Can Concierge Medical Services Work in the Restaurant Sector?  

For several years we have been considering the viability of high touch healthcare concierge programs in the restaurant space.   The market leaders in this field are several third party providers, although some carriers are also developing and offering these services.  The attraction of the strategy is increased employee perception of the plans while reducing plan costs.  One of our restaurant clients has adopted this strategy and our initial analysis is that first year medical spend was reduced by approximately five percent and, more importantly, that a two-percent reduced rate of increase is expected in future years. 

These results are achieved by dramatically increasing employee engagement and awareness of the benefits offering and gently steering members to the highest value providers and facilities.  The premise is that employees (especially those with significant health issues) have difficulty navigating the world of health insurance and, therefore, are susceptible to making poor and inefficient choices.  The theory is that ongoing interaction and assistance will build trust.  This is accomplished by changing how they receive service and advice.  Rather than contacting the insurance carrier with benefit, or service and care questions, members are directed to call a single number to speak to a concierge who will directly assist them (no more call trees).  The types and breadth of the services include:

• Requests for ID cards
• Coverage and benefit questions
• Assistance finding providers and booking appointments
• Pre-admission verification and counseling
• Discharge coordination and planning
• Overall care coordination
• Outbound calls based on individual health conditions and claims activity
• Medical bill questions and disputes
• Intake of all provider calls

Rather than trying to figure out which number to call, or whether they have to call, employees simply call one number for all benefit issues.  Since each employer is assigned a small dedicated team, the goal is to build trust between the concierge and the employees through the ongoing interactions.  The perception of the benefit program is enhanced by providing a significantly increased level of service, the costs are controlled by assisting in the managing of care gaps and earlier identification of potential large claims.

While the success of these programs in more traditional industries is well documented, we were uncomfortable whether a restaurant workforce would engage with the services: would this type of workforce appreciate assistance in navigating the realm of medical care?  In addition, the traditional belief was that it can take years to develop the trust required to be successful – a significant hurdle in a high turnover industry.  The data we are seeing for a large client (ABC) indicates that the approach can meet the goals.

As noted earlier, the key to this type of program is the amount of participant engagement.  As a result, we focused on four key metrics:

• The number of members who engaged (used) the program
• The percent of members with claims over $10,000 who engaged
• The percent of high claimants ($50,000) and higher who engaged
• The quality reviews of the users

The average interactions per member over the last 12 months for ABC were 4.5 versus 4.3 for the overall book of business.  More importantly, for the initial 12 month period, 66 percent of ABC’s members contacted the service.  This dropped to 54 percent for the most recent 12 months, but it is still close to the 56 percent Book of Business rate.

Savings are typically generated by engaging the high claimants.  A significant difference in the model from typical carrier or TPA claim management programs, is that there is a concerted effort to engage with claims down to $10,000 (as simple as a routine delivery).  The rate of intercept (direct contact) with these claims was 94 percent.  More importantly, on average there was contact involving these claim situations 56 days earlier than would have occurred under a traditional carrier or TPA medical claims management model.  This means that there was the ability to impact the situation before the treatment program was fully mapped out.

Prior to the concierge program, we were continually frustrated with the rate of large case management.  It was not unusual to have engagement results that were lower than 10 percent.  High claimants are not comfortable engaging with a service they have had little or no prior interaction with during a high stress period.  With the concierge program, we are seeing a connection rate that is 10 to 15 times higher in claims over $100,000. 

Finally, these programs will not have long term success unless the participants are happy with the service.  This satisfaction level is also key to the employer goal of increasing the perception of the plans.  A typical metric for the service industry is the National Promoter Score (NPS).  The two year results based on ABC’s participant responses were 83.  Just as importantly, 86 percent indicated that they would promote the service.  This compares to the average insurance provider score of 57.

The piece not yet addressed is cost savings.  While we have clear indications that the level of engagement is driving the forecast savings, given the volatility of claim trends during this COVID period, we are uncomfortable drawing concrete conclusions.  Additionally while initial results are encouraging it is important to note that concierge programs will have varying price models that can be challenging from an initial budget or funding perspective.  Our client  has realized at least initially, that the additional dollars spent have created a return on investment with hopes for even better results as employee engagement continues to increase.

As restaurants continue to struggle with staffing recruitment and retention, enhancing benefit programs can be one piece of the response.  An appropriately designed and managed program can have the rare impact of both enhancing the participants experience while controlling cost.  While not the answer in all situations, they are definitely worth consideration.