building blocks of health care confidence...building blocks of health care confidence • fidelity...

BUILDING BLOCKS OF HEALTH CARE

CONFIDENCE

HEALTH SOLUTIONS THOUGHT LEADERSHIP

2Building blocks of health care confidence • Fidelity Health Solutions Thought Leadership

Executive summary

Fidelity believes confidence is key to consumers being motivated to and capable of managing their health. But

how can we help people build confidence? Employers are positioned to influence how well people engage in all aspect of their health care through culture, policies, benefits, and services. With the right level of support, people can learn how to make better health decisions with confidence, leading to a greater likelihood of financial security.

To this end, Fidelity has developed a Health Care Engagement Framework that includes five dimensions across the health care experience: Health Status, Healthy Behaviors, Preventive Care & Treatment, Cost & Quality of Care, and Planning for the Future.

Our model is grounded in leading academic theories and has been validated by a survey of more than 5,000 respondents with representative samples across age, gender, race/ethnicity, income, and education.

Our findings indicate:

• Four dimensions significantly impact confidence in health care decisions, with Cost & Quality of Care and Planning for the Future mattering the most.

• These dimensions are highly interrelated, so that improvements in one dimension may create improvements in others.

• The framework is consistent across key demographic variables (age, gender, race/ethnicity, income, and education); however, we see substantial variation in how different subgroups are performing in each dimension.

• Consumers fall into five categories based on how they engage with their health care, ranging from people who struggle across

all dimensions to those who do well across the board. Neither age nor chronic illness drives where someone might fall on this spectrum.

Our approach offers employers deep insights into the challenges their employees face around health care. The framework enables data-driven decisions about how and where employers can intervene to help improve confidence in their employees. By applying this framework, employers can assess the greatest needs of their workforce and understand how to allocate their resources in the most meaningful way—all with the goal of helping employees build health care confidence to achieve a greater sense of financial security.

F ide l i ty ’s Hea l th Care Engagement Framework g ives employers the power to bu i ld a benef i t s s t ra tegy that a l igns to the d iverse needs of the i r workforce .


C O N F I D E N C E : A C R I T I C A L L I N K I N T H E C H A I N

Increasedengagement

Consumers don’t shop for health care the way they do for

other things. Engaging them in

the right way helps them build knowledge

and experience.

Greaterconfidence

Confident consumers make better decisions

around their health care.

Lower costsBetter

decision-making helps bring costs

down for both employees and

employers.

Financialsecurity Controlling health care

costs means a greater

likelihood of financial security.

Totalwell-being

Employees who have their health and finances under

control are happier and more engaged at

work and beyond.


ContentsExecutive summary 2

The growing importance of health care to financial security 5

Fidelity’s health care engagement framework 7

A deeper look into each dimension of health care 9

How the dimensions are interrelated and impact confidence 11

Different groups have different strengths 14

5 key health care engagement categories 18

How our framework can benefit organizations 25

Benefits for each dimension of health care 28

In conclusion 29

Acknowledgments 30


The evolution of health care to a consumer-driven model requires workers to become increasingly

adept at navigating their own health care. However, this shift does not mean people are ready, willing, and able to take on the responsibility. It brings to mind the transition from pensions to defined contribution retirement plans (401(k)s and 403(b)s) that required workers to take on responsibility for their own financial futures.

With the rising costs of health care and the expense of health care in retirement, it is vital that there is the same support for health care decisions as there is now for financial decisions. Like financial decisions, health decisions are complex

and high stakes. At the same time, health care decisions have vast and distinct considerations beyond the financial that can impact the quality of everyday living.

Helping people prepare for a lifetime of security when it comes to health costs cannot start in retirement; it needs to happen now. Fidelity’s Total Well-Being research shows that health is the primary driver of financial wellness over all other aspects of well-being. The health care decisions they make each day have a strong impact on their finances. As consumerism grows, so too does the number of health decisions being left up to the individual. Picking the right health care plan, being prepared for unexpected health setbacks, and using employer-

The growing importance of health care to financial security

$11,172Average spending on health care per person in the United States in 20191

$295,000Average health care spending in retirement for a couple retiring in 20202


sponsored benefits wisely are all critical, but too many employees only engage with these issues once a year, at annual enrollment. Consumers need to gather the tools necessary for adeptly engaging in health care, from practicing self-care to interacting with health care providers and successfully navigating systems to manage care today and prepare for the future. Through these avenues, consumers can cultivate experiences to help them handle all health care decisions with confidence.

