bringing healthcare consumerism inside: the communications...

175

Chapter Nine

Bringing Healthcare Consumerism Inside: The

Communications Campaign This chapter outlines in some detail a broad communication cam-paign approach that will help to ensure that your efforts to address the company’s healthcare concerns and wellness succeed. Getting employees to change their ways of living take a con-certed effort and a smartly crafted and consistently delivered message. A big first test for human resources and employee benefits managers is to educate executive management on the importance of this effort so that the right resources are allocated. This should be accomplished in the stages reviewed in the previous chapter. But translating “resources” into effective com-munications is another matter. The old adage about advertising that, “Half my advertising is wasted, but I don’t know which half,” also applies to other forms of communications. In most large companies, health communication is not the traditional function of HR or Benefits. But in the new world of healthcare consumerism, these departments will need to take on the added responsibility of forging effective health-related strate-gies and message flows to the employee population. This will likely require the supportive expertise of an outside organization or agency specializing in communication to get it right. HR needs to be at the forefront of change, however, in an expanded role. Behavior change is a process. Make no mistake: Changing health-related behavior is very difficult. Unlike most of their pur-chasing decisions, the vast majority of consumers do not choose willingly to make health-related decisions and purchases. They are responding to a condition, illness, or disease that needs to be addressed. In addition, most people, especially hard-working employees, claim they don’t have time to take care of health-related actions, whether they are preventative exams, filling their prescriptions, exercising, or eating right.

Why Healthcare Matters

176

Companies can begin to work toward changing the behavior of their people by using the same principles of consumer behav-ior change that advertisers use. But the issues related to changing behaviors are quite different from what is required to test market a new blend of coffee or a new fruit drink. The direct-to-consumer advertising experience is relevant. When prescription drug advertising to consumers began in the mid-1980s, many advertisers expected that if they put “See your doctor” in an ad for a particular condition, every afflicted patient would soon call for an appointment. Patient visits did, in fact, increase in the early days, but soon the novelty of a prescription ad in a magazine or on TV began to wear off. And once the FDA lifted its restriction in 1997 on broadcast ads for branded mes-sages (which feature both the brand name and the indication, requiring “adequate provision” for fair balance, side effects, and contraindications), consumers had seen quite enough. A more sophisticated way of thinking was required on the part of market-ers, such that they were able to better identify target prospects, understand their barriers to action, and create communications that would generate appropriate action. This experience of the pharmaceutical industry in marketing their prescription brands to consumers has real relevance for employee behavior change regarding healthcare, and the lessons learned have great value.

Bringing Healthcare Consumerism Inside

177

Lesson Learned from

Direct-to-Consumer Advertising

For the past 20-plus years, pharmaceutical marketers have used mass media to advertise their brand-specific and dis-ease-awareness messages to consumers. They have learned first hand that changing consumer attitudes and behavior is a real challenge. It has not always been a smooth road for drug marketers, but it has gotten better. Many lessons have come out of the experience that are highly relevant to employee-directed healthcare communication. Some of the key learnings from DTC marketing include the following:

• Relevant segmentation of the target audience can lead to smarter and more effective targeted messages and media strategies.

• Consumers invariably follow some sort of a decision pathway that begins with symptom recognition or some health-related concern and moves through multiple psy-chological and attitudinal barriers until they ultimately arrive at an effective treatment or solution.

• Too much information at once can be counterproductive. Bite-sized pieces of data, support, encouragement, and motivation can together create a cohesive communica-tion, doled out in meaningful doses.

• Consumers recognize and appreciate the importance and value of health warnings and drug contraindication, even though marketers fear their negative impact.

• Most healthcare products and services are not purchased out of desire, but rather because of need. It is generally a highly considered decision.

• Interactive communication opportunities can often be more productive than “push” marketing: people want to participate in dialogue, not be told what to do.


