Group of professionals sit around a table in an office

Employers are turning to applications that are both patient-centric and consumer-friendly to engage all employees, not only the sickest, in improving their health.

Though just 20% of commercially insured people consume 80% of healthcare spending, employers have found that they can reduce overall costs by helping all members avoid misusing, overusing or underusing their health plans, according to Jen McDonnell, vice president of solutions and growth for Accolade, a healthcare technology company that partners with health benefits providers, including Humana.

Managing healthcare costs

Employers are trying to manage ever increasing costs with employee-centered population health management programs that emphasize primary care strategies, including prevention, chronic disease management, mental health and whole-person care. 51% of large employers expect to have at least one advanced primary care strategy in place in 2021 compared with the 46% that did in 2020, according to the 2021 Large Employers’ Health Care Strategy and Plan Design Survey.1

Clinical programs that improve care for sick people—such as chronic-care management for health plan members with costly conditions—can generate significant savings for employers, according to a Deloitte article about strategies that are helping employers control healthcare costs.

Deloitte research shows that 54% of commercial healthcare dollars—medical and pharmacy—are spent on just 5% of the insured population, and 1% of the commercially insured population accounts for 27% of commercial healthcare dollars.2

Employers can also save money by keeping people from getting sick, for example, by connecting them to “health advocates who can help employees and their spouses navigate everything from understanding their benefit options to finding specialists for hard-to-diagnose diseases, to negotiating medical charges with hospitals and doctors, to resolving claims-processing issues with insurance companies,” wrote Sarah Thomas, managing director of Deloitte Center for Health Solutions.3

“Accolade is doing highly unique work in the healthcare space, as their connected platform and personalized service create impressive member satisfaction and value for employers,” said Chris Hunter, president of Humana’s Group and Military Segment.

“Humana Impact with Accolade reduces employer spending on healthcare by an average of $240 per employee per year within its first year of implementation, and by an average of $480 within 3 years. The savings come largely by helping employees choose appropriate care and follow-up to support them through the process,” McDonnell said. “Employees get highly personalized care support, including suggestions for both Humana and employer-sponsored clinical programs that can improve health and reduce spending.”

“Building on our own successful service model, we expect our Humana with Accolade service to be the standard of excellence for health plans, employers and consumers in a new open and collaborative era,” Hunter said.

All members save money within a year of using the plan, and 90% say they are satisfied with Accolade. Whether a member needs help from a claims specialist or a nurse, their Accolade Health Assistant has the necessary data and the clinical and administrative knowledge to advise the employee on how to best use their benefits.

Leveraging data

Accolade applies data, technology and human insights to help employers optimize the use of benefit programs, including identifying under-utilized programs that can be eliminated, with those dollars repurposed elsewhere. “Much investment has been directed toward population health solutions, and data plays a critical role in identifying specific population health needs,” said Bill Schmitt, vice president of business development for Accolade.

Similarly, Accolade can increase the utilization rates of clinical programs an employer offers by 3 to 10 times, McDonnell said. “Employers often offer high-quality benefits to their employees and their family members, including tremendous clinical programs.

“But we often find that members don’t know about these benefits or how to access or use them,” McDonnell said. “That’s where we come in. We help employees and family members navigate to those programs and get the most of their benefits.”

Increasing engagement in benefits takes a blend of human-and-technology intervention. Artificial-intelligence-powered software notifies members of programs that may benefit them, using texts, emails or phone calls. The technology learns from data, such as the types of care a member uses, whether they adopt benefits like second-opinion services, and how and how often they engage with Accolade, Humana, or their healthcare provider. This data intelligence fuels how Accolade Health Assistants support their members. “Our data is powerful. It helps our frontline care teams educate our members on important healthcare and cost savings options, and then take advantage of them,” McDonnell said.

Because data drives interactions between Accolade and members, the service shows employees that they have a trusted partner who knows about their benefits—and their families’ health. A member’s data and information blend into a seamless experience that helps them make good decisions about their health, improves their care and reduces costs.

“Humana recognizes that innovation breeds results that benefit everyone—most importantly their members, who are making difficult healthcare decisions and need help navigating the healthcare system,” said Rob Cavanaugh, president of Accolade. “We’re honored to be their partner, as we share the same member-centric goals.”

Personalizing care

Personalized, data-driven healthcare applications and services can create savings for employers and employees by helping members find affordable, quality care when they need it or before they do.

66% of members engage with their Accolade Health Assistant before making a healthcare decision. As an example, a member with flu symptoms may call their Health Assistant before visiting an emergency room (ER). The Health Assistant would connect that member with a nurse who might recommend that the member seek care in a less-emergent setting, based on the symptoms that they’d described.

The nurse could educate the member on available options, which may include getting treated by a primary care physician (PCP), visiting an urgent care clinic, or seeking care via telemedicine. Then the member’s Health Assistant could send the member a link to the telemedicine provider offered in their benefits plan, as well as contact information for an in-network urgent care clinic and PCP. After the member chooses the provider, the Health Assistant will follow up to ensure the member received the appropriate care and understood their treatment plan.

The Accolade Health Assistants can coordinate all of a member’s care and even manage complex cases like ongoing treatment for chronic conditions involving multiple care providers. “Sometimes a member doesn’t know what type of provider they need and struggles to manage the plans of multiple providers who aren’t connected in the healthcare system,” McDonnell said. “If we give members a list of 3 doctors with high quality standards, and help support their care plans across all of them, then they will be on a path to a high quality health outcome.”

Employees can engage with Health Assistants through convenient means, like secure messages via smartphone apps, online or by phone. Working with the same Health Assistant each time creates consistency in care and helps support the entire family. “It’s personalized, educational and holistic,” McDonnell said. “It’s taking care of the whole person and the whole family, not just their transactional questions in the moment.”

Sources:

  1. “2021 Large Employers’ Health Care Strategy and Plan Design Survey,” Business Group on Health, last accessed January 13, 2021, https://www.businessgrouphealth.org/en/resources/2021-large-employers-health-care-strategy-and-plan-design-survey, opens new window.
  2. Sarah Thomas, “To Innovate on Controlling Health Care Costs: Follow the Money,” The Wall Street Journal, October 3, 2018, last accessed January 13, 2021, https://deloitte.wsj.com/cfo/2018/10/03/to-innovate-on-controlling-health-care-costs-follow-the-money, opens new window.
  3. Thomas, “To Innovate on Controlling Health Care Costs: Follow the Money.”