At Fidelity, we know greater financial confidence breeds continued engagement and better progress toward financial security. As we focus more extensively on health care, we are finding confidence in health decisions to be just

as instrumental for managing health care. After conducting extensive research, our findings have led us to develop the Health Care Engagement Framework. This framework identifies the most important ways in which people engage with their health care and how each contributes to building confidence.

Seeing the impact financial confidence has on attaining financial security and the inextricable connection between

health and finances, we know helping people with their finances alone isn’t enough. With this in mind, Fidelity has spent the past two decades deepening our expertise in health care benefits and related behavior. We are applying this expertise to help guide customers in making informed and confident health care decisions. Only when we address health and financial needs together can we help our customers obtain a true sense of well-being.

At F ide l i ty, we know greater conf idence breeds cont inued engagement and bet ter dec is ion-mak ing when i t comes to f inances , and the same appears to be t rue regard ing hea l th care .


Fidelity Health Solutions Thought Leadership purposefully designed our research with a broad scope.

Our goal was to identify and assess the ways in which people engage with their health care across a full range of experiences. Taking this approach gives us a comprehensive view of people’s health needs related to healthy lifestyle choices, interacting with and navigating the health care system, and planning for health care in the future.

We also aligned to Fidelity’s Total Well-Being Framework, which outlines four dimensions of well-being: finances, health, work, and life. The Health Care Engagement Framework supports the deep connection between health and wealth while providing a deeper look at where to help people across all

dimensions of health, illuminating health care needs from multiple angles.

To ensure we measured health care engagement from all angles, we collaborated with industry thought leaders and academic partners, as well as reviewing existing in-house and academic frameworks from policy, public health, social sciences, and medicine. From this review, we created a set of key behaviors that consistently emerged as mattering most when defining health care. From this list, we identified common themes

and metrics that comprise those themes. We then used these findings to develop a quantitative survey of more than 250 behaviors that represented a full spectrum of health care experiences.

Using a nationally representative sample of more than 5,000 people with employer-sponsored health care coverage, five distinct dimensions emerged:

Fidelity’s Health Care Engagement Framework

The Heal th Care Engagement Framework ident i f ies the most important ways in which people engage wi th the i r hea l th care and how each cont r ibutes to bu i ld ing conf idence.


HEALTHY BEHAVIORS

PREVENTIVE CARE & TREATMENT

HEALTH STATUS

COST & QUALIT Y OF CARE

PLANNING FOR THE FU TURE

General self-care, including diet, water intake, exercise level, and quality of sleep

Preventive care, such as annual check-ups, screenings,

prescriptions use/upkeep

How people effectively access and managequality care at

a reasonable cost

Preparedness to pay for health care in the near and longterm,

and avoiding medical debt

Daily physical and mental health (no pain,

stress, negativity, chronic conditions, difficulty moving)

Because our goal was to determine how we can help customers build confidence with their health care decision-making, we looked specifically at the relationships between confidence and these factors. Only four of the five factors were found to be significant in driving health decision confidence. Health Status was not significant in driving confidence when accounting for the other four dimensions, so we did not include it in our final framework. Health Status is a key driver of a person’s well-being, however, so we treat this factor as an input in our analyses, similar to other demographic factors such as gender, race/ethnicity, income, and education.


Of the 250 elements we measured, 16 key elements emerged as most prominent. These elements are spread across the four health care dimensions and provide greater insight into improvement opportunities.

Within each dimension, we calculated how much each behavior mattered to the overall dimension score, or the sub-dimensional weights. These values reflect the relative contribution each behavioral element makes to its respective dimension. A value closest to “1” indicates the highest possible contribution, and “0” indicates no contribution. All elements included in the final model make a significant contribution to their overlying factor, but each varies in degree of importance.

