Health Information & Vulnerable Populations: Employers

To gain a better understanding of how various healthcare stakeholders see their role in developing and providing health information to vulnerable populations, Oliver Wyman, with support from the Robert Wood Johnson Foundation, recently conducted a multi-disciplinary study of the health information landscape. Over the course of the spring and summer of 2016, Oliver Wyman conducted interviews with nearly 100 marketplace leaders. The preliminary findings from that research were previously published. (Read the report.) Here, we provide further details from our interviews with employer leaders, and we highlight efforts that companies are making to provide more effective health information for vulnerable individuals within their employee populations:

Employers’ organizational priorities

Employers’ top organizational priorities revolved around becoming more competitive in the marketplace. No employer cited health information provision as a priority in and of itself, but rather as an important part of broader goals. To that end, the employers we spoke to recognized that health information can play a role in lowering medical expenditures, maintaining a healthier workforce, and retaining higher-caliber talent. When asked about the reasons for providing health information, one executive stated: “It's helping the employees save money and stay healthy.” Another executive aimed to leverage health information to create more attractive health benefit packages, explaining: “It goes back to being an employer that is competitive, as far as being able to offer competitive wages and benefits.”

Employers recognized that vulnerable consumers exist within their employee population (as part-time, low-income, uninsured, or non-English speaking workers). However, most employers we spoke with have not customized health information for these employees, and provision of health information for vulnerable individuals, specifically, was not cited as a priority.

Current landscape: Employers’ health information offerings

Employers were focused on providing health information that could help employees access care and manage health and wellness. They saw information related to benefits as the responsibility of health plans. Many companies provided some level of price transparency tools and healthy living guides, but most delivered this information via traditional channels; only a few have experimented with more innovative efforts, such as workplace discussions or hosting social workers who provide assistance with a broad range of employee needs.

Most employers took a broad approach to providing health information and did not customize offerings for specific employee segments. At the same time, the offerings were only available to employees enrolled in employer-sponsored health plans, meaning that some vulnerable employees – those who did not qualify for benefits and were uninsured – were unable to access the information. The exception was one employer that has taken a population health approach and is making its offerings available to all employees, regardless of enrollment status. This employer has also worked to segment its population base to provide more tailored materials.

Key obstacles: Employers ID main challenges to providing health information

Lack of engagement/unreceptive to information. Many employers voiced frustration with their inability to engage employees. Said one executive, “It's hard to engage people, so a lot of the disease management programs or other types of outreach that we do, it's hard to touch people.”

One reason engagement is low, employers said, is that people tend to ignore employer-provided health messages. “I’ll be honest, I respond more directly to the emails that come from the plan or my family's physician than I do for emails that come from our enrollment platform or the company,” admitted one executive.

Right message, wrong delivery. Another challenge is literally making contact with employees. “We have notoriously bad addresses, so we get mail returned,” said one leader. Another mentioned that many of her company’s employees don’t have work email addresses or a personal computer, and rely largely on their cell phone to communicate. In addition, some employees prefer print materials, telephonic guidance, or face-to-face interactions, and so ignore digital information. Finding solution packages that do not live solely in the digital world will be critical.

Information overload. The sheer volume of information being presented to employees presents another challenge. “I don’t think it’s a lack of information; I think it’s a lack of somebody helping them digest everything that’s coming at them,” said one employer. “We mail a lot of things to people. We aren’t sure how much of that is actually being seen, that people are taking action on it.”

Many/mixed messages. Information overload is further exacerbated by the high number of stakeholders – including plans, providers, health information companies, and unions – that all feel some responsibility for providing health information. The many players in the mix sometimes results in an uncertain division of responsibility. (Who should primarily communicate benefits information, the plan or the employer? Who should primarily communicate wellness information, providers or the employer?). Information coming from multiple stakeholders can also result in consumer confusion and uncertainty about which stakeholder is the go-to, trusted source for different types of information.

Ways to accelerate progress

Despite the many challenges employers face in delivering effective health information, some are having success with new kinds of programs and offerings. While these efforts do not target vulnerable populations, specifically, they still provide valuable lessons for stakeholders looking to 1) provide more effective health information to all employees and 2) engage vulnerable individuals within an employee population.

Below are three examples of successful health information initiatives. They can serve as a guide for employers seeking to accelerate progress:

1. Create targeted offerings for sub-populations. Recognizing that different segments of its employee population have different health interests and priorities, one employer is working to provide more targeted and tailored health information offerings. For its male employees between the ages of 18 and 25, for example, the company has shifted away from providing information on health savings accounts to focusing on primary care. “Our male team members 18 to 25 happen to be a very high-risk group; they are a little more daring than their counterparts,” said an executive at the company. “We're looking at not [giving] them every detail on the difference between an HRA and an HSA because they don't care. What they need is to know who [their] primary care provider is, why [they] might want to know who that is, and what it’s going to mean if [they] utilize the emergency room as [their] primary care physician.”
2. Develop effective delivery methods. A number of employers noted that health information is meaningless if it does not reach the target audience, and finding the right delivery method is as important as the health information itself. For example, while most new health information solutions live in the digital world, a few employers utilize print materials because they have learned that is what their employees prefer. Said one company executive: “Everybody went to digital because it's cheaper. [But] there are people who still like print.” Another employer is exploring the use of videos. “They might not respond well to the written postcard, but if there’s a website or a QR code they can scan or go to and see a video, maybe we try that approach as well. We’re trying to get creative in our approaches to communicating.”
3. Address non-clinical health needs. Employers are aware of the influence social and lifestyle factors have on an individual’s health, and one employer has placed a special emphasis on addressing these needs. For example, recognizing that their employees often have difficulties with transportation, the company offers commuter benefits to those who need to travel long distances for work. It also provides significant discounts on healthy food options. “Our team members have pretty good access to healthy foods, but don't feel they can afford it,” said a company executive. “As a team member, you get an additional 20 percent off all fresh and frozen fruits and vegetables that we sell.” In addition, the company hosts social workers at some of its workplace sites, offering further support to employees with lifestyle and social needs.

Effective health information strategies

To date, the majority of employers’ health information efforts have been directed at employees who are enrolled in company-sponsored plans. Only a select number of employers have adopted a population health approach that provides offerings to all employees, even those not enrolled in employer-sponsored plans. As employers move ahead with health and wellness initiatives, the broader, population health approach could be an effective tool to drive employee engagement. This is particularly true for those segments of the employer population that contain more vulnerable individuals (part-time, low-income, and uninsured workers) in their workforce. For all employers, effective health information strategies could lead to healthier employees, reduced medical costs, and a more satisfied workforce.