Why Smart Benefit Strategies Fail Without Employee Support

There are three ways to reduce a healthcare claim. Most advisors stop at one.

Level 1:  Get a better price for the same service. Network discounts, PBM contracts.

Level 2:  Redirect care to a lower-cost location. Move the knee surgery to an ambulatory surgery center. Move the MRI from hospital to outpatient.

Level 3:  Prevent the claim entirely. With the right steps between pain and loss of function, that surgery may never be needed.

The Execution Gap

We design strategies, then hope employees will execute them. They won't. Not without help.

Employees don't understand the healthcare system. Even when we explain it at open enrollment, they forget the moment they need it.

Why 800 Numbers Fail

People need trust before they'll accept help with healthcare. When I tried call centers as an advisor, nobody used them.

Now we embed one nurse into each employer's HR team. Employees call, text, or email her directly. They know her name. She knows them.

Two Critical Functions

First, the nurse solves immediate problems. Denied claims, prior authorizations, billing issues. This builds credibility.

Second, she uses claims data to engage high-risk members. She calls on every ER visit. She reaches out to people who haven't seen doctors in years. She connects people to what they actually need today.

An employee hadn't seen a doctor in 15 years. Our nurse convinced him to go and made the appointment. They caught early-stage cancer.

The Difference

When employees have someone helping them navigate, your solutions work. Large claims get prevented. Trends stay stable. You deliver on what you promised.