A deeper look into each dimension of health care

* Composite indicator, comprising more than one question

HEALTHY BEHAVIORS




16 key behaviors

■ Quality sleep (+0.71)

■ Healthy diet (+0.71)

■ Enough water (+0.46)

■ Activity levels* (+0.38)

■ Blood work frequency (+0.66)

■ Number of prescriptions (+0.58)

■ Chronic condition care (+0.52)

■ Short-term care (+0.43)

■ Regular checkups (+0.40)

■ Desirable insurance coverage* (+0.75)

■ Trust in sources (+0.58)

■ Use care wisely (+0.50)

■ Not avoiding care due to cost (+0.47)

■ Saving for retirement health care costs (+0.87)

■ Saving for near-term health care costs (+0.65)

■ No medical debt (+0.50)


To illustrate, for Healthy Behaviors, quality (not quantity) of sleep and healthy diet give you the most bang for your buck, with weights of 0.71 each. Their weights are greater than water intake (0.46) and activity levels (0.38). What does this mean? Although staying hydrated and getting plenty of activity are both important, assuming all other elements were equal, a person getting quality sleep most nights would score better on Healthy Behaviors compared to someone drinking eight glasses of water per day.

Next, to determine whether we had

developed an inclusive framework that could be applied to diverse workforces, we examined whether the structure of our framework was consistent across all demographic groups. Using a technique called multi-group structural equation modeling, we compared how well our dimensions and their linkages worked when we investigated group differences in gender, age, ethnicity, income, education, and presence of a chronic illness. We found that all factors and how they related to one another were consistent across demographic groups. These results demonstrate that the framework

is robust, scalable, and can be applied to heterogeneous workforces nationwide.

Once these dimensions were identified, we calculated an overall score for each health care dimension. These scores are based on how people performed in each dimension across each behavior, taking into account each sub-factor’s weighting. That is, those sub-factors with higher weightings counted more toward the overall score than those with lower weightings. We then normalized scores so that a score of 100 is the best possible outcome and a score of 0 is the worst.

66 61 43 61 48HEALTHY

BEHAVIORSPREVENTIVE CARE &

TREATMENTHEALTH STATUS COST & QUALITY

OF CAREPLANNING FOR

THE FUTURE

A V E R A G E O V E R A L L S C O R E S


How the dimensions are interrelated and impact confidenceInitially, we hypothesized there would be clear consensus that some factors would be more fundamental, requiring intervention first, and others would be more aspirational to be tackled once the fundamentals were covered. Instead, we found that all of these factors are interrelated. If someone was doing well on one aspect of their care, they were more likely to do well on all three other aspects.

The strong relationships between the factors allow for increased flexibility and adaptability when deciding where and how to intervene, as any dimension could be a good starting point, and improvements there could result in better outcomes for other factors.

For example, Healthy Behaviors has a

HEALTHY BEHAVIORS




+0.09

+0.63

+0.71

+0.71

+0.12

S T R E N G T H O F I N T E R C O N N E C T I O N SOn a scale of 0 to 1, with higher numbers indicating stronger influence


relationship with each of the other factors, but the strength of the relationship varies. Looking more closely, we see respondents who engage in healthier behaviors (diet, exercise, sleep) were more likely to feel that they had quality, cost-effective health coverage, kept up on their regular checkups, and had some savings put away for future health care costs.

Although we found that all dimensions play a role in confidence, Cost & Quality of Care and Planning for the Future had the largest impact. The data indicates that doing well in these two dimensions could help someone build up confidence to a greater degree than the other two dimensions. Specifically, our regression analysis estimates each dimension’s relative degree of importance from 0 to 1, with higher numbers indicating greater importance:

• Cost & Quality of Care (0.34)

• Planning for the Future (0.31)

• Healthy Behavior (0.21)

• Preventive Care & Treatment (0.07)

Given the interconnectivity of these dimensions with one another and how they relate to confidence, it’s clear that making improvements in one area could have a meaningful impact on other areas.

