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Can Navigation Unlock the Value of an Increasingly Complex Benefits Ecosystem?

Vera Whole Health and Castlight Health are now apree health.

Can Navigation Unlock the Value of an Increasingly Complex Benefits Ecosystem

Vera Whole Health and Castlight Health are now apree health.

author apree health
This post is contributed by Erik Sossa, president of E. A. Sossa Consulting LLC. In December 2020, Sossa retired from PepsiCo, Inc. as Vice President, Global Benefits and Wellness, where he led the strategy, design, and financial optimization of health & insurance, retirement, and wellness programs around the world.

Often, the first realization of a new benefits leader is that they have minimal time to do their more strategic work—because they’re spending most of their days meeting with vendors, whether it’s the organization’s health plan, the EAP provider, or one of many point solutions.

These days, it’s not uncommon for a single company to have two dozen or more benefits vendors. And while it’s exciting to see employers leverage these partners and technologies to address issues they may have struggled to meet in the past, many employers have reached a tipping point: Not only have benefits become unmanageable for benefits leaders, but employees are so overwhelmed by the plethora of options that they don’t know which they’re supposed to use—and ultimately end up choosing not to engage at all.

While employers have ramped up communication efforts in order to educate employees about all these great solutions and services, the traditional communication tools often fall short. Annual enrollment communications, periodic newsletters, and flyers are great for broad-based communications, but they unfortunately are not effective for the precision these new, more targeted programs require.

Employees need more than the standard communications—they need navigation. Using data and sophisticated technology to engage the right employees with the right programs at the right time is not just a nice-to-have—it is a must-do to ensure the value of this new, broader employer ecosystem is realized for both the employer and the employees.

The concept of navigation isn’t new. Imagine trying to find a specific book in a library without a card catalog. You are more likely to give up—or worse, not even try to find what you are looking for once you see how expansive the selection is. This experience isn’t that dissimilar to the volume of choices presented to employees on a daily basis for their benefits—what primary care doctor should I use, what specialist can best help me manage my condition, where should I go for imaging or to fill a prescription, what can I do to get healthier? And as populations grow even more diverse, with more backgrounds and generations represented in a workforce, this is likely to become more complex.

Employers cannot continue to build their ecosystems and be assured that the time, money, and energy spent will achieve the desired result of an engaged, healthier, and more productive workforce without a better means of engaging employees. Consumerism principles may motivate employees to try to make better decisions, but navigation is needed to make those decisions manageable. Employers can still have broad, comprehensive ecosystems of dozens of vendor partners, but navigation supported by a powerful data and technology foundation can surface the handful most relevant to each employee’s circumstance.  

For example, let’s say an employee just had a new baby. The navigation platform can present them with programs their specific employer offers, such as daycare support, a digital point solution that provides postpartum services, and financial planning services to help them set up a 529; it can also remind them this is a good time to review their life insurance policy and, if possible, increase their Health Savings Account contributions to aid with healthcare services for the baby. Often, employees don’t remember all the programs available to them—surfacing those that are most relevant in their time of need can both increase engagement as well as the overall value perception of the benefits program.

As another example, there are many employees out there who are trying to manage more than one health issue—like a patient who has hypertension and also needs help managing their cholesterol levels, weight, and Type II diabetes. A sophisticated navigation solution can mine claims, pharmacy, and employer-specific data to identify all the related services the employee can engage with to better manage their overall health. Ideally, this information can also be made available to other engagement points within the employer’s ecosystem—the employee’s primary care provider (PCP), their pharmacy benefit manager (PBM), and so forth—allowing them all to have a comprehensive view of the health status of the employee. On an ongoing basis, navigation can provide updates to each engagement point to ensure the communication loop is closed and everyone knows how well each intervention is working and can adjust the employee’s care plan appropriately. All of that would be much, much trickier without a navigator.

The good news is that the tools and capabilities to help employees with health benefits are more robust than ever. The digital explosion brings the promise of employers to reach deeper into their populations to address needs they could not before and to expand the availability of care that was often limited by geography. But before an employer adds another new program, point solution, or service, it is advisable to consider whether this is just adding to the challenge of a large, complex benefits ecosystem— and ultimately decreasing value rather than adding to it.

To ensure value realization, employers need to be able to connect the right employees with the right programs at the right time. This requires a new capability to realize this promise, one that leverages data and technology to help employees navigate the complex ecosystem to find the solutions that best meet their needs.

A navigation platform may be the most important addition to an organization’s benefits offerings—especially when it comes to increasing a population’s overall engagement in their health and care, which is absolutely critical for improving health outcomes and decreasing the total cost of care.

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