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Switching Employees On: Using Video to Entertain, Engage, and Educate

By DrScott – Posted on February 25, 2014 on www.compassphs.com

First in the series on Switching Employees On: Using Video to Entertain, Engage, and Educate Series

Engaging and activating employees challenges every company. Creating videos has become less expensive and can be a very effective way to communicate change to employees. Chip and Dan Heath in Switch, How to Change Things When Change is Hard, point out the need for three major principles to be honored (see previous blogs). The rider must be directed, the elephant must be motivated, and the path must be clear. In this video two of the three major principles outlined in Switch are used – directing the rider on exactly what to do, and laying out a new, simple, clear, and more convenient path. Thus the chance of “turning the elephant” from expensive, lower value care to higher value healthcare is increased. Click here to see the video.

Bending the Health Care Cost Curve. Making Sure Your Plan Can Succeed

 

By DrScott – Posted on February 13, 2014 on www.compassphs.com

Final Blog in the How to Switch On Your Employees Series

Engaging and activating employees to become more proactive in screening for and managing medical conditions when an employee “Feels Fine” is a challenge confronting every employer. Many companies are figuring out how, resulting in lower costs and healthier employees.

The authors Dan and Chip Heath, in the book Switch – How to Change Things When Change is Hard, point to key variables in any change management effort. Using the simile of a rider guiding an elephant down a path to your destination, they share three areas vital to success. Here are the key variables:

1. Directing the Rider. The culture and beliefs of a company are vital in identifying what will lead to successful change management. Start by:

  • Identifying successful efforts in the past and understanding why they worked;
  • Scripting the critical, necessary moves – like moving to outcomes based benefit design; and,
  • Pointing to the destination – moving from providing insurance to providing a culture that supports proactive early intervention and saves lives to insure every employee is there for their co-workers, family, and friends.

Mistakes often made by employers in directing the rider include: Failing to get C-suite support; not appreciating the politics and informal power structure within a culture; not making the key moves clear; not communicating clearly and repetitively; and failing to articulate the goal in a way that employees can appreciate and will understand the relevance to their whole life, not just their time at work.

2. Motivating the Elephant. Rational understanding of what to do and why is only one aspect of successful change. Elephants are large, have momentum, and don’t like to change from the well-known, understood, and worn path. Turning an elephant requires:

  • Appealing to the “heart” to touch, move and inspire action. “I have a dream” and “We choose to go to the moon,” united and solidified a change far more than, “here are the three things to be done and why we are going to do them.” Share inspirational moments along the journey so employees appreciate the difference being made by this change.
  • Create baby steps. Trying to bite off too much too quickly will choke the process. We all know the joke, “How do you eat an elephant? One bite at a time.”
  • The importance of a learner’s mindset, being open to growth and change, is so obvious it goes without saying. However, making this as a theme of the change effort is often overlooked. To embrace a new way of thinking about proactive health requires a shift in mindset from, “providing insurance” to “insuring that we are doing what we know to do to empower employees to be healthy and productive at work and at home.”

This is an area of health benefit change that will need significant attention in most companies. As opposed to directing the employees (telling them what to do), motivating the employees requires the HR team to lean heavily on their EQ (emotional), SQ (social), CQ (cultural) quotients as opposed to only the IQ.

3. Shaping the Path. Employees are busy. Having to stop and figure out aspects of their life, like health benefits, which are not central to everyday success at work and home slows the development of “muscle memory”.  Answering the question, “How do I get employees to ‘do the right thing’ to utilize their benefits to the fullest”, without them having to “figure it out” every time is the challenge being addressed.

  • The environment must support the change, making it easier to do what you want them to rather than going back to their old ways. Healthy on-site cafés; on site, near site, or mobile clinics; starting every shift with injury preventing stretching or activity; and on site activity centers will all change the environment and have been implemented (in the right situation) with success.
  • Building new habits such as “contact your Health Pro” for any benefit related question simplifies and allows employees to confront new challenges in a “just in time” fashion with the development of one simple new habit.
  • Elephants (and employees) travel in packs. Behavior is contagious and reaching the “tipping point” where embracing the change you are advocating in the company goes from, “you did what?” to “of course, that is what we all do” does not happen overnight, but will occur.

