Beyond Benefit Plan Design: How to Help Employees Make Smarter Healthcare Decisions

Employers design health benefit plans to encourage employees to choose lower-cost, high-quality care. But even an effectively designed benefit plan design won’t deliver its full value if employees don’t choose cost-effective options.

Employers can influence employee healthcare decisions by combining thoughtful benefit plan design with ongoing education, clear communication, and strategies that make the best choices the easiest.

Why Is Benefit Plan Design Only the First Step?

Benefit plan design can influence where employees choose to seek care. For example, employers may use a tiered network with lower or no out-of-pocket costs for lower tiers and/or other incentives to encourage employees to choose Preferred-Value Providers (PVPs). PVPs offer lower-cost options for select services, including primary care, colonoscopies, MRIs, and musculoskeletal (MSK).

These incentives create an opportunity for savings, but they don’t automatically change employee behavior. Employees may find it difficult to compare their options, continue seeing familiar providers, or assume a higher price means better care.

To get employees to make effective, informed decisions about where they receive healthcare, employers need to address the practical and personal factors that influence healthcare decisions.

Help Employees Understand What’s in it for Them

Employees are more likely to explore their options when they understand how those choices affect them personally. Messages focused only on reducing the employer’s healthcare spending may not feel relevant to someone deciding where to get care.

Instead, connect high-value healthcare options to benefits employees can recognize like lower out-of-pocket costs and improved access. Concrete examples make differences in healthcare costs easier to understand.

For example, employers can share illustrative comparisons of costs for common, shoppable services, relevant to the plan, and presented with appropriate context. Explain how choosing a different provider could affect an employee’s out-of-pocket costs, where that information is available.

The goal isn’t to tell employees where should go. It’s to help them recognize the value of their options and feel confident choosing the one that works best for them.

Acknowledge Fear of Uncertainty

Healthcare decisions are personal. Employees may have longstanding relationships with their physicians or feel more comfortable receiving care from a familiar health system. A message that suggests they should abandon those relationships to save money can create resistance.

Instead of telling employees what to do, explain that employees may have additional options for certain services and that comparing providers can help them find care that fits their needs and budget.
For shoppable services, such as imaging or certain outpatient procedures, employees may be more open to comparing options.

Make Finding High-Value Options Easy

Even motivated employees may not use Preferred-Value Providers if finding them requires too much effort. If they don’t know where to search for in-network providers, how to identify a Preferred-Value Provider, or who to contact with questions, they will be more likely to stick with familiar providers.

Employers can reduce this barrier by including direct links to provider directories in benefit guides, enrollment materials, and company intranet and highlighting available cost and quality information. The fewer steps employees must take to compare options, the easier it becomes to make informed decisions.

Repeat these messages throughout the year, not just during open enrollment. A reminder before employees are likely to need a service can be more useful than information delivered months earlier when they have no immediate reason to act.

The Alliance’s Find a Doctor tool helps users identify providers in The Alliance network, including Preferred-Value Providers.

Help Employees Feel Confident

Employees may hesitate to choose an unfamiliar provider if they’re uncertain about the cost and quality of the services. General statements about saving money won’t answer those questions.

Instead, employers can provide specific, understandable information that helps employees evaluate their options. Explain how the network works, where to find Preferred-Value Providers, and how to confirm coverage and expected costs. When possible, make comparisons available before employees schedule care.

Benefits teams should also coordinate with their third-party administrators, brokers, and network partners, so employees receive consistent answers. Conflicting information or unclear instructions can undermine confidence and discourage employees from exploring alternatives.

How Can Employers Measure Employee Benefits Engagement?

Employers need to understand whether employees are using their benefits as intended and where additional support could help.

Start by reviewing available claims and utilization data to identify patterns. Are employees using designated Preferred-Value Providers for services? Are there services where employees consistently choose higher-cost options? Are there gaps in utilization that may point to access or awareness challenges?

Use these findings to develop targeted communications.

Then evaluate whether the approach is working. Depending on available data, employers can track:

• Utilization of Preferred-Value Providers and other high-value options.
• Changes in provider selection for eligible services.
• Changes in claims costs and out-of-pocket spending.

Employers can share this information with their benefits partners and use the results to refine both plan design and employee communications. Improving healthcare decisions is an ongoing process.

Move Beyond Benefit Plan Design to Better Healthcare Decisions

Steering and tiering can give employees a financial reason to choose high-value healthcare, but lasting behavior change requires more than incentives.

Employers can influence employee healthcare decisions by making options clear, addressing employees’ concerns, showing how effective choices can benefit both employees and the organization, and making cost-effective choices the easiest choice.

The goal isn’t only to lower healthcare costs. It’s to help employees navigate their options and make decisions that balance cost, quality, and access.

The Alliance works with employers to develop custom tiered provider networks and benefit plans that support these goals.

Reach out to us to learn about how a thoughtful benefit plan design and employee education strategy can help your employees get more value from their health benefits.