Enrollment into an employer-sponsored health insurance (ESI) plan does not guarantee access to equal quality of care in the U.S. health care system. With complex cost-sharing mechanisms like high deductibles and out-of-pocket costs, many employees and their dependents are left with limited opportunities to truly improve their health conditions and progress towards better health.

A national survey by the Commonwealth Fund shows that despite care coverage by ESI, nearly two-thirds of Americans struggle to afford health care due to price inflations. In fact, 29% of those covered by employer sponsored health insurance reported delaying or skipping needed healthcare or a prescription drug in the past year because they couldn’t afford it, and more than half (54%) of those said a health problem got worse as a result. These health inequities within corporate America cannot be resolved by simply providing access to ACA (Affordable Care Act) and ERISA (Employee Retirement Income Security Act) compliant healthcare plans. Small, mid-size, as well as large employers need revolutionary healthcare plan designs, which not only comply with required laws, but also have the potential of offering true health equity.

Need for True Health Equity to Improve Health Outcomes of all Employees

Employee health is one of the most important factors for enhancing productivity, but if the increasing medical costs are preventing enrollees from accessing timely medical interventions, then employers need to rethink their health plan designs for providing true health equity.  

According to a KFF report, adults who have private insurance through employer-sponsored insurance or Marketplace coverage are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to their monthly premium, the amount they have to pay out of pocket to see a doctor, and their prescription co-pays. The higher rates of cost sharing often compel employees to delay or skip timely treatment, which in turn may lead to several unfavorable consequences, like aggravate diseases leading to higher healthcare costs for payers, including employers as well as employees.

A JAMA study (Journal of the American Medical Association) suggests that increasing health insurance premium costs are likely associated with decreased earnings and increased income inequality, including by race and ethnicity, among US families receiving employer-sponsored health insurance and are meaningfully associated with wage stagnation. This vicious cycle of increasing premiums and decreasing earnings deeply impacts employees with lower incomes, highlighting the need for innovative plan designs.

Envita Health™, as a Managed Service Organization (MSO) offers such plan designs, which are not only ACA and ERISA compliant, but they have been thoughtfully crafted by specially trained clinicians, who have over two decades of experience in treating patients with chronic and life-threatening diseases. These pioneering plans cater to the varied needs of each individual employee and help in addressing some of the root causes of health inequities, while offering equal access to the latest value-based care for all employees. It ensures that all individuals, regardless of race, ethnicity, socioeconomic status, or geographic location, have access to the same high-quality healthcare services.

How Employers Can Provide Equitable Healthcare Solutions for All

Through the meticulously crafted plan designs of Envita Health™, employers can not only improve their overall employee health and reduce costs of medical care, but also provide equal access to advanced personalized medicine and innovative preventive care, cutting across hierarchies. Here, we explore the systemic issues contributing to healthcare disparities and how Envita’s trailblazing approaches can pave the way towards more equitable healthcare solutions:

1. Access to Healthcare

Many Americans, especially those from minority and low-income backgrounds, do not have sufficient access to healthcare services. Geographic disparities also play a significant role, with rural areas often underserved by healthcare providers.

Envita Health™ Countermeasure

Envita Health™ offers access to a vast network of providers and facilities, ensuring that patients can receive care without the HMO-PPO limitations imposed by traditional network restrictions. This is crucial for patients in underserved rural or urban areas​​. With Envita Health™, its enrollees can access an open network, which includes over 1.3 million providers, and in case a provider is not a part of this vast network, team Envita offers concierge service to pre-authorize and approve the required physician to help members get coverage for care.

2. Socioeconomic Factors

Social determinants of health such as education, income, and employment status significantly influence health outcomes. Lower socioeconomic status is often associated with poorer health and less access to healthcare services, but with Envita Health™ plans, employers can break through this glass ceiling in health outcomes.

Envita Health™ Countermeasure

Irrespective of their position in the professional hierarchy, every employee gets access to personalized health coaching through one-on-one sessions, which can prove crucial in early identification, proactive treatment, and prevention of diseases. Through the Optimal Health program, a specialty telemedicine program, every employee is allocated a personal coach who considers each member’s family history, medical history, and socioeconomic conditions to guide them towards advantageous preventive care or treatment options.

