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Health Benefits Evolution

Harnessing innovation at any stage


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Summary

Questions about the future of the American healthcare system continue to swirl. Yet, for all the uncertainty in
the health insurance market, one constant is the majority of citizens receiving coverage through employers.
Sponsoring health insurance costs U.S. employers around $1.2 trillion per year typically their second-
highest cost after payroll and its estimated to rise an average of 6 percent annually over the next 10 years.

Employers spend more on health benefits every year, however, theyre getting less in return. Most lack
visibility into where their investment goes, have little influence over provider quality, and often pay for a
perfunctory series of transactions rather than successful outcomes. At the same time, theyre pushed to
offer increasingly competitive benefits while battling these cost trends.

Many have responded with blunt cost-shifting methods like high-deductible consumer-driven health
plans (CDHP). According to Brian Marcotte, president and CEO of the National Business Group on Health
(NBGH), 84 percent of large employers offer high-deductible plans. For 35 percent, thats the only option.
But once you do that, Marcotte says, you have limited options to control costs on the demand side. So
employers have to look at how they can influence the way healthcare is delivered. Turning to more precise
supply-side approaches is also the best way for employers to improve the quality of benefits.

[Figure 1] Whats the primary reason your benefits team is interested in exploring innovative health benefits solutions?

40%
Drive down costs in my healthcare investment

20%
Improve benefits offerings to compete in recruitment and retainment

18%
Make it easier for my people to navigate the healthcare landscape

15%
Boost productivity of my population by driving better outcomes through improved benefits

5%
Other

2%
Enhance the overall employee experience
Health Benefits Evolution 3

Stages of Innovation To address these pressures, employers have begun to adopt a wide range
of innovations that offer the potential for greater control over the cost
LONG-TERM and effectiveness of their health benefits. In fact, when asked about their
motivations for pursuing new solutions, benefits leaders surveyed for this
report were split between driving down costs and non-financial incentives
Direct
Contracting an indication that taking better care of their people is as top of mind for many
as their bottom line. Of the reasons not directly related to costs, improving
recruitment and retention (20 percent), making it easier for employees to get
Onsite Clinics
the care they need (18 percent), and boosting productivity (15 percent) were
nearly equal. [Figure 1]
Health Plan
ACO/COE This swell of innovation is lifting all ends of the market. Large companies
are taking control of the delivery system through direct contracting with
providers or building their own clinics, while smaller companies pursue
Near-site Clinics
groundbreaking point solutions to address specific gaps around everything
from fertility treatments to behavioral health.
Point Solution
Ecosystem
To find out how employers are putting the latest innovations to work, we
asked 150 benefits leaders from a diverse group of companies how theyre
Plan Design approaching the future and interviewed industry experts at the forefront of
employer-sponsored healthcare. In the following pages, well examine the
big trends driving change in enterprise health benefits and suggest ways
IMMEDIATE companies can plot a course from immediate impact to long-term results.

Taking Back the Delivery System

At a macro level, the last decade has seen significant consolidation of market power across health plans
and providers. As key stakeholders (and payers for employees healthcare), employers are looking
to leverage their own market power to drive more value from benefits programs. Narrow networks,
value-based payment frameworks, and direct contracting relationships, for example, are all gaining
traction with companies trying to stretch dollars further and improve healthcare quality by prioritizing
outcomes over transactions. Specifically, almost 66 percent of benefits leaders we surveyed reported
an interest in accountable care organizations (ACOs), centers of excellence (COEs), onsite clinics, or
narrow networks. [Figure 2]
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[Figure 2] As part of your benefits strategy within the next few years, which of the following healthcare delivery models is
your team interested in as a direct contracting opportunity? (Check all that apply.)

41%
Center of excellence (COE)

34%
None of these

33%
Onsite or near-site clinic

22%
Accountable care organization (ACO)

20%
Narrow network

Weve seen that motivations vary, but companies that are able to achieve meaningful results have
several traits in common. Typically, the minimum viable size required to make direct contracting effective
is 5,000 members. According to Andy Halpert, M.D., senior director of clinical and network solutions
at Collective Health and former benefits consultant at Willis Towers Watson, The population has to
be large enough to secure provider relationships and create an actuarial pool that justifies the costs of
program design and implementation. Members also need to be centralized within a specific geography
for it to be cost-effective.

