By Raffi Terzian, M.D.,
Senior Medical Director, Senior Vice President of Clinical Operations

The rapidly changing benefits landscape can present a significant challenge for overextended HR teams who are assisting employees with making plan selections during open enrollment. Since the passage of the Affordable Care Act (ACA), and with a continued trend toward High Deductible Health Plans (HDHPs), more questions have emerged for employees who are trying to get the most out of their healthcare dollars.

Trying to navigate open enrollment can leave employees confused and frustrated. It can be a daunting task.

In addition to plan design changes, surveys show that plan material that is difficult to understand and enrollment deadlines that may be rushed are significant sources of frustration. Employees can find it quite stressful and overwhelming to make informed healthcare decisions when facing a deadline. Without thoroughly evaluating their options, they can be left choosing coverage that may not work well for them.

Healthcare benefits education is crucial

One of the best steps to mitigate the complexity and frustration of open enrollment is to provide clear communication and personalized guidance. This is particularly critical when new plans are being introduced or changes are being made to an existing plan.

Many employees may not realize that not only can plan features change, but costs may change as well. It is important that employees understand how a new plan selection may differ from their existing plan, as well as their cost share for each option. Frequently, employees need help even understanding how HDHPs work.

High-touch improves the experience

It is important for employers to remember that employees want help when choosing health plans and that employees have questions related to their personal situations, such as dealing with a prescription issue or a pre-existing condition. While self-service and online tools can be valuable, employees can still benefit from personalized, unbiased and well-informed guidance from experts who understand how to navigate the landscape of open enrollment.

With better guidance comes better engagement and a better employee experience.



Read on to learn how our Enrollment Advocate program can provide that personal touch to get you and your employees through open enrollment

By Dr. Jocelyn Sivalingam M.D.,
Medical Director, West’s Health Advocate Solutions

As patients, we all have questions: How do we know when it’s time to get a mammogram? What are the currently recommended treatments for high blood pressure or diabetes? When does my child need a vision screening? Is thyroid screening recommended?

For providers, the main question is: how do we answer these questions to ensure that a care process is followed that eliminates unnecessary testing – preventive or otherwise – while also ensuring a patient receives the best quality care? The answer: Best-practice clinical guidelines.

What is a clinical guideline?
Clinical guidelines are science-backed recommended practices meant to guide preventive care and treatment. They are created and updated by groups of scientists, clinicians, pharmacists,  and others who are interested in improving health outcomes. Guidelines are generally published in print and online in major medical publications and may also be published on public non-profit or government websites (,, American Heart Association, etc.).

How do clinicians, health plans, and health systems use clinical guidelines?
Guidelines are generally used to help guide clinicians on what the optimal care is based on existing science for most people most of the time. For health plans, clinical guidelines can be used to determine what preventive services, such as tests, are covered at 100% under plans that comply with the Affordable Care Act—those recommendations issued by the U.S. Preventive Services Task Force (USPSTF). Additionally, clinical guidelines may influence health plan payment for drugs, services or therapies.

Some guidelines may also be the basis for care quality measures such as the National Committee for Quality Assurance HEDIS measures recommendations on flu vaccination and statin use.

Why is it important to keep clinical guidelines updated?
The science behind medical and preventive care advances rapidly. In 2017, for instance, the American Heart Association’s Hypertension Guidelines changed the classification of high blood pressure. Lack of current information can affect care decisions and potential outcomes for patients.

How are clinical guidelines put into practical action?
At Health Advocate, our team of experienced medical directors continually stays up to date on the latest standards, compiling our own guidelines from a wide range of trusted organizations for recommended preventive and treatment services.

Additionally, we analyze data from biometric screenings, health risk assessments, claims and other sources against the guidelines to identify members with gaps in care. From this, Health Advocate generates targeted communications to help them take action to improve their health.

Our Personal Health Advocates use these guidelines for teachable moments across a spectrum of medical specialties.

How do the guidelines benefit employees and organizations?
Our clinicians, coaches and benefits specialists use our most current guidelines to provide enhanced decision and administrative support across all of our programs including Advocacy, Wellness, Chronic Care Solutions and Personalized Health Communications. This ensures that members have the key information needed to take steps toward better health, leading to improved outcomes and reduced costs.