Now that we have developed a comprehensive, valid, and inclusive framework of health care engagement, we can apply it toward informing strategies for building health care confidence across populations of consumers. In particular, we can better target efforts

for those who are struggling in any one or all dimensions and connect them with benefits and solutions designed in a way that aligns with their needs. Like most complex subjects, there isn’t one solution that can tackle all needs at one stroke, nor is there a one-size-fits-all solution for each dimension. Not only do we have evidence of this in our findings that there are four distinct dimensions of health care engagement, there are distinct differences between subgroups within this sample as well. In the next section, we focus on groups for whom improving confidence will be especially vital to creating equity among health care consumers.

A l though we found that a l l d imens ions p l ay a ro le in conf idence, Cost & Qual i ty o f Care and P l anning for the Future had the l a rgest impact .


0.07

0.34

0.31

0.21Planning for the Future

Address by dealing with current costs and saving for the future. Employers should

consider providing estimates of health costs in retirement and savings vehicles to help

facilitate this, debt counselors, and medical billing review services.

I M P A C T O N C O N F I D E N C E A N D P O T E N T I A L I N T E R V E N T I O N S

Cost & Quality of Care

Reevaluate your health insurance plan: Is it easy for employees to see doctors they

want? Can they find quality doctors? Provide your employees with trustworthy, easily digestible

information about health care and finding the best care options.

Healthy Behaviors

Many employers already offer programs that promote healthy behavior, such as smoking cessation, accompanied with wellness incentives and promoting work-life balance. There also are

opportunities to promote better sleep and less sedentary behavior.

Preventive Care & Treatment

While the impact of this factor on confidence seems small, it is still significant. Consider

bringing preventive care to your employees through wellness days where they can get flu

shots, blood pressure checks, and blood work done.

Each dimension’s relative impact on confidence from 0 to 1, with higher numbers indicating greater importance


Different groups have different strengths

Although our Health Care Engagement Framework structure is consistent across groups, this

is not to say that there isn’t substantial variation in how well people are doing in each dimension. As expected, many differences between groups emerged.

First, we found significant differences in

health decision confidence, with men, Black/Latinx, high earners, and college graduates more likely to be very confident compared to their counterparts.

These results depict persistent and pervasive disparities in confidence similar to what we see when it comes to making financial decisions, with the exception of

Black/Latinx doing better than their white counterparts. Now that we know which levers matter to improve confidence, we may be able to mitigate the largest gender and socioeconomic disparities by aligning those levers with which needs are most pronounced.

% R A T I N G A B O V E - A V E R A G E C O N F I D E N C E I N H E A L T H D E C I S I O N - M A K I N G

58%48%

Men Women

57% 52%

Black/Latinx

White

61%47%

Highincome

Lowincome

62%46%

College educated

Lesseducated


These charts illustrate how well each demographic group is doing across all four health care dimensions. The farther out each point is on the white diamonds, the better the rating.

G E N D E R

C H R O N I C C O N D I T I O N

G E N E R A T I O N

H O U S E H O L D I N C O M E

R A C E / E T H N I C I T Y

E D U C A T I O N

Healthy Behaviors

Preventive Care &

Treatment


Planning for the Future

Preventive Care &

Treatment


Preventive Care &

Treatment


Preventive Care &

Treatment


Preventive Care &

Treatment


Preventive Care &

Treatment


Healthy Behaviors


Healthy Behaviors


Healthy Behaviors


Healthy Behaviors


Healthy Behaviors


MEN

WOMEN GEN X

MILLENNIAL/GEN Z

BOOMER

WHITELATINX

BLACK

<$50K

$50K-$99K$100K+NO CHRONIC

CONDITION

CHRONIC CONDITION

COLLEGE+

<COLLEGE


Let’s look at two comparisons, income and gender.

Not surprisingly, those with higher income do better across Healthy Behaviors, Cost & Quality of Care, and Planning for the Future. There are no income effects, however, on how well people engage with Preventive Care & Treatment.

In terms of gender, we see on the next page that men did better than women in all four health care dimensions except Preventive Care & Treatment where men scored lower as compared to women. Also, for both men and women, the scores for Preventive Care & Treatment fall closer to the middle of the chart, suggesting people aren’t under- or overutilizing care (that’s a good thing).

