20 Jun MAKING THE TURN – CHANGING TO OUTCOME BASED WELLNESS
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:
- Get their biometrics and normalize any that were not to goal,
- 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
- 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.