Managing healthcare for employees has become an increasingly complex task. Despite employers’ best efforts, HR and benefits leaders continue to report feeling overwhelmed by the evolving demands of population health and system complexity.
Far from being an abstract challenge, healthcare complexity directly impacts real-world health outcomes, productivity and employee satisfaction. At Skai Blue Cross Blue Shield we asked questions that need answers like: What factors have led to the overcomplication of employer-sponsored healthcare? And, having understood them, how can they be resolved?
Population health complexity
Chronic diseases are increasingly impacting more Americans, and at earlier ages than before. In fact, 59.5% of young adults and 78.4% of middle-aged adults report one or more chronic conditions. The growing prevalence of chronic conditions is a major driver of increasing healthcare costs and an extremely complex issue for employers to navigate. At the same time, workforces are more diverse, face a wider range of needs and are more vulnerable to health inequities. Disparities in preventive and mental healthcare mean that underserved populations face higher chronic disease rates—and these health inequities cost the United States $93 billion in excess medical care each year. Adding to the challenge, turnover remains high: median job tenure is only five years, with annual turnover averaging 13.5% and even higher in blue-collar roles. Such churn makes it difficult for employers to sustain engagement in long-term health initiatives.
System complexity
An abundance of options and data and poor coordination compound these challenges. Point solutions continue to flood the market, with employers offering 4 to 9 on average while others juggle as many as 20. Without integration, employers struggle to measure ROI, while employees who are confused about benefits skip preventive or timely care. Evaluating vendor effectiveness adds further complexity, with one study finding the direct cost of vendor reassessment totaled $21.57 billion. Many organizations avoid these costs entirely, sticking with the same point solutions regardless of fit.
Employers are drowning in data: More information than ever is available on population health, yet annual turnover means it must be analyzed continually to stay relevant. Fragmentation in the healthcare system leads to additional inefficiency, with coordination between providers becoming both essential and elusive. This can result in overtreatment via duplicative or unnecessary services, which account for up to 30% of healthcare costs.
The Skai solution: strategic integration
At Skai Blue Cross Blue Shield, we know employers don’t need more tools: They need a better way to manage them. Our integrated strategy enables smarter, less resource-intensive approaches and a better member experience.
1. Workforce insight beyond clinical data
Since 80% of outcomes stem from social, behavioral and environmental factors, we combine medical records, claims and social determinants of health data to build a complete picture of workforce needs, present and future.
2. Smarter clinical solutions
Our Innovations Hub offers:
- Diverse point solutions for broad needs
- Rigorous vetting and measurement
- Neutral, third-party selection
- Seamless integration via cloud-based infrastructure
- Flexibility to align with existing vendors
- Streamlined contracting and administration
- Ongoing re-evaluation and market scanning
This is paired with a clinical approach that includes:
- Expertise in complex care management
- Integrated teams of nurses, social workers, physicians, pharmacists and advocates
- Early risk prediction to prevent catastrophic events
- Cohort-based outreach, stratified by risk level
- Whole-person care addressing physical, mental and social needs
- A whole-system approach to medical pharmacy
3. A simplified member experience
Through our collaboration with Celeste, members can access navigation, engagement and benefits management via a single app that acts as one front door for all their care.
4. Real-time insight for employers
Our analytics platform, Illume, turns complexity into clarity by providing:
- Benchmarking for cost, quality and utilization
- Market-level data to identify cost and quality opportunities
- A broad variety of data sources for a complete picture of plan impact
5. Behind-the-scenes coordination
Our care management, social work, pharmacy and utilization teams integrate directly with each member’s care plan to minimize unnecessary treatment and improve outcomes.
Future-ready benefits start here
Over the next five years, we can expect to see a clear distinction emerge between organizations that future-proof their health strategies and those that fall behind. With Gen Z continuing to enter the workforce, new care models on the rise, and shifting expectations from the AI revolution, benefits must evolve to keep up with the changing times. At Skai, we’re not just solving for the complexity of today: We’re positioning employers to lead the future of healthcare and build benefits their workforces deserve.
Read the full report for more
Interested in learning more about how we’re helping employers move from confusion to clarity with an integrated approach? Read our free report “Simplifying Complexity in the Healthcare System,” to see how we’re streamlining solutions, improving member experiences and delivering real ROI.
Skai Blue Cross Blue Shield is a health plan built for national employers who expect more than the status quo. Drawing on decades of experience with leading companies, Skai provides flexible, data-driven solutions tailored to each workforce.
To learn more, visit SkaiBlueCross.com.