I N C O M E




Healthy Behaviors

Health Status

■ <$100K ■ $100K+

6569

5963

5963

4355

4343

Where lower earners lead

• Moderate exercise (+1)

• Trust in health insurer (+1)

• Sedentary behavior (+6)

Where high earners lead

• Healthy diet (+12)

• Quality sleep (+11)

• Quality health care coverage (+11)

• Setting aside money for current health care (+12) and health care in retirement (+17)


If we dive deeper, we see men score better than women across Healthy Behaviors, Cost & Quality of Care, and Planning for the Future. But women excel by engaging in all aspects of Preventive Care & Treatment, where they lead in ongoing care and filling prescriptions in the past year.

Whether we identify which dimension shows the largest gap or we delve deeper to identify which specific behavior might be the strongest driver of that gap, these results illuminate precise engagement pathways that are likely to progress a workforce toward a more equitable environment made up of highly confident health care consumers.

G E N D E R




Healthy Behaviors

Health Status

■ Men ■ Women

3236

6458

4245

63

58

53

42

Where women lead

• Filling prescriptions (+10)

• Ongoing care (+9)

Where men lead

• Healthy diet (+9)

• Quality sleep (+8)

• Physical activity (+8)

• Trusting sources (+8)

• Saving for health care in retirement (+13)

• Having money set aside for health care expenses (+12)

• Avoiding medical debt (+8)


5 key health care engagement categories

In some cases, employers may not be able to target employees based on demographic characteristics, or these

characteristics may be too crude to accurately describe an especially diverse subgroup. In this case, using data to define groups based on patterns of their health care behaviors might offer more precise insights for designing personalized strategies, products, solutions, and research insights.

To demonstrate, we conducted a cluster analysis in which we identified five distinct groups according to how they behave in each of the four dimensions of engagement. These groups, outlined on the following pages, vary based on the dimensions in which they are scoring well. We used those insights to ascertain what kind of help is needed.

All of these groups vary in terms of their demographic characteristics. We also compared their average ratings on health care decision confidence and total well-being, while controlling for each of the demographic characteristics shown. We’ve identified each cluster in terms of how well they are doing and highlight select, standout pain points.

At one end of the spectrum, individuals we identify as Facing Challenges make

up 18% of the sample and are more likely to be female than male, but less likely to have completed college, and are doing worse across all dimensions. We then dove into which metrics account for these poor scores. Although this group did tend to do worse on every metric than other groups, some that were especially in need of attention included sleep, exercise, getting affordable quality care, and trusting health resources, as well as addressing medical debt.

Our ana lys i s y ie lded f ive key categor ies based on the d imens ions in which people are scor ing wel l . They range f rom those who score poor ly across a l l four d imens ions to those who do un i formly wel l . Each group h igh l ights un ique opportun i t ies .


At the other end of the spectrum, we see Health Savvy consumers who are doing exceptionally well, especially in Planning for the Future. There is still some room for improvement, however, which might include more advanced ways to save

for health care in retirement, such as investing the money they save in a health savings account. Importantly, as you look across the spectrum of categories, you see a linear increase in both confidence ratings and total well-being. So, as people

are better at engaging in all dimensions of health care, they are also doing better in terms of having the confidence to continue doing so and, ultimately, experiencing higher levels of well-being.

F A C I N G C H A L L E N G E S

Percentage of survey population

U N E N G A G E D P R E S E N T - F O C U S E D S E L F - R E L I A N TH E A L T HS A V V Y

18% 19% 26% 17% 20%

H E A L T H D E C I S I O N C O N F I D E N C E S C O R E

T O T A L W E L L - B E I N G S C O R E

2.5 3.0 3.1 3.5 4.1

Both scores are on a scale of 1-5

2.7 3.1 3.4 3.7 4.2


Facing challenges

C A T E G O R Y 1

18% of people are truly facing challenges across the board. They sleep poorly and don’t exercise enough. They also struggle to find affordable,

quality care. Many also are saddled with medical debt. It’s no wonder that both their confidence and total well-being scores are low. This category has more women than any other group and has the fewest people with a college degree. More than 60% have a chronic condition, but this alone isn’t a barrier to doing better—a similar percentage of more confident groups also have a chronic condition.