As I wrote this blog, I received an email from a human resources director at a rural production facility:

“Hi all. I just wanted to let you know that one of our employees had one of his age and gender screenings due to the new benefit plan. An issue was found at an early stage and he will be having surgery to correct it and is expected to be 100%. He told me that if it hadn’t been for our new health plan he never would have gotten the screening and in about a year would have been in a much worse state. So, thank you for the new health plans.”

This is a recurrent theme. Plans that encourage and support effective change make a difference. If you enjoyed this blog series, I encourage you to read Switch – How to Change Things When Change is Hard. This blog only begins to scratch the surface of this revealing, well done book. The research and stories shared from Vietnam to radishes (and many others), in Switch provide more examples of how to navigate change successfully and will both entertain and motivate your team.

Charting a New Path. Why Creating New Habits Saves Money at Work.

By DrScott – Posted on February 11, 2014 on www.compassphs.com

Sixth in the How to Switch On Your Employees Series

For one Compass client, “Contact your Health Pro” became the mantra.

  • “Which plan should I choose: the PPO, HMO, or high deductible plan?” Contact your Health Pro.
  • “Who is a great female family doctor near my home?” Contact your Health Pro.
  • “Where do I get my colonoscopy done by the best doctor?” Contact your Health Pro.
  • “How do I find the best, lowest cost place to get an MRI of my back?” Contact your Health Pro.
  • “My doctor says I need glasses, how do I use the vision plan?” Contact your Health Pro.
  • “I have a 3 month prescription and I don’t know how to do mail order.” Contact your Health Pro.
  • “Where is the best cancer center and which doctor should I see?” Contact your Health Pro.
  • “Do I qualify for a weight loss program?” Contact your Health Pro.
  • “Have I met all the requirements for the best health plan next year?” You guessed it: Contact your Health Pro.

The human resources staff had only a few employees. The new outcomes based program had too many variables, something had to change. In the past employees called HR, they were given the phone number for the insurance plan, the wellness program, the PBM, the vision program, and so forth. But the number of phone calls and the complexity was too much. Often in frustration employees just gave up, the HR staff members were exhausted, participation in programs was low, and costs were not coming down.

A new concierge program was brought in. The Health Pro concept, telephone number and website link, were introduced through a number of communication venues that included:

  • Through open enrollment communication materials and meetings.
  • At company meetings.
  • On the back of the health, vision, and dental cards.
  • On the corporate intranet site.

Involvement in the program and services dramatically increased. Every contact was tracked, behaviors were followed, and results documented.

The results were significant:

  • Calls to the HR department went down 25%.
  • Over 40% of employees contacted their Health Pro.
  • Participation in mail order prescriptions, the employee assistance plan, smoking cessation and weight loss programs all increased by double digits.
  • Health care costs for CT scans, MRI scans, and colonoscopies were reduced by 50% for dozens of employees.
  • Use of the “Designated Physicians” who met quality and cost metrics increased by over 25%.

The financial return on investment for the new Health Pro program was reported quarterly and varied from 5:1 to 8:1. In addition, the Net Promoter Score for the Health Pro was 72 – the highest for any vendor the company used.

As Chip and Dan Heath share in Switch, managing the path forward required shaping a new path. The employees had to change their habit from relying on the HR department for all the answers to contacting their Health Pro first. They were beginning to use all of their benefits, and to provided cost and quality transparency information. The “herd” had made the turn and actually encouraging each other on this new path.

The third key ingredient in making the “switch” was successfully navigated and momentum was building. By managing the three aspects of change, the question was not “if” but “how much” success would occur each year. In the next blog we will complete this series and review how to successfully navigate to a high performance, outcome based system.

Motivating Employees. More Than Providing Direction

By DrScott – Posted on February 6, 2014 on www.compassphs.com

Fifth in the How to Switch On Your Employees Series

An employee from a remote office location stopped by the office of her President at the corporate headquarters. Unsure of the exact purpose for the visit, the CEO thanked her for stopping by and her years of loyal service. Once seated, he paused and asked “how can I help you today?”.

