In the Know

Helping Employees Become Smarter Health Care Consumers

12.18.2017 Sheryl Correa, VP Total Compensation and Benefits

We hear a lot about “consumerism” in health care today—but what does it really mean?

Most of your employees receive health care through company health insurance plans. And while they may be able to choose between a couple of different plans—including providers under those plans—choices are not unlimited.

Studies show that when people are preparing for an episode of care, they don’t really conduct research; they don’t make fact-based decisions; and they don’t shop around. All of which they probably would do if they were shopping for a new car, or another expensive consumer item.

Despite increased transparency and public availability of quality, safety, and outcomes information, most people simply follow doctor’s recommendation when seeking care—whether or not their insurance plan requires them to follow their primary care physician’s referral.

That said, it is true that employees are shouldering more responsibility for their health care—especially cost management. About 40% of health insurance enrollees now have high-deductible health plans, often with higher co-pays. Even though some have not yet adjusted to changes in spending behavior required by this “new normal,” more people are becoming more engaged with their own health care decision-making.

There is clearly one area of health care where a more consumerist attitude appears to have already taken hold—customer experience. As studies by McKinsey and others have shown, health care consumers are holding providers and payers to the same high standards as Apple and Amazon, in terms of customer service, making life easier, and offering value.

Consumer behavior is a complex dynamic, but most consumers are basically looking for two things—value and convenience. To that end, we need to encourage more innovation from providers and payers around these two primary drivers of consumer behavior:

  • Value: Some employers are experimenting with plans that rely less on deductibles and more on cost-sharing--from the first dollar to the out-of-pocket limit. This gives employees an incentive to behave like consumers all the time—while getting some help with all their health care costs. The economics for employers can work just like high-deductible plans—encouraging people to be smart buyers of medical services all the time, by prioritizing preventative services and looking for opportunities to shift from high to low cost settings.
  • Convenience: Consumers love convenience. As more health care providers recognize this, we’ll see more tele-medicine, video consultation, 24-hour nurse help lines, online patient portals, and other health services that mirror what people are used to experiencing in the rest of lives—banking, shopping, you name it.

    St. Joseph Hoag Health has already embraced many such innovations, including the aforementioned Nurseline, eVisit and online patient portal, which allows patients to access their medical history anywhere, any time. We also recently rolled out a new service called Reserve My Spot. It’s an online check-in tool for urgent care appointments where a patient can log on, check wait times at several urgent care locations, and make an appointment from their mobile device or computer.

Helping Your Employees Helps You

As your employees navigate this new territory, you should help them become smarter health care consumers—for the following two reasons:

  1. It’s simply the right thing to do. If employees make poor health care decisions, they might be unable to handle increasing out-of-pocket medical expenses.
  2. If employees are struggling, financially and medically, due to poor health care decisions, you will also suffer the consequences—absenteeism, presenteeism, low productivity, workforce debilitation, attrition, and so on.

Here are some specific ways you can help your employees become smarter health care consumers:

1. Leverage Outside Experts

Insurance Plan Brokers & Consultants

  • Your plan providers and partners are experts in health insurance—let them be your guide.
  • Your consultants can help you understand what is going on in the market place and share best practices.

Health care Providers

  • Most providers will offer education and training to your employees. St. Joseph Hoag Health offers numerous lunch-and-learn programs on a variety of wellness topics, like flu shots, or how to incorporate healthy habits into your workday.
  • Partner with a provider like St. Joseph Hoag Health that is dedicated to building healthier communities. For example, our Shop with Your Doc program is extremely popular in many of our local supermarkets. This yearly event connects shoppers with St. Joseph Health experts who offer friendly advice on the importance of a nutritious diet and how to make healthier choices.

2. Educate Your Workforce

  • Start with the alphabet soup of insurance terminology—FSA, HSA, PPO, HMO—and other health benefit fundamentals.
  • Demonstrate the public price/quality transparency tools—and teach your employees how to use them.
  • Most important, ask your workforce how they want to be educated. You probably have a diverse, multi-generational workforce—and not everybody learns the same way.
  • As a tip, we have found online videos to be a very effective teaching tool—especially with a person (or voiceover) speaking in plain language. People can watch them at home, with family members, on their own schedule. Plus, they can re-watch them to make sure they get it.

3. Offer Compelling Incentives

  • Incentives work best when they promote ongoing engagement—not just one-time interventions, say at Open Enrollment.
  • For example, many employers now offer incentives to encourage preventative care—e.g. contributions to employees’ Health Savings Accounts for biometric screenings. Why not spread that incentive out over an entire year for sustained engagement —with quarterly payments for specific screenings and a bonus payment, deposited immediately after the fourth screening in Q4?
  • Design benefits plans to incentivize more cost-effective utilization; e.g. “tiers of care” with employers sharing more cost for more effective, higher value treatments. If it’s feasible, try to include ongoing cost-sharing initiatives, like premium discounts.
  • Personalize your programs by helping your employees set personal health goals and providing tailored recommendations and rewards.

As health care evolves—becoming more consumer-centric—employees need your help to change their behavior. As an employer, your reward will be persuading people to take more responsibility for managing their health and their health care cost—probably the biggest opportunity to deliver better care at lower cost.

To learn more about Lunch & Learn opportunities and other ways we can help your employees become better health care consumers, please visit our website on Employer Health Plans orcontact us at