178

One of these lessons is that the process of behavior change occurs at different “paces” and in different ways across segments of the population. Some individuals can see a piece of informa-tion and act on it immediately. Some ignore it, some do in-depth research, and some ask friends or family about what to do. This is why you have to constantly work to understand and engage your people. In most organizations, there is not much health-related communication throughout the year beyond the annual open-enrollment period, except maybe for the winter flu shot days, a charity run, or a blood drive. However, there are many areas of health-related dialogue and information sharing that can be leveraged at other times and throughout the year: You can, for instance, provide all employees with regular updates about important health topics in the news, while targeting selected populations with more relevant information. You can also pro-vide disease-specific information and disseminate simple ques-tionnaires for targeted individuals, on-line or on paper. Communications is marketing. The elements of a health-oriented communication campaign need to be considered in much the same way a marketing team would think about launching a new product or service. Think like a marketer and ask yourself:

What do you know about your market now? What additional information would you want to know? Who are your key target consumers? What is your communication objective? What do you want your target audience to do? What should the media plan to accomplish, and how? What is the timing for the messages? How will you know how effective the campaign has been? What pre-testing can be done?

These questions just scratch the surface of the sort of in-depth thinking and consideration that goes into the development of a successful campaign. This is not an effort that can be done by the seat of your pants or on an ad-hoc basis. All these and


179

many more questions need to be identified and addressed by the internal team and any outside communication consultants you enlist. They form the basis for the work of the planning team. Market research, audience segmentation, and creative strategy are all key components of the development phase, and they will lead to a more effective communication process. If you use the same rigor and discipline that a brand manager would in devel-oping a marketing and advertising campaign, you’ll be well on your way to creating a successful initiative, with built-in measur-able objectives and expectations around positive outcomes. A 10-Step Plan to Building a Communications Program There is no one best approach to developing a marketing or communication campaign, but the 10 steps outlined here can pro-vide a fundamental base for building yours. The steps are really universal, but some will require more involvement from the team, some will require outside resources, and some will take a lot longer than you might like. Done well, they will help to create a robust and powerful path to building a more healthy company. Step 1: Identify your communication objectives. Think through all your goals. Be clear in your statement of objectives about what the company wants to convey, to whom, and in what time frame. The objectives might change from year to year, and build on the previous ones, but the focal point needs to be on the current effort. The strategic plan will take care of the longer-term view. Your communication objectives must address the key aims of what can be accomplished in a given time frame within the avail-able budget. Consider the objectives with all aspects of employee health in mind, along with the retrospective experience of how it’s been done in the past. Think through the full year and be realistic about what can be accomplished.


180

Step 2: Define your target audience. Many of the key mes-sages you’ll convey will go to the entire workforce or a clearly defined subgroup, such as one or more specific offices or work-sites. Many others need to be tailored to either an easily identifi-able demographic group (e.g. mothers of younger children) or a more-difficult-to-identify segment of individuals with a particu-lar disease or condition (e.g. people with diabetes). This is where the targeting can get a bit trickier, because of privacy issues. Any disease-related communication that goes to an identifiable subset of the population can be contracted to a relationship marketing firm or disease-management outfit that can provide relevant and supportive interventions and appropri-ate communication related to the disease, therapeutic options, and treatment alternatives. Don’t get too crazy with over-defining the target audience at the outset. A lot of the communication messages will need to reach all employees, but it is worthwhile to find ways to be as personalized as possible. Consumers don’t generally respond to “Dear Resident” letters, and employees behave the same way—they’re consumers, too. Put their name in the correspondence or send it by mail to their home address, or find other smart or unique ways to reach them in the right environment. Sometimes it’s not what you say; it’s how you package the message. Step 3: Build the communication strategy. With the objectives and target defined, the area of communication strategy is next. Strategies need to align with the objectives and accommo-date the multiple segments of the employee population. Each strategy may call for sequenced messages to accommodate the “build” of the story or to address inaction on the part of the recipient. This is a tough part of the process, because it must anticipate a range of possible outcomes. Scenario planning can be very important. Marketing research among a representative sample of the workforce such as surveys or focus groups and will save a lot of wasted time and effort in the long run. It’s a big step for a company to evolve from the straight-forward open-enrollment event to a fully integrated, strategically