She looked at her hands folded in her lap and said, “Two years ago you announced that we were going to have to get our biometrics done, see our doctor, and get our cancer screening done to qualify for the best health plan. I was really angry. I am 28 years old, a single mother of two children, and frankly, I can barely get everything I need to do done and catch a few hours of sleep at night. To tell me I had to do more felt unfair. But I also could not afford to pay more for my health insurance, so I complied. At my exam the doctor found a breast lump and sent me for a mammogram. I then found out that I had stage one breast cancer. To make a long story short, it was a real hassle, but I got my treatment and the doctors say that I am now cured.”

She paused, obviously straining to maintain her composure. She looked at him directly and continued, “I can tell you that without you requiring me to get my screening I would have put it off another five years. The doctor told me that if I had waited even one more year my cancer would have spread and my chance of surviving would have been a lot less. So I came here today to tell you thank you. Thank you for caring enough to require me to do the right thing, even though it costs the company more money and you didn’t have to. Thank you for saving my life, and thank you for giving my kids their mom; they are still young and would have been alone if I had died.”

Surprised, the President expressed his appreciation at her stopping by to share her story and the great news that the doctor thought she was healed from her cancer. This was the second time in a month an employee had contacted him to thank him for helping discover early cancer.

Their health plan had gone from just another requirement, to a campaign to catch disease early, and to save employees lives. Employees were inspired, and morale was better than ever. They had even begun a program to support “Health Champions” who encourage and support their employees in taking the ‘Baby Steps’ to go from reactive to proactive lifestyles, and to create a culture of wellness.

Chip and Dan Heath in their book, Switch – How to Change Things When Change is Hard, point out the need for three major principles to be honored in order to promote successful change (see previous blogs). The rider must be directed, the elephant must be motivated, and the path must be clear.  In this instance, the company provided employees motivation to move down a different path to a new destination. The employees not only understood the task at hand, but also found the feeling that motivated them to change. The change had been broken into realistic small steps, and employees gained more knowledge and experience in proactive wellness. A new mindset was emerging. It had taken two years but success was no longer in question.

Implementing Outcome Based Wellness – Making the Switch

By DrScott – Posted on February 4, 2014 on www.compassphs.com

Fourth in the How to Switch On Your Employees Series

How does a company switch directions to a plan that will actually improve the health of their employees and reduce health care costs? Using the paradigm for effective change from the book Switch by Chip and Dan Heath, the analogy of a rider changing the direction of an elephant as it walks down the well-established (less desirable) path, they reveal that it is not a single strategy that insures success, but multiple concurrent strategies that are needed.

In this blog we are going to focus on the first of these factors; the rider. The “rider” must know:

  1. The exact destination (To change, the rider must know where to go):
    • In health benefit terms, employees must:
      • get their biometrics done,
      • get their numbers to goal, and
      • identify and see a high quality primary care doctor for US Preventive Services Task Force (USPSTF) wellness, cancer screenings, and fulfill diabetes and heart disease recommended guidelines.
  2.  Script the critical moves (The rider must understand the specific steps to complete):
    • The employee learns where they must go to accomplish required steps and where to get more information:
      • Biometrics will be done at certain locations without charge for employees throughout the year, or get biometrics done at their primary care doctors and send in a required form;
      • Seeking out a high quality primary care doctor and following recommendations;
      • Being directed to the list of USPSTF age and gender appropriate tests that are available on line.
  3. Why go to this destination? (The rider must know why the change is necessary):
    • Treating conditions early, or preventing conditions, improves and saves lives, and also saves money.
    • Just acting based on if an employee “feels fine” delays identification of early diabetes, heart disease, and cancer. Early disease must be addressed before symptoms appear.

The rider is much smaller than the elephant and therefore must exert significant energy to change its direction. Clarity, commitment, and a well-designed plan are vital. Otherwise, the resources needed to promote change without such clarity, commitment or a well-designed plan make having to attempt to “turn the elephant” a second or third time cost prohibitive in both resources and energy, and usually without the desired sustainable results.

There must be a sense that the journey is attainable. If the destination seems too far away, or the required change is too drastic, the rider can lose enthusiasm and focus. Laying out realistic and attainable “baby steps” allows the rider to stay focused.

Insure the “rider” of your change efforts knows exactly what to do and how to do it. Breaking the steps into smaller manageable steps increases the likelihood of change being successful. But the rider is only one part of the equation. In the next blog we will look at motivating the elephant to stay on the right path.

