Incorporating wellness initiatives into your organization’s large group health plan

December 30th, 2024

As companies look for new ways to increase the health and well-being of their employees, they are pursuing both plan design innovations and wellness initiatives. These programs are no longer optional perks and are now seen as essential to improving overall employee satisfaction, reducing absenteeism and controlling rising health care costs. By fostering a healthier workforce, employers can see tangible benefits, such as increased productivity and reduced long-term medical expenses, which contribute to a more sustainable business model.

A large group health plan—typically defined as a plan covering 50 or more employees (or 100+ employees for New York-based groups)—provides employers with unique opportunities to integrate novel benefit designs and wellness initiatives. In today’s evolving health care landscape, large group health plans are transforming from traditional models to innovative structures that include wellness programs, disease management and coordinated care. This shift is redefining the role of employer-sponsored health plans, turning them into a key driver of workforce well-being, which ultimately can result in cost savings.

Additionally, benefits that holistically address the health and wellness needs of employees can support recruitment and retention. According to the 2023 Bentley-Gallup Business in Society Report, 78% of people said an important factor when deciding if they want to work for a company is if the employer makes investments that improve people’s health or well-being.

Drew Thompson, the head of sales at Northwell Direct, shares that people looking for a new role are keen to understand the big picture as it relates to a job offer: “When people are looking to join a new organization, the salary obviously is important,” said Thompson. “A lot of people are looking at, ‘What is the health insurance benefits that I'm going to receive from this employer?’”

Innovations in large group health plans

Innovations in health plan design and composition for large groups are fundamentally shifting how employers approach employee health and wellness. Today, many employers are incorporating features that deliver value while improving employee participation, including:

• Partnering directly with local providers: Partnering directly with local health systems, hospitals and providers to better manage total cost of care. These collaborations focus on reducing low-value utilization—such as unnecessary emergency room visits—while improving outcomes through proactive and coordinated management of chronic conditions and high-cost services.
• Tiered networks for cost efficiency: Tiered networks are a powerful tool for large group employers seeking to lower both employer and employee health care costs while preserving choice. Through distinct provider tiers within the health plan, employees are encouraged to choose high-quality care at lower costs, while still having access to a broader set of provider options.
• Disease-specific care management: Tailored care management programs are another innovation driving value in large group health plans. Employers can work with their plan administrators to build programs focused on their specific claim history, addressing prevalent conditions like diabetes and heart disease.
• Coordinated clinical access and navigation services: Coordinating access to essential services like primary care, preventive care and behavioral health is essential for ensuring employees receive the right care at the right time and place. Many large group health plans now include robust clinical navigation services that guide employees through the complexities of the health care system, connecting employees to the highest-quality and most affordable options along their care journey.
• Centers of Excellence (COE): Given the expense of surgical procedures, many large group health plans are either considering or have implemented centers of excellence strategies, which are specialized programs with select providers that focus on delivering high-quality care for specific medical conditions or procedures. Often built into benefit design, COEs aim to improve patient outcomes, ensure medically necessary care, enhance care coordination and reduce costs.
• On-site and virtual care delivery: By lowering barriers for employees to engage in their health, on-site and virtual delivery programs can encourage healthy behaviors, improve employee satisfaction and reduce long-term health risks, lowering the need for costly interventions down the line. From on-site vaccinations, disease screenings, provider consultations and health workshops to virtual navigation and telehealth tools, employers can encourage greater focus on preventive care and holistic employee health.

Northwell Direct’s role in innovating with large group health plans

Northwell Direct supports large group employers through various wellness programs and innovative benefit design options. From a tiered plan design featuring the Northwell Direct high-value network to provider-led chronic condition and care management, these initiatives are designed to meet employees where they are and encourage sustainable, long-term health improvements, including:

• Tiered network: Northwell Direct provides access to a contracted network of Tier 1 providers and care management services for large group employers as part of their self-insured benefit. The innovative tiered network provides access to more than 32,600 providers across the New York metropolitan area and is coupled with a Tier 2 national wrap for broader access with minimal member disruption. The network offering is combined with our provider-led, at-the-bedside care management programs, which help high- and rising-risk members better manage and navigate their care needs.
• Diabetes care management: Engagement, education and navigation services for employees with diabetes. Customized based on an individual’s health status, the program includes health coaching, medication management, glucose monitoring, navigation and support in medical appointment scheduling, and preventive care guidance.
• Maternity Management Program: This navigation and care management program covers prenatal care through the first year of the child’s life, promoting healthy maternity and new childhood journeys and proactively identifying and caring for high-risk cases. The program includes health coaching, ongoing employee engagement and education via an interactive digital app, care navigation, tele-lactation virtual education and support with certified nurse specialists, and a virtual content library.
• Behavioral health services: A comprehensive set of services related to behavioral health care for employers including clinical triaging (“What type of care do I need?”), navigation (“Which provider is right for me and how do I get an appointment?”), and care delivery (virtual and in-person). In addition, Northwell Direct provides on-site education and support programs related to well-being and stress management. Through our comprehensive offering, employers can customize a service package to address a critical area of health that impacts both workplace productivity and overall employee satisfaction.
• Primary care access and navigation services: Concierge services that can be flexibly packaged to fit the employer’s needs. Services include same day and next day appointments with Northwell Health primary care providers, access to a 24/7 clinical nurse triaging and navigation, and/or temporary or permanent primary care provider staffing at employers’ offices. These services encourage employees to proactively engage with their health through increased access and convenience with high-quality providers.
• On-site services: A variety of on-site wellness services delivered at the employer’s office. These include on-site vaccinations, health education seminars and screenings related to biometrics (blood pressure, cholesterol, glucose, and BMI), certain cancer screenings, vision and hearing acuity. These services can improve employee health, reduce absenteeism and meet the unique needs of the employers by bringing care directly to the workplace.

Northwell Direct offers innovative solutions that deliver tangible benefits for both employers and employees. By connecting employers directly with the providers who ultimately care for their employees and members, Northwell Direct ensures that large group plans can optimize their benefit offerings while controlling costs. With a focus on employer needs and employee wellness, Northwell Direct can help companies drive better health outcomes, reduce health care costs, and enhance employee satisfaction.

As the health care landscape continues to evolve, large group health plans will play a critical role in improving the health of workforces across the country. By incorporating wellness initiatives and innovative benefit design strategies, Northwell Direct is poised to help organizations meet these challenges head-on, allowing organizations to create a health plan that truly drives value.

To learn more about the large group health plan solutions at Northwell Direct, call (844) 694-3728 or email NWDirect@northwell.edu.

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