October 31, 2023
Positive experiences with employer-sponsored benefits and optimal employee engagement in health and well-being are impacted significantly by the extent of coordination and/or integration between programs, services and health care system providers.
Research suggests that a disjointed health care, benefits, and well-being experience can lead to significant frustration from plan members/patients, potentially even leading to poor health outcomes.3 That’s because lack of coordination and/or integration within the health and well-being ecosystem can create:
- Difficulty in finding and accessing necessary or desired supports;
- Frustration with needing to repeat or duplicate efforts to access appropriate care;
- Unnecessary or inappropriate care;
- Lost time; and
- Increased costs.
Integration and Coordination in Action
There are many examples of coordination or integration making an impact on health, costs and engagement. Several studies for decades have suggested that even basic coordination of health care services across settings of care, specialties and employer benefit programs can improve the patient experience and health outcomes.1 Some health plans and PBMs merged in part to create greater integration between different benefits offered by employers, leading to improved outcomes and reduced costs, some report.2 Furthermore, many new virtual care providers selling directly to employers are able to embed other employer-sponsored benefits or services directly into their electronic medical records (EMRs), facilitating connections between medical services and those offered outside the traditional health care
In turn, such a negative experience can lessen employee health engagement and reduce productivity (and vice versa).4 Moreover, it may decrease employees’ perception of the value of health benefits and well-being initiatives.5
An entire industry of vendor solutions, including health care navigators, advocates and care coordinators, has been created to help employers strengthen the coordination and decrease the siloed experience that otherwise high-quality benefits, programs and providers can deliver. But although these solutions can provide value to employees and their family members, they may not always be sufficient in the creation of a seamless experience. The Business Group’s 2022 report, The Voices of Virtual Health: From Digitization to Transformation, documented feedback from focus groups composed of employers, consulting firms and vendors, who shared concerns about the lack of integration across employer-offered health programs and health care services.
This resource includes four key considerations that employers should weigh to increase coordination/integration among their various health and well-being offerings to improve the health care experience and outcomes. In doing so, employers can also positively influence employee engagement, a win for employees and employers alike.
Key Considerations for Boosting Coordination/Integration in Employee Benefits and the Health Care Experience
1 | Consider whether a “best-in-class” or a “bundled” approach to vendor contracting is best for your company, factoring in each strategy’s impact on the integration of benefits.
Health plans and pharmacy benefit managers (PBMs) are often the most familiar vendor that a plan member interacts with in their health care and well-being experience. In addition, there are also hundreds of vendors that address dozens of health conditions, individual patient segments and their needs.6 Among these vendors, some can optimize care for a specific condition or unmet needs of specific populations (e.g., the LGBTQ+ community). As a result, most large employers contract with multiple vendor companies as they seek to offer an attractive and comprehensive approach to health improvement and advancement of well-being. Some employers contract with 12 or more vendors they consider to be “best in class” for their area of focus.7
But as the number of vendors that an employer can contract with grows, so does the difficulty and/or confusion among employees in finding a desired or needed program. A large ecosystem of individual vendor programs also runs the risk of creating duplication of services and communication challenges. Furthermore, selecting and monitoring the effectiveness of vendors to address conditions individually can become time-consuming for HR teams, especially related to procurement and communications of many disparate services. As more vendors interact with a given person, it can become increasingly difficult to parse out which vendor influenced a particular outcome and which may have made less of a difference, complicating vendor procurement strategy.
Journey Mapping the Employee Experience to Assess Options
There is no right answer for how an employer approaches their benefits and contracting strategies to achieve the best possible results for their employees and family members.
Employers may want to go through a “journey mapping” exercise to better understand how employees of different backgrounds and health status interact with their benefits, including barriers to appropriate services and opportunities to improve their experience.8 This process may help employers assess whether a “bundled” or “all in” approach to vendor contracting might be right for them or better understand where there are gaps in their benefit offerings or provider networks that need to be filled.
Often utilized in user experience design and customer service industries, journey mapping involves imagining the experience of a customer or user of services that will result in the best outcome. For HR professionals, journey mapping focuses on how their employees and family members navigate their benefits, job responsibilities and health care.
Going “All-In” vs. “Best in Class”
Due to the challenges cited above, some employers have chosen to go all in with health plans and/or PBMs, dropping partnerships with point solutions in favor of utilizing a given health plan’s services that may address several of the same needs. This approach is intended to save on administrative burden, as employers can more easily “turn on” health plan and PBM offerings they are already contracting with, rather than going through vetting, procurement, and engagement efforts for each additional vendor. A significant downside of the all-in approach is that it can reduce an employer’s flexibility and specificity in their benefits strategy, but for some employers, the tradeoff of relative administrative ease and communications is worth it.