Making the Turn – Changing to Outcome Based Wellness

By DrScott – Posted on January 28, 2014 on www.compassphs.com

Third in the How to Switch On Your Employees Series

Recently an HR team met to plan next year’s health benefits. It started with a review of last year’s changes and outcomes. Health costs went up 5%, but the projection for this year was closer to 10% with the new Accountable Care Act changes. Their President made it clear that the company could not tolerate a 10% increase and they had to find a way to better manage the situation.

There was a general sense of frustration around the table. Catastrophic costs driven by diabetes, surgeries, cancer, and heart disease again were the top challenges, and little headway had been made. The wellness program had paid out thousands of dollars to encourage employees to eat better, exercise more, and get their biometric screenings, but participation was still in the low 30% range. The HR team knew they had to make a significant change to make progress.

They studied other companies that had been successful in managing costs and decided that the keys for success were for every employee and their spouse to do the following:

  1. Get their biometrics and normalize any that were not to goal,
  2. Get age and gender appropriate wellness tests and exams recommended by the United States Preventive Services Task Force (USPSTF) performed by a high quality primary care doctor (preferably a patient centered medical home), and
  3. Get the USPSTF recommended screening for cancer and treatment for diabetes, and heart disease performed at high value providers

All employees were to be moved to a high deductible health plan to increase their involvement and to create a personal investment in making sure they took care of their health and had “skin in the game.”

The HR team was really concerned about the reaction by the employees when this was announced. They appreciated their President wanting to save money on health care and wanted to have this go off without a hitch.  Therefore, they reached out to the HR staff at several companies that had successfully made this change and got their advice on how to roll out the plan.

In the next few blogs we will review how they decided to roll this out to insure success. To make it more accessible, and interesting, we will use the paradigm laid out in the book Switch by Dan and Chip Heath. We will explore how to change the direction of the “elephant” walking down the old familiar path, directing the rider, motivating the elephant, and re-shaping the path.

Increasing Employee Engagement: Switching Your Focus

By DrScott – Posted on January 23, 2014 on www.compassphs.com

Second in the How to Switch On Your Employees Series

Have you ever been overwhelmed by all the TBU (true but useless) data provided in your Health Insurance Annual Report? It reminds me of looking at a photograph of a car accident – lots to see that went wrong, vehicles damaged, people hurt; but it is already done. To add insult to injury, the Annual Report is often received months after the end of the year and a whole new set of wrecks have occurred. There has got to be a better way!

In this series, we are going to examine how to get your employees to follow you as you plan and execute a new path to lower healthcare costs, higher quality care, with fewer hassles.

In previous blogs we discussed the three keys to success in changing behavior for yourself or your employees. The paradigm is laid out in the book Switch by Dan and Chip Heath, and they use the example of trying to change the direction of an elephant walking down a path.

  1. First the rider (representing our reason) must know the destination, the steps to get there, the reason to go there, and have a sense that the journey is possible.
  2. Second, the elephant (our emotions or the inertia of our life based upon habits, beliefs and experience) needs to be inspired and has to have the journey broken down into achievable, small steps, and, where necessary, the employees will need to cultivate an “I can do this” mindset.
  3. Third, understanding the path of least resistance based on the terrain, well-formed habits, and following the pack.

Let’s go back to the somewhat depressing and very sobering annual report on health benefit spends we spoke of earlier. What do we see?

  1. We see Sarah, a 50 year old diagnosed with stage 3 breast cancer,
  2. John, a 48 year old who had a heart attack at work,
  3. Kristen, a 23 year old diagnosed with advanced cervical cancer,
  4. Bill, a 37 year old having low back surgery,
  5. Randy, who had a serious car accident when he fell asleep driving one evening, and
  6. Twins born at 26 weeks who spent six weeks in the hospital,
  7. And the many employees with neck, back, hip, knee, chest, pelvic, and other pain going to emergency rooms and doctors trying to figure out what is causing their pain, while spending millions of dollars.

With the exception of the twins, these medical problems built up over time – five to fifteen years – and didn’t have to happen. What could have been done to avoid these tragedies? Basic prevention, wellness, and treatment recommendations – in today’s vernacular the evidence based “Gaps in Care” would have to be closed. Sarah and Kristen would have their screening for cancer done earlier, John would have his blood pressure and cholesterol treated, Randy would have treated his sleep apnea, and Bill would have maintained his weight and focus more on fitness. All reasonable and very possible goals.

