Cost sharing is an important tool when it comes to offsetting the rising costs of healthcare. Along with the increasing cost of groceries, gas and other services, employees are feeling the pain of rising healthcare costs.
Why are healthcare costs rising? Like other industries around the world, inflation affects medical operations, supplies, administration, and facilities costs. Medical advancements such as new technology, while an important resource, also are a major player in increasing healthcare costs. Other factors such as overuse of care, overprescribing and poor health habits also impact cost in the long run. Regardless of the reason for the increase, employees are feeling the stress and financial burden of increasing premiums as well as increasing cost at the point of service. As a result, employers are searching for options to help their employees with these additional costs.
Cost sharing is a way forward and the good news is employers have many options that allow cost sharing opportunities for their employees. Cost sharing opportunities, when taken advantage of, help offset the increasing costs by saving employees money in various areas. For example, when employers opt to add in $0 or low-cost access points to a curated list of vendors, their employees experience savings on services that would otherwise cost an out-of-pocket copay or fee if simply filed with their employer sponsored health plan.
Zero Cost Telehealth
Vendors like freshbenies offer services such as $0 telehealth including primary care, urgent care, and behavioral health. This program comes at an extremely low monthly premium (often covered by employers). Rather than paying copays through their health plan or high self-pay costs for primary care, urgent care or behavioral health, employees can utilize these services with no out of pocket costs at the point of service. freshbenies also offers 10 - 85% savings on generic and brand medications, 20 - 40% savings on dental and vision services, as well as advocacy programs which contribute to cost savings through review of medical bills. The advocacy program helps ensure benefits were applied correctly and prevent the employee from overpaying.
Employees should also pay close attention to carrier and plan specific $0 telehealth options. Certain carriers embed free telehealth into some of their plans. When telehealth is an option, employees are able to save the copay specified in their plan design by utilizing the telehealth benefit instead.
Direct Primary Care
Direct Primary Care (DPC) programs offer savings when offered as an employee benefit. A DPC program is a healthcare model where patients (or the employer) pay a monthly membership fee directly to their primary care clinician. For employees, this means straightforward costs and no surprise medical bills. Direct Primary Care can reduce overall healthcare costs for patients. These programs can be offered as a stand-alone option or in addition to an employer sponsored health plan.
One of the benefits of a DPC is patients have a regular physician they see each visit and options for virtual and in person care. Telehealth programs typically assign patients to random physicians each time they call in and do not include any in office options, providing less continuity of care than a DPC.
Prescription Savings Programs
Prescription savings programs are another major cost sharing opportunity.
Vendors like Haloscrips offer $0 chronic medications to employees limiting the number of prescriptions processed through their traditional health plan. This can be a significant savings for self-funded employers.
GoodRx and Clever Rx offer patients up to 90% off medication costs and can assist them in finding the lowest option.
Reward Smart Decisions
Other vendors reward employees who make smart decisions in their healthcare.
For example, Kis Imaging offers $0 imaging services such as MRI, PET, and CT when the employee visits a provider in the KisX network. The savings are substantial giving the cost of an MRI can be anywhere between $400 and $1200 depending on the length of time and part of the body involved.
Medmo is another company that offers a range of imaging services and provides the option to use insurance or save up to 80% with special self-pay rates. Their company focuses on reducing imaging challenges such as long wait times, extensive travel, and high costs.
Employee Assistance Programs
Employee assistance programs (EAP) can assist employees with discounted and no cost services such as counseling, legal assistance, elder care assistance, financial wellness tools, will planning/preparation, and mental health services. Often these programs will offer a limited number of mental health visits or legal consults as well as discounts on various services.
Guardian’s employee assistance program offers 30 days of access to a personal money coach who helps identify financial goals, assess current financial situation, and suggests an action plan. They also offer three counseling visits per year, one legal consult per year for each separate legal issue, and discounts if the lawyer is retained.
Incentive Programs
Carrier specific reward programs or incentive programs offer employees specific dollar amounts for completing one-time tasks like an annual physical. These programs are geared toward encouraging subscribers to take a proactive role in their health journey.
United Healthcare members have the opportunity to earn $1,000 by completing tasks like a health survey, walking 5,000 steps a week, tracking sleep for 14 days, getting an annual checkup, and going paperless.
Employers and employees both play an important role in cost sharing. Employers have the opportunity to offer thoughtful benefits programs in order to provide those opportunities and employees must understand what’s offered to them and take advantage of those options. The increasing healthcare costs can feel overwhelming, but cost sharing can ease that burden. Cost sharing is the best way to maximize any potential savings and offset increases in other areas.