Additionally, Dr. Halpert says organizations should be willing to commit to a multi-year effort and ensure
network services are consistent with member utilization patterns. Those with the right size, geography,
and organizational backing will be in position to drive better employee outcomes at a below-market
rate. But the approach thats best for each employer depends on the specific needs of their population
and level of investment theyre prepared to make.

DELIVERY MODELS WITH MOMENTUM

Of the possibilities for employers to gain more control over the cost and quality of health benefits, some
models are in their infancy with the long-term impacts unknown. Others are more established, with proven
success. But all are essential for benefits leaders to understand as they balance the pressure to deliver
competitive benefits packages against continuously rising costs.
Health Benefits Evolution 5

ACOs are the newest and most talked about of these direct contracting options, with large employers like
Boeing, Intel, and Walmart recently forming their own ACO networks. The major driver, says Marcotte,
is that these employers have exhausted their options for effecting change on the demand side but still
need to offset medical trend and drive efficiencies in their healthcare programs. At the end of the day,
healthcare is local, so theyre turning to delivery systems by going direct.

And, while its too soon to tell what the ultimate results of these early explorations will be, Dr. Halpert
suggests companies should have certain expectations going in. A direct contract with a provider delivery
system takes a lot of time, money, and effort. You have to have the resources to support that. Its a heavy
lift for HR teams, even with a consultant involved, so their leadership has to be willing to commit to whats
probably a two-year effort that has a high upfront cost.

In late 2016, Boeing expanded its direct-contract ACO to Southern California, becoming the first employer
in the state to implement one while still offering high-deductible and HMO options to employees.1 In 2013,
Intel entered into its direct-contract ACO agreement with Presbyterian Health Services in New Mexico for
some 5,400 employees.2

The trend has been limited to such groups thus far because theres not yet enough data for most benefits
teams to make the business case. You need a compelling value proposition for your C-suite on how an
ACO will deliver better value than the market on cost, quality, and the consumer experience, stresses
Marcotte. You also need that value proposition to be able to communicate to your employees what will
be different if they join an ACO.

Aligning expectations between the ACO, employer, health plan, and employees is critical to success, he
explains. The expectations for an early-stage ACO and most of them are early-stage should be
different from the expectations for a more developed or mature model. An early-stage ACO, for example,
will most likely focus its resources and care coordination on the small percentage of high-risk patients
that drive most of the cost. As a consequence, most employees experiences with the healthcare system
wont be that different from what they experience today. In a more mature ACO, consumer outreach and
care coordination is expanded to moderate-risk and even low-risk populations. Understanding an ACOs
development across a core set of competencies, and how these competencies will mature over time, is
important to an employers decision about whether to contract with an ACO. Every ACO is different, so
this is an exercise that has to be done market by market.

For a narrow network model with fewer variables and less ambiguity around ROI, companies like JetBlue,
McKesson, and Walmart have contracted with COEs to provide employees with cost-effective, quality
care for highly specific needs. Similar to ACO payment arrangements that focus on outcomes, COEs are
often established with a bundled payment system that allows employers to negotiate rates for complete

1
Stolz, R. (2016, July 11). Boeing expands its ACO plan to cover 15,000 employees in southern California. www.benefitnews.com/news/boeing-expands-its-aco-plan-to-cover-15-000-
employees-in-southern-california
2
Evans, M. (2013, July 13). Intel offers employees narrow network of health insurance. www.modernhealthcare.com/article/20130713/MAGAZINE/307139976
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episodes of care (e.g. back surgery) rather than a series of transactions.

