At a time when everything seems to cost a little more, employees may be hesitant to use health care services — especially if they do not know the cost beforehand. For many, cost can be a top barrier to accessing health care. In fact, 7.1% of Massachusetts adults avoided health care due to costs in the previous year, according to the 2023 America’s Health Rankings report.¹ While across the U.S., 43% of insured working-age adults with employer-sponsored health plans said it was very or somewhat difficult to afford their health care.²

People who do not pursue needed health care may run the risk of poorer outcomes that can exacerbate chronic conditions and may drive increased medical costs. Fifty-four percent of people with employer-sponsored coverage who reported delaying or forgoing care because of costs said a health problem of theirs or a family member got worse because of it.³

6 tips to help make employee access to health services easier
with the goal of helping lower their total cost of care

1. Remind employees of the importance of preventive care. Health.gov reports that getting preventive care reduces the risk for diseases, disabilities, and death—yet millions of people in the United States don’t get recommended preventive health care services.⁴ Higher-quality preventive care can play an important role in promoting the health of your employees, which may help mitigate the onset or progression of diseases, facilitate healthier lifestyles, and promote cost savings.
   
   Consider choosing a health plan that offers population-specific wellness information such as important screening and vaccine reminders directly to your employees. HR and managers should reinforce these interventions with supplemental communications to the workforce. By helping increase awareness of important preventive care measures, you can help more of your employees access these critical services with the goals of staying healthier and potentially avoiding costlier services down the road.
   
   
2. Foster a culture of health to help make it easier for employees to succeed in improving their well-being. Encourage your employees to be proactive about their health and to engage with their benefits. This may help them achieve better outcomes and lower their out-of-pocket costs.
   
   HR leaders and managers may help influence and create a culture of health.⁵ For example, depending upon your business:
   
   • Consider allowing flexibility with your employees’ work schedules and locations, as well as time for medical appointments and work-life balance.
   • Check to see that you are adequately staffed to better allow employees time away from work, avoidance of long hours and high-level stress—all of which may negatively impact an employee’s physical and mental health.
   
   Use health and well-being programs and resources within your organization to help with creating a sense of community and connection among your workforce, while encouraging participation. Some carrier-sponsored programs reward employees and their families for taking healthy actions. They can earn incentives designed to improve their health and well-being, and rewards can be used to offset medical premiums or deposited into a health savings account (HSA), for example.
   
   
3. When meeting with your broker or directly with a health benefits carrier, inquire about any new health plan options that might be a better fit with changing employee needs and your bottom line. Many insured adults said they or a family member had delayed or skipped needed health care or prescription drugs because they couldn’t afford it in the past 12 months—29 percent of those with employer coverage.⁶ This suggests that financial obstacles, including copayments and deductibles, may be a barrier to accessing health care for many employees. Some more modern employer-sponsored health plans:
   
   • enable your employees to shop for needed health care services and to budget ahead of receiving care. By empowering your employees to compare options and choose high value care, these newer benefit designs may lower out-of-pocket employee expenses and the total cost of care;
   • now offer employees upfront pricing and coverage information. There are no deductibles and coinsurance. Employees may be able to use an app to see variable copays for different network providers, with lower copays assigned to providers offering high-value care.⁷
     
     
4. Encourage employees to stay in your plan’s network. Out-of-network utilization continues to drive the total cost of care surpassing $4 billion.⁸ Receiving care from an out-of-network provider or facility may lead to surprise medical bills for your employees.
   
   To help reduce the risk for your employees of surprise charges, check whether your health plan will proactively contact your employees before they go out of network, sending a text message, emailing, or calling to notify them about network options that may be more affordable. If an employee receives a surprise medical bill, let them know they can request a reduction or waiver from the support personnel at the doctor’s office or hospital. Check with your health plan about resolution services it may offer to assist your employee in negotiating the bill.
   
