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Measuring Employee Satisfaction with Healthcare Benefits

Thursday, February 14, 2019   (0 Comments)
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Danielle Ledford, VP of Sales, Nonstop Wellness




How important is it that your employees are satisfied with their benefits? Probably more important than you think – especially when it comes to healthcare benefits.


A recent survey conducted by America’s Health Insurance Plans (AHIP) indicates that 56% of U.S. adults with employer-sponsored health benefits say that whether or not they like their health coverage is a key factor in deciding to stay at their current job. Another 46% say health insurance was either the deciding factor or a positive influence in choosing their current job. If your organization is concerned about its ability to attract and retain high-value employees, you should be paying attention.


   Taking a strategic approach to benefits plans

Employees’ perceptions of their health benefits matter. Considering that turnover rates at nonprofits hover around 19%, organizations that wish to be in a position to compete for top talent, and keep recruits happy and engaged once they are hired, need to make employee satisfaction with benefits a high priority. If satisfaction levels turn out to be low, you may need to look for more innovative benefits packages that are tailored to your employees’ specific needs.



Many forward-looking community health centers are doing just that, using benefits plans as a strategic tool for talent recruitment and retention. The Society for Human Resource Management (SHRM) reports that organizations that take a strategic approach to benefits are almost twice as likely as those that maintain the status quo to report better business performance and achieve better-than-average recruitment and retention rates. Progressive organizations understand that high levels of employee satisfaction are directly related to a more positive work environment, a healthier workforce and a better overall image for the organization as a whole.




   Measuring Satisfaction

Understanding your employees’ perceptions of your healthcare offerings should be the foundation of a strategic approach to benefits. But too often community health centers rely on anecdotal evidence when assessing employee satisfaction with benefit plans. Getting out of your office and talking to your employees is certainly a good first step. But a more precise, valuable and actionable approach is to conduct a formal survey of employee satisfaction that is tailored to your organization and is methodologically sound. It doesn’t have to be a time-consuming or complicated process. A standard employee engagement survey for small or midsize organizations can cost less than $1,000, and the return on that very modest investment is likely to be significant.



   Surveying employee engagement in the nonprofit sector: A case study

Unity Health Care, a 501(c)3 nonprofit community health center (CHC), was founded in the mid-1980s, to provide quality healthcare to homeless people in the Washington, DC area. Today, Unity not only serves those facing homelessness; it provides primary and specialty care for all DC residents. including thousands of “disadvantaged, disenfranchised” Washington residents with a range of services in 29 facilities.



Unity is a member of the National Association of Community Health Centers (NACHC), and uses the employee survey firm Insightlink as its survey provider. Insightlink is an NACHC partner and approved vendor that specializes in measuring employee satisfaction and engagement based off its proprietary 4Cs survey called StaffPulse, which focuses on commitment, culture, communications and compensation. The development of StaffPulse was a coordinated effort between NACHC, representatives from health centers, and state and regional primary care associations (PCAs).The questionnaire for employees is customized specifically for use by health centers and was fully tested for both content and usability. The company also conducts an online survey called ExitPulse, which allows health centers to easily survey departing employees to track their reasons for leaving and their attitudes toward the health center.


Giving employees a voice

 Unity’s benefits manager, S. Michele Ottley, has worked for the organization for 10 years, and throughout that period employee satisfaction surveys have been commonplace. Unity uses a range of surveys that gauge employee morale, satisfaction with the benefits package, overall engagement and other topics to inform its internal strategic plan.


“The value of a survey is getting an employee’s perspective,” says Ottley. “It can be very difficult, even impossible, to get information in an employee conversation. Because we can’t have that kind of one-on-one engagement, the survey gives the employee a voice. It allows us to capture the information, to find out where we are doing well and where we can we do better. It takes the pulse of our organization and employees, and helps us decide where to implement change.”



Surveys managed by Insightlink have shown that CHC benefits must be “good enough” to compete with other employers, says Marilyn Mitchell, a senior researcher at Insightlink. “You want to make sure benefits aren’t undercutting your retention and recruitment efforts. Ideally, they are good enough so people can focus on other areas,” such as the mission that drives the organization.


