The Case for a Personalized Employee Benefits Experience

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All about consumer experience

The consumer experience has changed dramatically in recent years. Thanks to online banking, waiting in line for a teller or physically depositing a check is a thing of the past. Ride share services are now the norm; the car finds you, rather than the other way around. And, depending on how hungry you are, you can track your pizza from the time they put it in the oven to the moment the delivery driver turns down your street.

And while this is all true, the emergence of a hyper-personalized experience has made the biggest impact on today’s consumer. Online retailers recommend products based on your last purchases. An app on your phone even knows when you—or your teenager—are speeding, helping to lower insurance rates.

Little debate exists as to whether this is the approach of the future for marketers.

Salesforce’s 2020 Evergage report found that 99% of marketers say that personalization helps advance customer relationships.

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Consumers now demand personalization
  • 83% of consumers are willing to share their data to create a more personalized experience.
  • 72% say they only engage with personalized messaging
  • 42% say they’re downright annoyed when marketing content isn’t personalized.
HR is late to the party

Only 37% of employees strongly believe their employer’s benefits communication is customized to address their personal situation. This percentage tells us many employees feel disenfranchised with the way their employer engages with them about their benefits.

Failure to provide employees with a positive experience, including the one you deliver when it comes to their benefits, is an opportunity lost. 95% of employees reporting a positive experience with their company say they take part in activities that are beneficial to their organization but aren’t necessarily part of their job. That extra effort makes all the difference in business results.

When employees have a positive experience, it results in increased engagement. Positive experiences can decrease employee turnover by 50% and increase customer satisfaction by as much as 81%.

Benefits programs present employers with a unique opportunity

Consumer experiences and employee experiences share a lot in common, especially when you look at what’s happening psychologically. Empathy is key to a positive experience for consumers and employees. A truly empathetic HR pro asks themselves questions like:

  • What does this employee find valuable?
  • How does this employee prefer to receive information?
  • When will this employee need help taking action?

These are the beginnings of a more empathetic—and a more personalized—approach to your benefits programs and strategy.

From benefits selection to benefits activation

Your organization might have already begun to adopt a more personalized approach to benefits. For example, you may already provide your employees with access to a decision support tool during annual enrollment to help them build their most suitable benefits package. Or perhaps your benefits platform allows employees to personalize their communication preferences, such as email, text messages, or mobile phone push notifications. You may even proactively reach out to employees who had a baby recently to remind them to add their child as a dependent.

If you’re doing any of these things, you’re headed in the right direction.

Some employers go the extra mile in delivering a more personalized and holistic benefits experience. These HR pros help employees take full advantage of their benefits when anywhere they need them, thereby supporting their overall health and well-being.

The experience they’re aiming for extends beyond benefits selection to benefits activation.

This page discusses five technology-driven programs and resources employers are increasingly using to help their employees activate their benefits through a hyper-personalized benefits experience. Each Includes some relevant statistics and a use case—or “activation path”—to demonstrate the impact on your employees, your HR team and your bottom line.

Care Navigation

The U.S. health care system is not known for its simplicity nor its efficiency. In fact, the estimated total cost of waste attributed to administrative complexity alone is a staggering $265.6 billion per year.

“The result (of such complexity) is that the system is pluralistic, mysterious, capricious and impossible for patients and providers to understand,” says Harris Poll Chairman Humphrey Taylor. “We believe this complexity is a major reason why we have the most expensive, inequitable, inefficient and unpopular health care system of any developed country, with poor to mediocre outcomes.”

A short history

Since the 1990s, health care professionals—particularly those treating serious or chronic conditions—have recognized that health outcome are often directly linked to patients’ ability to adequately navigate the complexities of the health care system. These findings resulted in an increased focus on primary care physicians as the central point of access and the hub for coordinating the care of patients with complex needs.

Today many of these strategies are used by third-party health care supervisors (a.k.a., clinical advocates). These individuals are registered nurses or highly trained laypeople. Their responsibilities include:

  • Helping patients find and access treatment
  • Maximizing employees’ understanding of their health care plans.
  • Facilitating more effective use of available services to achieve better health outcomes
  • Coordinating individual patient care among multiple providers and services

It’s just good business sense

Helping your employees navigate the health care system is not only the right thing to do, it also improves your bottom line.

One study found that a group of layperson navigators yielded a 10-to-1 return on investment, with average costs for cancer patients receiving navigation declining by $781.29 per patient per quarter. The largest cost reduction in the study were for inpatient and outpatient care, each declining by $294 and $275 per patient per quarter, respectively. And, emergency room visits declined by 6%, hospitalizations by 7.9% and intensive-care unit admissions by 10.6%.

Another study sampled 28 employers and discovered a 17.6-to-1 return on investing in comprehensive care navigation based on the sustained lower-than-market per member-per-year medical costs. And, when it comes to care coordination for individuals with chronic conditions, yet another study found that employers could reduce their health care spend by more than $4,500 per patient per year.

