Reset Healthcare focuses on innovators and early adopter employers in the small and mid-size group (50+) market who want to, and yet struggle to, reduce their health benefits cost trend. The Reset Healthcare solution targets key cost drivers that impact healthcare spend for every organization through stop-loss & risk management solutions. Take the first step to learn more about how Reset Healthcare can impact your organization’s bottom line by contacting us for your free consultation today.

Patient Advocacy – Educated Patients are the Best Patients

“Healthcare is complicated” is the single greatest understatement of our time.

As an employer, you are picking up the lion’s share of the cost for the decisions that your plan participants make regarding their healthcare choices. Because of this, you have a vested interest in ensuring that plan participants are their own patient advocates and that they are armed with reliable information they need to make the best decisions regarding their care. Providing plan participants with dependable tools and resources is vital to the financial health of your plan and your fiduciary responsibility as a plan administrator.

Since what is traditionally offered through health plans only touches a fraction of the population many plan participants are left to fend for themselves. In many cases, this results in poor decisions which ultimately end up with patients accelerating through the healthcare continuum. Unfortunately, many of these plan participants culminate to the top of the plan utilization list in short order. By proactively investing in these patient advocacy tools, employers will directly impact medical cost, medical management utilization programs, and medication adherence numbers – all of which will result in better outcomes, increased member engagement, and lower costs for the plan.

There are at least five advocacy and education levers that an employer can pull to support their plan participants. These areas cause the most confusion to a participant and can have the greatest financial impact to your plan:

Broad-based Education
Educating plan participants on the financial impact their decisions have on them as well as the plan is the first line of defense for employers. Understanding basic insurance terms like deductibles, co-insurance, annual maximums, network vs. out-of-network coverage specific to your plan, and the member’s out-of-pocket costs empower plan participants to make smart decisions.

Engaging Plan Participants
Helping plan participants select a PCP, schedule annual wellness visits, coordinate specialty care, and manage chronic conditions are all areas of opportunity for plans to make an impact on their plan costs by engaging plan participants early and providing them with quality information and direction. It’s important that this is done quickly. Requiring a pharmacy benefits manager (PBM) to send first fill reports daily to the disease management company reduces the lag time between fill and initial contact (this is what many enterprise companies negotiate into their PBM contract).

Utilization Review
Many plans have utilization review (UR) programs. Obtaining prior approval for in- and out-patient procedures, diagnostic testing, imaging, and certain therapies is required by plans to mitigate unnecessary treatment. Employers have a unique opportunity to change the narrative and help plan participants understand “why” these programs are necessary and how they can positively impact the plan participant as well as the plan itself financially. Education around how the plan and the plan participant both share in the overall cost of healthcare is key to activating plan participants. This can be accomplished through short educational video clips for members to view as part of the UR process.

Accessing High-Value Providers – Care Management
Patients who have reliable information will make smart decisions. Guiding patients to reliable third-party provider review sites for example like Healthcare Bluebook is the first step in helping plan participants on the path to smart healthcare decision making. Also helping plan participants recognize that not all medication needs to go through the plan, sometimes it is just cheaper for them to pay cash or use discounts available through pharmacy discount websites such as GoodRx.

Navigating the Health Care System
Providing plan participants with a live actual clinician they can contact to discuss their medical situation will result in the right level of care, at the right time and with the right provider. Plan participants want to be treated as if they are special, so marketing advocacy programs as “white glove” healthcare advocates will exponentially increase utilization, regardless of whether organizations have purchased the Cadillac advocacy program or not. Having that “personal touch” builds trust and plans participants will try out the program. Once they have had a successful experience, they will continue to engage and use the advocate to assist with all their healthcare needs.

Literacy is a significant challenge, even for the most seasoned healthcare professionals, let alone plan participants trying to navigate the system efficiently to receive the highest quality of care at the lowest cost. There are many Patient Advocate options available in the market, do your research, understand the pricing and services provided, and provide your members a better experience. Everybody has had a bad experience in the healthcare system, a personal story, maybe even a few. Provide these services and get in front of the problem.

The Cure for Vacation Deprivation: 401(play) – It’s like a 401(k) for Vacations!

Before Covid, it was a well-known fact amongst U.S. benefits professionals that employees lose millions of days of vacations each year. Crazy work schedules, little disposable income, and life itself does not lend to taking leisurely relaxing vacations to refresh recharge, and relax. In the end, employees were not enjoying their earned time off as it was intended.

This has always been an issue for employers, and the problem that the 401(play) vacation funding accounts (VFA) aim to solve. VFA’s allow employees and employers to budget, plan and save for vacations quickly and easily through payroll deductions and simple to use platform.

Unless you lived under a rock, our world changed in 2020 and many employees were not even able to take their PTO for most of the year. Everyone was under lockdown for months and finding toilet paper was more important than planning a family vacation or even a weekend getaway.

To make matters even worse for employers, the PTO liability became astronomical since working from home became the “new norm”. Besides the fact that employees could not plan for vacations, the PTO employees would use for taking care of their personal business (e.g., doctors office visits, school functions, handling personal affairs) was no longer necessary since they could manage personal affairs more easily throughout the workday.

This combination created the perfect storm and had several unintended consequences for employers such as:

  • Increased mental healthcare plan costs. There has been a significant increase in mental health costs attributable to loneliness, isolation, burnout, and alcohol abuse among other factors.
  • Increase Coronavirus burnout and pandemic fatigue disability claims. These became real medical conditions during 2020, impacting productivity and absenteeism. Employees in many industries (not just frontline workers) suffered from these conditions due to the impact of the great resignation on businesses.
  • Increased PTO liability. The national shutdown required employers to choose whether to upset the employee population by invoking the use-it-or-lose-it rules leaving employees feeling cheated or keep a massive PTO liability on their books (which never makes for a happy CFO).

In 2021, the world began to open, and people were tired of staying home and there was an even greater pent-up demand for travel! According to the Expedia Annual Deprivation Survey, “the pandemic put a damper on vacation plans, the study results show that the desire for travel has not diminished. In fact, 66 percent of people globally were inspired to create a travel bucket list, and the longer the pandemic has waged on, the longer bucket lists have become – 60 percent of respondents said they continue to add to their lists”.

Employer awareness in this value shift is an amazing opportunity for employers who want to attract and retain the best talent in the world. The right program helps employees achieve these goals and position them as an employer of choice.

Until now, there was no effective way for employees to plan, budget, and save for vacations through payroll deduction since most rewards and recognition programs require the employer to pay the costs of the rewards.

401(play) is designed to be that differentiator!

When employers partner with 401(play), employees can save their money through convenient payroll deductions and then purchase their vacation accommodations (e.g., hotel, car, airfare, and excursions) through our proprietary vacation booking platform. Our tool is deeply discounted and, in many cases, also provides cashback to employees once travel is booked. This makes travel much more affordable for employees and their families.

Giving the gift of memories through travel is one of the most meaningful gifts an employer can give. To learn more about how we can help you bring this joy to your employees, contact 401(play) today.


David Loggins
CEO, Reset Healthcare