is why we’re working with brokers, consultants and employers to build benefits strategies grounded in engagement and personalization.
Advocacy and support for those who need it most
Let’s start with the 10% of an employee population with complex needs. On average, those with complex care needs are likely to:
- Generate five times more claims2
- Have hospital stays that are 10 times longer3
- Use out-of-network providers 11 times more4
These employees and their families can benefit from targeted services that help them navigate the health care system. As an example, our Special Needs Initiative assigns an adviser to families with children who have special health care needs. This advocate supports every member of the family (not just the child), takes responsibility for each inquiry that surfaces along a care path and can help drive coordination with the child’s care team. Based on our learnings from the Special Needs Initiative, we piloted a similar program for adults with complex needs called Complex Care Concierge in 2020.
With both programs, a trusted care adviser is engaged early and often. This advocate focuses on optimizing people, processes, organizational structure and technology with the goal of creating a seamless experience for employees and their families.
For healthier populations, engagement is a focus
For the great majority of members whose health care needs are less frequent, it’s important to get them engaged in wellness programs with an aim of maintaining healthy habits and keeping costs lower for an employer. The goal is to help these members through value-add experiences and services in the realms of exercise, sleep and diet.
It’s often said that our health is one of the easiest things to take for granted, and for that same reason, it can be tough to engage individuals on their health before they need the system. That’s why I see relationships with consumer brands that employees recognize and have an affinity for as crucial. Building partnerships and programs featuring well-known brands that consumers want to be associated with makes that engagement far easier. It’s about meeting members where they are and collaborating with products and experiences they know and respect.
The overarching goal is to incentivize healthy habits, gaining momentum around certain behaviors to help members save money while improving their health. Our work with Peloton is a great example. Members in our fully insured plans can access 12 months of the Peloton Digital Membership at no additional cost to them. They can also save on Peloton equipment through exclusive discounts.
Putting members in the driver’s seat
Members aren’t passive in their everyday consumption habits, digitally or in person. Having goods and services at their fingertips is the expectation, and that extends to their health care. They want to feel in control of their benefits experience, and they want plan options aligned with their needs. The days of one-size-fits-all plans are long over. It’s essential to meet members where they are, with tailored services, benefits and wellness experiences.
For example, we’re evolving the digital experience to allow for customized member-portal dashboards and seamless access across devices and platforms. It’s about helping people get the type and level of information they need so they can better understand and use their benefits — whether frequently or only a couple times a year. We’re also working with employers to enable the flexibility to offer more plan options during enrollment time.
We are relentless in our efforts around this, and I know that it will be a journey. To help us stay on track, I often remember this quote from one of my all-time favorites, Bruce Springsteen: “Getting an audience is hard. Sustaining an audience is hard. It demands a consistency of thought, of purpose, and of action over a long period of time.”
It may seem like a rock legend’s ideas about success would have very little bearing on health insurance, but this quote is incredibly relevant to the work we’re doing in this area. And for us, we know that sustaining our audience of employer clients and members is contingent on personalizing our offerings to best meet their needs.
1 UnitedHealthcare National Accounts book of business, 2019.
2, 3, 4 UnitedHealthcare Commercial book of business 10/2019-09/2020 comparing non-eligible families vs. eligible families.
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