Technology’s Role

It’s not enough to simply enough to make these services available. Employers must also ensure their employees know about and make the most of the care navigation services available to them. When patients are made aware of these services, 60% make use of them. This is where technology comes in.

A powerful benefits platform coupled with your preferred care navigation partner can help you create an ecosystem that supports convenient employee self-service options and, when needed, personal outreach to enhance the employee experience and improve health outcomes. Powered by individual employee demographic and claims data, the right tech partnership can:

  • Leverage a deep and data-driven understanding of each employee, not just those with chronic conditions or high-cost claims.
  • Identify care optimization opportunities and gaps in care, such as missed screenings
  • Give employees a single place to go for help, often accessible through their benefits platform or mobile app.
  • Provide employees easy access to benefits experts and nurses who can guide them to right program at the right time.
  • Connect employee to second-opinion services to ensure the accuracy of diagnoses and the efficacy of treatment.

Better health, less waste

These services are not only effective at improving health outcomes, but they also help address a great deal of waste within the health care system—waste that ends up impacting employers’ bottom lines. Each year, failure of care coordination costs the U.S. an estimated $27.2 billion to $78.2 billion per year.

Provider Guidance

Employees and dependents who aren’t regular health care consumers have many reasons why they aren’t. Some don’t have a primary care physician, while others lack the means to get from their residence to a healthcare provider, they might even be a part of the 80% of Americans who fail to seek routine preventive care each year because they are too busy or confused by the healthcare system.

Whatever the reason is, infrequent health care consumers run the risk of making less-than-optimal decision when they eventually find themselves in the position of needing care. And, this can be expensive. In fact, the Agency for Healthcare Research and Quality estimates that 13% to 27% of emergency room visits in the U.S. could be managed in physician offices, clinics and urgent care centers, saving $4.4 billion annually.

Right care, right time, right place

Even when the situation isn’t urgent, people find themselves in the position of not having all the information needed to make optimal decisions regarding where to seek care. According to the Kaiser Family Foundation, nearly one in five inpatient admissions includes a claim from an out-of-network-provider. Meanwhile, countless others find themselves unnecessarily readmitted to the hospital after failing to seek care from a provider participating in the health plan’s center of excellence program.

Self-service to the rescue

To ensure their employees receive the right care from the right provider, more employers are turning to services that help their employees find, evaluate and book appointments with high-value providers in their network and geographic location. Today’s self-service technologies can help employees:

  • Identify in-network providers.
  • Schedule one-time and recurring appointments.
  • Locate urgent care centers.
  • Take advantage of telemedicine options.
  • Find high quality hospitals for inpatient care.
  • Identify cost-effective imaging services.
  • Maximize appropriate use of primary care for common health needs
  • Arrange care through highly experienced outpatient surgery centers

Claims Support

According to a study by the American Medical Association, inaccurate health care claims waste $17 billion annually in administrative inefficiencies. A random sampling of approximately 2.4 million electronic claims also found an average error rate of 19.3% among health insurers. And, another study found that administrative tasks associated with avoidable errors, inefficiency and waste in the medical claims process resulted in an average administrative burden of $2.36 per claim—a cost often borne by patients and their employer-sponsored health plan.Although insurance carriers have made headway in reducing error rates, the employee experience with health care claims continues to be compromised by several factors, including:

Surprise billing. A 2019 survey found that 44% of Americans have received a surprise out-of-network bill. Among those who had, 68% said the bill was difficult to pay, while 11% said they could not pay the bill at all.

Denials. With initial claim denial rates hovering around 9%, employees are spending a lot of time—often on the clock—talking to their provider, insurer or HR team to sort out why their claim was denied. Meanwhile, providers are spending an estimated $8.6 billion annually in appeals-related administrative costs.

Decreased benefits literacy. Prior to COVID-19, just over a third of employees indicated they were confused about their benefits. Mid-pandemic, however, almost 40% of employees reported high levels of confusion—an increase of over 25%.

Prior authorization. While requiring documentation to determine the medical necessity of certain drugs, tests and treatments is vital to controlling medical spend, 28% of physicians say the prior authorization process required by health insurers has led to serious or life-threatening events for their patients. Oftentimes, the patient finds themselves in the uncomfortable—and confusing—position of coordinating the flow of information between their health plan and the provider just to get approval to receive care.

Billing complexity. The typical explanation of benefits (EOB) features at least a dozen pieces of information presented in a format and using language that can be more confusing than a mortgage, lease agreement or bank statement. The current procedural terminology (CPT) codes are downright intimidating, while the tables related to charged amounts, negotiated rates, and cost share breakdowns is enough to give someone nightmares about impossible-to-solve story problems in math class.