After commissioning many annual surveys at Unity, Ottley notes the organization’s benefits package – and especially health insurance coverage – “is always among the top three factors for satisfaction” for its employees. A few years ago, Unity had switched to a high deductible health plan, with the employer covering some of the deductibles. But as the employee share of costs continued to rise year after year, employees expressed dissatisfaction in recent surveys with their remaining exposure to co-pays, deductibles and total out-of-pocket costs.


Survey findings reveal employees are avoiding care

 “We found out people were avoiding care” due to the remaining exposure in out-of-pocket costs, Ottley says. A year ago, when premiums with their carrier were about to increase again, Unity’s President/CEO, Vincent A. Keane, took a risk and made a decision to leave the traditional fully-insured model of health insurance, opting instead for a partially self-insured program called Nonstop Wellness. The new program gave Unity greater financial control over healthcare spending by immediately reducing premiums and employee out-of-pocket costs, and allowed Unity to create a health insurance plan that by design actually promotes primary care access. What makes Nonstop Wellness so unique is that it completely removes the financial barriers associated with partial self-insurance and efficiently manages reserve funds so that there is no financial unpredictability whatsoever for the organization.


“After year one, I can say overall satisfaction is great,” Ottley says. “Folks are still learning how to use Nonstop Wellness. But now that the out-of-pocket exposure isn’t there, people are accessing the plan responsibly. Access has increased. The people I talk to say this is the best thing Unity could have done for us. Most employees love it!” Not only did Nonstop remove the main obstacle to employees access to healthcare, but premiums were lowered for some, and Unity was rewarded with a very significant premium reduction – without having to change medical carriers.


The revelation that employees were frustrated with Unity’s benefits package and were avoiding seeking care because of cost led directly to a strategic focus on benefits and a new, innovative approach – and Unity’s commitment to annual surveys made it possible. NACHC brought Insightlink into its partnership stable because NACHC leadership believes that understanding how employees rate their employer is vital to the well-being of these mission-driven organizations.


“We want to make sure the health center employees are happy and productive at work. We believe that in terms of recruitment, it’s more important to retain staff. Turnover can be very expensive,” says Katja Laepke, director of clinical trainings at NACHC, “and it is better to retain good employees than to have to replace them.”



What Unity and other CHCs are discovering is that while offering health insurance is important, satisfaction will quickly erode if employees feel they can’t afford to use it. Evidence shows that one in four Americans, on average, will defer or skip visits to healthcare providers if they think the cost will be too high, and older Millennials and Gen Xers are particularly likely to skip visits to the doctor to avoid excess spending.



  Get help from a reputable vendor

Employee surveys should be designed not just to quantify satisfaction levels, but also to capture the details and motivations behind satisfaction levels. Are employees actually using the health benefits that are offered? What are the barriers to use? If employees forego regular primary care visits or are coming to work sick, is it because of deductibles and other out-of-pocket costs? If the benefits plan includes perks like wellness programs, virtual health services and gym memberships, which of these extras do employees find valuable, and which ones do they not care about?


Writing a questionnaire that can reliably and accurately elicit this kind of nuanced information requires a solid understanding of research techniques and best practices. Organizations should resist the temptation do write their own surveys using free or inexpensive DIY tools. Use a reputable third party instead. That will ensure your employees’ privacy is protected, which is essential to ensuring that as many employees as possible participate and that the answers they provide are honest. Seeking professional guidance will also will prevent you from wasting time and energy on poorly designed, badly written survey questions that are ambiguous, inherently contradictory or simply hard to understand. Finally, if your organization plans to compare internal survey results with normative results from comparable organizations, make sure that any third party you use has access to statistically meaningful, valid benchmark data that is representative of your industry and your organization type.


Most organizations seeking to measure employee satisfaction with healthcare benefits will want to include customized questions that ask about the specific benefits you want to analyze, as well as questions about any benefits you are considering adding. You may also wish to design the survey for easy ranking of benefits and levels of satisfaction associated with each, and ask questions that can measure how employees regard trade-offs of existing benefits against alternative options. Most organizations will wish to include open-ended questions along with yes/no and multiple choice questions to identify any concerns that standard questions don’t capture.