Contact us
Our guidelines support our health and well-being programs so we can get all employees the help they need when they need it. Find out how we can help you put the right programs in place to drive engagement, save money, improve outcomes and get people healthy across your organization.

Enhanced Support for Employees During Open Enrollment

Helping employees understand major benefit changes presents a challenge to an overextended HR staff. Our trained benefits specialists can step in to ensure that all of your employees understand the ins and outs of their coverage before the enrollment deadline so they can make the best choices. Serving as a primary resource for benefit-related questions, our benefits unit frees up your HR department to focus on other important priorities. We handle the high-volume calls and provide employees with confidential help to make confident decisions based on their individual situations.

Program features:

  • Provides personalized help from trained benefit specialists, knowledgeable about the specific details of the plan offerings
  • Explains details of plans in plain language
  • Educates about pre-funded health spending accounts (HSAs, FSAs, HRAs)
  • Helps employees understand costs, including payroll deductions and out-of-pocket expenses (deductibles and coinsurance)
  • Helps identify in-network providers as employees change health plans; assists with provider issues
  • Addresses specific issues, such as pre-existing conditions
  • Assists employees as they consider and evaluate voluntary benefit programs
  • Offers appointment scheduling service available for employees to consult directly with a Health Advocate benefits expert at a time that works best for them
  • Provides direction to enrollment tools including explaining the process to enroll in selected benefits
  • Is seamlessly integrated with all Health Advocate services
  • Assists with any clinical issues affecting the employee’s decision regarding a new health plan
  • Helps locates in-network doctors and hospitals available in plan options

Key benefits for employers:

  • Reduces employee confusion and frustration
  • Promotes better understanding of all plan options
  • Increases acceptance of high-deductible health plans
  • Supports the introduction of new benefits, changes
  • Educates employees about plans that may meet special needs
  • Minimizes administrative tasks
  • Supports better plan selection, leading to lower costs
  • Ensures that all key dates and requirements are properly communicated
  • Seamlessly integrates with all Health Advocate programs – employees can receive personalized help to find doctors, make appointments, and get assistance with other healthcare and insurance-related issues

Key benefits for employees:

  • Clearly understand plan options from a knowledgeable, unbiased expert
  • Easy access to one-on-one help—no limit on call duration and call-backs
  • Information held strictly confidential
  • Can easily be connected to a Personal Health Advocate for help with healthcare and insurance-related issues


Next Story >>

By Marcia Otto | HR Daily Advisor

Organizations continue to focus on helping employees improve their overall well-being, which in turn can positively impact productivity and costs. The key to realizing the value of this focus is an engaged population, yet despite best intentions and large investments, many employers still face low benefits utilization.

According to a recent Health Advocate survey of HR professionals, top approaches to maximize employee engagement in benefits include ongoing communications, events and meetings, and health savings account contributions, however mobile and social media usage is increasing. Despite the growing reliance on technology-based tools, 82 percent of respondents also indicated that incorporating high-touch support services helps employees more effectively navigate their health and wellness benefits.

The survey demonstrates organizations are prioritizing and expanding their efforts to engage employees. Yet while employers continue to seek new and innovative ways to drive participation in their benefits programs, this may create new challenges.

Fragmentation Creates Confusion

To try and move the needle, employers have added an increasing array of support programs as additional benefits. Many offer valuable resources, but the resulting program mix tends to only increase the complexity of health benefits as employees strive to be more savvy healthcare consumers. While the available offerings provide a wealth of assistance, employees may be unsure where to turn for their specific issue, leading to lackluster utilization.

According to survey respondents, the biggest hurdle to engagement is that a multitude of benefits programs is often disjointed, confusing, or difficult to access and navigate. Fifty-four percent of organizations offer employees access to a series of separate benefits tools or platforms, each requiring a separate login.

Additionally, 40 percent indicated that working with multiple benefits vendors led to a lack of utilization, with another 35 percent noting technology issues. These factors contribute to challenges for benefits managers trying to address employee’s confusion and streamline the experience. To mitigate this issue, a quarter of respondents report moving toward a single integrated platform where employees can access all of their benefits in one place, making it easier for employees to take advantage of available offerings.