181

segmented effort to keep your employees involved. Take a step at a time. Step 4: Outline the tactical approach. From the various strate-gies follow the tactical deliverables. Thinking beyond the stan-dard communication tools, what other vehicles or forums could be effective in conveying various elements of the plan? Consider the array of possibilities, from town hall meetings and Web-based senior management briefings to afternoon barbecues and weekend boat rides. There are innumerable ways to capture your audience and share the sorts of messages that are required in the plan. Sometimes the zaniest ideas are the ones that are most memorable and most action-oriented. Creating competitions between groups can be highly motivating. Many companies are using “10,000 Steps” programs to promote walking or issuing “Biggest Loser” challenges to encourage and reward weight loss. These kinds of programs have a cumulative effect as well; when non-participants see how their colleagues have succeeded, they often feel they can, too, and will join up the next time around. The tactical plan will need to consider different incentives, discount offers, and motivational ideas to encourage behavior change. Explore how major marketers successfully use loyalty programs and other incentive-based approaches to reach out to their stakeholders or customers to motivate behavior change and reward positive actions. It’s always helpful to find analogous scenarios in different markets. Step 5: Evaluate media choices. This is a lot of fun because it can involve a good amount of creativity to think through the possibilities. Many good ideas can be found right there in the workplace. Think about each of these:

• Most large employers have plasma screens in the lobby or office area or cafeteria tuned to CNN or another news pro-gram. They are good ways to broadcast health information.


182

• Magazines, newsletters, and other print vehicles are per-fect for carrying messages or ads for the healthcare and wellness program.

• Broadcast radio is less common in most companies, but there are probably ways to broadcast audio messages (in elevators and common areas, for example).

• Your intranet is a perfect place to reach compliant indi-viduals; the healthcare program can also drive people to the intranet as a strategy.

• Portable billboards or posters can be placed in any num-ber of venues, from the parking lot to the restrooms to the outdoor quad and can be changed easily.

• Direct mail (e-mail or snail mail) is clearly a good option.

• There is buzz in every company. Whether positive or negative, it’s there. The key is to harness it in the right way and get people talking and acting.

So there are many options. Use your media smartly, strategi-cally, and in a way that delivers maximum benefit without over-doing it. Strike a balance and consider all the ways that your people can get information from the company in the planning and selection process. Everything counts, and everything needs to be considered as a possible vehicle for health-related mes-sages. Wellness isn’t achieved in a day—it happens one step at a time—every single day. Step 6: Prepare the key messages. Here’s where the storyline gets created. Be sure you start with the big-picture story of the company’s commitment to make healthcare a high-level business strategy. Outline the broad-stroke features of the employee health benefit plan and the wellness programs and other initia-tives, and explain what each individual can do to participate. Develop a flow diagram for yourself to illustrate to the team just how and when the story will get told. By phasing the timing of the information rollout, employees will be able to take on the content and digest it so it begins to create meaning for them.


183

Some of the story must also be interactive in that you’ll want to drive some action or response. Be sure to accommodate a two-way component in the messaging. In addition to the broad audience messages, there needs to be a separate message flow prepared for each of the identified strategic segments, which would be delivered on an individual-ized basis. Use live feedback via telephone or Web chat (via third party provider), for example, to be sure that the uptake is happening in the right way and that everything is clear. Whatever vehicles you use—presentations, newsletters, post-ers, group meetings, and so on—you will definitely need to make adjustments, revisions, and additions. The development team has to be flexible enough to monitor progress and accommodate changes. And the content needs to always be consistent with the objectives, oriented to positive change, aligned to the corporate culture, and well presented. Step 7: Do the creative work. Craft every message to have maximum impact and to drive appropriate action. If you have the budget, hire a media company or advertising agency to create the right look and feel and in effect brand the effort. Employees respond to company communications in much the way they respond to media in their world outside of the workplace. They pay attention to what is important to them, scan what may be moderately relevant, and reject a whole lot of what’s out there. It is definitely a bit different at work, because people are being paid to pay attention to memos, presentations and reports, but there is still a selling process going on. Just because an employee attends a business meeting or reads a status report doesn’t mean that he or she is buying into what’s being said. This is even more of an issue when you cross over from job-related communications to something that is more personal. A soft touch combined with facts and data and compelling visual imagery may be needed for some of the story, while a simple typed memo may be enough for other parts. Communication experts who understand behavior change can help you package and sell an important series of messages that will have long-term