   Plan carefully before you start, and don’t ignore the results

 Interviews with Insightlink, Unity and other CHCs suggest that employee surveys should not be undertaken unless the organization as a whole understands the value of the process and is prepared to respond to the results with concrete action. For that reason, it’s essential before you begin conducting surveys that you get buy-in from top leadership. Executives must be convinced that engagement surveys are valuable to the health of the organization, and they must be willing to communicate directly with staff about the value of surveys and the importance of participation. They must also provide assurances that any employee concerns that emerge from the surveying process will be taken seriously and addressed. Keep in mind that responding requires an investment of time and money, as well as an admission by leadership that working conditions need to be improved.


Annual satisfaction surveys produce the most valuable results. Be wary of surveying more often than that. Repeating an employee survey before leadership has digested the information from the original survey, created an action plan for changes and followed through on the action plan is likely to backfire and have a negative impact on employee engagement in the long run. The survey is only a starting point. Specific actions based upon survey results are critical to securing employee trust and to boosting engagement.


Similarly, focusing solely on the positive results of the survey and ignoring or explaining away problems the survey has exposed risks undermining employee morale. Any underlying problems that emerge from the survey must be addressed. If employees participate in a survey and nothing changes, the survey’s value is lost.


While the advisability of sharing survey results with employees depends upon the organization’s culture, in organizations with a relatively open culture sharing results would be expected. Just keep in mind that employees are less interested in survey scores than what is going to change as a result of their participation. You don’t need to try to fix everything in a single year, but it’s important to communicate to employees that you recognize problems and are addressing the highest-priority issues first.


Benefits packages represent a significant investment for a community health center, with employee health insurance often the second most expensive and unpredictable spend an organization has. Annual premium hikes are consistently outpacing employee’s wage increases and inflation – 2.6% and 2.5%, respectively. This is what motivated Community Health Ventures, the business development affiliate of NACHC, to launch the Value in Benefits (ViB) program that helps health centers across the country to reduce employee health insurance costs so they can focus on serving their communities.


“Since I joined CHV in 2001, I've heard many health center leaders express their desire that Community Health Ventures develop a program to help control costs in providing employee benefits,” said Danny Hawkins, Senior Vice President of Community Health Ventures, business development affiliate of NACHC. “We are thrilled to offer our members access to Nonstop Wellness, an innovative and cost-effective alternative to fully-funded insurance. Nonstop's mission to provide quality, affordable healthcare for everyone is perfectly aligned with our health centers’ missions to ensure no one goes without the medical services they need.” In 2018, Nonstop Wellness saved health centers across the country more than $20 million in premium reduction and the workforce more than $4 million in out of pocket costs.





Community Health Ventures (CHV) and the National Association of Community Health Centers (NACHC) recognize the critical impact of employee health benefits on community health centers. As significant as increased costs are to organizations, so too is the significant positive impact that offering quality, employee benefits has on workforce retention and recruitment. According to FRACTL, 88% of respondents said that better health, dental and vision insurance weighed most heavily when considering employment options. While community health centers are subject to the same pressures as other organizations, health centers are unique to these pressures because of their mission.


To help address this challenge, CHV and NACHC created a program called Value in Benefits (ViB) in partnership with Nonstop Administration & Insurance Services to help health centers control the cost of employee health insurance. Through ViB, Nonstop offers health centers a partially self-insured healthcare program called Nonstop Wellness that lowers the cost of employee health insurance and reduces or eliminates all employee out-of-pocket expenses.   "We believe that no one should go without high-quality, affordable healthcare –especially CHC employees," said David Sloves, CEO of Nonstop. "Our current CHC clients save between 12 and 41 percent annually on healthcare costs while also vastly improving benefits, leading to increased staff retention and opportunities for program development.  We are excited to expand Nonstop Wellness to more CHCs across the US through this valuable partnership with CHV."


In 2018, Nonstop Wellness saved community health centers more than $20 million in premium reduction and saved health center employees more than $4 million in out-of-pocket costs. To learn more about Nonstop Wellness and the ViB program, go here: https://www.nonstopwellness.com/value-in-benefits/




NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

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