The Value of Integration

The “missing link” is the connective tissue that blends benefits in a meaningful way, delivering the most relevant choices to each employee according to preference and frequency.  Solving this dilemma requires an intuitive approach, “high-touch” and “high-tech” – a single, unified platform that can successfully guide employees on their journey.

With a single platform, employees can easily access all of their benefits in one place, online or via a mobile app. Nearly 60 percent of respondents said that this model presents each employee with a single point of contact that is personalized, intuitive and interactive, with another 46 percent indicating that it improves employee engagement with benefits.

Breaking it down, there are five key attributes required to ensure that an integrated engagement platform is likely to succeed:

  1. Integrated

It’s critical that the benefits platform unify data from a myriad of sources and programs. That includes benefits information, essential phone numbers, healthcare expense and chronic disease management tools, and Health Savings Account (HSA) balance management from a single mobile engagement platform, for example.

  1. Relevant

Relevancy would include the option to create a personalized “to-do” list to meet each employee’s specific needs and preferences. Reminders like “Keep up the good work and become tobacco free!” or “Schedule your diabetic eye exam” are also important. Actionable items would offer claims history, gaps-in-care analytics, personal preferences and employer-provided benefits information.

  1. Consumer-like

If it’s not easy, it won’t be used. Much like shopping online, the platform must minimize the need to “hunt” for relevant information. Well-designed platforms mimic the online consumer experience, cleverly presenting the same information in multiple appropriate places to reinforce messages without seeming redundant.

  1. Smart

Real-time information access to things such as updates on pending support requests and appointment reminders are table stakes. Plus, feedback about progress towards employee health goals and customized information based on health status must be available.

  1. Connected

This means offering an open door to access all benefits seamlessly, using the communications channel that best serves each employee. It also means a platform backed by live support available via online chat, email or phone.

An effective benefits platform must eliminate confusion and anxiety. It should be the first option for all employees, but it might not be the last. By connecting to employees through multiple communication channels, employers can increase every employee’s engagement in their health journey, regardless of tech savvy.

The Human Touch Remains Critical

While technology plays an increasingly important role in employee benefits, survey participants also signaled the importance of balancing technology with the human touch when it comes to driving engagement. Seventy-eight percent currently offer employees access to live support to help with their health and benefits, with more than 80 percent confirming that having some level of high-touch support increases engagement. Technology is valuable, but employees often prefer speaking with a real person when it comes to navigating complex healthcare issues.

As digital tools continue to gain traction in employee benefits, considering how to tie available programs together in a cohesive, holistic way is critical. An integrated approach that incorporates data analytics, a seamless experience and high-touch, expert support can increase utilization, improving the health of the workforce while managing costs for employers. When programs are connected and personalized, it is more likely that employees’ needs will be met in the way that works best for them.

In order to address these issues and create an approach that will drive engagement, it is important to find an experienced benefits partner that understands how to effectively tailor benefits programs to best meet the needs of the organization and its employees.

Episode 15: Preparing for Flu Season

The flu can have a major impact to organizations and their employees, and it’s never too early to start preparing for next year’s flu season. In this episode of Health Advocate’s Ask the Expert series, we’re joined by Health Advocate Medical Director Dr. Jocelyn Sivalingam to discuss the importance of the flu vaccine in the workplace.

By Jocelyn Sivalingam | BenefitsPRO

While this year’s flu season may be winding down, now is the time to start planning ahead to protect your employees and your business ahead of next year’s flu season.

Influenza can have a devastating impact on individuals and organizations. While this year’s flu season may be winding down, now is the time to start planning ahead to protect your employees and your business ahead of next year’s flu season.

The Centers for Disease Control and Prevention (CDC) estimates approximately 1 in 5 people get the flu each year, leading to tens of thousands of hospitalizations and thousands of deaths. While these numbers may be startling, there are ways employers can help minimize the risk of their employees becoming sick—specifically, the flu vaccine.

Recent studies indicate that getting a flu shot can reduce an individual’s chances of getting the flu by up to 60 percent. This impact can be amplified within an organization, helping to prevent illness from spreading among the workforce and reducing time employees spend away from the office while sick.