45 46

12 43

HEALTHY BEHAVIORS


PLANNING FOR THE FUTURE

COST & QUALITYOF CARE

Average age 41

Women 61%

Non-white 17%

College graduate 32%

Chronic condition 62%

Engagement opportunities

• Healthy Behaviors: Focus on better sleep quality and exercise habits

• Cost & Quality of Care: Provide education and guides for choosing affordable, quality care and finding trusted sources

• Planning for the Future: Help set up goals for paying down medical debt

Targeted benefits

• Health navigator

• Health coach

• Financial planning


Unengaged

C A T E G O R Y 2

19% are not exactly struggling, but they don’t actively engage in their care. These unengaged consumers do pretty well with healthy behaviors,

although they could sleep better and exercise more. But they fall far short in the Preventive Care & Treatment domain, including getting annual checkups and preventive screenings, and planning for the future. Only 24% have a chronic condition, so they likely don’t need ongoing care and may only seek care when they are acutely ill.

58 19

37 56

HEALTHY BEHAVIORS




Average age 40

Women 44%

Non-white 28%




• Healthy Behaviors: Focus on better sleep quality and exercise habits

• Preventive Care & Treatment: Encourage annual checkups and screenings, and educate about preventive services

• Planning for the Future: Provide basic education on health savings accounts as a way to save for the unexpected

Targeted benefits

• Health savings account

• Telemedicine

• Wellness programs


Present-focused

C A T E G O R Y 3

26% of people are present-focused—the most common category. These individuals fall short largely in one area: planning for the future. They

practice healthy behaviors—although they could get more exercise and eat better—and they’re reasonably satisfied with the cost and quality of care they receive, but they’re not saving for the unexpected. Two-thirds of those who are present-focused have a chronic condition, the highest percentage across all the categories. They are focused on today at the expense of tomorrow.

60 55

38 63

HEALTHY BEHAVIORS




Average age 43

Women 51%

Non-white 24%




• Healthy Behaviors: Promote more exercise and healthy food options

• Preventive Care & Treatment: Remind or facilitate recommended screenings

• Planning for the Future: Make opening HSAs and contributions easy, and emphasize its value for today and the near future

Targeted benefits


• Telemedicine

• Health coach


Self-reliant

C A T E G O R Y 4

17% of people fall short in one area specifically: preventive care and treatment. These self-reliant individuals do fine at taking care of themselves, but they

don’t seek care from professionals. They fall far short in following recommendations for preventive care and screenings, but they also could take a little better care of themselves, specifically getting more exercise and drinking more water.

61 31

76 62

HEALTHY BEHAVIORS




Average age 42

Women 41%

Non-white 24%




• Healthy Behaviors: Promote more exercise and hydration practices

• Preventive Care & Treatment: Remind or facilitate recommended screenings

• Planning for the Future: Provide education on using an HSA for long-term saving

Targeted benefits


• Health center

• Wellness incentives


Health savvy

C A T E G O R Y 5

20% of people fall into this category, which corresponds with the highest levels of confidence and total well-being. The Health Savvy group scores well

across all four dimensions. Their score in Preventive Care & Treatment may look low, but it hits a sweet spot—a higher score could mean they are overutilizing care. This category has the highest proportion of college-educated and non-white individuals, and a lower proportion of women.

78 57

81 75

HEALTHY BEHAVIORS

PREVENTIVE CARE& TREATMENT



Average age 40

Women 32%

Non-white 30%




• Healthy Behaviors: Promote more exercise and less sitting

• Preventive Care & Treatment: Encourage recommended screenings

• Planning for the Future: Provide information on using an HSA for investing and long-term saving

Targeted benefits

• HSA investment options

• Financial planning support

• Health coach


Using Fidelity’s framework, employers can choose where to focus as they develop an overall

health care and engagement strategy to build a happier, more productive workforce. There are other health care models, but many do not take into account all four dimensions of health care at the same time. Other approaches tend to focus either on healthy behaviors or utilizing and accessing the health care system. If we take the lens of managing all facets of health care, we can gain a broader understanding that fully captures consumers’ experience of health care from beginning to end.