Were seeing a lot more interest in innovations like this because of all the changes with the ACA and the
market in general, says Olivia Ross, associate director of the Employers Centers of Excellence Network
(ECEN) at Pacific Business Group on Health (PBGH). In the past, employers were focusing more on blunt
tools, like cost sharing. But theres an endpoint to how much cost shifting you can do, and some employers
are realizing that being too aggressive can create retention issues or reputational concerns. Now theyre
a lot more willing to look at their data and use it to figure out sophisticated solutions. Theres progression
toward direct engagement over the last few years and its exciting because things have moved from
conceptual to evidence-driven.

Even with many participating employers providing travel expenses and zero copays for participants
and a caregiver, PBGH data shows that theyre seeing ROI on COEs within two years. Most of the cost
savings, according to their studies, can be attributed to the minimized risk of costly follow-ups, avoidable
complications, and unnecessary procedures.3

These contracts typically also include strictly defined quality guidelines, which is crucial for benefits
managers to ensure returns. The term COE has seen such broad usage in the market as a whole that
employers cant always assume its reflective of true specialization. When deciding on a COE, understanding
what requirements providers have to meet to be part of the network is as important as agreeing on rates.

Another way for employers to achieve a more direct role in healthcare delivery is establishing their own
clinics, which may offer the greatest amount of control over quality standards. A recent study by Willis
Towers Watson showed that 56 percent of large employers have already been pursuing this strategy for
more than five years. And of that majority, 75 percent are seeking to enhance productivity, 74 percent
trying to reduce healthcare costs, and 66 percent interested in giving employees better access to
affordable care.4

Among supply-side models, onsite clinics offer a significant degree of flexibility. Employers have the ability
to closely manage services, co-pays, and availability in order to continually optimize for utilization. For
software company SAS, the first three years of onsite clinic offerings resulted in a nearly $600 reduction
in claims costs for each member that relied on it for primary care.5

Compared to the previously discussed models, onsite clinics are a viable option for more employers.
Results are easier to project than they are for ACOs, and their range of services is generally much broader
than COEs. Goldman Sachs, USAA, and Capital One Financial all offer onsite clinics for anything from
limited health screenings to acute care and onsite pharmacies. In his time at Willis Towers Watson, Dr.
Halpert recalls working with employers to establish onsite facilities for services from standard primary

3
Ross, O. Employers Centers of Excellence Network. www.pbgh.org/ecen
4
Towers Watson, Achieving High-Performance Employee Plans with On-site Health Centers, 2015
5
Moore, R. (2015, July 30). Study Shows Cost Benefit of Onsite Health Clinics. www.plansponsor.com/Study-Shows-Cost-Benefit-of-Onsite-Health-Clinics/
Health Benefits Evolution 7

care to chiropractic, physical therapy, acupuncture, even dental.

One Medical which has partnered with employers nationwide to establish comprehensive, tech-enabled
onsite clinics says a successful implementation largely depends on setting realistic ROI expectations
with senior executives and creating a member-focused experience that drives utilization. In their recent
whitepaper, One Medical states, As with any large-scale undertaking, its a challenge to measure success
for the first few years, and timelines for achieving breakeven will depend on the scope of clinic services.6

Citing the Willis Towers Watson study, they specify, Clinics exclusively focused on wellness should be
prepared to take a loss for the first year or two, break even over the next few years, and begin to see
possible returns by year four or five. They encourage benefits teams to keep in mind that employee
expectations are just as important, and tailoring the clinics services to align with their populations needs
is essential. The success of your clinic is dependent upon the patient experience you provide your
employees.

Delivery Innvoation without Direct Contracting

Many self-funded employers face obstacles to contracting with provider networks directly. In fact,
of those surveyed, only 12 percent reported no barriers to direct contracting. Not surprisingly, cost
is a common concern for those who are unable to move forward. However, benefits leaders are also
challenged by less concrete factors like defining goals and performance metrics, establishing the
business case to drive executive buy-in, and finding the right partners to make these efforts successful.
[Figure 3]

Fortunately for these companies, there are still ways to take advantage of innovative healthcare delivery
models even if theyre not yet able to influence provider rates and quality standards. In most cases,
existing ACO and COE networks are available through an employers health plan. These are essentially
prepackaged options that dont afford the flexibility to control terms, but can still help benefits leaders
make their investment work harder through value-based payment models.