Partly in response to employer interests in easing administrative burden and improving coordination across sometimes disjointed services, companies that previously provided standalone services – considered point solutions – have merged with others to create a more comprehensive array of capabilities for employers. Examples include navigator programs buying virtual care providers and women’s health companies, with the goal of merging to create a broader set of services for women outside of family-forming. Such consolidation alone doesn’t necessarily lead to greater integration; true integration requires seamless sharing of data and streamlining the user experience.
Table 1 highlights some of the benefits and drawbacks of going best in class or all-in. In reality, however, most employers will land somewhere in between, buying as much as they can from one vendor where it makes the most sense, then adding standalone solutions for specific areas of need or opportunity.
Table 1: Pros and Cons of Best-in-Class vs. All-in Approach to Vendor Contracting
|Key Considerations||'Best-in-Class' Approach||'All-in' Approach|
Ease of contracting
Requires multiple RFPs, procurement processes, communication campaigns, etc.; potentially leads to “point solution fatigue.”
Much fewer vendor relationships, contracts, and points of contact to manage.
Vendors are each responsible for a smaller portion of the benefit offering, so replacing one with an alternative does not necessarily disrupt a significant population.
Changing vendors becomes potentially very disruptive given that most or all plan members will have a relationship with the former contractor.
Employers are able to pick and choose which vendors to work with across many areas of need, including those they determine to be “best” for their company.
Less flexible; employers rely on health plan partners’ decisions on how to address health conditions and experiences.
Each vendor will have their own capabilities for processing, sharing and acting upon data.
Data sharing across services provided by a health plan should be easier, though consolidation does not guarantee this.
Integration of health care and benefits experience
Selecting the best-in-class vendor partners across many conditions may optimize specific needs while creating confusion, duplication, or negative disruption if they are not coordinated.
Service providers housed within a health plan can make communications, data sharing and referrals easier, creating a more integrated experience.
Employers can contract with vendors they see as the best, most appropriate or innovative among their competitors, but new and targeted does not guarantee innovative approaches; vendors can be more readily replaced by newer innovative solutions.
Innovation can come from anywhere, including from major incumbent industry players who can take advantage of scale to expand their impact, but large companies may have constraints that stunt disruption where it may be necessary. For employers using this approach, it becomes difficult to adopt new innovations if the all-in provider doesn’t adapt and evolve their product.
Employers need to decide how they will manage their vendor relationships, which will impact their ability to provide a coordinated and/or integrated benefit offering. This can be done by contracting best-in-class vendors separately to address a range of health care and benefits needs of their plan members or going all in with a health plan to manage these vendor partnerships and services together. Ultimately, most employers take a hybrid approach that is somewhere in between the two options presented above: integrating some offerings where possible and carving out targeted services as they see fit for areas of opportunity or need.
Regardless of approach, employers should ask vendors capable of addressing multiple health conditions and health care challenges how they are coordinating or integrating those services to create a streamlined health care experience for patients.
2 | Push health and well-being vendors for more data sharing.
Many health and well-being vendors and providers don’t know which other vendors in an employer’s health and well-being ecosystem are interacting with the employees or patients they also touch. These vendors and providers don’t have access to utilization data associated with other vendors and often aren’t able to locate valuable information like clinical outcomes or costs associated with other health care services. This not only reduces the impact that a streamlined team supporting a patient might have, but also potentially creates confusing (or dangerous!) situations in which uncoordinated providers and programs may be telling patients to do two different things or are both prescribing medications that could be overused without alignment.
While these types of arrangements may require some additional upfront administrative setup and additional documentation or contracting to ensure that each party understands and can fulfill its independent and interdependent obligations, employer plans and their covered individuals can experience long-term benefits from such an investment. Coordinated programs help ensure that individuals receive appropriate care from their plans’ carefully designed offerings and can avoid costly duplication and confusion.
Data-Sharing Nirvana – Interoperability and Outcomes
Absent data interoperability, it can be exceedingly difficult in some cases to transmit information across and even within vendor ecosystems. Likewise, data that only accounts for utilization of programs or services without reference to outcomes is common but lacks the result that is most often valued by the patient/employee – their health! Employers should push their vendors to share health outcomes data where appropriate and join in efforts to advocate for data interoperability.
Employer Plans Own Their Data
In general, self-insured employer plan sponsors assert ownership over health care data generated by the plan and its covered individuals. Certain vendors have challenged the plan’s ownership and control of the data and have not always fully disclosed when sharing the plan’s data with their employer clients or other programs in their ecosystem.
In recent years, litigation and federal policymaking have supported and even required employer plans and their vendors to divulge and, in some cases, publish a wide array of data to the general public, or directly from vendor to employer. Among other developments, the Consolidated Appropriation Act, 2021 (CAA) and the Final Transparency in Coverage Rules (TiC) require employer plans to work with their vendors to ensure open access to unprecedented amounts of health-related data. In conjunction with their legal obligations, employer plan sponsors can use their purchasing power to push vendors to unlock the data that ERISA-governed employers are entitled to. This gives employers opportunities to uncover potential synergies between health and well-being providers that can streamline care for patients.