184

positive benefits for both the employee and the organization. If we all behaved in a way that led to long-term positive benefits, none of this would be necessary. But the reality is that life and bad habits and daily living get in the way. The key is to break some of the negative cycles of behavior, improve health, save money, and improve efficiency. Step 8: Measure results. Plan how you will measure the results well in advance of launching the effort. List all the desired behavior changes, along with the data sources to track those changes. Be sure to establish pre-campaign baseline levels across a range of metrics. Think also about the attitudinal areas where you’ll want to see some improvements: attitudes about the benefit plans, how the company communicates, job satisfaction, and other relevant areas. Be mindful of the effort and expense required to accu-rately collect data and prioritize what is most important to track so you can budget accordingly. Incorporate analyses on claims data, health risk assessments, and disease incidence, because these are areas where you can really lower costs, achieve better health outcomes, and generate higher productivity. Improvements in health status are the desired end result, but you also need to know how well you’re communicating your message. Some companies hire a market research expert to construct a measurement system that can deliver credible results from a good representative sample of the employee population. Done well, the data can be written up in an employee benefits or work-force management journal or otherwise be used to highlight your company’s success. Step 9: Encourage and share feedback. Never ignore the importance of feedback, including negative feedback. Clearly, an effective communication campaign cannot be one-way. It needs some active participation of the workforce to be sure it’s being properly received, accepted, and acted on. Get people talking in positive and constructive ways, but also in honest and critical


185

ways. Ideas: create a blog, put up suggestion boxes, hold live open forums, or organize discussion groups. You’ve seen the late night infomercials that encourage you to “call now” or the magazine ads with pop-up reply cards. Con-sider using offers and opportunities to enroll in various programs or sign up for events, which can help you collect feedback from participants. Include ample ways for individuals to send their views anonymously as well. Emphasize that Big Brother is NOT watching, and that you are all in this together (“The company is doing this to help you and to help us.”) In the end, everything should be better all around. Step 10: Revisit the whole process with an eye to making continual improvements. The idea that “We did it like this last year” won’t work. Some things that work should not be changed, but you have to be flexible and ready to shift gears in those areas that were not effective. W. Edwards Deming, the eminent quality expert, strongly advocated the notion of continuous improvement. In his four-step process for quality improvement that became known as the Deming Cycle, he taught business leaders the following sequence of steps:

• “Plan” to improve a product or process. • “Do” what is planned. • “Study” the results. • “Act” on what has been learned so that the process can be

repeated and continuously improved.

Deming believed in the importance of the system. “What we need to do is learn to work in the system, by which I mean that everybody, every team, every platform, every division, every component is there not for individual competitive profit or recognition, but for contribution to the system as a whole on a win-win basis.”


186

For companies just getting started, this will be challenging but worth the effort. For those at the leading edge of change, be open to sharing your best practice and lessons learned. Compa-nies are banding together in unusual ways to share their experi-ences and find new ways to tame this beast of out-of-control health insurance costs and unacceptable health outcomes. There is much to do in transforming employee health, and a lot begins and ends with communication. Employee Satisfaction and Retention: Increasingly Important Factors Healthcare benefits are important for the obvious reasons of pro-ductivity, health, and quality of life, but they are also important for employer satisfaction and retention. The 2007 MetLife Study of Employee Benefits Trends con-sists of two distinct studies. The employee part of this annual survey polled a diverse mix of 1,380 full-time employees, while the employer part of the survey consisted of 1,652 interviews with those in charge of decision making for their company’s employee benefit plans. One of the study’s conclusions is that employee retention is the top benefits objective among employers. Employee retention was identified as the most important benefits objective by more than half (54%) of employers overall. Interestingly, in 2003, fewer than half of employers acknowledged employee retention as a primary goal. In an environment where 40% of employees say they have changed employers at least once in the last five years, there is growing recognition of the need to create benefit plans that address the struggle to recruit and retain employees. While employers seem to recognize the importance of health benefits as an important factor in keeping their employees, they do not all seem to recognize the role benefits serve in building loyalty, which can serve as an underlying driver of retention. When asked to identify the importance of work-related factors that give employees a feeling of loyalty to their employers, 81% of employees surveyed cite health benefits as important, second


