Optimize your organization’s health ecosystem 

Over the past ten years, digital-health venture funding in the US has surpassed $100B, spurring an impressive amount of innovation in the healthcare market. We’ve also seen vendors broadening their offerings – often through consolidation with other vendors – which can result in overlapping services in an employer’s program offerings. Optimizing this evolving ecosystem of vendor partners requires a dynamic management approach that includes ongoing evaluation of employee engagement and program performance.

Focus on solutions that maximize value to your employees and your organization

We know from our Health on Demand employee research that workers receiving the most varied health and well-being benefits are the most positive about their employers, their jobs and their ability to afford the care they need. The high cost of healthcare means that employees rely on their employers to provide resources to keep themselves and their families fit and well. But with healthcare cost growth on the rise, it’s more important than ever to ensure your investments in employee health are on target. As you look at current as well as potential programs, consider these fundamental questions:

• What are your employees saying about areas where they need support? How does this input vary across different employee cohorts (e.g., age, gender, income, full-time/part-time, etc.)?
• What does your data tell you about the key health conditions and cost drivers in your population?
• Where is there the biggest gap between employee needs and current offerings?

Create an up-front measurement strategy

Our most recent National Survey of Employer-Sponsored Health Plans indicates that employers are generally satisfied with the performance of their key stand-alone health solutions, with only 6% or fewer indicating that they’re not satisfied. About a third of participants, however, indicate that it is either too soon to tell or that they don’t have metrics to assess program performance. Before entering into a contract – or renewing with a current vendor – ensure that you have a game plan to assess how program success will be measured.

• Measurement framework. For each program, define how impact will be measured over time. Understand the components of engagement, how savings will be calculated (for example, how the number of avoided ER visits will be determined) and the timeframe in which different results can be meaningfully measured. Be clear on when and where you’ll see employer-specific versus book-of-business results.
• Engagement. As the marketplace has evolved, contracts have moved from per-employee-per-month (PEPM) fees to pricing based on “per engaged member.” The time to negotiate the definition of “engagement” and “sustained engagement” is during the initial sales process or prior to renewing your contract – and keep an eye out for any changes in how engagement is defined and reported over time.
• Clinical outcomes. Many of the digital health offerings reaching the market today have a clinical component. Negotiating clinical performance terms in your service agreements with these programs should be table stakes. For instance, with a pre-diabetes or type-2 diabetes solution, key performance indicators should include fees at risk for reduction in A1c levels, BMI reduction, medication elimination, and improved lab values (e.g., hypertension, liver function, cholesterol).

Measure ongoing performance

Having an up-front plan for monitoring vendor performance on an ongoing basis is a key to optimizing performance. We recommend a multi-pronged assessment strategy that considers engagement, health improvement and cost management outcomes across all interventions (e.g., by looking at medical trend), at a segmented level (e.g., by looking at trend for those with chronic conditions), and at a program level (e.g., by comparing medication compliance rates for those actively engaged in a given program vs. those not enrolled).  Operational, member experience and clinical impact audits are also important tools to support continuous program improvement.

Review your portfolio

The market is constantly changing as vendors merge or combine solutions and new vendors emerge.  Tightening capital availability may spur additional M&A activity as well as greater focus on operational efficiencies/expense controls. To stay on top of how your programs are performing against your goals – and to keep up with what’s new or potentially more compelling in the market – you’ll need to review your portfolio on a regular cadence. Tracking performance over multiple years – changes in engagement, cost per engaged member and other metrics – is valuable for determining if a vendor is on target or if it’s time to evaluate alternatives. Optimization is not a one-time event, but an ongoing process to get to “just right” – and stay there.

This post is one in a series of Seven breakthrough benefit strategies to explore this year.