Flipping the Pyramid – New Health Benefit Strategy?

Many, if not most employers in US organizations approach benefits design with the mindset that benefits are an investment in employee wellbeing and engagement rather than simply a cost. But in a three-day global virtual event on the path forward for businesses post-COVID hosted by Marsh McLennan last year, an array of thinkers challenged us to go further. Consider this: Traditionally, benefit plans have provided more comprehensive benefits for the people at the top of the pyramid in terms of income and quality of life, even though it is the people at the bottom who need more support to address health care accessibility, affordability and quality issues.

The concept of “flipping the pyramid” isn’t new in the business world; it was first used to describe an organizational model that put employees at the top rather than executives, in which the role of leaders is to serve their workers. But applying this concept to benefit design could be an excellent way to address health disparities and inequities. Start with affordability. When the health plan premium contribution is the same for all employees, those earning the least are paying a much greater share of their income for coverage than those earning the most. The same is true for healthcare expenses incurred before the deductible is met. According to Mercer’s National Survey of Employer-Sponsored Health Plans, salary-based contributions are currently used by just 16% of all employers with 500 or more employees (26% of those with 20,000 or more), and salary-based deductibles are rare. We know that cost considerations prevents people getting needed care. Should more employers consider basing contributions and plan design on income? Onsite clinics and direct primary care models can also remove cost (and transportation) barriers to getting good basic care.

But while health care affordability is certainly an important issue, it’s not the only issue. Currently, many health and well-being programs are designed to reward healthy people with healthy behaviors. But what if we shifted the focus to consider what it would take to make someone’s life work well enough that they have the time, energy and money to take better care of themselves? Framed that way, a company would take steps to understand the specific barriers that their people face and offer a menu of options to fit specific needs. For example, caregiving without adequate support can lead to “time poverty” that makes self-care take a back seat to others’ needs. Providing stipends for back-up day care, or elder care support, can help ease that burden. Food deserts are also a serious impediment to healthier living, and often intersect with transportation deserts, compounding the problem. Kroger’s “Food as Medicine” pilot program – where doctors prescribe specific healthy food choices for an individual, who then meets with a dietician at a Kroger’s grocery store to fill the prescription – elevates the importance of food, a good starting point for creative approaches to improving peoples’ diets. 

Think about your current benefit design from an investment perspective – the investment in your employees. What is the return on your current investment? What do you want it to be? Offering a benefit to “keep up with the Joneses” may not be the right answer in a post-COVID world. Don’t be afraid to flip the pyramid and make a real difference in your employee’s lives.

Last year Marsh McLennan brought together a network of experts and leaders in a three-day, global, virtual event to articulate a vision for what is possible and design a path forward for industry and society in a post-COVID world. The theme was “Better by Design” and included luminary leaders like Her Majesty Queen Rania Al Abdullah of Jordan, Adam Grant, Parag Khanna, Francesca Gino, Dr. Vivienne Ming, Sarah Lewis, and Dr. Zach Bush, along with our own internal experts from across the Marsh McLennan family. All the sessions I attended were fabulous as you would expect with that line-up. 

Tracy Watts
by Tracy Watts

Senior Partner, National Leader for U.S. Health Policy

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