187

only to salary/wages. Only 60% of employers surveyed said that health benefits are the most important, however. If employers can close this loyalty perception gap and recog-nize the important role benefits play in influencing company loy-alty, they will be in a better position to retain their most talented workers. A correlation between benefits and retention appears stronger than in the past. Benefits satisfaction among employees has risen to 44%, an increase of 8% over 2004; 58% of employers now view benefits as important to retaining their employees. In addi-tion, among those who are highly satisfied with their benefits, 85% plan to be working for their current employer 18 months from now, compared to just 50% of those employees who are not satisfied with their benefits. Employees are more satisfied with their benefit plans and are increasingly saying that benefits play an important role in their decision to join or remain with an employer. Forty-five percent of all employees say benefits are an important reason they remain at their current job, up from 33% in 2006 and 35% in 2004. One-third say benefits were an important reason for taking the job in the first place, up from 25% in 2004. Of those who are satisfied with their benefits, 70% say benefits are an important reason to remain with an employer. Only 14% of those who are not satisfied with their benefits say this. So the good news is that a strong benefits plan can be a real asset for recruiting and retaining employees. The bad news, though, is that the privacy limitations hinder the ability to drive behavior change. This can, however, be achieved through the use of credible third-party firms that directly engage with employees and help guide them through health improvement actions. Employers Rank Last In its first-ever survey about health insurance, J.D. Power asked consumers which sources they trusted the most for health information. Not surprisingly, a large majority cite their own doctors, with 70% naming their primary care physician and 31% saying


188

they most trust the specialist they see the most. Family and friends (24%) and their spouse (17%) came next on the list. Perhaps the most startling finding was this: Approximately 60% of Americans said they get health insurance from their employer, but only 3% trusted their employers the most for health information—well behind online health articles (23%), articles on their health plan’s Web site (14%), their health plan (12%), the government (8%), and even none of the above (6%)!

Thanks, but no thanks

Your primary care doctor

The specialist you seethe most

Family and friends otherthan your spouse

Health articles you read in thedaily newspaper or online source

Your spouse

Health articles you find onyour plan's Web site

Your health plan

Health information producedby the government

Your employer

None of these

70%

31%

24%

23%

17%

14%

12%

8%

3%

6%

J.D. Powers & Associates asked 9,246 consumers which sources they trust themost when it comes to advice about how to stay healthy and how to get the besthealth care.

Source: J.D. Powers and Associates J. D. Power did not ask survey respondents to elaborate on the reasons behind their choices, but David Stefan, the firm’s executive director of healthcare practice, has one observation. “It’s a ‘Big Brother’ issue. Employees being fired for smoking and losing health insurance [for unhealthy behaviors] has created fear


189

among employees and made them realize that employers have a financial stake in what you do healthwise. Employees might be thinking, Maybe this wellness information is more about lowering health costs than caring about my health as an employee. Some health analysts say that while the results are disappointing for employers, they are not surprising. The fact that only 3% of consumers look to their employers as a primary source of information on healthcare is probably not that big of a shocker when you put it in context. For instance, employers have historically outsourced health benefits to major insurers or other third-party administrators. This creates a perceptual distance that is generally shortened only around the time of the annual open enrollment period. Also, there’s the issue of privacy, which is supported by the Health Insurance Portabil-ity and Accountability Act. There’s a general distrust of employ-ers around certain aspects of healthcare, especially with sensitive medical conditions. And finally, most employers do not have qualified medical professionals on staff who know the medical history of employees. But while this explains today’s situation, expect to see big changes as healthcare consumerism, fueled by employers, takes form. In-house clinics, proactive wellness and prevention pro-grams, personal health records, health savings accounts, and more are now being implemented in companies across the coun-try. In fact, in-house clinics are quite hot right now. Employers Shifting Views (EDITOR: I’m not sure if this section and the next is placed correctly. I’m also not sure what level subhead they are supposed to be.) But while this explains today’s situation, we expect to see big changes when healthcare consumerism, fueled by employers, takes form. In-house clinics, proactive wellness and prevention programs, personal health records (PHRs), and other innovative approaches are now being implemented in corporations across the country.


