Catalyst for Payment Reform

Employers, does your high-value program need CPR?

Employers, does your high-value program need CPR?

Take a moment now to think of all your monthly memberships and subscriptions – we’re willing to bet there’s at least one that you’re likely not using to its full potential. Maybe it’s a gym membership or a vegetable box subscription (yes, we had to share health-related examples!). And because you don’t know 100 different ways to cook turnips, as a consumer, you’re paying full price for something of which you’re not getting the full value of the benefit.

Frequently, employers and other health care purchasers deal with a similar dilemma. The purchaser evaluates their data and identifies the need for an innovative, high-value program– for example, a near-site clinic or navigation solution. Just like there are a million subscription services available to every day consumers, there is no shortage of health plans, third-party administrators, and niche vendors marketing their high-value programs to employers and other health care purchasers. Think of all the successful business-to-business matches between employers and vendors that are working to improve patient’s wellbeing across the nation. 

But wait, there’s a twist…

High-value programs aren’t valuable if members aren’t using them

If the program launch isn’t planned out appropriately, the purchaser may not get the expected utilization of the new program or resource. Or, the benefits team may pull off a successful launch, but then finds that utilization of the benefit quickly drops off after a few months or a year. 

There are multiple strategies to achieve high member engagement in a program and no one-size-fits-all approach. These strategies may take the form of:

  • Incentives, including rewards for program registration, participation, and completion, as well as value-based insurance design.
  • Disincentives or gatekeeping, such as requiring use of the program (e.g., a Center of Excellence) or reducing coverage if a benefit (e.g., expert medical opinion) isn’t used prior to a service, (e.g., surgery).
  • Communications, including having a comprehensive launch and ongoing strategy to ensure members remain aware of and engaged in the program.

Over the past few years, CPR has featured purchasers’ stories on high-value program successes and challenges, including:

  • CHG Healthcare experiencing 6 years of increased utilization of its telehealth benefit. 
  • Google establishing an ambitious goal of reducing health care costs by 8% by redirecting 50% of outpatient visits from low-value to high-value settings.
  • Walmart’s expert medical opinion vendor determining spinal surgery was not necessary for 50% of referrals.
  • And many others.

Now, CPR is taking the next step in supporting purchasers’ strategies by launching a collaborative aiming to increase utilization of these and other high-value programs. If you’re an employer-purchaser looking to get more out of a benefit, this collaborative may be for you. Similarly, if you’re a vendor that has an employer challenged with member engagement, your client may benefit from participation.

After all, whether it’s a television subscription or a telemedicine benefit, no one wants it to go unused.

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