Case Study Shows Benefits of Engaging Employees in Health Benefit Design

As open enrollment season for health insurance gets underway, a new case study shows that employees who are meaningfully engaged in deliberating and designing their health care benefits may have a more positive view of their coverage options.

As open enrollment season for health insurance gets underway, a case study released today shows that employees who are who are meaningfully engaged in deliberating and designing their health care benefits may have a more positive view of their coverage options.

The case study, “Prioritizing Health Care Spending: Engaging Employees in Health Care Benefit Design,” was based on an effort developed by Janet McNichol, SPHR, CAE, human resources director at the American Speech-Hearing-Language Association (ASHA), to redesign a benefit option offered at the association. Experts from George Mason University and the National Pharmaceutical Council contributed as co-authors.

The case study is especially relevant as more than half of insured Americans get their health insurance through their employers, but more costs have been shifted to employees in the form of deductibles, copayments and coinsurance. Between 2006-2016, total out-of-pocket expenses for people with employer-provided coverage rose 54%, while wages rose only 29% in the same period. Annual premiums for employer-sponsored family health coverage rose to an average of nearly $20,000 for a family plan in 2018.

“I wanted to develop a participatory, deliberative approach to learn what employees value the most in a health care plan, while increasing their understanding of health care benefits and the tradeoffs necessary to make the benefit affordable,” said Ms. McNichol. “By engaging employees in health benefit conversations, it helped us to better determine how to allocate our health care dollars.”

The case study describes a framework for engaging employees in the design of an employer-sponsored health benefit. ASHA employees were asked to participate in small group discussions using a gameboard featuring 12 categories of health care services (e.g. maternity, prescription drugs, mental health) with varying levels of coverage (good, better, best). Participants first created an individual health plan reflecting their individual coverage needs and preferences, then worked together to design a single health benefits plan for the organization. 

There were several key takeaways from the group discussions:

  • Exchanging or limiting types of care for the benefit of others. As employees discussed their health care needs and preferences in a group setting, individuals were willing to accept less robust coverage in certain areas of care, such as dental, vision and diagnostic benefits, so that the broader group could have access to more comprehensive mental health and maternity services.
  • Willingness to pay. Approximately half of the participants who completed a debrief survey following the group discussions were willing to pay more—roughly $38 per month—for additional coverage in one or more benefit category.
  • Satisfaction. Results from the debrief survey indicated that 92% of participants were satisfied or very satisfied with their individually designed plan, and 83% of participants were satisfied with the group plan. The small difference in satisfaction between the individually designed plan and the group-designed plan suggests a high level of buy-in to the process, despite significant movement from individuals’ ideal preferences.
  • Broader policy implications. If employees are engaged in the deliberation process, necessary limits on coverage may be more likely to be considered ethical and accepted as legitimate and fair. This type of consultative and deliberative process, appropriately modified for different circumstances and beneficiary groups, could be useful for broader discussion of health care spending tradeoffs.

The case study can be downloaded from NPC’s website. Along with Ms. McNichol, authors included Len M. Nichols, PhD, director, Center for Health Policy Research and Ethics, and professor of Health Policy, George Mason University; Shruti Aiyar, MS, graduate research assistant, Center for Health Policy Research and Ethics, George Mason University; Lisabeth Buelt, MPH, research associate, Michael Ciarametaro, MBA, vice president, research, and Robert W. Dubois, MD, PhD, chief science officer, all of NPC. NPC provided funding for the written case study.

About the National Pharmaceutical Council

The National Pharmaceutical Council is a health policy research organization dedicated to the advancement of good evidence and science, and to fostering an environment in the United States that supports medical innovation. Founded in 1953 and supported by the nation’s major research-based pharmaceutical companies, NPC focuses on research development, information dissemination, and education on the critical issues of evidence, innovation and the value of medicines for patients. For more information, visit and follow NPC on Twitter @npcnow.

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