More employers and health plans are offering new online tools to help their employees better navigate their health care and group plan benefits, which are often a source of confusion and frustration for many American workers.
These tools, known as navigation platforms, are apps and websites designed to help health plan enrollees tread a path through the health care system. Companies that have adopted the tools say that they have freed up their human resources staff, whom employees will normally call for assistance when they don’t understand or run into obstacles with their health insurance.
One of the biggest complaints that health plan enrollees have is that it’s difficult to access care and understand how their health insurance works. A 2022 Gallup poll found that 72% of Americans report having felt confused about purchasing or using their health insurance, particularly citing their frustration with surprise bills and denied claims or prior authorization denials.
A 2023 survey by Quantum Health found that:
- Only 20% of employees said they felt “very confident” they understand and know how to use their health benefits.
- Employees said they felt most supported at open enrollment. However, after the plan takes effect and they must navigate and make decisions, they feel the support is not there.
- 67% of workers are currently navigating their health care journey alone, without enough support from their employers or health insurance to help understand the options available to them.
How they work
Some platforms focus on guiding workers through the open enrollment process while others aim to help them understand their benefits, how to use them and improve their health outcomes.
The latter will use the health history of each employee to provide customized reminders or prompts when they should be making appointments or taking other actions relative to their personal health care needs.
These platforms can be used either as part of a benefits administration dashboard or as a stand-alone tool.
Examples
Open enrollment assistance: Nayya — Nayya’s platform learns about each employee’s needs through a series of questions about their medical history, lifestyle, financial situation and current health care usage. From that information it can steer them to a health plan that is the best fit for them, in addition to other recommendations.
Two case studies of employers who have contracted with Nayya yielded a number of benefits to both workers and the business:
- It drove health plan participation rates.
- Employees were more likely to opt for a health savings account and a flexible savings account, and to enroll in supplemental benefits like critical illness and hospital indemnity insurance.
- Clients saw a significant decrease in the administrative burden on their HR departments.
Helping to access care: HealthJoy — HealthJoy’s platform prompts employees to schedule preventive screenings, improving health care outcomes through early detection. The platform also includes live health care navigation support and case management.
One case study on its website states:
“Over nearly 4,000 member interactions, (the client’s) employees have used HealthJoy to find a provider or facility, book an appointment, review a prescription, or access telemedicine 1,102 times.
“HealthJoy concierges also helped TCW employees find providers, facilities, or schedule appointments nearly 400 times — a massive time savings for employees who spend most of their time in a truck cab.”
The takeaway
These platforms require a significant amount of engagement between employers’ HR crews, the vendors and sometimes the insurers. There are a number of variables that are unique to each plan and implementation hurdles may vary between platforms.
And once you settle on a platform, you’ll have to ensure ongoing communication. Finding a solution is just the beginning. Ongoing communication and education are critical to ensure effective use of navigation systems.
Call us if you have questions about these tech platforms.
Article Source: https://www.insurancenewsletters.com/