Dr. Halpert recommends asking the health plan provider some key questions before encouraging your
population to seek care from their ACO. Look at how much youre paying in care management fees and
retroactive rewards being paid out, so you know how much ACO attribution is costing. The next step is
understanding what youre getting for it ask to see the results, specifically metrics and data thats
specific to you.

6
One Medical, Best Practices for Implementing a Thriving On-Site Health Clinic, 2016
8

[Figure 3] Whats the primary obstacle to moving forward with direct contracting opportunities?

20%
Projected cost

17%
Executive buy-in

16%
Finding the right partners

14%
Other

12%
None

11%
Defining goals and/or measuring performance

10%
Company size

Business associations and nonprofit organizations like PBGH also enable employers who cant establish
their own networks to provide employees with cost-effective access to specialists through COEs. Through
the groups ECEN, they can steer members to providers with proven excellent outcomes and predictable,
fair prices. The ECEN uses rigorous evaluation to select both centers and surgeons, leads continuous
quality improvement across the network, and provides concierge patient support to achieve superior
outcomes. For example, just 0.5 percent of ECEN joint replacement patients required readmission within
30 days versus 4.6 percent receiving care through their traditional health plan.

But companies of any size have opportunities for positive disruption, says Ross. We want to move
the market in the right direction by educating employers about having productive conversations with
provider groups. When participation in ECEN isnt the right fit for an organization, Ross recommends
working with a regional business group to start asking hospitals hard questions about cost data and how
they evaluate provider quality. Hospitals are far more responsive to the business community than most
employers think theyll be.

In a similar fashion, some smaller employers choose to partner with other companies in the same
geography to share the costs and benefits of a private clinic. Dr. Halpert has worked with organizations
Health Benefits Evolution 9

as small as 500 employees to implement full-service, near-site clinics that provided care for up to 6,000
members across participating companies.

This is a great example of finding a shortcut to adopting an innovation many think is reserved for the
biggest companies, says Dr. Halpert. Wed work with a vendor to build a clinic that was not on the
premises of any particular client, but served three to six of them...because at that size the numbers could
justify it.

Planning to Harness these Innovations

Regardless of what size and stage a company is today or which obstacles to evolving health benefits
strategy are most acute there are some questions benefits leaders should ask about their readiness to
adopt new healthcare delivery models.

ORGANIZATIONAL

Does your organization have sufficient membership within a geographic area to make
direct contracting or onsite clinics viable?

Do you need better data on cost and member inquiries to begin moving toward a fully
self-designed and managed direct contract relationship?

Do direct contracting options align with your organizations strategic objectives?

What does your CHRO/CFO need to know to support this investment? How do you
build the business case for innovation?

How can you get your people to be good consumers of healthcare who make smart
decisions about quality and cost?
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PROVIDER PARTNERS

What insights do you have about provider quality, especially relative to cost, with direct
contracting options?

Can a prospective COE partner provide a complete list of mandatory outcome


measures used to evaluate their centers and surgeons?

Do prospective healthcare partners maintain a collaborative quality improvement


process? Can employers participate?

How do prospective healthcare partners coordinate with primary providers to ensure


consistent health plan management?

Can your health plans COE or ACO options provide client references?

Smaller Steps, While You Build Toward the Future

While the full potential of supply-side healthcare innovations (i.e., direct influence over provider cost
and quality) may be either out of reach for all but the largest companies, or simply too complex to move
toward today, employers should look to take advantage of other health benefits innovations that are
available for short-term implementation and immediate impact.

Newer approaches to architecting and administering benefits programs, in particular, can help provide
better care options and drive more value right away. They also bring the enhanced flexibility and visibility
essential to successfully implement the latest delivery models as those become accessible to a wider
range of companies in the years to come. Benefits leaders who embrace short-term improvements now
will put their organizations in a stronger position to start establishing their own networks early on.