190

A recent study by Hewitt Associates suggests that big changes are in the offing. Two Roads Diverged: Hewitt’s Annual Health Care Survey 2008 revealed that the number of employers who say they will get more directly involved in managing the health of their employees jumped 25 percentage points from last year. The survey of more than 500 U.S. companies found that keeping employees healthy was a top business and workforce issue for 2008. Approximately 88% corporate respondents said that they plan to make investments in long-term solutions aimed at improving the health and productivity of their workforce over the next three to five years, up from 63% the previous year. Employees Differ Employees, however, have a different view of the role of their companies. In a separate survey of 30,000 employees, 74% respondents said that they believe employers are responsible for helping them understand how to use their health plan. Only 12% believe that companies have a role in helping them understand how to stay healthy. This reflects the sentiment of the JD Power report. Clearly, employers have a long way to go to gain the trust of their workforce in this area. Employers are in a tough spot, because they must grapple with the challenge of maintaining a healthy workforce. As Jim Winkler, leader of Health Management Consulting for Hewitt, notes, “With complex global economics, legislative uncertainty, and increasing healthcare costs and healthcare risk, health and productivity had gone from being viewed as a cost that needs to be managed to a critical business investment.” The Hewitt study reported that 95% of employees surveyed believe that taking care of their health today will have a direct impact on what they pay for healthcare in the future, and that 88% say they currently engage in healthy behaviors. This raises a question of perception: Most consumers believe that they are doing healthy things, yet the reality is that few do. In fact, when asked about specific actions they take toward living a healthy lifestyle, only 47% of those employees said they eat right; 40%


191

report that they exercise regularly; and 40% say they do a good job at asking for advice on how to stay healthy. So while most employees do not seem to feel that the employer has a role to play in helping them understand how to stay healthy, it is unlikely that they will reject good guidance in this area from their employer, as long as it does not cross the pri-vacy line. Bringing Healthcare inside with Company Clinics Another approach to addressing the healthcare crisis that is being implemented by several U.S. companies is to bring healthcare directly to the people in the form of in-house clinics. This is proving to be an effective way to provide convenient and low-cost care. Milt Freudenheim of the New York Times reported in a January 14, 2007 article entitled “Company Clinics Cut Health Costs” that Toyota, Sprint Nextel, Florida Power and Light, Credit Suisse, and Pepsi Bottling Group have all opened or expanded on-site clinics as a way to offer convenient service and free or low-cost healthcare. More than 100 of the nation’s 1,000 largest employers now offer on-site primary care or preventive health services—a number forecast to exceed 250 by the end of 2007, according to David Beech, a healthcare specialist at the Watson Wyatt benefits consulting firm. At the newer corporate health centers, by contrast, the goal whenever possible is to help solve the employee’s health problems without the need for addi-tional outside care. For employees, on-site clinics can mean faster medical atten-tion and lower out-of-pocket costs, since visits are usually free or carry only a small co-payment. Some workers may fret about the privacy of their medical records, but employers say they treat the information carefully and responsibly. Some companies hire out-side providers to run the clinics, thus offering an additional pri-vacy firewall. For employers, on-site clinics can mean gains in worker pro-ductivity and lower health-insurance outlays. ‘‘A clinic serving a couple thousand employees can probably save $1.5 million to $2


192

million a year,’’ said Beech, ‘‘Right away, it’s easy to see reduced referrals to hospital emergency rooms and specialist physicians, and a shift away from hospital outpatient doctors to the clinic.’’ Pepsi currently has 15 clinics and plans to open 15 more over the next couple of years, according to David Kasiarz, the company’s vice president for compensation and benefits. ‘‘We think health affects business performance. Our drivers and sales people define how customers look at Pepsi Bottling. We need to keep them on the street; we need to keep them well and happy.’’ The nurses and physician assistants who run the Pepsi Bottling clinics are employed by a unit of Johns Hopkins University. ‘‘It is important that this is considered independent, ‘‘Kasiarz explained. Although many companies still run their own clinics, a growing number have been hiring independent vendors. CHD Meridian, a unit of I-Trax, is the largest clinic-outsourcing company; others include Whole Health Management, Compre-hensive Health Services, and IMC HealthCare. All say they have pending orders from employers for new clinics that will offer primary care and other services. Big health insurers report that they are closely watching the growing trend toward establishing such clinics, which might pose a competitive threat to them. A vendor company that runs on-site clinics, for example, could steer patients to its own pro-grams for, say, disease management or smoking cessation instead of to equivalent ones offered by the patient’s health insurer. Cigna runs clinics for its own employees in Philadelphia, Phoenix, and Bloomfield, Connecticut. Tom Richards, a Cigna senior vice president, sees Cigna’s role as a partner with the em-ployer and the clinic provider, making sure an employee’s doctor is fully aware of the patient’s medical history and health needs. Brad Fluegel, an Aetna vice president, says Aetna is talking to its large corporate customers about ways to dovetail Aetna’s own ‘‘wellness’’ and chronic disease-management programs with the company’s expanding on-site programs.


