The first part of an article is often used to convince the reader of the writer’s credibility, right? Here goes… I’ve been in the benefits industry for over 10 years and consult with clients that have 1,000s of members and those with 100s. Over the last five years we have plans with flat to negative trend in cost. We have plans who are increasing benefits and lowering contributions. I would like to think I could hand over my client list to a prospective client and let them choose who to call for a recommendation.
So, whether you trust me at this point or not, I’ll go ahead and dig in. Can one word truly save healthcare? My thesis is that behavior can be that word.
As this is a noun with several meanings, I’ll stick with “the way in which one acts or conducts oneself, especially toward others.”
So how might behavior save a broken system accounting for 15% of our GDP (and growing)? Here are three fundamental areas where changing behavior could be the savior:
Lack of education often leads to poor employer choices.
I have been on record as saying the healthcare system is broken. It is difficult, confusing, expensive, and frankly, dangerous. What is more alarming, though, is my new realization – the system is working exactly as it is meant to work. I understand that choosing who to trust is exceedingly difficult. However, employers blindly relying on large publicly traded organizations just seems silly.
Notice I didn’t mention any single piece of the puzzle (i.e., payors, brokers, health systems). I didn’t mention one because the test always works: quarterly returns trump any 500- or 1,000-employee group. Incentives are not aligned.
- Poor perspective
This behavior is baffling. Employers, specifically CFOs, keep a meticulous eye on EBITA and can easily rattle off the cost of goods. Sadly, most cannot tell you the cost of a diabetic on their plan, or how much a high-risk hypertensive will cost the company.
I’ll sum up this behavior with a quote I often hear: “Yeah, Nick, healthcare is crazy expensive, but lucky for us our last three renewals have been 8% or less!” If that is the case, I hope everyone is growing their profits at a minimum of 12% YOY!
- The easy button
Everyone knows the old popular commercial with the “easy button”. This is the only behavior listed that I understand. It is human nature.
It is easy to have a carrier bundle up all your services in a fully-insured plan. It is easy to keep things the same and move on to your other priorities. No situation is the same, but if everything is easy, then you are likely falling behind.
Employee and Family Behavior
Poor employer choices may not lead to poor employee choices, but they don’t help.
- Personal choices
America is overweight. People still smoke though it is incredibly dangerous for your long-term health. Surgeries are dangerous, but are way more dangerous if you smoke… Q&A Stop Smoking
This is a missing trait for many reasons: the complexity of the system, the stress of a health event, simply following the doctor’s instructions. My favorite reason, though, is ‘If it’s free, I’ll take two!’ Why do you think outpatient facilities and operating rooms around the country are packed October through December? That pesky little deductible has been met and it’s free, so let’s go!
- The easy button (again)
Piggy backing on the first two, fast food is easy, cooking at home is time-consuming. It’s a lot easier to keep smoking or drinking or making poor food choices — or whatever your vice may be — than it is to quit. It just seems easier to have that back surgery than to lose weight and rehab.
No one is perfect, but taking the easy way out is a behavior we must change.
I am too young to be quite as cynical as I sometimes feel. With that in mind, let’s focus on the positive behaviors driving positive results here.
Like any industry, there are consultants who I absolutely love to compete with (hint: because they generally have the wrong incentives). On the other hand, there are also those who strive for proper alignment with their clients. It is difficult to entice a company away from their consultant when the consultant has proper alignment through leadership, compensation arrangements (incentives), and overall transparency. The good news is that there are consultants doing the right thing for employers. Hopefully they won’t all sell or merge in the rampant industry wide consolidation.
There are so many smart people in the benefits industry; the ones who do an incredible job, educate their clients on what possibilities are out there. The wise consultant takes a complicated industry and breaks it down to bite-size pieces, constantly pushing clients towards a better, achievable future. If you are not learning something from your consultant, then find one that can provide the education needed. Fiduciary liability is no joke…
- Attacking barriers
A few years ago, we held a Leadership Series with the theme, ‘The Obstacle is the Way’ (which is also a fantastic book). The basic premise is simple; when our industry puts up a roadblock, you and your consultant should create a battering ram and head towards it.
So, can one word really save healthcare? I think so. But just as employers are the real payors for this healthcare conundrum, they are also responsible for picking out the parties that can fix it –the consultant with proper behavior.
- Pharmacy Benefit Management Optimization
- Employee Benefit Captives
- Population Health Data Analytics
- Disability Contracts
- Government Contractors