Designing A Digital Benefits Program

By Paris Wallace, CEO Ovia Health

With the proliferation of digital health solutions in response to employee demand from an increasingly technology literate workforce, our customers are increasingly turning to us to help answer the question: how do we design a best-in-class digital health benefits program? To help customers answer this question, we have developed the following framework to guide benefits professionals through designing and implementing a digital health benefits program that engages employees while improving health outcomes and reducing costs.

Program components

There are three types of digital benefits solutions: population platforms, condition hubs, and point solutions. An effective benefits program seamlessly incorporates all three of these to meet the needs of the employee and organization. Each solution has different strengths and weaknesses that complement one another, and the whole is greater than the sum of its parts.

Population platform: A population platform is designed to identify all employees so they can be triaged to the right condition hubs and point solutions. It is the place where employees enter the digital ecosystem and navigate all of their benefits. Examples include incentive platforms, concierge services, and TPAs. An effective population platform is broad enough that it is inclusive for all employees looking to explore their benefit options, but it’s engaging enough that employees actually want to return to the platform weekly or monthly.

Condition hub: A condition hub is designed for daily engagement for a specific employee population that has a chronic or long-term issue. Examples include digital health solutions developed for pregnant women, people with diabetes, and people trying to lose weight. An effective condition hub is engaging enough that employees return on a regular basis, and it’s substantive enough to effect a behavioral change that leads to a positive outcome. Condition hubs also connect people with point solutions when there is an acute issue or decision to manage and back to a platform when appropriate.

Point solution: A point solution is designed to help employees manage an acute issue or answer a specific question. Point solutions don’t need to engage users on their own, but rather they should be accessible to those who would benefit from them through both a population platform and condition hubs. Examples include telemedicine products, second-opinion services, and price-transparency programs. An effective point solution will present itself to an employee at the right time and solve an acute problem that it is specifically designed to take on.

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No one vendor solution will do a great job addressing identification, engagement, and outcomes. Each will excel at one or two of these program goals. The key to achieving the triple aim of identification, engagement, and changing outcomes is building a multi-vendor digital benefits program that combines vendor solutions to achieve these goals.

Designing an effective program

Designing an effective program starts with a vision and data that can guide your decision-making. It is incredibly important to have a clear vision of what you want your program to accomplish. A program set up for employee retention may be very different than one setup to reduce costs. You can always add more functionality to your program later, but start out with a specific vision that you want to set in motion. Next, gather the data you need to realize your vision. Asking questions like, “What are my three largest medical cost drivers?” and/or “How effective are existing vendors?” can help you better choose which problems to prioritize and what type of vendors to work with.

Once a benefits professional has a clear goal for the program and a data-driven hypothesis on what issues she wants to prioritize, she must select solutions that work together to address the needs of the employee and employer. Think about it like this — a well-designed program will have:

  • A population platform that helps identify and triage all employees
  • Hubs that address cost centers and/or common health issues within the employee population
  • Point solutions that address employees’ highest-value and most costly problems

The solutions you choose should be driven by your vision and data. For example, let’s say you want to create a program that encourages better health outcomes for your employees. If you know from claims data that your employees’ three most common claims are related to diabetes, cancer, and childbirth, you would want to design your program around addressing these issues. You may want to chose a platform that allows you to incentivize employees around benefits utilization and healthy living. For condition hubs, you could pick a pre-diabetes solution and a diabetes management solution, along with a fertility and pregnancy hub to help moms. Lastly, you can select a second-opinion service to help employees with cancer get more accurate diagnoses and a telehealth solution to help employees with diabetes and pregnancy questions. With this design, you have an integrated system that helps users address their health concerns and be rewarded for doing so.

The key takeaway is that you need to design a program with the end goal in mind that includes the different types of vendors working together to achieve your goals. If you start implementing one type of solution without an ecosystem around it, it will be very hard to show long-term results. If you build your program around the identification, engagement, and outcomes framework and ensure that you have a group of vendors that will allow your organization to achieve all three of these goals, your program will be able to achieve your vision.

Selection criteria

After determining the needs of employees and the organization, specific vendors must be selected. Benefits professionals should use a comprehensive set of criteria when evaluating an individual program. Below are the criteria that we see being used in the market to determine the quality and effectiveness of vendors’ solutions.

1. Interoperability: How does this solution work with the rest of my benefits package? An interoperable program will pass data from solution to solution, streamline contracting and payments, allow single sign-on across the ecosystem, and seamlessly refer employees to other vendors in the benefits program.

2. Design/usability: It’s one thing to have an effective digital solution, but if it’s a clunky product, your employees won’t engage with it. Ask yourself if this is an application that a human would actually use. There are several metrics with which to evaluate the usability of an application:

  • Net Promoter Score: Look for solutions that have both employer and employee NPSs above 50
  • App Store reviews: If the vendor has an app available on the App Store, look for positive reviews, a star rating of >4, and the number of reviews (the more the better)
  • Identification metrics: What percentage of the addressable employee population does the vendor expect to identify in its population, and/or what percentage of total interactions does the vendor expect to be part of?
  • Engagement metrics: DAU/MAU (the ratio of daily active users to monthly active users)
  • Try it: If you don’t have access to any of these metrics, try the product for yourself, and ask others you trust to do the same. Don’t just rely on a demo, but actually use the product and see what the experience is like  Accessibility: Consider whether the solution has a mobile application — it’s far easier to engage an employee through their smartphone than through a website or hotline

3. Reporting: Will you have a window into this solution’s performance? If you don’t have a lot of visibility into how the program is working and how your employees are interacting with it, you won’t be able to effectively judge its performance. An effective solution will ensure transparent, real-time reporting that shows engagement and impact based upon criteria that has been agreed upon about identification, engagement, and outcomes. Even better is being able to have one central place that aggregates information across all of your vendors in real time so you can see the health of the entire program at once.

4. Cost: Understand the cost structure of the solution, and make sure that it’s cost-effective for your organization and your employees. Many benefits solutions charge per employee per month (PEPM), which makes it relatively easy to assess the value that a solution provides. Calculate the value per interaction with a solution, and make sure it exceeds the cost.

5. Security: There are a few different levels of security certifications, but they aren’t all built equal, so it’s important to know what to look for. Being HIPAA-compliant is a good start, but claiming to be compliant requires no certification from an outside authority. If you want to be truly confident in a solution’s security, make sure they are certified by the Health Information Trust Alliance, known as HITRUST certification. Anything other than HITRUST should raise red flags.

Conclusion

There’s no one-size-fits-all answer to how to design the best digital benefits program for different employee populations, but there is certainly a framework under which to work. Best-in-class benefits plans have amazing platforms, hubs, and point solutions that address the needs of individual employees and the organization as a whole, and these are transparent enough for benefits professionals to constantly evaluate performance and adjust the program composition as their needs change. Designing a digital benefits program that is both effective and efficient isn’t always easy, but organizations who fully understand both their employee populations and the interplay between the three levels of benefit solutions will be able to create a package that attracts, retains, and delights employees while improving health outcomes and reducing healthcare related costs.