193

‘‘Employers are so frustrated with health costs that they are looking for any solution,’’ said Dee W. Edington, director of the Health Management Research Center at the University of Michi-gan. ‘‘One option is to find ways to take care of people before they get sick.’’ ROI for Corporate Healthcare Sometimes the biggest obstacle to corporate change is the what if question. “What if we try it and it doesn’t work?” “What if it doesn’t improve our way of doing business?” As a result, the burden of making a change is quite often avoided or delayed by the challenge to prove it. “Show me precisely what we will gain, and we’ll consider doing it—if you can assure a good outcome.” Well, there are few guarantees in the world of employee health, but for corporations committed to transforming their approach by encouraging employees to take personal respon-sibility for wellness, there is mounting evidence of successful outcomes. But the results of others don’t necessarily translate to what is possible within your own company. Companies adopting consumer-driven health plans, health savings accounts, wellness programs, and the array of related support programs also need to work on establishing their own standards and their own metrics for success. What results will be significant enough to continue to support healthcare consumer-ism in a substantial and meaningful way? The answer will vary from company to company, but having the tools to actually measure the results will be a key step for-ward. This next section will outline some of the ideas and princi-ples to consider in the ROI planning process. Measurement begins with objectives. The place to begin is to clearly define the objectives. Specifically, what are you trying to achieve by employee segment, by disease area, by investment type? Some examples:

• Reduce the overall cost of certain chronic diseases by a specific amount.


194

• Increase the defined fitness level of all staff by a particu-lar factor.

• Eliminate all tobacco from the workplace.

• Motivate every single employee to engage in a new well-ness or prevention-oriented behavior.

• Institute a personal health record for all employees to use proactively.

Specific objectives can vary widely and can incorporate a broad variety of features. What is important is that each should be measurable, because as Peter Drucker has taught us, if you can’t measure it, you can’t manage it. After defining your objectives, you need to be clear about just where you are right now.

• What is the current status of your employee’s health?

• What do you know about the employee population?

• What do the claims data tell you about the population?

• What are you spending?

• What risks are you facing?

• What’s being done now in the area of prevention and wellness?

• What industry standards can be used for comparison?

Tons of usable data about your employee population are col-lected each year by your benefit plan providers. Dig into the quan-titative information that is available and supplement it with primary research. Use focus groups, surveys, and in-depth interviews. Setting a Clear Measurement Plan Your ROI research methodology needs to be established and budgeted in advance. All too often, small businesses invest in a promotional program and then ask about whether or not it worked only after it’s over. By establishing a methodology for


195

measurement and pursuing results with rigor, you’ll get a clear picture of effectiveness. Consider test marketing. Some ideas and programs are better evaluated with select employee populations as an early indicator of acceptance and outcomes. These can be compared to “control cells” elsewhere in the population. For credible comparison, however, be sure the two groups can be seen as fairly equally representative. For full population programs, look at longitudinal tracking studies to really understand what might help change behavior. Use the employee feedback not just for measurement, but also for improvement. Many companies have adopted principles of Total Quality Management (TQM) in certain facets of their infrastructure. Manufacturing, research and development, and other high science or quantitative departments often run their operations based on process management. Employee health programs should have similar concepts and approaches built in. Deming’s concept of continuous improvement fits rather well. What, How, and When to Measure On the “what to measure” question, we know that all investment against employee health should yield an economic impact, but there are many components to that outcome. There needs to be a mix of attitudinal and behavioral areas to track. These can include measures for preventative exams, health risk assess-ments, the number of smokers, and the like, along with quantita-tive claims data. Identify the array of possible data sources, and then decide what is relevant and measureable over time. The “how to measure” question can be addressed by first understanding the currently available data points from claims and other secondary sources. That will need to be supplemented by quantitative surveys, results from health risk assessments, along with other available information from blood draws, weigh-ins, and other diagnostic tools. The real key is to measure aspects of the programs that relate back to the objectives.


196

The last point is the “when to measure” question. Taking a benchmark at the beginning and then another measure a year later provides some knowledge, but a series of measures that could be looked at monthly or at least quarterly would provide a more robust picture. More is better as long as it is relevant and representative. In the end, few companies will really go all the way with a fully sophisticated research plan, but even taking the first step is laudable. When they see all they can learn and how they can adjust their benefits to suit their population, it will be hard to go back.

bringing healthcare consumerism inside: the communications...

Documents