Following the money

Similar to care navigators, claims support representatives (i.e., advocates) can greatly improve the employee experience. Unlike care navigators, however, these highly trained professionals focus more on the financial side of receiving care. Today’s claims advocacy services do this by:

  • Analyzing billing documents to uncover coding errors or troubleshoot issues related to network status.
  • Providing advocates with access to each employee’s real-time benefits information.
  • Ensuring advocates have a deep understanding of the complex claims process, including CPT codes.
  • Helping employees through the manual claims filing process when necessary (e.g., for out-of-network services).
  • Establishing relationships with providers and health plans for expedited claims resolution, including reimbursements.
  • Helping employees work with third-party entities, such as disability and workers’ compensation carriers.
  • Working with providers and health plans to proactively address common claims filing errors.
  • Ensuring prior-authorization rules have been followed and assisting where necessary.
  • Helping employees negotiate terms with providers or establish payment plans.

Personalized Health Communication

In the U.S., where 5% of the population consumes 50% of total health care costs, benefits administrators and risk managers understand the value of helping their employees stay as healthy as possible for as long as possible. This is especially true of those with chronic conditions, whom the National Institutes of Health say account for 85% of health care spending.

However, some employers are reluctant to address even the most basic, yet consequential, health behaviors due to employee privacy concerns—a fear often driven by the regulatory environment. While quite rational, this fear can paralyze HR teams from doing what’s right by the health of their employees, not to mention their bottom line.

Why it matters

First, employers have a vested interest in the health of their employees, especially if their health plans are self-funded. From a purely economic perspective, strategic and targeted health communications are justifiable, as long as they are HIPAA compliant.

More importantly, however, offering help to those employees who need it most is an expression of employer empathy—a trait many organizations lack. In fact, 92% of employees say organizations should do more to address the overall well-being and needs of their employees.

Then, there are the less urgent—yet no less consequential—situations that make a strong case for targeted health communications. These include local or global disease outbreaks, age- or gender-based health screenings, financial well-being reminders, mental health promotions and more.

Trust through technology

Fortunately, today’s data-driven technologies provide HR teams and employee wellness professionals with a variety of tools to conduct effective and empathetic outreach to employees in the right place and at the right time. And they can do so while protecting the individual’s private health information from unauthorized access through services such as outsourcing, thereby allowing HR teams to separate themselves from sensitive data. Today’s benefits technology can:

  • Build and maintain a unique profile for each employee based on demographic data, health and pharmacy claims and benefits ecosystem activity.
  • Analyze claims data to identify members experiencing a gap in care, such as overdue screenings, office visits or prescriptions.
  • Deliver messages year-round through employees’ preferred communication channels, such as push notifications, text messages, email or print.
  • Facilitate rapid response to urgent situations (e.g., natural disasters, disease outbreaks, etc.) by connecting impacted employees with available benefits and local resources.
  • Send only the most relevant messages based on strategic variables (e.g., demographics, claims history, etc.), thereby preventing “message fatigue.”
  • Maintain list accuracy in real time through automated data refreshes to ensure you’re reaching the right people, right now.
  • Track employee engagement through opens and clicks via a real-time dashboard so you can measure return on investment.


In early 2020, the U.S. experienced a revolution—or perhaps a revelation—in the need for remote care in a socially distanced world. Faced with the prospect of exposing themselves or others to COVID-19, a Johns Hopkins study found that 20% to 30% of Americans stopped going to community physicians, while the Commonwealth Fund reported that 60% of Americans stayed away from ambulatory care centers.

Meanwhile, telemedicine (a.k.a., telehealth or virtual visit) services exploded. According to FAIR Health’s Monthly Telehealth Regional Tracker, telemedicine claim lines increased 4,347% nationally, from 0.17% of medical claim lines in March 2019 to 7.52% in March 2020.

Telemedicine takeaways from 2020

In an otherwise bleak financial year for employers, the increased use of telemedicine in 2020 was good news, as remote care services have been shown to result in significant cost savings. A recent study showed that telemedicine saves an estimated $19 to $120 per traditional patient visit. And, diverting patients from emergency departments with telemedicine can save between $309 to over $1,500 per visit.

Overcoming utilization barriers

Despite employees’ newfound comfort level with seeing a provider in a virtual environment, telemedicine’s potential remains largely untapped. Some barriers to adoption, like access to broadband internet, are beyond employers’ control.

Other factors, however, are very much within employers’ spheres of influence. Here are some tips.

Consider a direct relationship with a telemedicine provider.

Prior to the pandemic, employers who relied on their health plan’s embedded telemedicine benefit saw utilization rates of only 2% or 3%. By contrast, those who established a relationship with a direct-to-employee telemedicine provider and promoted the benefit for front-door episodic care saw utilization rates of 15%.

Ensure integration with your benefits platform.

