Field Notes I Global Benefits I Mental Health is Definitely the Focus, ONEM Has an Edge

Background: Our contact has spent nearly 10 years in benefits, starting out with a US self-funded plan and got a feel for core benefits, life, disability, mental as well as supplemental, telehealth, fertility, etc. Also has a few years' experience in non-US markets/benefits, and over the last few years has had global responsibilities for 2,500-3,000 employees (from new grads and interns -> retired, average age skews younger: early 30s).

What's been your main focus recently? We hear about a focus on telehealth, metabolic, and mental health (people talk about them being bound together)...what bins are you looking at?

• Mental health - we've doubled-down there due to the pandemic.
• We are not trying to "out-benefit" everyone (Google and Facebook want to offer every benefit). I want the 15-20 that make the most sense. It can be difficult to educate/market internally, and we always want care pathways - one to another - and things are becoming more complex. By complex I mean that bringing on new partners is more complicated: security reviews, NDAs, MSAs take more time. We won't do a deal unless we feel strongly about the partner.
• We've become more interested in coordinated care for the member experience b/c employees don't care what the back end is like. It's all about about the experience - talking to a psychiatrist, but the PCP doesn't know, is not a good experience (need connected care). We can't have the employee coordinating.

Example?

• Mental health/well being - frequently people w/ mental health challenges have other things going on. The company only gets a snapshot by vendor, so we're late to know someone is in crisis (hear from EAP or see in emergency care remittance. We're not getting a full picture of the person/member - they could look like six different people or one engaging in different places.
• At the extreme end - psych issues, but more recently it's been burnout and anxiety - e.g., not sleeping well, and the PCP might pick up on a hint, or an anxious employee might be engaged w/ coaches or therapists - CBT is the bucket that's much more common and there's a huge amount of opportunity to provide resources for course correction before anything escalates. Having one entry point that can guide to a range of resources for low anxiety or depression is an ideal situation (a "graduating" model or approach w/ members progressing as needed).

What's the uptake for these benefits?

• We're seeing increasing participation, especially with a new vendor meeting the need (or because people are in crisis - hard to tell). Lyra is the vendor. We looked at Modern Health, had worked with Joyable (acquired by AbleTo). 
• Also, seeking help is becoming more culturally accepted.

Do you have any diabetes, weight loss, other metabolic w/ your workforce?

• I try to keep an eye on preventive models like Virta - I'd like to roll out before people need it, but it's hard to make the pitch.
• Our base is younger, less likely to be overweight, and on average a bit healthier and higher income, so they are less in need.
• For telemedicine, we have actually worked with One Medical (ONEM) for years. There's a PMPM but w/ ONEM near some of our offices, we had employees begging for it and a good number were paying for it. So, offices close plus telemed = it made sense. 

Are you starting to worry about telehealth utilization or utility to employees as a standalone?

• No. We doubled-down on it during the pandemic because we started to see more ER visits - hypothesis, direct people to call into ONEM = win/win, then the doctors just send people who need to go to ER to the ER. The reassurance for parents with kids was very positively received.
• Is ONEM special? Last one we looked at otherwise was Parsley Health - for younger demographic, for family planning, getting pregnant. But the tech that ONEM provides is so much easier to use than anything else: Rx, appointments, etc. Their tech still feels above and beyond what's offered out there, and employees want that "Uber experience" - great UI, great UX... that experience matters; ONEM provides it. Parsley was tempting though.
• We have a fairly mobile population with people transferring - I'd say about 90% sign up for ONEM.
• The other thing is ONEM works as an entry point to see other specialists, but even for employees that have a PCP and are covered by the health plan, the telemed with ONEM feels value-add.
• Does ONEM actually save you money? It wasn't quite what they sold us, but it still made/makes sense. It's a no-brainer if they have a presence near your office(s).
• If we didn't have telehealth, we'd be looking to add it - now, there's a general push for specialty providers that offer it.

Is there harmony between ex-US and US?

• For Teladoc you mean? Yes and no. I've looked at a lot and there's Babylon in the UK, for example, but a lot of international depends on the local markets and public health systems. There are some cultural issues too - people are used to engaging care in certain ways. It's tricky. Ex-pats use telehealth through the health plan. 

Do health plans try to sell you on adding telehealth through them?

• All the time. The price points don't make sense. Employees are getting it "for free" and it's still not compelling enough vs. ONEM - nothing has been close.
• OK, what would it take to dump ONEM? We monitor utilization closely - who is engaging, how they are engaging, etc. If those NPS or satisfaction scores slipped or we saw other concerning feedback flags that indicated ONEM wasn't adapting to the needs of members. 

Are you familiar with Livongo?

• Yes, but no. I would be more interested if saw a need in our claims data.
• With mental health, diabetes, etc. we don't need to see employee-specific data. What we see in aggregate is helpful and interesting (e.g., topics people go to coaches for vs. therapists).

What about MyStrengh/BetterHelp - Teladoc's mental health offering. Have you heard of or tried them?

• No, I haven't seen them. We piloted Ginger, had a partnership w/ Headspace, but Lyra was just very positively received. 
• We've heard that before - why do they stand out? Access to care. If a member is in a bad mental state, the last thing they want to do is be on Zocdoc finding someone. They want someone that protects anonymity and to have access to care - they do w/ Lyra, which makes super quick connections and allows for filtering on all sorts of criteria (it's a great network). We cover X number of sessions, and then rest is through insurance w/ copays. It's very easy, completely confidential, and we like the different grading of support. They offer groups too - e.g., a parents group that was helpful during home schooling.
• What about ONEM's [mental health]? I've seen it, but they aren't pushing it. Combining things is great, but only if the things are best-in-class. This is where going with best-in-class point solutions makes sense. 

We hear that smaller companies prefer platforms and larger will do point solutions...

• A lot of it depends on internal resources - if one person is running HR, they don't have time for vendor management. If you bring a Lyra in to do session on something for your members, it takes time and effort. It also takes time and effort to implement. 

Curious - with diabetes as a % of total - if 25% of people have some sort of metabolic issue - where do you fall?

• Maybe 20%, max. It's not high enough. It's like a revamp of wellness programs. We are more inclined to have someone on site doing scans, screens, etc. for pre-diabetes or do at-risk assessments. I'd need to see more data on Livongo or these chronic care programs to figure out what to add on next. 

More recently there's been an inability for some providers to hire and meet demand - mental health is one area where demand is clearly high. Do you worry about vendors being able to meet demand?

• I've seen that a little bit in mental health and primary care in general. I think it's a combination of staffing and fluctuating demand - also, everyone has been deferring care. But as vaccines came about, we heard of massive waits for different things (US and OUS). An international vendor was having trouble meeting turnaround times and levels of service that they had committed to.
• We haven't seen an uptick in acuity from claims data, but we did see a lot of deferral since May 2020. One thing about ONEM is the push notifications - those are very helpful. We use Collective Health and ONEM for that - we can't send reminders. 
• There's still some deferral going on. I think it'll be a trickle back - it's not a light switch. Providers will chip away.

What about the switch from PMPM to per engaged member?

• I definitely want to pay per engaged member per month or based on actual utilization. If a vendor is as good as they say, they make more. If not, or if you're not meeting our needs, we're not paying or what we're not using. This puts more pressure on the vendor, but it also makes for a better relationship/partnership and feels lower risk - especially in the first year when it's hard to know what engagement will look like.