benefitexpress April 30, 2021 11 min read

The Future of Benefits: Alternative Healthcare Delivery and Financing

The transition to alternative care models

The COVID-19 pandemic has upended almost every aspect of our personal and work lives. And some of the most seismic changes have come in healthcare delivery and payment models.

As we’ve discussed in previous posts, patients and providers continue seeking new ways to safely obtain and deliver care.

For example, the cost and quality benefits of moving non-emergency care out of the hospitals have been highlighted by changes forced by the pandemic, and that shift appears likely to be permanent.

Employees have also made it clear that more affordable, flexible and personalized payment are needed, along with more personalized advice and assistance from healthcare providers, insurers, third-party administrators, and employers’ benefits teams.

And some of the many government regulations put in place as emergency measures during this pandemic will likely continue even after the worst is over, impacting HR and benefits departments, administrators, and employees.

In response, benefits technology firms are innovating to offer employees and families flexibility in how they find, select, and pay for healthcare during this period of employment and benefits uncertainty.

All of that change impacts the same place – HR and Benefits departments. That’s where we must continue focusing all of our efforts, addressing their unique needs today and helping them plan for what’s coming.

“There’s a responsibility on us to question all the things we do, to question standard procedures in HR, how we integrate with all our partners, timing, etc.,” said Chris Wiley, director of partnerships at benefitexpress.

The healthcare delivery model has shifted, much of it permanently

The pandemic has driven and accelerated changes in the needs of almost every workforce and the HR and benefits pros that work to support them.

Workforce benefits management now has to accommodate more remote workers and their local compensation and benefits compliance requirements and, often, insurance carriers located in multiple states.

As the economic recovery progresses in fits and starts, there are also more employees moving between full-time, part-time, and various temporary contract and contract-to-permanent roles.

Those shifts are pressuring employers, insurers and their administration partners to move beyond traditional paycheck deductions in paying for covered services.

How services are covered is also changing, perhaps most noticeably in how mental and emotional healthcare is integrated into comprehensive benefits plans and how those services are paid for. We look at those issues in detail here.

Benefits must also evolve to catch up to the new ways that employees and their families live, work, learn – and access healthcare. As employers, providers, and insurers adjust to these emerging and evolving issues, it’s time to carefully evaluate how we manage and pay for all healthcare services and procedures.

Technology plays a critical role

At its core, this transition is about how all healthcare stakeholders access and use complex data to make decisions. And the amount of data involved is massive and spreads across a multitude of systems.

Benefits managers, insurance brokers, administrators and their partners need tools to capture and analyze that data. Powerful analytics are needed to help employers select and optimize plan offerings.

As we discussed in another post, wellness programs have proven extremely effective from both a health outcome and financial perspective, but only if employers can rely on technology partners to ensure they comply with changing regulations.

Employees need easy-to-use decision-support platforms to select the most appropriate and cost-effective care based on their unique medical needs and financial requirements.

The ability to make effective decisions becomes even more important as more employers move to high-deductible health plans and employees pay more of the cost of care.

In addition to helping find services, employees may need more financial planning assistance that extends beyond retirement planning to include information about the cost of comparable services, alternative financing options, help with medical budgeting, and more.

What hasn’t changed is just as important

Medical care and benefits providers, employers, brokers, and insurers are all seeking new, more flexible ways to serve employees and their families. Designing and delivering benefits that fit such a rapidly changing landscape requires working with the best partners we can find.

We need to work together to understand what employees need and want from any new healthcare delivery model, what each of our partners does well, and where we can improve together.

There are so many smart people, here at benefitexpress and our current and future tech partners, who are coming up with great solutions,” said Wiley. “Our job is to think about how those things play off each other and make sure they’ll work together for our advisors, clients, employees and their families.”

Feedback and flexibility

While not every employer is ready to react immediately to the emerging alternatives in how benefits infrastructure will change to support emerging healthcare delivery and payment alternatives, we all need to understand how their employees’ needs are changing and get ready for those changes.

We need to be diligent in getting and using feedback to find out what is important to clients, what’s important to our distribution partners, and how we can integrate more into the benefits administration experience,” said Wiley.

Also, with so much of benefits administration value coming from the quality of support, it is critical that we think ahead about how we will expand support capabilities as we introduce new features and functions for employers and employees.

Business leaders trying to equip their organizations to compete in a fast-paced world speak of finding people who are multi-lingual in the various languages of business – tech, finance, resource management, and production.

Beyond technology and integration, brokers and their benefits administration partners need to be interpreters.

We need to understand and be able to clearly explain the benefits and challenges of introducing new features or modifying existing offerings. Because employers must be able to clearly explain them so each employee, manager, and stakeholder understands what is changing and why.

That can’t only happen during a hectic few weeks each year.

As benefit administrators, we sit in the middle of things. As change accelerates, we have a great opportunity to add value as a repository of easily accessible and useful information.

That information should help our partners and clients make the best choices about technology, help employers and employees prepare for new ways of delivering and using benefits, and help us gather feedback to continually improve our offerings and how we work together.

Today, much of that information is captured somewhere in various HR, payroll, benefits administrator, and carrier systems. It’s very fragmented.

HR and Benefits teams and employees don’t have access to all of the information and data they need to make the best decisions,” Wiley notes. “How can we help them bring it all together?

Our commitment to our clients

Part of our partnership commitment is to ask those questions, leverage access to data and analysis capabilities, and share insights with all of our partners and clients.

By continuing to integrate more closely with our partners, clients, and carriers, we can do more with the incredible data we have access to. We can, and will keep improving decision support tools that will allow employers and employees to anticipate, evaluate and adapt to alternative healthcare service delivery and payment models as they emerge.

Check out Part 1, Part 2, and Part 3 of this article series, and get even more articles delivered straight to your inbox. Click here to subscribe to our weekly newsletter.