As the annual benefits open enrollment period takes off across the country, public and private entities will offer an array of programs and coverage options designed to keep employees and their dependents healthy, engaged and productive throughout the coming year.
While employers in all industries are grappling with labor shortages, the public sector continues to struggle with staffing challenges. With some 18.28 million people employed by state and local governments in 2021, the “quit rate” for government workers jumped to 11.7% in 2020 from 9.7% in 2016, and that trend has continued. That could mean continued disruption of everything from community and residential programs to public works, parks and recreation, public safety, and more.
Health benefits can be a hiring and retention tool
According to the Bureau of Labor Statistics, in 2021, 88% of state and local workers enrolled in health benefits that were made available to them through their employer. Meanwhile, a recent survey showed that changing jobs to secure better benefits and flexibility is a key strategy for employees.
Despite this evidence, achieving participation and engagement in employee benefits can be a struggle. According to research from Quantum Health, this is due in part to the gap that exists between what organizations think employees understand about benefits and what they actually understand. Meanwhile, employees say they lack confidence in their benefits knowledge and their ability to use the benefits programs available to them.
The Quantum Health survey quantified this phenomenon as a “confidence disconnect,” or gap, between employers and their employees regarding healthcare benefits. The survey showed that 88% of employers believe their workers are confident in understanding their healthcare benefits. However, only 52% – barely half – of individuals surveyed say they feel confident. Meanwhile, only 45% find it easy to use health benefits, and only 35% find it easy to navigate the system.
Gaps in benefits knowledge can be problematic
When it comes to healthcare benefits, employee knowledge gaps can negatively influence utilization, engagement, and compliance with care plans. In addition, surveys continue to show that healthcare literacy is lacking, which has been linked to poor health outcomes and higher healthcare costs caused by inappropriate use of healthcare services and benefits.
Healthcare navigation can be a solution
Healthcare navigation is a solution that state and city governments can offer as part of their overall employee benefits package to help employees understand and use their benefits, and to provide personalized support when employees have questions or are experiencing a specific healthcare need. Healthcare navigation that is coupled with care coordination can increase adoption and engagement in employee benefits, support employees through a complex healthcare journey, deliver better health outcomes, and reduce healthcare costs.
For example, state employee health plans traditionally see the biggest cost increases from hospital costs. Inflation and post-COVID utilization increases are expected to continue to drive these costs up by an additional 6.5% as consumers seek care that was put off during the pandemic. By guiding employees to the right care, at the right time, and within their covered benefits, healthcare navigation can help offset these cost increases.
What public employees need to know during benefits open enrollment
Following are the top five most common challenges related to health benefits that employees say they experience. Healthcare navigation experts offer these tips for how to use open enrollment to help employees overcome these challenges, so they get the most from their benefits throughout the year.
1. Finding coverage details. Key to appropriate benefits utilization is understanding coverage details, including plan type (HMO, PPO or high-deductible health plan, for example), how copays and coinsurance works, and how their deductible works. Communicate early and often, and make coverage details easily accessible within the Summary Plan Description or your organization’s online benefits portal. Doing so can help employees avoid surprise medical expenses down the road.
2. Finding doctors and accessing care. While this step may seem like the easiest part of healthcare, it’s an area employees find challenging. Open enrollment is a good time to educate employees about how to find a doctor, research provider cost and quality, and understand telehealth options for their chosen plan and network. Healthcare navigation with care coordination addresses this by ensuring employees get the care they need at the right time and within their covered benefits, thereby avoiding missteps that can generate unnecessary costs or delays in care.
3. Deciphering EOBs and bills. The health plan Explanation of Benefits (EOB) can generate concern among employees if they don’t understand what it means and how it relates to the actual invoices they will receive from care providers. A sample EOB can help explain to employees how this document works and how to reconcile their EOB with the bills they receive from providers. It’s important that employees understand never to pay for services until reconciling their bill against their EOB.
4. Securing prior authorizations and referrals. Employees with limited healthcare encounters likely won’t know if they need prior authorization or a referral for certain types of care, prescription drugs or durable medical equipment. However, failure to secure a prior authorization can impact their coverage, which makes this information essential. A healthcare navigation partner can ease this burden by facilitating prior authorizations on behalf of employees.
5. Test results and treatment options. Accessing and understanding test results and treatment options is scary and foreign to most people. Here again, open enrollment is an ideal time to educate employees about their patient portal and the information it can provide. This is also a good opportunity to inform employees about supportive services available to them through the health plan or healthcare navigation partner.
The risk to employers of over-communicating these details is low, because the employee knowledge gap is real. If steps aren’t taken to bridge that gap, it can lead to inefficient use of healthcare services, high healthcare costs, poor outcomes and low satisfaction. Open enrollment is the perfect time to begin this education process, and healthcare navigation can play a central role by supporting employees all year long – regardless of their position or health status. This ultimately improves benefits adoption and utilization while supporting talent retention and contributing to overall operations and financial performance of your community.
Christy Gigandet, SHRM-SCP, is benefits program manager for Quantum Health, a provider of healthcare navigation services.
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