How do we motivate the rider, change the path, and turn the elephant to a new direction? Every trip starts with a clear destination. Focusing on what we can do to stop the tragedies and reduce the cost by closing Gaps in Care is one example. In the next blog we will show how a company focused on this and how it saved employee lives and hundreds of thousands of dollars.

What Does Your Employee Health Balance Sheet Look Like?

By DrScott – Posted on January 21, 2014 on www.compassphs.com

What is the most expensive item on your statement of revenue and expenses every month? Employee payroll tops the list for almost every company, with health benefits landing in the second or third position depending on whether you are in manufacturing (raw materials often in second place), or a service industry.

Now, how carefully do you manage employee costs? Cost of raw materials? What about health costs? When I ask this question of most CEOs and CFOs the answer is consistent – on employees and raw materials they are meticulous, but they don’t feel like there is much they can do when it comes to health benefits.

Really? As we have examined in these blogs, there is A LOT that they can do. In fact, given the high cost of health benefits it would not surprise me if soon companies will not have to add “Employee Health & Wellbeing” to their Balance Sheet. How? Well, disease doesn’t appear in a person overnight – it takes years, and if detected early it can be cured or slowed dramatically. Why don’t we slow or prevent disease progression?

The “I Feel Fine” Syndrome lulls us into a false sense of security (as we discussed in the last 4 blogs). But this is not inevitable – identified and handled properly, costs stay down, employees stay at work, and families keep their mothers and fathers.

Smart venture capital firms like Blackstone have already figured this out and established companies like Equity Health to get control of this issue. Imagine buying a company, putting in place proactive solutions, and dropping the cost of your number 2 or 3 spend by 10 – 30% in the first 36 months consistently. Regardless of how much the rest of the company performs, you already have created significant shareholder value.

So what will the Balance Sheet say? No one knows exactly, but an educated guess includes:

Assets:

Employee Health (Assets = lower costs relative to average employee of $X)

  • % of Employees

Healthy Employees : $3,000/employee

  • 15%

Employees with Chronic Conditions well managed : $1,400/employee

  • 8%

Liabilities:

Employee health (Liabilities = higher costs relative to average employee)

  • % of Employees

Employees with poor physical fitness <$500/employee>

  • Unknown

Employee with unknown health status <$1,400/employee>

  • 57%

Employees with uncontrolled Chronic Conditions <$3,200/employee>

  • 14%

Employees with Serious Illness <$19,000/employee>

  • 6%

So let’s take a company with 1000 employees paying on average $5000 per year for health benefits. This calculation would be a net negative of <$798,000> on the balance sheet. Getting biometrics, age and gender screenings along with active primary care involvement would shift this from a net negative on the balance sheet to a break even on the balance sheet. It would also reduce health care costs by over $60,000 per month. This approach is logical and attractive both from a financial and employee well-being standpoint. However, it takes experience and competent systems to achieve.

Tremendous opportunity to make very significant differences for your employee’s health and well-being exists. Designing systems that help your employees keep their Seven Numbers at goal will add years to their life and life to their years. Thank you for following this series. Please let us know if you have thoughts or stories of how you are accomplishing this in your companies.

How the “I Feel Fine” Syndrome™ Is Costing You Millions – Part 3

By DrScott – Posted on January 2, 2014 on www.compassphs.com

In the last blog we took an honest look at what is accomplished by closing our gaps in care for primary and secondary prevention. Primary prevention is defined as taking actions to prevent a disease from occurring. So identifying and addressing metabolic syndrome, the “pre-disease” for diabetes, heart disease, strokes, and certain cancers is an example of primary prevention. Secondary prevention is helping employees identify the problem after a disease has occurred, but before the person notices that anything is wrong. Early detection of cancer is a great example of this.

What both primary and secondary prevention highlight is that the person with the pre-disease has the “I Feel Fine” syndrome. Said another way,  how do we get an employee who feels fine, who has gotten up and gone to work for decades, usually without having a health issue arise in their life, go through the trouble of:

  • finding a good provider;
  • setting up an appointment;
  • going to the doctor’s appointment; and,
  • making additional appointments for additional testing (mammograms, colonoscopies, and so forth), every year?