Hold Vendors Accountable for Data Sharing and Cross-Referrals
If a vendor is unwilling to share data with their employer clients or the other vendors that the employer contracts with, it is a potential red flag for employers looking to create a high-quality, coordinated benefit strategy for their plan members. In some cases, employers have difficulty getting access to data from vendors that is explicitly owned by the self-insured employer itself. Employers need to hold their vendors accountable for their willingness to share data with others in support of simplifying the benefit and health care experience for plan members, including by being willing to change vendors to those that do share data and referring plan members to other services where appropriate.
Using Data to Streamline Employees’ Well-being and Benefits Experience
Employers can also require vendors to cross-refer their employee users and patients to other benefit programs that are available to them. Vendor summits are a good example of how employers can bring together their vendors to better understand the services that each provides and to create multivendor requirements for how they coordinate in support of their employees. While it may be difficult for an average provider to have the benefits available to their patients at their fingertips while making referrals and care plans, there are virtual care programs and on-site/near-site clinics that focus specifically on employers that have built these connections into their EMRs. This makes it easier to share patient information and connect patients to services they might not have been able to find or know they could benefit from.
Data-sharing agreements and governance should be included in your contracting processes. Vendors unwilling to share data with others – especially with their employer clients – may be less attractive to many employers.
3 | Encourage vendors to treat employees and patients as whole people, coordinating and/or integrating with other health industry partners where necessary to support people’s many needs.
Many employer health care programs, vendors and communications focus on specific portions of the workforce based on their demographics, diagnoses or other factors. This approach often makes sense – focusing resources and expertise on key areas of need for the workforce and business increases the likelihood of delivering value to those who need it the most. One consequence of a multi-pronged benefits and well-being approach, however, is that uncoordinated or fragmented strategies can treat people like a collection of diagnoses rather than whole human beings whose life experience, backgrounds and health all impact each other.
Treating People as Whole Human Beings
Employer programs, vendors and provider partners should incorporate upfront and periodic screening for issues that are often related to their direct focus, even if it is not something that they can address on their own. For example, vendors that treat a “physical” ailment like diabetes can help patients by screening them for issues related to mental health or social determinants of health (SDOH), like access to healthy foods or safe places to exercise. Such screenings should become routine, even if that vendor doesn’t directly provide mental health treatment or community supports; other employer programs and vendor partners may have resources and expertise to address those needs in ways that can help improve outcomes related to diabetes and other aspects of their lives.
Patient Example – Unexpected Mental Health and SDOH Challenges
Imagine a 50-year-old employee who enjoys playing pickleball in their spare time breaks their ankle. The physical surgery to repair their bone may be straightforward and not apparently related to mental health. But the surgical recovery is going to be lengthy and frustrating and will prevent them from doing things that bring them joy or stave off symptoms of anxiety, such as an afternoon with friends on the pickleball court. If that employee lives in an apartment with stairs, they may not be able to go home without risking further injury. Inability to move to see other people may cause feelings of loneliness, exacerbating any depression they may already be at risk for. Or they may have difficulty accessing healthy food without being able to go to the grocery store. The list goes on. This “physical” injury has the potential to significantly impact mental health, and recovery is seriously affected by food security, social connectedness, and housing. Vendor programs, services and providers of all sorts should incorporate screening and referrals (or direct services) to address mental health and social needs.
Identifying needs is the first step; providers and vendor programs need to then connect their patients to other services that can address those needs. An employer may offer a diabetes program and a separate weight management vendor, but both will lose effectiveness if there are not cross-referrals to make sure those who could benefit from these services the most are engaged in both alongside each other. Ideally, these vendors will also share data and coordinate care so that patients are supported efficiently and effectively.
Employers have several ways to facilitate connections and encourage coordination between disparate programs or services:
- Require vendors to screen for patient needs related to the condition that they address directly; these include mental health, social needs and challenges that are often comorbid (e.g., weight management and diabetes programs).
- Ask how industry partners will tailor support to employees with related needs, which may require referrals to other programs offered by employers and their partners. Employers can use referrals to other relevant services as a key performance indicator for their vendors where there are clear opportunities.
- Contract with primary care providers that have integrated mental health care support, whether through physical co-location (e.g., in the same office location) or a virtual connection.
- Push vendors that address topics not regularly related to mental health to screen for and refer those who have a need to mental health programs or provide services directly.
- Consider partnerships or referrals to groups that support people’s social needs in their communities. Many vendors are adding the ability to refer patients directly to community partners within their provider or benefits search functions.