How our framework can benefit organizations

Apply insights to inform your interventions

In addition to building confidence, fostering engagement in the four domains of health care can help employers achieve specific organizational goals. The accompanying table shows which dimension plays the most important role in achieving some common organizational goals.

We believe confidence is a powerful place to start, but we recognize employers may have other goals too. Here are some common ones and which dimensions matter most.

If your goal is ... Focus on ...

Improved mental health

Healthy Behaviors

Increased trust in employer health care recommendations

Healthy Behaviors, Cost & Quality of Care

Lower absenteeism Planning for the Future


Evaluate your current health risk assessment

Many organizations gather some data on their employees’ health, but there are gaps. Overlooking one or two dimensions may lead employers to misinterpret employees’ pain points or key drivers of consumer confidence and well-being. There is also risk that the value on investment for many benefits will be missed without assessing their impact on all dimensions. Creating a more comprehensive view on how your employees are faring and feeling about making confident health care decisions could guide you to more meaningful actions and benefits to offer. If this is too difficult, begin with the category analysis presented here as these types of people exist within any organization.

Foster equitable health care outcomes

Disparities in health care behaviors and outcomes are apt to grow as workforces become more diverse, health care decisions become more complex, and costs increase, further widening gaps between groups of employees. Targeting sources of key outcomes, such as confidence, offers clear pathways to mitigating those disparities. In this research, we find that the group differences observed in confidence are completely attenuated when accounting for how well people are doing in all four health care dimensions.

Understanding differences in demographic groups offers insight into more tailored solutions. This approach allows an employer to highlight opportunities that might otherwise be overlooked (i.e., if one group scores high and another scores low, these will cancel each other out so an organization may assume the workforce is average overall). A deeper look

at a key demographic comparison allows employers to see who is doing well and who is not, as well as which solutions are scalable and which may require tailoring. Employers and their employees might welcome the benefit, depending on the cohort group. As an example, you might look at key demographic groups and offer a specific benefit that you think will work as a pilot. Then, see how it works and decide if it’s scalable.


Look at collective “weak” areas

Zeroing in on a dimension that is particularly weak can give an employer a strategic focus area to evaluate, educate, and engage employees. Looking at benefits or services that can fill the gap and provide additional education to employees is a good way to start. For some of these factors, education could be more practical, such as tackling a topic around understanding an Explanation of Benefits (EOB) or a claim. If the opportunity area is around Preventive Care & Treatment, reminding employees about what care is covered in their high-deductible health plans without co-pays might be important, or even offering preventive care, such as holding an on-site clinic for flu shots or other vaccinations.

Create personalized plans

Partner with a firm that understands engagement and behavioral science and can help you create a personalized experience for your employees. This is not the easiest approach, but as health is very personal, it would be the most targeted. If demographic information about your employees won’t yield effective personalization, using general personas might be the best alternative. Otherwise, generating data that captures performance in all dimensions will provide employers with their own organization’s categories with data directly tied to the exact behaviors that need to be addressed. Depending on the size of a workforce along with organizational offerings, solutions, and strategic goals, a set number of categories can be chosen as a first step. Then, align the category scores and characteristics with new and existing engagement efforts to create a highly personalized course of action (e.g., messaging, informational topics, education, personalized portals) that also allows for scalability.

Track the value of your benefits

Instead of measuring ROI or physical health outcomes that take time and resources to accurately measure, the current framework can serve as a useful method for evaluating the utility of an employer’s benefits. For those benefits built to support health care, this framework helps to both unify how value is measured and also acknowledge that not all benefits were meant to influence the same employee behaviors. Employers can see how well employees score on health care engagement overall but also whether benefits, such as health navigators, are indeed helping employees find quality, affordable care they can trust (see the figure on the following page). This can be done with a quick snapshot comparing those who use the benefit, assessing scores before and after a benefit is offered or tracking people over time. Either way, applying this framework for strategizing or measurement gets directly to the heart of what health and wellness benefits are designed to do.