To realistically expect this to happen, efforts must be made to address the inertia that has kept them from doing this previously. This requires answering the following questions:

A) Why should I do this?

  1. What are the implications to my life for doing or not doing this?
  2. What are the implications to my job for doing or not doing this?

B) Who is best to go to?

  1. Should I go to a primary care doctor or specialist? What is the difference? Why is one better than the other?
  2. Are there differences between doctors? Who is the best?
  3. How do I know if they are good at addressing this problem and even if they are good overall?

C) How do I get this done?

  1. Is it as simple as making an appointment?
  2. Will they do the right test?
  3. If I have to communicate to my employer that I have taken these actions, how do I do this?

D) Where do I get this done?

  1. How are my choices impacted by my health insurance plan?
  2. Can I go close to home or work?
  3. Do different doctors cost different amounts?

E) Who can I ask to get answers to these questions?

  1. Do I call my human resource staff, the health plan, etc.?
  2. How do they get cost and quality information on doctors and tests?
  3. Who can I trust to get these answers?

While intuitive for most of us in the health care arena, these are often intimidating issues that must be overcome for employees before they act. While it may be as simple as saying “call your family doctor”:

  • Over 40% of employees have not been to a primary care doctor at all in over 2 years; and,
  • 40% have only seen them for acute illnesses and have no true continuity of care established for prevention or chronic issues.

That means that up to 80% of employees may not know where to go to get their physical and age and gender appropriate tests performed properly and at the best price.

What if there were a way to simplify this process and greatly improve the chance of the right tests being done at the right place, by the best medical provider, at the right cost virtually 100% of the time?

In the next blog we will examine specific strategies companies are incorporating to help overcome the “I Feel Fine” Syndrome.

How the “I Feel Fine” Syndrome™ Is Costing You Millions – Part 2

By DrScott – Posted on December 31, 2013 on www.compassphs.com

In the last blog we examined the fact that during the early phases of disease development we don’t feel symptoms. Despite this, the disease is developing in our body and we can discover and cure it, but over 80% of us don’t take action.

So why don’t we do it? Why do 8 out of 10 of us put off these simple tests and condemn ourselves to years, or decades of pain and suffering?

Asked another way, why would a rational human being who is busy and challenged keeping up with obligations to family, employer, friends and social groups, stop what they are doing to:

  • go spend their time sitting on hold trying to make an appointment,
  • take time off from work – usually unpaid or using personal time,
  • take off their clothes and have a stranger probe their body, stick a needle in them,
  • go to another facility to have their body squished (mammogram) or a tube inserted (colonoscopy),
  • spend time worrying and waiting for results, and then,
  • often pay their hard earned money for additional tests or procedures that often turn out to be “nothing.”

This on top of the fact that this person has awoken for forty or more years and not discovered a problem, they don’t feel any different now, and frankly they really could not afford emotionally and financially if a problem was discovered.

Hard to imagine, isn’t it? Looked at from this perspective, one does wonder how we ever get anyone to get these tests done! To get people to overcome the “I Feel Fine” Syndrome, an effort to simplify and support employees’ acting effectively must occur.

The wonderful news is that it is happening. One company required their employees to have a biometric screening done and discovered that nearly a third of their employees were not only overweight or obese, but they had metabolic syndrome. Heart disease and diabetes were at the top of the list for health costs and their healthcare spend was rapidly increasing every year. They decided to actively engage in primary prevention with an aggressive metabolic syndrome program. Three years later heart disease and diabetes were costing them literally millions of dollars less and had fallen down on the list of causes of pain, suffering, disability, and death for their employees.

“Our costs were going up rapidly and difficult economic times created a very real challenge to our company. Our advisors were recommending that we change directions and become more proactive and aggressive with our health benefits by doing biometric testing and taking other steps that would mean more cost and a change in our culture towards wellness. The decision we made was to bet on the future health of our team members and not short measures to control cost.”

— Cary Evert, President Hilti North America

To learn more about their journey, request a copy of The Seven Numbers and read the introduction by Cary Every, President of Hilti North America.

In the next blog we will examine the issues companies are addressing to help overcome the “I Feel Fine” Syndrome.

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