Are De-Centralized Benefits Strategies in our Future?

Most people decide where to live based on proximity to job opportunities and family. But what if jobs were taken out of the equation? The abrupt changes to our daily lives brought about by COVID-19 have made this a real question for many Americans.  

Around 80% of people in the US live in cities – but will that be the case in the future? What people originally thought would be a short stint of remote work has turned into 12 months and counting. Some companies (REI and Target, to name just two) have made early decisions to embrace a larger remote workforce. According to USPS data on change-of-address requests, the number of people who permanently relocated during the first half of 2020 rose 4% compared to the same period in 2019, while the number relocating temporarily rose 27%. This migration was largely out of large cities like New York City and San Francisco and into smaller cities or rural areas. While people moved for different reasons – to leave areas with high rates of infection, to be closer to family, or to save money – one big reason that so many were able to move is that they could work remotely. 

As vaccine distribution accelerates, employers are facing key decisions about the future of their workforces. Some – maybe many – of their employees who have been working remotely will want to continue to do so. And as more employers announce new strategies to permit remote work on a larger scale, more employers will feel pressure to provide this option to enhance their organization’s employee value proposition.

But health benefits are an important part of the value proposition, too, and remote working may well have a broad-reaching impact on employers’ health benefits strategies. Here are a few things to start thinking about: 

Medical networks: Plan members may find themselves with fewer in-network providers to choose from after they move away from a company location, especially if they have moved out of a big city. If that means they start seeing out-of-network providers, their costs could go up. Medical networks often provide national coverage, but if members are no longer centralized in one location, you may need to run a new disruption analysis to see if your members still have adequate access to providers based on the new demographics. This analysis should include quality indicators as well. Employers with ACOs may need to look at restructuring their ACOs if enough employees move away from the ACO primary location(s).

Specialist access: Specialists generally are centralized around cities. Members moving to smaller urban or rural areas may face challenges finding specialists that are conveniently located. If a 15-minute commute to a specialist becomes a one- or two-hour commute, how will this impact members’ ability to get the quality care they need, or to adhere to a treatment plan? And consider this related issue: As white-collar workers move out of cities to more rural areas, the demand for access to care in those areas will increase. At the same time, advances in virtual care is making it easier specialists to work remotely. If they also start to move out of cities, we could see care disruption in urban areas. The new normal may require regular review of quality specialist access.

Health advocacy: If employees don’t have access to a health advocacy service today, it’s worth exploring adding it to your benefits lineup. The way employees access care changed abruptly in March of 2020 and will likely keep evolving as we transition to the new normal. Providing employees with help in navigating the changing health system is more important than ever to ensure benefits are being efficiently used and lead to good health outcomes.

Behavioral health: Mental health has been the most common reason to engage telehealth during the pandemic so far. There are already more barriers to mental health care access in rural areas compared to urban areas. As employers monitor where remote employees choose to live in the post-pandemic world, it is critical to ensure they have access to quality behavioral health resources and providers.

Health benefits are a critical consideration in a remote working strategy, but there are others as well, such as ensuring appropriate legal and tax infrastructures are in place and pay equity is maintained. Employers have big decisions to make in the coming few months that will affect the future of their workforce. While there are advantages to both employers and employees in more flexible working, it’s important to analyze, as much as possible, the many impacts that each decision might have.  

Amber Boehm
by Amber Boehm

Solution Architect, Center for Health Innovation

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