HSA

HSA/FSA

Chronic condition management

Alternative therapies

Mental health support

Stress management

Health planselection tools

Cost transparencyPhysician finder

Second opinion

Telemedicine

Chronic conditionmanagement HSA employer

contribution

Health navigator

Benefits optimization

Long-term care insurance

Retiree medical

Retiree health care cost estimate

Wellness centersNutrition counseling

Weight-loss programs

Fitness programs

Wellness incentives

Smoking cessation

Work-life balance programs

Benefits optimization

Legal support for health proxy

B E N E F I T S F O R E A C H D I M E N S I O N O F H E A L T H C A R EBenefits we measured and identified as having a statistically significant impact on engagement are listed in bold.

HEALTHY BEHAVIORS





In conclusion

Building confidence around health care has become a necessary life skill—whether it’s knowing the right

questions to ask, finding trusted tools and resources when needed, or planning ahead for unexpected (or expected) health care costs.

Fidelity’s Health Care Engagement Framework provides a deeper understanding of the dimensions of health care, what drives confidence, and key levers to pull as employers reimagine their health care benefits strategy.

Employers can use this information in actionable ways by identifing where their employees are struggling and what

interventions might be most valuable. And, as each dimension underlying this framework is highly interrelated, helping employees in one dimension will likely yield improvements in others, all working toward improving their level of confidence.

With this additional confidence, employees can better navigate and control their health care costs, allowing them a greater chance at financial security and a true sense of well-being. As an employer, instituting the learnings from this framework will help you cultivate a happier, healthier, and more productive workforce.


A C K N O W L E D G M E N T S

Fidelity’s Health Care Engagement Framework was developed in collaboration with Dr. Lisa Berkman from Harvard’s School of Public Health and Dr. Ellen Peters from

the University of Oregon’s Center for Science Communication Research, in addition to several Fidelity clients and internal business partners. We thank our collaborators

for their thoughtful suggestions regarding the assessment methodology and insightful feedback on this paper. We also thank our health care and behavioral

experts for their participation on formulating our framework concept.

C O N T R I B U T O R SStan Dorsey

Nancy EmersonRobert Kennedy

Mary LiebmanBrittany Mathis

Sarah Raposo, Ph.D.

Aditi SharmaTamara Sims, Ph.D.

Pearce Weaver

• Margie Lachman, Ph.D., Brandeis University• Mirjam Stieger, Ph.D., Brandeis University• Erika Weisz, Ph.D., Harvard University• Laura Kubzansky, Ph.D., Harvard School of

Public Health

• Erika Sabbath, Ph.D., Boston College• Eileen McNeely, Ph.D., Harvard School of

Public Health• Patricia Rich, AllWays Health Partners• Vincent Capozzi, AllWays Health Partners

ABOUT FIDELITY’S HEALTH CARE ENGAGEMENT FRAMEWORK RESEARCH

Unless otherwise noted, data represents the Fidelity Investments Health Care Engagement Framework Research online survey of 5,014 employees. The survey was conducted by Greenwald and Associates, an independent third-party research firm, on behalf of Fidelity from February 20–March 5, 2020.

1 Kaiser Family Foundation analysis of Organisation for Economic Co-operation and Development and National Health Expenditure data. Health consumption does not include investments in structures, equipment, or research.

2 Fidelity Benefits Consulting estimate, 2020. Estimate based on a hypothetical couple retiring in 2020, 65 years old, with life expectancies that align with Society of Actuaries’ RP-2014 Healthy Annuitant rates with Mortality Improvements Scale MP-2016. Actual expenses may be more or less depending on actual health status, area of residence, and longevity. Estimate is net of taxes. The Fidelity Retiree Health Care Costs Estimate assumes individuals do not have employer-provided retiree health care coverage but do qualify for the federal government’s insurance program, Original Medicare. The calculation takes into account cost-sharing provisions (such as deductibles and coinsurance) associated with Medicare Part A and Part B (inpatient and outpatient medical insurance). It also considers Medicare Part D (prescription drug coverage) premiums and out-of-pocket costs, as well as certain services excluded by Original Medicare. The estimate does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care.

For plan sponsor use only.

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© 2020 FMR LLC. All rights reserved.

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