Prioritizing Health Care Spending: Engaging Employees in Health Care Benefit Design

Authors: McNichol J, Nichols LM, Aiyar S, Buelt L, Ciarametaro M, Dubois RW.
Publication: November 13, 2018
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This case study was based on an effort developed by Janet McNichol, SPHR, CAE, human resources director at the American Speech-Hearing-Language Association (ASHA), to redesign a health benefit option offered at the association.

The case study describes a framework used by ASHA, a self-insured employer, for engaging employees in the design of a health benefit option that better reflects employee needs and preferences, identifying the tradeoffs employees were willing to make between their individual preferences and what was best for the group.

ASHA employees were asked to participate in small group discussions using a gameboard featuring 12 categories of health care services (e.g. maternity, prescription drugs, mental health) with varying levels of coverage (good, better, best). Participants first created an individual health plan reflecting their individual coverage needs and preferences, then worked together to design a single health benefits plan for the organization. 

There were several key takeaways from the group discussions:

• Exchanging or limiting types of care for the benefit of others. As employees discussed their health care needs and preferences in a group setting, individuals were willing to accept less robust coverage in certain areas of care, such as dental, vision and diagnostic benefits, so that the broader group could have access to more comprehensive mental health and maternity services.
   
• Willingness to pay. Approximately half of the participants who completed a debrief survey following the group discussions were willing to pay more—roughly $38 per month—for additional coverage in one or more benefit category.
   
• Satisfaction. Results from the debrief survey indicated that 92% of participants were satisfied or very satisfied with their individually designed plan, and 83% of participants were satisfied with the group plan. The small difference in satisfaction between the individually designed plan and the group-designed plan suggests a high level of buy-in to the process, despite significant movement from individuals’ ideal preferences.
   
• Broader policy implications. If employees are engaged in the deliberation process, necessary limits on coverage may be more likely to be considered ethical and accepted as legitimate and fair. This type of consultative and deliberative process, appropriately modified for different circumstances and beneficiary groups, could be useful for broader discussion of health care spending tradeoffs.

These findings are especially relevant as more than half of insured Americans get their health insurance through their employers, but more costs have been shifted to employees in the form of deductibles, copayments and coinsurance. Between 2006-2016, total out-of-pocket expenses for people with employer-provided coverage rose 54 percent, while wages rose only 29 percent in the same period. Annual premiums for employer-sponsored family health coverage rose to an average of nearly $20,000 for a family plan in 2018.