An increasing number of employers recognize the benefits of offering on-site flu shots to employees. A 2017 survey from the Society for Human Resource Management found that nearly 60 percent of employers offer on-site flu vaccinations. Some organizations may provide vouchers to get vaccinations at clinics or other health care providers. This trend is yet another sign of the increasing financial and organizational importance of flu prevention to the business community.

How the flu impacts the workplace

When employees are sick, typically one of two scenarios plays out. Either the employee stays home, causing absenteeism, where they can also make family members sick (and require more time to care for relatives), or the employee comes to work sick.

In the latter case, at work while ill with the flu, he or she is not performing optimally. This is presenteeism. Additionally, an ill person actively spreads the virus to coworkers, multiplying the number of infections. For an unlucky employee, or one who may have an underlying condition, such as asthma or diabetes, the results can prove catastrophic. Both situations reduce productivity, increase costs and cause suffering.

The CDC estimates annual direct costs in the U.S. related to flu (i.e., medications, laboratory services, hospital and outpatient visits) to be approximately $10.4 billion, and while estimates vary, there is a huge economic burden counted in the billions of dollars related to sick days and lost productivity from influenza. This includes millions of days absent, as well as millions of doctor’s visits and thousands of hospital stays.

Further, when employees are often sick or absent, the overall culture of a workplace may suffer. Employees may feel pressured to come in sick to keep up with work, or they may face challenges completing projects due to colleagues missing time, creating negative consequences. The flu can take a major toll on organizations in terms of both direct costs and lost productivity, making it in everyone’s best interest to prevent the spread of this virus.

The value of the flu vaccine

Flu vaccination has many benefits for employees and their employers. When organizations offer onsite flu shots, it’s convenient for all, increasing the chances that their workforce will be immunized. Currently less than half of adults get the flu shot each year, but when organizations offer the vaccine at work, the CDC reports that 85 percent of employees participate.

Offering the vaccine at no cost further helps ensure employees take advantage of the opportunity, improving the level of immunity in the workforce. As mentioned, the flu shot reduces the risk of getting sick by up to 60 percent. This means employees are much more likely to stay healthy and not give the flu to others.

Even when the vaccine is not a perfect match for the circulating virus strain, the CDC notes that vaccination still offers benefits, including reduced flu severity, lower chance of death, ICU admission, and length of hospitalization, making it important to immunize annually. Studies show influenza vaccination can help reduce sick days due to respiratory illness as well as the spread of illness when employees come to work sick. This decrease in absenteeism and presenteeism has a positive impact on productivity, and reducing the number of employees contracting influenza each year can help organizations reduce health care costs.

Consider that the cost of lost productivity due to the flu is approximately $1,000 per employee on average. This does not include the direct medical costs associated with being sick, including doctor’s visits, medication and more. Alternatively, the flu shot costs an average of $32 per person. While the flu shot may not prevent everyone from getting sick, it can significantly reduce the risk and number of people affected, making the potential cost savings easy to see.

Strategies to reduce flu at work

While the flu shot is the most effective strategy to reducing the risk of getting sick, other basic healthy habits encourage the workforce to prevent the spread of bacteria and viruses. These include covering the mouth and nose when coughing or sneezing, regular hand washing (after coughs and sneezes, before meals and after the restroom). Having hand sanitizer available when washing facilities are not easily available is recommended. Inform workers about flu and other contagious respiratory disease symptoms. Facilitating appropriate use of sick time and making policies known helps keep those who are contagious from coming to work sick.

Employees might need motivation to take advantage of vaccination opportunities at work. Incentivizing flu shots has the potential to be a major driver, whether through raffle entries or wellness points toward a larger goal. Further, organization leaders should set examples as role models by getting flu shots themselves and publicizing their participation. Note that ongoing communications are crucial to reinforcing the value and importance of the flu vaccine and other healthy habits. Reminders about opportunities to get vaccinated as well as strategies to stay healthy via email, posters and more will help to ensure high flu prevention awareness.

Integrate with other programs to maximize impact

To maximize efforts for flu vaccine promotion, making it part of the organization’s well-being strategy and offering flu shots with health screenings can boost participation.  Acting on prevention with flu shots and screenings can positively impact company culture, showing that the organization truly cares about their employees.

