Payment Reimbursement and Managed Care

HHS considers bringing healthcare concierge services into federal programs

May 14, 2019 8:57 pm

April 11—A relatively new employer trend of making healthcare navigators available to insured employees has caught the attention of the Trump administration’s healthcare policy leader.

Alex Azar II, secretary of the U.S. Department of Health and Human Services (HHS), hailed the emergence of navigator systems that employers are increasingly using to help their employees navigate the health system. He also suggested his department could incorporate such approaches.

“We believe there may be a role for employers to connect patients with providers or some other trusted intermediaries, who can act as guides through the healthcare system,” Azar told attendees at a Washington, D.C., meeting of the National Business Group on Health (NBGH).

“This is an area HHS wants to explore, as well, so let us know where HHS can assist your efforts, and we’ll look to innovations in the private sector to improve our own programs,” Azar said.

Azar was identifying an increasing practice among employers. In the 2018 survey of the large employers who comprise NBGH:

  • 33% were using “virtual and digital care point solutions, navigation and concierge services” to help employees get the care they needed
  • 39% were considering adding such services in 2019

“There’s real growth in navigation in terms of trying to simplify things for employees,” said Brian Marcotte, president and CEO of NBGH.

Additionally, among the 56% of large employers that offer onsite (or near-site) health centers, nearly a quarter include onsite navigation or health-concierge services at those locations.

Although employers view such employee assistance programs as being some of the best among various “engagement platforms,” according to the survey, the available commercial options are perceived to have a lot of room for improvement.

“There’s significant interest in finding end-to-end platforms that can support their populations,” Marcotte said. “But the maturity of these platforms is not where employers want them to be.”

Employer experience with healthcare guides

Marty Webb, vice president of benefits for AT&T, said about 10% of his employees have used the mid-level navigator service the company provides at no cost to find physicians for various health problems.

Brendon Perkins, vice president for Nielsen, which has a full-service concierge feature, said the benefits stem from the education provided to employees on important offerings, like evaluations of provider quality, and why those matter to their care.

Such forms of active assistance are seen as more beneficial than benefit designs like narrow networks, which “just take away options,” Perkins said.

Additionally, Marcotte noted that many employers use such concierge services because they don’t have the option of narrow networks in locations with dominant health systems that require employer plans to accept their employed clinicians of all types.

Ami Parekh, chief medical officer with Grand Rounds, one such concierge services provider, said her company’s “care coordinators” actively push employees of clients to use higher-quality providers, and even make appointments for employees. The service’s quality ratings are based on purchased provider-level commercial plan data sets and Medicare data, weighed based on individual patient needs.

Although employers have had difficulty getting patients to use web-based quality- and price-assistance programs in the past, Perkins said 6,000 people, about a quarter of Nielsen’s workforce, used the concierge service in the first quarter after its Jan. 1 launch. Additionally, 10% of employees used the service in those three months to find better physicians.

So what’s the ROI?

Marcotte said the spread of concierge programs and other employer-based assistance programs followed previous efforts to control healthcare spending through the widespread adoption of high-deductible health plans (HDHPs).

Steering patients to the best provider was key to the effort of Grand Rounds to obtain savings for its employer-clients, Parekh said.

Perkins said Nielsen plans to boost the potential of its concierge program to control spending by adding components that focus on specific patient populations, such as those with diabetes, while also providing other information to ensure those individuals don’t feel targeted.

Parekh said Grand Rounds also responds to patient queries about elective treatments by first helping them determine whether the treatment meets recommended guidelines. Such efforts have led 40% of those seeking elective procedures to change their mind about the treatment they want.

Then, patients calling about provider options are told which ones are “fair price, high price, or low price.” Additionally, the service helps to inform patients about the actual costs.

Tom Kahl, senior vice president of sales for Grand Rounds, said the company’s clients typically obtain a 2-to-1 ROI within two years.

“This isn’t Yelp,” said AT&T’s Webb, who used such a concierge service to find care for a foot problem. “In terms of my foot problem, you don’t just get something back saying, ‘These are the top 10 foot people.’”

To provide the guidance, the service’s staff physicians examined Webb’s medical records to help direct him to treatment. That approach gave him insights he had trouble finding on his own.

“That’s the feedback we’re getting from our employees as well” when they use such services, Webb said.


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