   
5. Consider offering employees an HSA, HRA or FSA to complement your employee health plan(s). Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs) offer employees tax advantages that can help them save on eligible health care expenses, but in different ways. Determine which plan or combination of plans is right for your employees’ needs and your business as another opportunity for helping lower employee costs.
   
   
6. Counter increasing pharmacy costs with a whole person, integrated and collaborative approach. Lowering employee pharmacy costs is possible with a multi-pronged strategy: integrating medical and pharmacy benefits, collaborating across the health system, and launching new initiatives that have the potential to save money and improve health outcomes while delivering a better experience.
   
   The starting point is a whole-person approach that keeps the patient at the center. That means considering all options for treating a condition, and knowing which may create the best outcomes from both a health and cost perspective. 
   
   When your health benefits carrier and pharmacy benefit manager are synced up on how to manage your employees’ treatments that have options under both benefits, your employees are more likely to end up with a better cost outcome. This integrated approach includes considering if there is a less expensive drug available for treating the same condition with similar outcomes. Prescription Drug Lists (PDL) that incentivize employees to use covered, clinically appropriate and cost-effective medications, and utilization management programs, are also helping manage the costs of some drugs.
   
   The potential for collaboration across the health system to reduce costs and expand access is growing with the complexity and variety of treatments. For instance, embedding patient and prescription cost information into providers’ workflows may enable them to make more informed decisions for their patients at the point of care.
   
   And look for a pharmacy plan with a drug-pricing tool that empowers employees to compare prices for traditional generic drugs based on their insurance coverage. If people cannot easily afford the medications they need, they are less likely to take them, which contributes to poor health outcomes.⁹

Having a greater awareness of health plan options and plan features may help you better select the offering most appropriate for your workforce, while a greater awareness of the health care system may help your employees avoid barriers to care. Given the rise in costs for many products and services, it is important to find solutions that help promote affordability and access.

By Eric C. Swain, Vice President
UnitedHealthcare E&I, New England
[email protected]

¹AmericasHealthRankings.org, allstatesummaries-ahr23.pdf; hhs.gov; 2023 Annual Report; accessed Sept. 2024.

²The Commonwealth Fund; Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer,10/26/23; www.commonwealthfund.org; accessed Sept. 2024.

³The Commonwealth Fund; Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer,10/26/23; www.commonwealthfund.org; accessed Sept. 2024.

⁴Health.gov; Healthy People 2030, Preventive Care; accessed Sept. 2024; Borksy, A., et al. (2018). Few Americans Receive All High-Priority, Appropriate Clinical Preventive Services. Health Affairs, 37(6). DOI:10.1377/hlthaff.2017. 1248

⁵Harvard Business Review; hbr.org, Strategies to Improve Your Employees Health and Well-being, Oct. 2021; accessed June 2023, Sept. 2024.

⁶The Commonwealth Fund, www.commonwealthfund.org/publications/surveys/2023/oct/paying-for-it-costs-debt-americans-sicker-poorer-2023-affordability-survey; accessed Sept. 2024.

⁷The UnitedHealthcare Surest^TM health plan. Aon’s actuarial analysis compared a cohort of Surest members (derived from Surest’s 2021 and 2022 self-funded and fully insured book of business with complete medical and pharmacy data, plus three months of run-out, and who were not excluded by certain normalizing eligibility and experience restrictions) against a control group (derived from a multi-employer database with matching demographics, geographics, diagnoses, and health comorbidities for the same time period), and utilized Aon’s member-level Cost Efficiency Measurement (CEM) methods. Claim reduction figures apply to the 2022 plan year.

⁸Sourced from claims data from Out-of-Network Non-par Opportunity dashboard, United HealthCare Services, Inc., Naviguard, Inc., 2023.

⁹Witters, Dan. In U.S., an Estimated 18 Million Can’t Pay for Needed Drugs. Gallup, Sept. 21, 2021;
https://news.gallup.com/poll/354833/estimated-million-pay-needed-drugs.aspx.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates.

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