Linking directly to your preferred telemedicine carrier within your benefits portal and mobile app eliminates employee confusion of knowing where to start. Ensuring that your benefits platform plays nicely with your preferred telemedicine service through single-sign-on functionality removes complexity and provides a seamless employee experience.

Maximize eligibility awareness.

Let employees know they’re eligible for virtual care services. Start by creating excitement during your benefits fair and keep reminding your employees of this benefit throughout the year. Consider campaigns tied to cold and flu season, mental health awareness month, company-wide health challenges and other opportunities.

Help employees think beyond episodic care.

While the pandemic made a strong case for seeing a doctor for conditions such as colds, injuries, infections, and other intermittent care, telemedicine’s capacity for meeting ongoing health needs has remained largely unnoticed. Make sure your employees know that telemedicine can be used for treatment such as mental health counseling, chronic disease management and even some types of physical therapy.

Optimize utilization in the moment of need.

Ask your benefits administration vendor to help you think through opportunities to remind employees of telemedicine services based on their touchpoints with members or the data in your system. For example, can their member services representatives be trained to recommend telemedicine when employees call for help finding a doctor?

The advantage of direct access

Is telemedicine here to stay? Within health care systems, it would appear so. A recent survey of hospitals and other providers reported that 92% currently offer telehealth services, or plan to roll them out by the end of 2021.

Is telemedicine here to stay? Within health care systems, it would appear so. A recent survey of hospitals and other providers reported that 92% currently offer telehealth services, or plan to roll them out by the end of 2021.

Five Tips for Creating a Personalized Benefits Experience

Rising health care costs, a complex health care system, and low benefits literacy make a good case for a more personalized employee benefits experience. By helping your employees activate the right benefits and programs, you can dramatically reduce your health care spend, while increasing employee loyalty and engagement through this strong demonstration of empathy.

But you must also ensure that the execution of these technologies and services is, itself, empathetic. It isn’t enough to simply make these value-added services available. To realize a real return on investment, you need to provide your employees with an experience that integrates personalized services alongside their core electable and non-electable benefits. In short, you must create awareness, convey value and help employees to get started.

To do so, here are five tips.

1. Bring everything together under one roof.

To create a benefits experience that supports positive health outcomes while creating greater employee engagement, the importance of integration cannot be understated. Employees are much more likely to use provider guidance, telemedicine and other self-service options when they’re integrated directly into their benefits portal and mobile app.

The same can be said of more “high-touch” services like care navigation and claims advocacy. When you allow your employees to get started via your benefits platform or the member services number they use for other benefits-related issues, you make the right choice the easy choice.

2. Maximize automation, algorithms and artificial intelligence.

Today, we expect technology to play a role in nearly all our consumer experiences. From engaging with our preferred retailers to accessing streaming media services and everything in between, we have come to expect the three A’s—automation, algorithms and artificial intelligence. Our benefits experience should be no different.

When looking for a vendor to help you execute your personalized benefits strategy, make sure to find out how they use algorithms to determine when and how to conduct employee outreach, whether they use personas to send automated messages to subsets of your employee population, and whether they use artificial intelligence applications, such as a 24 to help employees.

3. Employ an omni-channel communication strategy.

Today’s HR teams must think like marketers. Omni-channel refers to a marketing strategy that combines content, personalization and technology to create an enjoyable consumer experience. In the retail environment, for example, a customer can be shopping online from a desktop or mobile device, or by telephone, or in a brick-and-mortar store and the experience is seamless.

In the , an omni-channel approach implies employee-centric content that is simple, educational and inviting. Also, omni-channel benefits communications are personalized, based on each employee’s preferred communication channels and life stage. Lastly, an omni-channel approach to benefits relies heavily on technology to engage with employees when and where they want.

4. Ensure you have real-time visibility into utilization.

Today’s data-driven technology has changed the way employers gain insight into how their employees are using their electable benefits. With just a few clicks or a call to their client services team, employers can access periodic or ad hoc reports to gain visibility into real-time metrics like eligibility, changes due to qualifying life events, service center call volume and much more.

When offering services such as those described in this page, make sure your vendor and benefits technology can generate real-time reports on the metrics you care about, such as engagement rates (e.g., email open or click-through rates) and other indicative data points that demonstrate increased activation into the benefits and programs you make available, not to mention return on your investment.

5. Create your own ecosystem.

The rapidly growing popularity of the technology and solutions featured in this white paper has resulted in a wide variety of vendors from which to choose. Some may offer two or more types of these personalized services, while others specialize in only one. That’s good news for you, as it allows you to select service providers based on your organization’s unique needs and business goals.

In creating the right mix of services, also consider how well each vendor integrates with the core technology you’d like to use to engage employees. If you plan on using your benefits administration platform to host these non-electable benefits, for example, ask your vendor whether they have preferred vendors that can help create a seamless delivery experience.


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