Make the most of your health benefits: 6 questions employers should ask their healthcare insurer

Help employees protect their health and feel supported by their healthcare provider

Maria Proulx, president of Anthem Blue Cross and Blue Shield in New Hampshire, oversees Anthem’s business serving individuals and groups, and drives improvements in healthcare access, quality, outcomes and affordability. Learn more at

Employee productivity and performance are directly tied to the health of your workforce. When your employees feel supported and confident in their healthcare coverage, they are more likely to take the necessary steps to protect their health, and thus more likely to produce better quality work.

We invited Maria Proulx, president of Anthem Blue Cross and Blue Shield in New Hampshire, to explain which questions employers should ask of their health plans to maximize their health benefits and improve health, satisfaction and productivity among employees.

Q. How are you controlling our healthcare dollars?

Eighty-two percent of employers surveyed by the National Alliance of Healthcare Purchaser Coalitions said high healthcare costs are affecting their ability to be competitive. Your health plan is an integral partner in managing your healthcare costs. There are four main ways health plans do this:

Network/benefit design can optimize employer costs through value-based care arrangements, network discounts, high-performance and curated networks, centers of excellence, and benefits tailored to your employee population’s health.

Clinical programs may lower overall employer costs through population health management, care management of at-risk members, medical and pharmacy integration, and integrated physical and behavioral health care.

Total cost of care is often affected by wasteful billing practices or inaccurate claims. Advanced data and analytics, pre- and post-payment reviews, and fraud prevention can help mitigate costs.

Members’ engagement with their benefits can be improved through personalized resources,

digital tools, health advocacy and navigation support, as well as health and wellness programs. (More about this later.)

At Anthem, we are especially focusing our efforts on 1) reinvesting in primary care, which is a critical component of improving health outcomes and reducing hospital admissions and emergency room visits; 2) expanding value-based care arrangements, which base payments to providers on quality and outcomes instead of volume; and 3) encouraging greater adoption of digital tools that not only expand access to care, but provide individuals with a more simplified and personalized healthcare experience. Combined, these factors have a significant effect on lowering costs and encouraging members to take a more active role in their health.

Q. How can we support our employees’ behavioral health?

Many health plans now offer both in-person and virtual behavioral health care options, and encourage members to choose in-network providers for the lowest out-of-pocket costs. Here is where having access to a comprehensive network with a variety of care options is crucial because treatment that works well for one employee may not work as well for another. At Anthem, we have been working to expand provider capacity in the system and bring new types of providers into the state, including residential, outpatient, at-home and virtual behavioral health providers. We were the first to work with Aware Recovery Care, a 52-week, in-home substance use disorder treatment program, and the first carrier to contract with Aspire365 for its new in-home mental health treatment program for

teens and adults. We continue to add new providers to our network every month.

Q. How are you controlling pharmacy costs?

Your pharmacy benefit manager adds value by improving health outcomes using evidence-based clinical programs, designing effective pharmacy networks, and reducing prescription drug spending and costs. Automatic refills and medication adherence programs such as medication reviews and proactive outreach can help employees be healthier.

Bundling medical and pharmacy benefits and integrating that data can help close gaps in medication therapy, better manage care and produce cost savings.

Specialty drugs are a significant cost driver. At Anthem, we have taken steps to keep these costs as low as possible by negotiating more affordable charges for specialty drugs with all New Hampshire hospitals and, when appropriate, encouraging members to use lower-cost, independent outpatient infusion therapy providers like Local Infusion and Novella Infusion.

Q. Do you offer a mobile app? What digital tools are available?

Ask your health plan which tools it offers and what the capabilities are to help your employees proactively manage their health. Anthem’s mobile app, Sydney Health, includes all of a member’s benefits, health records and care options in one place. Members can, for example, connect with a mental health care professional, access a symptom triage tool, or track their nutrition intake all via one application.

What types of virtual care options does your health plan offer? Tools such as remote patient monitoring and telehealth services can help manage chronic conditions, identify gaps in care and deliver care in a more convenient, accessible setting. When employees find an easy way to engage with a particular modality, they will become more comfortable using it to access care and take greater control of their health.

Q. Wh at is the member experience like?

When your employee contacts your health plan, you want to be assured their questions or concerns will be addressed quickly and satisfactorily. What options exist for employees to contact customer service (e.g., virtual chat assistants, phone) and look up information about their benefits? For example, Anthem’s Sydney Health app enables members to find answers to many of their questions without having to pick up the phone, such as finding a provider, seeing claims or looking up benefit information.

Some additional questions to ask: Are issues resolved on the first call? What are your member satisfaction scores? How quickly do representatives answer calls (also known as the average speed of answer)?

Q. How do we get our employees to take an interest in their healthcare?

Simplifying the experience for employees and offering member engagement programs are key to making them more willing to access care. Wellness programs and digital tools are important pieces (see above), but here is where plan design and member education come into play.

For example, at Anthem we offer innovative plan designs where member cost shares reflect the value of the service (i.e., lower-cost shares when rendered at high-quality, lower-cost facilities). Our SmartShopper program offers financial incentives to members when they voluntarily choose high-quality, lower-cost providers. These programs provide our members with a way to know about their healthcare options and gives them a reason to care. Together, our site of service and SmartShopper programs drive considerable cost savings for our customers, and results in a more engaged member population.

Keeping your employees engaged in their overall health means a happier, stronger, and more productive workforce. Your health plan is your partner in promoting better health while helping to manage your healthcare dollars and keep care affordable.

Our team at Anthem is here and present in the state and available to meet and talk with you about how we can support you and your employees through our programs and more.

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