Offering the flu shot at work is an easy way to reap benefits for both organizations and their employees, contributing to a healthier workforce and bottom line.

The Holistic Perspective

Jeff Silver | American Healthcare Leader

From financial impact to wellness, Pam Mortenson shares how she helps Health Advocate develop customized solutions that address customers’ goals

For decades, West Corporation has been a leading technology-enabled company that connects people all around the world and makes companies more efficient. It provides innovative solutions to companies ranging from telecommunications and entertainment providers to financial services firms. But in 2014, a new opportunity arose when the company acquired Health Advocate, a national health concierge and benefits solutions company. The acquisition merged West’s communication technologies with Health Advocate’s expertise at supporting employer health benefits. As a result, Health Advocate now offers even more valuable insights and services to employers and their employees who face ongoing health- and benefits-related challenges.

“We offer an integrated approach that addresses the many different factors impacting claims costs and overall employee health,” explains Pam Mortenson, Health Advocate’s Executive Vice President, Product strategy. “Many start-up companies in the wellness space only focus on solving one isolated area and miss the holistic perspective that’s needed to produce meaningful results.”

Mortenson says that Health Advocate’s clients and members face four main challenges. First, employees encounter risks associated with high-deductible health plans. Second, companies struggle to increase user engagement with their health programs at the same time that they want to see quick returns on their investments. Simultaneously, their claims costs continue to rise without a clear understanding as to the reasons why. And finally, employers often offer so many different programs that employees may not realize what is available or how separate services are all connected.

Health Advocate addresses these issues by simplifying and clarifying healthcare for its members. A consultative approach is used to garner information from members through health risk-assessment questionnaires and, in some cases, biometric screenings. Claims data analysis is also used to help spot gaps in care, such as missed physicals or inconsistent diabetes care management, as well as pinpoint sources of care costs and identify chronic conditions that may need to be addressed.

“We work with our clients to understand their goals and issues, and then we recommend services and programs that will help meet the needs of the employee population,” Mortenson says. “Otherwise, you’re throwing a lot of darts and hoping one or two of them actually hit something that produces the value you’re looking for.”

Once those issues and priorities have been assessed, Health Advocate helps employers connect appropriate programs and services to the right employees. This is accomplished through both print and digital communications, as well as person-to-person interactions. Employees can call a single number that connects them with a Personal Health Advocate. From this single point of contact, they can then get answers to questions about their health plan options or referrals for second opinions, among other types of assistance.

In addition to these interactions, personalized digital programs have also proven to be effective. The Smart Goals program, which recently completed its pilot phase, sends text messages about personal goals, such as daily diet and exercise reminders. The results have been staggering, as a reported 95 percent of participants completed the pilot program, 68 percent agreed to continue their participation, and a majority felt that the program helped them achieve their health goals.

In the spring of 2017, a major upgrade of Health Advocate’s member portal and mobile app was also rolled out. Improvements increased the ease of use as well as the value of the available information. Although available services vary by employer, members can find health plan information, health and wellness advice, health procedure cost estimates, information about various incentive programs and fitness challenges, and tools to help track their levels of participation in the programs.

Since the launch, member visits to the online portal increased by roughly 55 percent, and first-time downloads of the mobile app jumped by 129 percent. There have also been more than two million actions tracked indicating that members took specific steps to improve their health.

“The combination of so much information developed for specific users who can access it through so many different channels is what makes our approach successful,” Mortenson explains. “Having digital solutions in addition to live coaches and nurses enables us to address everyone’s preferences and a variety of needs.”

Mortenson often focuses with her clients on transitioning from traditional wellness programs that highlight physical fitness to well-being initiatives that emphasize a broader view of holistic health. In addition to physical conditioning and healthy eating, for example, the well-being approach could include support and advice for chronic illnesses, education on planning for retirement, guidance on finding a physician, and referrals for substance abuse.

“Overall physical fitness is obviously important, but we have to be sure to meet the needs of the entire person,” Mortenson says. “That means going beyond traditional exercise and medical visits.”

Mortenson speaks from experience. As an avid runner, she rediscovered the sport when her late husband was fighting a terminal illness. In addition to strengthening her cardiovascular system, running relieved some of her stress and gave her extra energy to care for him and her family.

