wellness

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.

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.

How is Your New Year’s Resolution Coming? This Year it is Time to Succeed!

By DrScott – Posted on January 14, 2014 on www.compassphs.com

First in the How to Switch On Your Employees Series

What is your New Year’s resolution? If you are like most Americans, the resolution will be given up by Super Bowl weekend and things will be back to status quo. But what if things were different this year? What if you succeeded and lost that weight, got in shape, or saved that money? What if 2014 became the year to get things done in a way you have never experienced before? What would you have to do differently in 2014 compared to previous years?

The science of change management, which is what we are speaking about, has come a long way in the past 5 years and it’s time to incorporate these discoveries into achieving our goals.

Let’s start by asking: is knowing what to do enough? As a weight loss expert who has helped hundreds of people lose weight, it is clear that there are many patients who can literally recite encyclopedic knowledge on calorie balance, exercise, food labels, and the latest best seller’s strategy on effective weight loss, but they don’t lose a pound. They know what to do, but are not doing what they know.

Maybe the key is to create or overcome strong emotional issues. In the patients mentioned above, often a life event preceded the significant weight gain. When this occurs there is no question that getting in touch with “what happened” and re-framing the experience in a more empowering and less threatening way makes a difference. However, often there was no preceding trauma or the traumatic experience was resolved through beneficial and significant counseling but no weight loss occurred, suggesting that attention to emotional issues may not be enough by itself.

Perhaps the environment makes the key difference. One Compass client discovered their employees gain, on average, over twenty pounds of weight in the first year they are working in certain departments (and this is not muscle weight – it is good old fashion fat). Employees are not allowed to be out of their seats more than 5 minutes an hour, they are rewarded with food when they achieve performance goals, birthdays are celebrated corporately with large cakes and free soft drinks (there are over 500 employees – more than one birthday per day on average), and long work days are common, leading many to work 10 or more hours a day minimizing the time for non-essential out of work activities like exercise.

Challenging environments are not just created at work. At home, the refrigerator often contains soft drinks, cabinets contain potato chips and cookies are baked and shared as a sign of love. Nutritious food is difficult to find and more expensive than fast food. Unfortunately, many obese children and adults do not have the resources to access nutritious food. So perhaps the reason we fail so frequently is that we are not looking at the bigger picture. Some combination of these factors work together to block our change efforts. What are the results if you address two or three of these issues at the same time? In the next blog, we will look at the interaction between these factors and at what the research is telling us about making sure we win this year with our New Year resolutions!

How The “I Feel Fine” Syndrome™ Is Costing You Millions – Part 4

By DrScott – Posted on January 7, 2014 on www.compassphs.com

In the last blog we addressed specific occasions that prevent employees from knowing where to go for the right test at the right time, with the right provider, and at the right cost. In this blog we will examine specific strategies that companies use to overcome these barriers.

Below are six strategies that companies have used:

  1. Get and explain the importance of their biometric numbers. Biometric screenings can be done at work or at the doctor’s office.
  2. Make sure employees know where they are at risk and the need to act.
  3. Remove the cost of the screening test (now necessary with the Affordable Care Act).
  4. Give employees time off from work for their physical and testing.
  5. Reward employees for closing their age and gender appropriate gaps in care.
  6. Inspire employees to “do the right thing” for themselves, fellow employees, their employer, and their families.

If you are responsible for employees at a corporation you may be asking yourself why do all this work? Is it really a company’s responsibility to help cure the “I Feel Fine” Syndrome? From my perspective as a practicing doctor I would say to you: I cannot do it without you.

Employees have to be engaged and encouraged. Doctors cannot do it without your support. With your support in health plan design, focused communications, and providing the right tools to your employees and their families, outstanding life-saving and cost reducing solutions are possible and corporations are winning the war on disease and disability.

This change in thinking is redefining what the Human Resources Department means to corporations. Always focused and concerned with the experience of the employee at the corporation, the HR department now has the opportunity to take the employee experience to the next level:

  • From “I always had health insurance” to “I am alive today because of the proactive programs my employer put in place”!
  • Teaming up with the insurance company and medical providers to create a system of care that helps employees get it done, as opposed to creating frustration and unnecessary expense!

As Karen Rogers, an insurance broker at Holmes Murphy & Associates in Dallas Texas said in her introduction to the book, The Seven Numbers, “When I started my career in the insurance industry, I never expected to be saving lives. Yet, 22 years later, as I consult with employers on their employee benefits strategy, it is what I do”. If you work in health benefits you are either saving lives, or allowing employees to remain at risk. Choose to save lives and appreciate the tremendous opportunity available to you today.

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.

How Regularly Are You Exercising? 2014 May Be The Time To Start

To stay up to date on the latest information I listen to the Massachusetts Medical Society Journal Watch.  They say medical knowledge doubles every 9 months these days so it is important to stay on it! 

I thought you might enjoy this summary on exercise;

Robust midlife cardiovascular fitness is associated with lower heart related disease, but what about death? To answer that question, researchers evaluated the associations between fitness and several chronic conditions (namely, ischemic heart disease, congestive heart failure, stroke, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, Alzheimer disease, and lung or colon cancer) in older patients by linking a preventive medicine registry to Medicare data. Nearly 20,000 patients got full baseline fitness and medical evaluations and were stratified into five groups based on their fitness level (the patients’ average age at study entry was 49; most were men). A good number of the patients had relatively favorable cardiovascular risk profiles at study entry. Findings appear in the September 24 Archives of Internal Medicine (http://viajwat.ch/WhxcCO).

During a median follow-up of 26 years, the patients who were most physically fit had about half of the prevalence of chronic conditions than did those who were least physically fit. In adjusted analyses, each Met (metabolic equivalent) increase in baseline fitness was associated with a roughly 6% reduction in risk for developing a chronic condition.

Although these results on midlife cardiovascular fitness being a predictor of healthy aging are not surprising, they add another motivation for encouraging midlife fitness: This approach can lower the risk for frailty and comorbidities while improving quality of life for older people. 

Here is to aerobic exercise at least every 48 hours in 2014!  Happy New Year.  SC

It’s time to rethink the way we eat

One of the joys of my life is teaching Weight Loss The Jabez Way at local churches. The first line of the Prayer of Jabez is “And Jabez Cried out to the God of Israel” 1 Chronicles verse 4:10. Note, he didn’t ask, request, suggest or inquire – he CRIED OUT! When have you cried out in your life? When you are desperate, frustrated beyond belief, or hopeless? What are you willing to do at this point? To try something new?

With our weight if we knew how to fix it we would.. So the fact we are struggling means we need to be open to a new way, we don’t know what to do, and it is time to change and be a learner (as opposed to a knower).

Here is a must read article that suggests that what we have taught in the past may not work for everyone, and in fact may be harmful. Please take a moment to read it at: http://io9.com/5979523/why-you-should-starve-yourself-a-little-bit-each-day ” Starve Yourself!>