A manager’s guide to cutting costs without sacrificing quality care

Ilustration by Israel Vargas
Ilustration by Israel Vargas
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Covid-19 has highlighted the gaps in our fragmented, complicated healthcare system. For companies, it’s time to adopt a comprehensive approach, one that caters to employees’ mental, physical, and financial needs through personalized, data-driven services and treatments. 

Above all, we want our loved ones and peers to stay healthy. But affordable, quality care, via a comprehensive workplace benefits package, can also help your business drive down costs without losing superior clinical care. Studies show that happy, healthy employees are more productive and more likely to stay, two crucial metrics for any modern company focused on growth and retention.

This guide breaks down how to build a comprehensive benefits package that’s cost effective, driven by data, and tailored to your employees’ unique needs.

Provide care on the member level, not the plan level

Creating an effective health benefits package is a balancing act. Historically, companies have leaned on a one-size-fits-most approach that has left many employees without support for their unique health concerns. As technology and data science continue to grow in the healthcare space, new options for personalizing individual benefits are coming to market. These tools also help identify and address group health concerns, in an approach known as population health. While this allows business leaders to predict risks and optimize resource allocation, members should be seen and treated as more than just a data point. The human elements of care must remain intact, even while incorporating new technology. 

To prioritize both, you need a single platform to view holistic member and population health information. Having all of this data in one place makes it easier to connect members with the specific medications and treatments they may need, via services like specialized pharmacies. For example, the Oncology Therapeutic Resource Center from Accredo, an Evernorth company, has a dashboard that helps that team offer cancer patients a wide variety of support, including intervention outreach to address gaps in care, a dedicated financial resource assistance team, and access to specialized pharmacists and nurses trained to meet their particular needs. The result? Increased treatment adherence, extended, in-depth consultations, and connection to an average of $13,000 per member in financial assistance. Having holistic member and population health information, as well as better connected care, prepares you for whatever members require and reduces complexities and financial waste for your company down the line.  

Read more: How big data, analytics drives population health, closes care gaps

Keep your key players connected

Healthcare plans are made up of several moving parts: members, providers, and pharmacies. The back and forth between these parties can cause critical information to get lost in translation. As many companies move to optimize care and minimize costs, those striving for better solutions have embraced an integrated approach and are raising the bar for expansive and strategic care.

Comprehensive view programs, like RationalMed® from Express Scripts, an Evernorth company, can integrate medical claims, prescription drug claims, and laboratory test results to create a patient-specific integrated profile. This profile contains comprehensive data used to analyze and detect treatment-related safety and health risks. For employers, this decreases pharmacy and medical costs by identifying potential safety issues or gaps in care for their members, improving health outcomes, decreasing emergency room visits, and decreasing inpatient hospitalizations. For members, this collaborative workflow ensures that members receive the most thoughtful care, without them or their employer breaking the bank, and that providers have visibility to the full patient journey.

Read more: Solving the unique challenges of hospitals and health systems

Pay for outcomes, not products

Every single member is different, and so are their healthcare needs and communication preferences; therapies that work for one may not be right for others, and one member might prefer text messages over phone calls. Members with complex conditions in particular, like diabetes, often are treated with the same therapies, no matter their comorbidities or preferred ways to stay connected. One option to avoid paying for ineffective products and cut costs for future medication or treatment is to move to an outcomes-based price model. This requires negotiation with healthcare vendors to align costs with efficacy. 

Through strategies like Health Connect 360SM from Express Scripts, an Evernorth company, clinical outcomes are guaranteed for members with diabetes and a host of other chronic conditions. For instance, employers can set clinical goals within their plans, like helping members with diabetes who do not follow medication and treatment regimens properly become adherent, or helping members with diabetes who have high HbA1c values improve. Through personalization at the member level and coordination among those caring for members, Express Scripts can achieve the promised outcomes. If not, they pay a refund to the client at the end of the year.

Read more: A prescription for America’s drug-pricing problem?

Predict the risks and intervene when necessary

Speaking of climbing costs, among today’s biggest healthcare concerns is the price tag on medications, whether it’s a one-off drug for an acute condition or chronic medication. For companies, there are the added risks of non-adherence to prescription regimen or dependency. It is crucial that members get the right medication, in the right dose, at the right time, with the right information, to help curtail inappropriate drug authorization, keep members safe from the dangers of drug reliance, and cut down on financial waste. 

Predictive analytics can help with this. The technology identifies members who are likely to disregard their treatment and helps companies, through their insurance provider, intervene when necessary to keep them on track. Programs like SafeGuardRx from Express Scripts, an Evernorth company, also incorporate a suite of solutions to protect members and keep medications affordable. The emphasis on cost-effectiveness and clinical integrity encourages affordability and adherence and reduces the chance of hospital readmission.

Read more: Covid-19 is undoing a decade of progress on the opioid epidemic

Meet your members where they are (online)

Life will probably never go back to the way it was before the pandemic. One positive outcome, however, could be the rise and resilience of digital health solutions. With more than 300,000 digital health apps already on the market worldwide, and another 200 health apps added to the top stores each day, it’s time to set up your digital solutions for the long haul.

That said, just because these apps and other platforms are available, it doesn’t mean they’re all worthy of your time, money, or trust. It’s important to vet digital health solutions to ensure that they are providing not only convenience and accessibility, but also top-quality services and data protection. Evernorth Digital Health Formulary helps plan sponsors wade through the complex waters of personal health technologies and interventions, evaluating services based on specific criteria. The tools your company uses should meet rigorous clinical standards, align with your business’ long-term vision, protect member privacy, and keep them engaged. It can be daunting to take on these responsibilities, but with the right support and resources, your company can handle it—and your employees will be better off in the long run.  

Read more: Why AI is the next way patients will choose their doctors


To learn how to make healthcare more affordable, predictable, and simple for your company and employees, visit the Evernorth website.