“Running was a huge part of how I got through a very difficult time in my life,” Mortenson says. “I wouldn’t have been able to care for my husband the way I did without the benefits I got from taking care of myself by getting out on the road every morning.”

As a firm believer in a healthy lifestyle, she welcomes the opportunity to deliver that message to Health Advocate’s customers as often as possible.

Brett Christie | WorldatWork

As organizations become more invested in engagement, employee health and well-being programs are a point of emphasis. To maximize this form of engagement, organizations are increasing communication through technology.

However, as organizations add more health and wellness benefits, it leads to more platforms and the message becomes less concise and more confusing for employees, according to a new survey by Health Advocate.

The “Driving Benefits Engagement: Strategies to Optimize Employee Health and Well-Being Programs” survey found that the biggest challenge for 44% of organizations that work with multiple partners or vendors for benefits is that the experience is disjointed and confusing for employees. And 40% said there is a lack of utilization as a result, as well as technological issues in integrating systems (35%).

A significant reason for the lack of utilization is employee fatigue stemming from multiple logins and multiple notifications from these separate vendors. Where organizations can improve this issue is through consolidation.

“One of the approaches for those different challenges is having all those different benefits on one platform, so that all the messages are coming from one place,” said Marcia Otto, Vice President of Product at Health Advocate. “It’s really tying together data in so many different ways to personalize messages to target members, so they will participate and be aware of the benefits that they have.”

The survey, which included responses from more than 300 HR and benefits managers, found that 60% of respondents said that a single platform “presents each employee with a single point of contact that is personalized, intuitive and interactive.” To further drive home the need for consolidation, 46% said it improves employee engagement with benefits.

Aside from consolidation of benefits data, a critical element to having an effective wellness program is the human touch. The survey of HR and benefits managers found that 82% said having some level of high-touch support increases employee engagement with their benefits. And a majority (78%) offer employees access to live support to help with health goals and benefits navigation.

“What this survey and many other surveys have shown is not only having all the benefits in one place to have a unified message, but to have the high-touch component of being able to call somebody with your questions,” Otto said. “One phone number and one person to help you navigate all the different benefits that you have to help steer you in the right direction ­— that’s one of the biggest points of the survey. In this world that’s moving toward everything being digitally touched, we want to point out that there’s a human touch, that shows that not everybody wants to do everything on their phone and they want a live person to talk to.”

Having both of these elements — an easy-to-navigate digital system as well as live personal support from an expert — is the ideal combination to a successful benefits program that will drive engagement, the survey concluded.

Episode 14: Health and Benefits for Higher Ed

Colleges and universities are unique when it comes to providing healthcare and other benefits and resources to their populations, including faculty, staff and students. In this episode of Health Advocate’s Ask the Expert series, we welcome back Matt Verdecchia, Senior Trainer and Organizational Development Lead with Health Advocate’s EAP+Work/Life division, to discuss health and benefits issues specifically impacting higher education institutions.

HR Daily Advisor

A new survey conducted among HR and benefits managers on employee benefits engagement and utilization has found that despite the ongoing growth of technology, employees desire personalized, human interaction.

This was among the findings of the Driving Benefits Engagement survey by Health Advocate.  Specifically, 78% of respondents said that they offer employees access to live support to help with health goals and benefits navigation, while 80% confirmed that having some level of “high-touch” support increases employee engagement with their benefits.

As explained by Health Advocate in its survey report, “when it comes to navigating the often tricky and sensitive nature of health and wellness benefits, the importance of relying on and interacting with another person – rather than a screen – can’t be underestimated or understated. ”

The survey further found that the consolidation of vendors and platforms may be advantageous when it comes to employee engagement and utilization: 44% of respondents noted that working with multiple vendors creates confusion for employees and 40% said that this “fragmentation” of benefits results in a lack of utilization.

Meanwhile, more than half (54%) of respondents said that used separate benefit tools (with separate user interfaces requiring separate logons).   But 6 in 10 respondents agreed that integrating benefits into a single platform “presents each employee with a single point of contact that is personalized, intuitive and interactive” and 46% believe using a single platform for accessing benefits improves engagement.

The full survey report is available from Health