- Look for health industry partners that integrate multiple approaches or can directly address multiple related conditions themselves. Partly in response to employer concerns about “point solution fatigue,” some vendors have merged or developed internal capabilities to expand the services they offer, increasing their ability to support their patients more holistically.
People do not separate aspects of their lives like their health, work, family and homes, but a fragmented benefit and health care experience can treat them as a collection of distinct challenges or opportunities. In particular, the health care experience is often divorced from the elements of people’s lives outside the medical setting that impact their health outcomes. Employers can positively impact the integration of people’s benefit experience by ensuring that their health industry partners screen for and address concerns like social needs and mental health issues.
4 | Assess navigator services offered through health plans, engagement platforms and other third-party vendors to help employees access appropriate services.
In the absence of a perfectly integrated and/or coordinated experience in health care and benefits, many vendors offer the services of navigators, advocates or coordinators to support individuals as they try to access appropriate benefits and health care services. See the text box for definitions of these different terms.
There is good evidence that these types of services can increase access to appropriate care and benefits, adherence to preventive services, quality of care and health outcomes, especially for vulnerable populations and those with chronic illness.9,10 This is part of why 34% of employers have an engagement platform in place in 2024 and another 27% are considering them for 2025/2026. Engagement platforms can personalize messages and outreach to employees about benefits, navigate employees to appropriate solutions based on their needs and aggregate data across vendors to support further coordination of services for each individual.11
Making Sense of Navigators, Coordinators, Advocates, Concierge and Engagement Platforms
There isn’t a perfect definition or distinction between each of these types of services, and in some cases, they are used interchangeably. “Pure” navigation services tend to refer to helping people identify the health benefits and programs that are most useful for them, whereas care coordinators tend to be more focused on helping people once they’ve encountered the health care system. Some vendors may require people in these roles to have a level of clinical certification, whereas others may for cost or other reasons decide that training for non-clinicians is enough to provide them with the expertise they need to work with their clients.
Engagement or concierge programs often offer some combination of navigation of benefits and the health care system, whereas most health plans, PBMs and point solutions have care coordinator staff whose role it is to support people as they manage multiple health care providers and access appropriate services.
Employers should make sure that they are clear about the roles of individuals identified as navigators, advocates, care coordinators or by other titles.
Nonetheless, according to the Business Group 2024 Employer Health Care Strategy Survey, employers have mixed feelings about the ability of engagement platforms to execute different tasks related to employee navigation to appropriate benefits and health care providers (Figure 2).
The prevalence of employers using employee advocacy tools, medical decision support and high-touch concierge services is somewhat higher than their use of engagement platforms. These tools can support a coordinated employee benefits and health care experience in various ways (Figure 3).
Considerations for Partnering with a Benefits and Well-being Navigator
Navigator services are not a silver bullet for improving coordination of benefits, well-being and health care strategies, but they can be a powerful tool for helping plan members find the right services and programs for them.
There are several steps employers can take to maximize the benefits of navigators, advocates, care coordinators and the vendors that employ them. These include the following:
- Embed navigation services in on-site and near-site clinics to maximize the benefits of employees accessing care in these locations.
- Assess all the points at which an employee might encounter navigators, advocates and care coordinators from different vendors and health care providers. When assessing vendors that provide these types of services, consider where there may be opportunities to streamline these types of supports so employees/patients aren’t overwhelmed with guidance from multiple people who may not even suggest the same actions.
Health Plan vs. Third-Party Navigation
Employers don’t necessarily need to contract with another vendor to provide navigation services; many health plans have navigation capabilities. All the same considerations listed in this section hold for health plan offerings as well. Using a health plan’s navigator programs can save an employer from needing to contract and pay for another vendor. On the other hand, health plans have their own vendor partnerships and ecosystem that they may naturally favor, implicitly or explicitly, and in cases where an employer has multiple health plans, the benefit of reducing the number of vendor programs to manage is blunted.
- Consider which level of clinical experience you want these types of supporters to have. Some vendors employ non-clinicians to do navigation services, whereas others may require certifications in general or specified clinical areas depending on the services being provided. When a navigator, advocate or care coordinator has clinical experience, they may be able to navigate the system more effectively or provide clinical services directly, but these clinical requirements tend to make services more expensive.
- Ask vendors about their ability to connect employees and patients to social services outside of their health benefits or the health care system. Providing this service is difficult given that many social services are geographic-specific and numerous, but vendors are increasingly adding this capability.
- Assess the capability of navigation vendors to support employees from a range of racial, ethnic, socioeconomic and other backgrounds.
Employees regularly encounter a complex system of employee benefits and a fragmented health care system that threatens to negatively impact their experience and health engagement. This, in turn, can lead to negative outcomes and lack of engagement. As outlined here, creating additional coordination/integration across benefits and the health care system is a key strategy to increase satisfaction with employee benefits, create connections to new partners who could benefit employees and their families and improve the overall health of the workforce.
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