Improving Your Health Benefits Doesn’t Have to Be All or Nothing: One Small Change Can Make a Big Impact

When healthcare costs continue to rise year after year, it’s easy to assume that the only way to make a meaningful impact on health benefits is through a complete overhaul.

But employers are seeing success through rolling up their sleeves and making granular improvements to specific areas of their health plan rather than doing a complete redesign.

Improving your health benefits doesn’t have to be an all-or-nothing effort. By identifying one opportunity, measuring the results, and building on that success, you can gradually create a benefits strategy that improves employee health while controlling healthcare costs.

Start with Your Data

Claims data can reveal patterns that identify opportunities for improvement. Rather than making broad changes, employers can use data to pinpoint the areas driving unnecessary healthcare spending.

Ask questions like:

• Are employees using the emergency room for non-emergency conditions?
• Are they receiving care in high-cost settings when lower-cost alternatives are available?
• Are preventive services being underutilized?
• Are certain conditions or services driving a disproportionate share of healthcare costs?

The answers can help you identify one area where a small change could have a meaningful impact.

Instead of trying to solve every challenge at once, focus on the opportunity that offers the greatest potential for improvement.

Example #1:

Encourage Employees to Choose the Right Site of Care

One area employers commonly find unnecessary spending is emergency room utilization.

Many employees visit the emergency department for illnesses or injuries that could be treated in a primary care office or urgent care clinic. While an emergency room is the right place for life-threatening conditions, it is the most expensive option for routine care.

Employers can influence unnecessary ER utilization by making the right site of care the easiest choice.

For example:

• Lower or eliminate copays for primary care visits.
• Offer lower out-of-pocket costs for urgent care than emergency care.
• Get specific; Learn why employees are utilizing different care settings. (Sometimes operational hours limit where employees can receive care).
• Use targeted education to teach employees how to navigate common care situations.
• Share simple decision guides employees can reference when they need care.

These small adjustments can help employees receive the appropriate level of care while reducing unnecessary healthcare spending.

Example #2:

Make High-Value Care the Easy Choice

Another opportunity often identified through claims data is where employees receive imaging services.

Many people automatically schedule MRIs, CT scans, or X-rays through large hospital systems because that’s where they are referred. However, independent imaging centers can perform the same diagnostic tests and meet the same nationally recognized quality and accreditation standards while costing significantly less.

Without guidance, employees may not realize they have another option. But employers can encourage better choices by incentivizing high-value care.

For example:

• Remove cost sharing for imaging performed at designated independent imaging centers.
• Offer cash incentives for employees who choose Preferred-Value Providers.
• Promote provider search and cost comparison tools so employees can easily identify lower-cost, high-quality options.
• Educate employees about why prices vary and how choosing a different provider can reduce costs for both them and the health plan.

When employees understand their options, and the process is simple, they’re more likely to make informed healthcare decisions.

Choose One Change to Focus On

Think about improving your health plan the same way you would improve any other business process.

• Choose one measurable goal.
• Implement one change.
• Evaluate the results.
• Repeat the process.

Over time, incremental improvements can add up to substantial savings on healthcare spending while creating a better experience for employees.

Measure What Matters

Every change should have a clear objective and a way to measure success.

Depending on your strategy, you might track:

• Emergency room utilization.
• Use of urgent care or primary care.
• Imaging costs.
• Preventive care utilization.
• Employee engagement with healthcare decision support tools.

Measuring outcomes allows employers to determine what’s working, identify opportunities for refinement, and build confidence in future benefit decisions.

The Alliance helps employers measure success and find opportunities for improvement with a personalized healthcare analytics report (Smarter Health^SM analysis) that includes a breakdown of employee ER, urgent care, and primary care utilization.

Then Build on Your Success

Once you’ve achieved success in one area, identify the next opportunity.

For example, if you’ve successfully reduced unnecessary emergency room visits, next, you may focus on increasing preventive care utilization. Then you might encourage employees to choose Preferred-Value Providers for common procedures.

Each improvement builds on the last, creating a stronger, more effective benefits strategy over time.

A Long-Term Strategy Delivers Long-Term Results

Lasting change doesn’t happen overnight. Transitioning from a fully insured to a self-funded health plan involves a 3-year strategy. This multi-year strategy can also be applied to targeted benefit plan changes.

Year over year, employers use claims data to better understand utilization patterns, make incremental benefit plan changes, measure the results, and refine their approach.

In this way, employers can continuously improve their health plan through steady, intentional progress.

Progress Over Perfection

There’s a common saying: Don’t let perfect be the enemy of good.

The same principle applies to health benefits.

Waiting until you have the time, budget, or resources to completely redesign your health plan may mean missing valuable opportunities that are available today.

You don’t have to redesign your entire health plan to start seeing better results. Whether you’re looking to reduce unnecessary healthcare spending, encourage employees to choose high-value care, or better understand your claims data, one small change can make a meaningful difference.

At The Alliance, we help employers identify opportunities, design benefits that promote better healthcare decisions, and measure the impact over time.

Contact us to learn how one small change can strengthen your benefits strategy and help your healthcare cost trend.