STEP ONE: DRIVE ENGAGEMENT AND ENSURE EFFECTIVE MEASUREMENT

Before benefits teams start to manipulate the many levers available for short-term wins in benefits
design, its important to ensure the tools are in place to effectively track the impact of new solutions
Health Benefits Evolution 11

and drive engagement. Even the best healthcare delivery models have limited utility if the right people
dont use them when they need them or, even more commonly, if benefits teams lack visibility into
performance. Without this data, moving toward a long-term investment in direct contracting or onsite
clinics is hard to justify to leadership.

Engagement is the number one issue for employers, affirms Marcotte. Employers dont have good
data to measure engagement and performance across the numerous assets and resources they make
available to their populations. Theyre realizing that, as much as they want their employees to be
sophisticated consumers of healthcare, they dont touch the system with enough frequency to ever
reach that potential.

Understanding how your population is engaging with benefits programs is an important first step, but
visibility alone wont guide members down the optimal care path. With concierge support solutions,
employers can keep members better informed about the options most relevant to them even
proactively connecting members to the best providers for their needs.

Were at a point where data, predictive analytics, and technology are converging to allow employers
to push personalized, timely, and relevant messages to their population through mobile devices to
reach them at the time they most need it, says Marcotte. Supporting health benefits with this layer of
advocacy is important because it can avoid delays in care and promote usage of lower-cost preventive
treatment.

Health plans from major carriers havent traditionally provided the level of member service and data
necessary to measure performance, drive engagement, or align spending with employee coverage needs.
Working with the right partners to implement solutions for analyzing and effectively communicating
about all options available to employees is vital to the long-term success of a companys benefits
offering.

STEP TWO: NEVER IGNORE PLAN DESIGN

For employers that havent moved their populations to CDHPs, theres still some room to explore potential
gains through plan design. Self-funded companies that have the opportunity should always innovate
within their core health plans to optimize coverage for their populations today while setting the stage
for larger-scale innovation over the next few years. Marcotte notes its not a new approach, but analytics
have given employers more insight into how plan rules and value-based designs can better align cost
levers with the outcomes theyre looking to achieve.
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Companies with CDHPs can still use plan design changes to take better care of their employees, even
if those methods dont necessarily reduce fixed costs. One way theyve done this, says Collective Health
plan design operations manager Michelle Gard, is by setting out-of-network cost sharing similar to
in-network for categories like behavioral health benefits where networks may not be robust. Some
employers will also work with carriers to expand preventive drug lists for their CDHP plans, Gard adds.
Giving members an avenue to avoid deductible requirements for prescriptions often keeps them from
putting off care and allowing conditions to become more serious and more costly.

But there are a couple caveats benefits leaders should keep in mind as they negotiate plan design. First,
be cautious about how much complexity customization will add a simple, streamlined plan design is
easier to evolve with as you begin to pursue narrow networks or value-based payment models. Gard and
other plan design experts recommend defining a set of core principles that both inform and bound the
ways in which youll extend coverage, rather than trying to pull too many levers individually and ending
up with a plan thats difficult to administer.

And, as with transparency or concierge support services, choose your partners carefully. The impacts
of plan design decisions arent always easy to predict. Working with the right consultant and third-party
administrator (TPA) can help benefits teams see around the corners to prevent unintended consequences
down the road.

STEP THREE: EXPLORE THE ECOSYSTEM OF TARGETED SOLUTIONS

Many employers are already augmenting their core health plans with non-network benefits programs
for specialized types of care. Those that arent may be missing out on opportunities not only to address
some of their populations biggest needs but also to provide better, less expensive care to their highest-
cost claimants.

The benefits leaders we surveyed expressed strong interest in extending their health benefits with
best-of-breed point solutions for screening and preventive care, as well as highly specialized paths like
behavioral health, disease management, and maternity/fertility treatments. [Figure 4]

Including point solutions like these in a benefits offering isnt enough, however. Having the right
technology platform to understand the specific needs of your population and match members with the
most relevant programs is the only way for the majority of benefits teams to maximize the effectiveness
of this approach. Without integrating a suite of point solutions into a unified ecosystem, alongside
the health plan, benefits managers can invite significant operational challenges and create friction for
members in accessing the care they need.
Health Benefits Evolution 13

[Figure 4] What types of non-network benefits programs are you most interested in? (Check all that apply.)

