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High Deductible Health Plans Could Be More Employee-Centered—with a Little Pretty

Pretty isn’t always necessary.

For instance, health economists and plan sponsors delight in monochromatic medical cost trend lines that dip down.

Physician scientists (and digital health entrepreneurs) see success when a cohort of patients lower A1C values by 1%.

Parents find a pile of dirty clothes evidence of happy, healthy kids. (Ok, some parents.)

My “samples” folder relaxes my creative muse, though you’d purge it faster than used Kleenex.

Specialists—we’re invested in the meaning that is invisible to the non-expert.

But consider this: If you’re a high deductible plan, a little splash of color isn’t such a bad idea. The fundamentals aren’t particularly human-centered. They’re smashingly actuarially-centered.

When I talk about benefits marketing, or clarifying the call to action, or making something scannable, I’m really talking about making things pretty. Thoughtful presentation is always better. Beauty is a form of diplomacy. It seeks the eye, calls the ear, invites connection.

It also highlights the untidiness of reality.

Rather than prodding them towards smarter, more efficient health care choices, high deductibles are keeping employees and family members from getting care.

It’s making them less financially secure.

We both might say, Ditch the high deductible plans! Plenty of people are on that bandwagon. There are some particularly nefarious aspects I’d march to the DOL to discuss. Yet, I’m more of a doer than a marcher. While there are some intriguing system disruptions that I’m watching with the baited breath of a benefits-geek, right now, HDHPs are a fundamental aspect of change right now.

After you roll your eyes, could we make them a bit more palatable? Pretty?

Here’s one of our goals: helping a diverse-in-every-way group of employees and family members fast-think their way into better decisions about their point of care. In our idealized world, they choose urgent care rather than the emergency room after a Saturday afternoon baseball injury. Or, reflexively get their MRI at a free-standing facility instead of the hospital across the street from their doctor’s office.

I know, health care consumerism is as unsexy as taxes. But we’re still in this industry, so…

Let’s go back to the diversity of the participant group—a big, overlooked issue.

Plan sponsors fast-think about their employee demographics. For instance, a certain internet company might think about their warehouse and corporate folks as distinct groups with knowable salary and educational levels. To shelter lower wage workers from the common pitfalls of the blunt edge of a high deductible, employers might pair it with a fully funded HSA, targeted education, an on-site clinic, and wellness incentives. That’s a really good start.

What happens when you throw in spouses and children?

A pile of dirty clothes, sure. And the full demographic, psychometric and health status spectrum of the American population.

I get overwhelmed by that too.

Because what we’re really after is not only system change, but culture change. We need less people to submit to a hierarchical doctor-patient relationship, and feel confident to lift their heads and voices up for better health care.

That is beyond our pay grade, maybe.

But think what we’ve learned!

Everyone used to have a job with a pension. Then 401(k)s came along and we rung our hands raw over the overburdened, ill-educated individual who had the full weight of retirement savings on their shoulder.

Okay, so full retirement readiness isn’t a realized vision yet.

But we’ve experimented and found some things that do work. No longer do we have to wrangle the lawyers to implement auto-enrollment and auto-escalation; now the DOL comes to us to understand how we’ve helped individuals save more. We find ways to improve mandated notification language.


While smart minds pontificate on what Amazon, JPMorgan Chase and Berkshire Hathways are up to, focus on your health plan strategy and how you’ll communicate it this fall. How can you meet people where they are?

Can you know how employees, spouses, and dependents make choices within the health system?

Here’s one idea.

If we can reach people where they are, we can architect more human-centered benefit systems.

You were right to cringe, by the way. Shopping malls and Super Bowl commercials are pretty. Thoughtful systems are beautiful.

Let’s focus on beauty.

Photo: Andrian Valeanu via Unsplash

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