How will people understand and thus use these differently designed benefits?

EmployersWeb.com May/June 2009



By Debra C. Leon, President & Founder, Health Contact Partners

That is the unstated question. Yes, innovators are building creative benefits solutions that no one understands and people are hesitant to use. However, this is not the first time. Just a few short decades ago, people came kicking and screaming, but they all came reluctantly to the conclusion that they had no choice but to make their own retirement decisions and take individual actions to achieve financial well-being.
     This same resistance is at play with consumer-directed health care as it was with retirement benefits. People worked for the same company most of their working life and their defined benefit plans were handled by employers. This has changed dramatically for most of the U.S. workforce; they now have “employee-responsible” retirement commitments, rather than an “employer-responsible” environment.

Too Busy to Be an Expert
     As we all know, this same paradigm shift is now happening in health care. We’re confronted with too many choices to make regarding our health care benefits programs and no crystal ball to predict what our families may need in the short and long term. We are not actuaries, we are not health care professionals, and, frankly, our lives are too busy to become the experts we feel we need to become.  
     This shift of burden has created stress, resistance, and fear as people realized they were now responsible for a level of commitment and planning for which they did not feel prepared or able to do. An entire industry, financial planning, was born out of a need for retirement planning, created to advise and direct people in regard to their personal financial future.
      So we turn to the experts in health care planning. But who are they? Can our physician help us to choose or navigate the complexities of these new plans being offered to us? How about our HR departments? Do they have the time to walk each and every employee through the choices they need to make during enrollment or during a family emergency? And, since things also happen at night and on the weekends, who will answer the phone to help?

Health and Benefits Advocacy
     As with retirement benefits, this downward pressure has created the need for a new support service. An entirely new service, health and benefits advocacy, has taken hold rapidly in the past five years. When my company started providing advocacy services five years ago, we would hear brokers and consultants ask, “Yes, but what is the ROI?” At that time, we had no answer. And I’m still not convinced that there is an answer to that question today. Or maybe the answer today is, “Does it really matter?” Hopefully, we are beginning to understand that the real value of advocacy services is that they protect the investment made by an employee and their employer. 
     Let’s say that the annual health care benefit spend is somewhere between $6,500 and $7,500 per year per employee. An advocacy program, which helps individuals find the resources they need, make good decisions about appropriate care, uncover and resolve billing errors, and even protect the individual’s credit rating, costs about $30 per employee per year. For less than 1% of the overall cost of benefits, individuals are guided appropriately and protected financially, as is the employer. 
     HCP’s team of advocates, called Care Champions, assists with issues ranging from finding an in-network provider to arranging to have a ramp built for an elderly wheelchair-bound family member at no cost to the family; from finding resources for financial aid for much-needed medications to uncovering double-billing issues for a family whose child was hospitalized unexpectedly. Care Champions link arms with employees as highly trained, trusted advisers to answer benefit questions, advocate for equitable claims resolutions, provide clarity about health conditions and diagnoses, and provide around-the-clock advice from registered nurses.
     The real value for advocacy lies in the trust and support that is created between the advocate and the employee or family member. At the same time the industry continues to build new and innovative solutions experts need to encourage and guide the consumer towards these solutions. A trusted, neutral, and skilled health and benefits advocate can be the beacon that guides the consumer towards the resources they need to embrace the responsibility they now have for their own health and well-being. And then, yes, we can “build it and they will come.” 


Debra Leon is an expert on member enrollment and engagement, serving as past chairperson for the Employee Enrollment and Engagement Strategies Summit. Debra has written numerous articles and facilitated workshops for national organizations about effective employee and member communication. Health Contact Partners specializes in creative communication strategies that promote high engagement rates for its clients’ services and programs. Contact: dleon@healthcontactpartners.com; 847-465-5000, ext. 7101.