By: MARIA PROULX
PRESIDENT OF ANTHEM BLUE CROSS AND BLUE SHIELD IN NEW HAMPSHIRE
Q: Healthcare costs continue to be a major concern for employers. Where should businesses start?
Maria Proulx: Start by understanding what is driving your healthcare spending. There is not one cause.
Hospital and physician prices, prescription drugs, chronic conditions, utilization and where employees get care can all have an impact.
Employers should work with their health insurer and broker to better understand their overall costs and identify opportunities specific to their workforce. The goal is not simply to spend less; it is to help employees get the right care, in the right setting, at the right time.
Q: How much difference can employees make through their own healthcare choices?
Proulx: More than many people realize. The price of the same healthcare service can vary significantly depending on where it is delivered, and a higher price does not necessarily mean higher quality.
An MRI, lab test or outpatient procedure performed at a hospital may cost considerably more than the same service at an appropriate independent imaging center, lab or ambulatory facility.
Employers can encourage employees to compare both quality and cost when shopping for care. Tools like our Anthem Sydney Health app are helpful with this. Giving employees the right information can help them lower their out-of-pocket costs while also reducing the employer’s overall healthcare spending.
Q: How can employers help employees become better healthcare shoppers?
Proulx: First, make sure employees know which tools are already included with their health benefits.
For example, Anthem members can use digital tools like the Sydney app to find in-network providers and better understand their benefits and healthcare options. Certain Anthem plans also include SmartShopper, which helps members compare eligible healthcare services and may provide financial rewards when they get care from high-quality, lower-cost providers.
Employers are also encouraged to keep communication top of mind. A healthcare-shopping tool has no value if employees do not know it exists. Employers should regularly remind employees about available resources — not just during open enrollment.
Q: How important is preventive care when it comes to managing costs?
Proulx: Prevention is one of the best investments we can make.
When conditions such as high blood pressure, diabetes or cancer are identified earlier, there is a better opportunity to manage them before they become more serious and expensive.
Employers should encourage employees to establish a relationship with a primary care provider and stay current on recommended screenings and vaccinations. Many preventive services are covered without member cost–sharing when employees use in-network providers, depending on their plan.
A healthier workforce can also mean fewer missed workdays and better productivity.
Q: Prescription drugs are another major cost concern. What should employers be watching?
Proulx: Prescription drugs — particularly specialty medications — are an increasingly significant driver of healthcare spending.
Employers should ask their health insurer how it is managing pharmacy costs, whether medical and pharmacy information is integrated, and what support is available to help employees best use their pharmacy benefits.
At the same time, employers should recognize the tremendous value many new medications provide. The challenge is preserving access to effective treatments while making sure we are getting the best possible value from every healthcare dollar.
Q: What about employees with chronic or complex health conditions?
Proulx: That is an area where better coordination can make a huge difference.
A relatively small number of people with complex health needs can account for a significant portion of an employer’s healthcare spending. Helping someone manage diabetes, heart disease or multiple conditions can improve that person’s quality of life while potentially avoiding emergency department visits and hospitalizations.
Employers should ask whether their health insurer proactively identifies people who may benefit from additional support and connects them with care management resources.
Q: Are virtual and digital healthcare primarily about convenience, or can they help with costs too?
Proulx: They can do both. Virtual care can give employees another appropriate option for accessing care without taking significant time away from work. Digital tools can also help people understand benefits, find providers and navigate a healthcare system that can otherwise feel overwhelming.
The objective should be a connected experience that combines virtual, digital and in-person care — not technology for technology’s sake.
Q: What’s the most important advice you would give a New Hampshire employer trying to manage healthcare costs?
Proulx: Do not treat healthcare as an expense you can only react to at renewal time.
Make affordability a year-round strategy. Understand what is driving your costs. Promote preventive care. Help employees manage chronic conditions. Encourage healthcare shopping and appropriate sites of care. Make sure employees understand the tools and resources already available to them.
And engage your employees in the conversation. Employers, health plans, providers and individuals all have a role in making healthcare more affordable.
We will not solve rising healthcare costs with one program or one decision. But many better decisions — made consistently across an entire workforce — can add up to meaningful change.
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