53%
Screening and preventive health

43%
Behavioral health

33%
Disease management

26%
Maternity

16%
Fertility

16%
Other

For benefits leaders interested in pursuing this approach, now is the time to evaluate what types of
point solutions are aligned with their peoples needs and overall benefits strategy:

Screening and As healthcare delivery organizations increasingly look at genetic information


Preventive Care for personalized medicine, genetic screening can provide the insights
necessary for truly individualized treatment. One of the leading innovators
in this space, Color, has established an entirely new category known as
precision prevention. By bringing together expertise in both genetics and
technology, Color offers an effective and scalable health service that serves
as a global platform for preventive health. With the goal of saving lives,
Color arms people with the knowledge of their inherited risk for disease,
empowering them to actively manage their risk with a tailored treatment
plan.

Jill Hagenkord, M.D., chief medical officer for Color, is optimistic about the
companys ability to achieve that goal in partnership with employers. There
are over a million people in the U.S. who are at risk for hereditary cancer and
not currently eligible for genetic testing. This results in human and economic
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cost that could have been avoidable with proper risk management. By
coupling expertise in genetics with cutting-edge software and data science,
we are able to offer affordable, accessible, and actionable genetic testing
in a way the market has never seen. As employers increasingly seek to
improve employee satisfaction and reduce claims costs, we find more of
them investing in preventive health and offering hereditary risk testing and
disease management.

Disease Management Todays leading disease management point solutions are designed to meet
and Prevention the healthcare needs of an employers highest-cost claimants while providing
tailored education, coaching, and peer support. Biometric and connected
technologies can also introduce accountability for participants, enabling
close management of diseases such as diabetes.

Diabetes disease prevention program Omada uses smart scales, behavioral


analytics, and other innovative technology to create a lifestyle change in
participants who enter the program at elevated risk for chronic conditions
like type 2 diabetes and heart disease. These inputs are the basis for value-
based payments against their program success metric of pounds lost. 65
percent of Omada participants are engaged at 12 months, compared to 6.5
percent of participants in a commercial weight loss program.7 Employers
using Omada typically appreciate ROI within 24 months or sooner, by
preventing employees from progressing to chronic disease, and avoiding
associated medical costs.

The operational requirements of overlaying a value-based billing system


onto a fee-for-service healthcare and benefits infrastructure arent easy,
explains Tom Schoenherr, chief commercial officer at Omada Health. But
we think its the right way to charge we want to make money when we
deliver on the clinical outcomes we promise to our clients.

Behavioral Health Due to the proven correlation between behavioral health and workplace
productivity, many employers are taking advantage of new behavioral health
point solutions. Everything from innovative Employee Assistance Programs
(EAPs) to cognitive behavioral therapy, mindfulness and meditation, even

7
Outcomes | Omada Health www.omadahealth.com/outcomes
Health Benefits Evolution 15

sleeping apps employers have a lot of options to choose from. For example,
technology-forward programs like Lyra offer a new way for companies
to provide behavioral health benefits to their people. Through a data-
driven approach to matching members with care, Lyra offers personalized
recommendations to specialists they contract with directly, so participants
can contact them in person or via video chat without network limitations.

Fertility and With fertility coverage, point solutions have shown to reduce employee out-
Reproductive Health of-pocket costs significantly especially more innovative companies in this
space such as Progyny. Through advanced fertility methods and a unique
approach to reproductive healthcare coverage, theyre increasing success
rates, reducing the likelihood of multiple births, and achieving 30 percent net
savings for employers. Traditional fertility coverage plans require patients to
pursue unnecessary treatments for months, and still operate on a fee-for-
service basis. In contrast, Progyny strives to connect members with the right
treatment the first time and bundles benefits to align payments with holistic
treatment instead of transactions.

Specialists and For plan members facing a diagnosis, point solutions may be the best way to
Second Opinions provide cost-effective and convenient access to top specialists. One of the
most popular options in this category is Grand Rounds, described as the
fastest way for employers to curb costs without cutting corners. By providing
remote second opinions from world-class physicians, Grand Rounds is able
to change the course of care for members 66 percent of the time.