3. Lack of Personalization

Standard health insurance plans cover one-size-fits-all treatment protocols, based on Medicine 2.0, which focusses only on diagnosing and treating illnesses, along with some basic preventive measures. In contrast, with Envita Health™ every employee not only gets coverage for standard Medicine 2.0, including basic primary care, specialist consultations, ER visits, and hospitalizations, but they can also utilize the latest in advanced personalized medicine, based on Medicine 3.0. Healthcare consumerism is here, but with few organizations primed to integrate consumer health behaviors into a personalized medicine approach, the consumer experience is falling short of expectations, according to the 2022 State of the Healthcare Consumer Report from Kaufman Hall. (https://www.techtarget.com/patientengagement/news/366584792/Poor-Personalized-Healthcare-Limits-Healthcare-Consumerism)

Envita Health™ Countermeasure

Envita Health™ utilizes advanced Medicine 3.0 because this paradigm shift in medicine is aimed at utilizing the latest technologies to personalize treatments for disease prevention, early intervention, and overall holistic recovery. With this revolutionary treatment approach, enrollees get access to personalized treatment plans that consider individual genetic profiles and specific health needs. This level of personalization helps to improve the efficacy of treatments and reduce wasteful healthcare expenditure, which can go a long way in preventing unnecessary hikes in health insurance premiums.

4. Insurance Coverage Gaps

The lack of comprehensive health insurance coverage is a major barrier to accessing healthcare services. More than six in ten U.S. adults say that affordability in general is among the biggest barriers to accessing healthcare – followed more distantly by other factors that impact affordability, such as, the system being too focused on profit, access to insurance coverage, and difficulty understanding what is covered through insurance.

Envita Health™ Countermeasure

The clinical experience of healthcare providers trained in personalized medicine, who designed these plans, shine through Envita Health™ plan designs. These customized plans are focused on true outcome-driven, value-based care, going beyond the agenda of factors like profit through vertical integration, which drive the standard health insurance industry. By designing healthcare plans that overlay onto existing insurance or replace them, Envita Health™ addresses the gaps left by traditional insurance plans. These plans are smartly designed with proactive intercepts to reduce costs and improve the health and well-being of each enrollee.

5. Cost Drivers

Studies show that pharmacy, cancer, cardiometabolic diseases, musculoskeletal conditions, and hospitalizations are some of the key spending categories of the insured employee population.

Envita Health™ Countermeasure

Envita Health™ plans have targeted approaches to address these major cost drivers, which in turn helps to keep a check on insurance premiums. With a series of programs like 2nd opinion for oncology and autoimmune, pharmacy discounts, including access to physician-grade supplements, custom-compounded adjuvants, and advanced preventive care, going beyond annual wellness assessments, Envita Health™ aims to keep the costs low for payers.

6. Overlooked Areas of Concern

Latest national health survey indicates that mental health needs among workforces continued to climb this year, but ironically mental health care is one of the top six areas that gets overlooked due to costs.

Envita Health™ Countermeasure

With Envita Health™, enrollees get access to virtual care specialized in the area of mental health, going beyond any other standard major medical plan. To include microbiome, diet, exercise, genomics and neurotropic support.

7. Enrollees’ Varied Preferences

Studies show that there has been a growing interest and demand for the use of integrative medicine, particularly for pain or cancer, but unfortunately standard major medical plans do not cover integrative care.

Envita Health™ Countermeasure

Envita Health™ is a first of its kind national network, which covers standard conventional as well as integrative medicine, as it developed the first-ever adjudication and billing codes for integrative medicine, covering treatments such as naturopathic care, IV therapy, and functional medicine. This integration allows Envita Health™ to cover conventional as well as integrative, naturopathic, and functional medicine as part of their standard healthcare plans, providing options that were typically only available out-of-pocket. By doing so, Envita Health™ not only meets the specific health preferences of a broader demographic but also enhances the overall effectiveness of healthcare. Envita’s model of integrating personalized medicine, advanced technology, and equitable access serves as a pioneering example of how health disparities can be effectively addressed. This approach not only improves health outcomes but also enhances the quality of life for all Americans, regardless of their background.

8. Care Coordination

U.S. adults spend the equivalent of an entire workday each month coordinating care for themselves and/or their family or loved ones, but team Envita believes that no one should have to do healthcare alone and struggle with these operational difficulties of care coordination.

Envita Health™ Countermeasure

Envita Health™ offers concierge care navigation to guide enrollees towards the most appropriate value-based care for their specific health condition. Unlike other care navigation services, Envita Health™ is physician driven in navigating all enrollees, irrespective of their professional hierarchy, to healthcare providers and facilities with top quality scores. Such high-quality care navigation is crucial for improving outcomes and reducing overall healthcare costs for payers.

Call Us Today

In essence, Envita Health™ initiatives represent a forward-thinking response to the health equity challenges, providing a blueprint for how health benefits can be structured to offer equitable access to all employees, thereby enhancing the overall health and well-being of the workforce. Envita Health™ draws its strength from Envita Medical Centers, which has 25 years of clinical experience in treating chronic and autoimmune conditions and late-stage cancer patients, many of whom were left with limited options in standard of care facilities. To know more about this innovative health insurance plan, please feel free to call us at 877-214-8660. May God bless you on your healthcare journey!