Top 5 Healthcare Benefit Challenges and How To Solve Them

Employers and health plan sponsors are always looking for ways to make healthcare easier, more affordable, and more effective. However, it’s not a simple process. Healthcare benefit challenges have increased in the past decade due to fluctuating prescription drug costs and federal price transparency mandates. It’s tough to meet your clients' needs, give them ways to engage with their healthcare benefits, and improve their overall experience.

Healthcare Bluebook is committed to giving employers and plan sponsors new ways to make smart healthcare choices with solutions designed to help tackle your healthcare benefit challenges. Curious? Read on:


Challenge:  Low-Value Care

The U.S. has the highest healthcare costs in the world. In 2020, the U.S. spent about $4.1 trillion on healthcare—about $12,530 per person—according to the Centers for Medicare & Medicaid Services. This is a 9.7 percent increase over the past year. And yet, we trail behind other developed countries on common health outcomes, including life expectancy, unmanaged diabetes, and infant mortality.

Part of the problem is that there’s little to no visibility into the cost or quality of care until after that care is delivered. Plus, Bluebook’s data show that the quality and cost of a service are often unrelated. Unless patients shop for care, they may pay prices that vary as much as 600% for the same procedure among in-network facilities in the same market. Without an effective quality and cost transparency tool, patients may unwittingly choose a higher-price or lower-quality option.

Solution: Objective Quality and Cost Navigation 

Healthcare Bluebook is powered by the largest healthcare quality and cost dataset nationwide. We help employers, consumers, providers, and payers make more informed healthcare decisions using a simple intuitive color-coded system(i.e., green, yellow, and red) to help people identify the best value care for their needs.

Helping employees find the highest quality, most affordable healthcare providers near them is an employer’s best defense against rising costs, and the most effective way to improve the overall quality of care for enrolled benefits members.

Bluebook also offers a solution to help benefit brokers provide sound advice on healthcare options. Bluebook Insights™ generates deep analytics that enables brokers to pinpoint overspending and lapses in quality—information that informs their client benefit strategies.

Challenge: Rising Prescription Drug Costs

When you walk up to a pharmacy counter, you likely don’t know how much your prescription will cost. What happens if you can’t pay for it? Recent research indicates that as many as 18 million Americans cannot afford their prescription medications, which is about 7 percent of America’s adult population.

Prescription medications—especially specialty and brand-name drugs—have created an unsustainable cost situation for consumers and businesses. With prescription drug costs outpacing inflation, some large employers shell out nearly a third of their total healthcare benefit spend to pharmacy. Plan sponsors also need support managing costs once new medications come to market.

Solution: Bluebook Rx Pharmacy Savings Solution

“Everyone should be concerned about the rising costs of brand-name specialty medications. A generic alternative can cost as much as 99 percent less than its brand-name counterpart,” said Samantha McMaster, PharmD, senior director of Pharmacy Solutions at Bluebook.

Bluebook Rx was launched in 2021 to give plan sponsors and members an independent look at employers’ prescription drug spending.

With Bluebook Rx™, plan sponsors get an objective analysis of pharmacy spending that identifies the drugs and drug categories driving high costs. With that information, Bluebook Rx offers members personalized savings reports that suggest lower-cost, clinically effective alternatives that can save them and their employer money. Members can potentially save thousands of dollars in out-of-pocket costs, and companies can potentially cut costs by millions.

Challenge: Navigating a Complex System

When an employee needs a complex, high-cost medical procedure, finding, scheduling, and coordinating the right care can be overwhelming, especially without visibility into quality and costs.

Solution: Bluebook CareConnect Member Concierge Support

Our Bluebook CareConnect™ solution provides individuals with a member concierge who works with them to find and schedule the right care with a high-value provider, from the initial consultation to follow-up appointments. Members develop a trusting relationship with the concierge throughout their care journey.

“When I needed surgery, the cost was overwhelming and I felt lost. But when I called Healthcare Bluebook, member advocate Jami Carswell assured me they could help me,” said a member who saved $10,964. “They negotiated a package for the surgeon, hospital, and anesthesiologist.”

Challenge: Meeting Federal Price Transparency Deadlines

The Departments of Health and Human Services (HHS), Labor, and the Treasury are enforcing provisions of the Transparency in Coverage rule and the No Surprises Act

Self-insured employers, TPAs, health plans, and hospitals are sprinting through regulatory obstacle courses to reach compliance. So far, only a percentage of hospitals have posted their files publicly, largely because of the complex process.

In 2022, insurers and plan sponsors are on the hook for compliance. They are required to disclose their negotiated in-network and out-of-network rates and offer members good-faith cost estimates before care (i.e., enhanced explanation of benefits [EOB]). 

Solution: Bluebook Comply Compliance Solution

“Healthcare Bluebook has been active in the push toward price transparency, and we’re helping partners reach milestones toward compliance, ensuring readiness for coming deadlines,” said Bill Kampine, chief innovation officer at Bluebook.

Bluebook Comply™ is a comprehensive compliance solution that addresses critical mandates, including the price comparison tool, Advanced EOBs, and Machine Readable Files. It is designed to help organizations not only meet the mandates, but also deliver value far beyond the requirements.

Learn how to choose a healthcare navigation tool that’s right for your company. 

Challenge: Engaging Employees

Although providing solutions to identify high-value care is important, it’s only one step in the process. You must also encourage good shopping behaviors so your employees make better choices.

Solution: Bluebook Engagement Solutions

Bluebook’s Engagement Rewards program creates savings by changing employees’ healthcare shopping habits through targeted financial incentives that reward smarter, quality-driven, cost-effective healthcare choices.

Employers who implement Bluebook’s engagement best practices—Educate, Remind, Reinforce—see as much as 20 percent monthly utilization with an ROI of up to 6:1. There are additional ways to drive employee engagement, including making it fun and adding incentives.

“I did this yesterday and saw that the hospital where I had my kidney stone removed was one of the highest: $2,200 out of pocket! I found that I can get my second one done at a surgical center much cheaper—green light,” said a member after playing Bluebook’s Pricing Game.

We’re Here to Help

You are likely facing at least one of these healthcare benefit challenges. The good news is that you don’t have to find innovative solutions alone. The Healthcare Bluebook team is here to help you along the way, giving your team members or clients an engaging and successful healthcare benefit experience.

Interested in how Bluebook solves common healthcare benefit challenges? Contact us today to learn more about our solutions.

eBook cover of How to Choose a Healthcare Navigation Solution That's Right for Your Organization