While offering non-network benefits programs in addition to a core health plan helps employers improve
outcomes and gain more control over costs, it can also make health benefits more difficult to manage.
Marcotte suggests, Employers are increasingly getting point solution fatigue. Theyre very interested
in these innovations, but often lack the bandwidth to go through procurement, data security, eligibility,
communications, et cetera for each one. Theyre looking for ways to plug them into existing platforms
and simplify the employee experience.

An ecosystem approach that connects these programs through a single platform not only makes it
easier for benefits teams to continue adding new services, it also offers several other advantages.
When a members care journey requires engaging with multiple solutions, the handoffs between
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providers become more seamless for both benefits managers and members. Data sharing between
point solutions maximizes each programs effectiveness and helps demonstrate value across the entire
benefits offering. And, when member engagement with point solutions is a challenge, bringing them
all together streamlines the experience so employees can easily find, understand, and use the options
available to them.

Creating a Sound Foundation

As benefits teams outline strategies to harness delivery system innovation within the next three to five
years, effectively implementing todays most accessible market trends will set their teams on the right
course. Working through these questions is a good place for many benefits teams to get started.

INFRASTRUCTURE

Does your team have a clear understanding of how session limits and other plan rules
impact members? Are you able to identify opportunities for improvement?

Do you need better data on cost and member inquiries to identify gaps in your existing
coverage?

INFORMATION

What quality metrics for point solutions and core plan coverage are most important,
especially for members of your population with specialized care needs?

What does your member inquiry data tell you about employee needs for point
solutions, modifications to session limits, or other changes to core plans?
Health Benefits Evolution 17

ALIGNMENT

Do your core plans align with your organizations strategic objectives, including
benefits and business goals?

What does your CHRO/CFO need to know to support your need for integrated
engagement and measurement tools, flexibility in plan design, and new point solutions?

Conclusion

Regardless of an employers size, population needs, or level of sophistication with benefits, there are a
number of innovative market trends any company can take advantage of to better manage healthcare
costs and give their people higher quality care. Evolving in the ways that are within reach today, with an
eye toward bigger leaps over the next several years, creates the foundation of continuous improvement
that will set benefits leaders up for long-term success.

With upfront costs steadily rising, in lockstep with the pressure to demonstrate returns, the need to take a
product development approach to health benefits strategies is only becoming more acute. This represents
a significant philosophical shift for most organizations. And the disparity between those that maintain the
status quo and those that adapt will become more apparent as direct contracting models are available at
a broader scale.

Fortunately for benefits teams, the changing healthcare landscape is making it easier than ever to
transition from being passive consumers of carrier products to designers of their own. And as with any
product facing todays accelerated marketplace dynamics, its no longer sufficient to simply design, build,
and ship. An agile methodology informed by strong guiding principles and a deep understanding of
member needs then optimized through a commitment to data-driven testing is the key to turning
health benefits into a competitive advantage.
More about Collective Health

Collective Health partners with employers to make health plans work the way they should, both for benefits
teams and the members who rely on them. By applying a product development mindset to health benefits,
we enable self-funded companies to realize immediate results while maintaining the flexibility to take
advantage of new innovations in healthcare. Our data-driven, people-first approach empowers you to:

Effectively measure the impact of existing and new benefits programs

Maximize engagement in your core health plan and targeted solutions

Deliver concierge-level support for an effortless member experience

Adapt for whats next

Ours is the only platform that connects and administers the entire benefits ecosystem health plan, benefits
programs, spending accounts, employee support to ensure you get the most out of your investment
while taking better care of your people. Collective Health is the smarter way to provide healthcare coverage
through technology.
Collective Health gives companies a smarter way to provide healthcare
coverage through technology and a premium member experience for
their employees. We replace traditional health plans with a flexible, data
driven alternative that connects and administers the entire health benefits
ecosystem, so companies get more out of their investment while taking
better care of their people.

844-265-3288 | info@collectivehealth.com | collectivehealth.com