A colleague of mine had a chance to attend the healthiest employers of Oregon awards program last week and he was intrigued and excited to share the ideas of the event with me.

Like him I was very pleased to see organizations focusing on this area and recognizing the importance of managing health rather than health care.

I would be less than candid however if I didn’t acknowledge that there were only a total of 57 organizations represented in the survey.

The U.S. spends more dollars per capita than any other industrialized country, and not a small margin. In 2012 we spent 17% of our Gross Domestic Product on health care expenditures; the next highest spending was 12%.

The other really disappointing thing is even given our spending our outcomes are in the middle of the pack.

As a former human resources executive, C level operating executive and management consultant I see this as one of the biggest failures and opportunities available to us to address. I see many opportunities to apply this in how we manage health and the delivery of health care.

I distinguish between the two because I think they are indeed different. Our approach to managing and dealing with health in my experience has been reactive rather than proactive and very much a model of doing things to rather than with people. That applies both to the end user or patient, but also to the care giver community.

My research tells me that more than 60% of our health care related costs in the U.S. are directly related to individual behavior, meaning they can be significantly affected by changes in eating habits, exercise and movement, work environment, etc. You don’t hear us talking very much about those things because they require one of the most difficult strategies we face as organizations or individuals- changing individual behavior. There are a lot of factors and strategies that play into managing a successful change effort including education, incentivization, and reinforcement.

The reality is that in many cases there are other players in the mix who can play a much more meaningful catalytic role in that process than the health care delivery community. If we are going to see meaningful action and results we need to see those players step up.

My research also tell me that one of the most important vehicles to address the management of health is to engage the employee/patient in the management of their own health, for them to see themselves as a stakeholder rather than a passive observer in the process.

That is why I want to give kudos to these organizations that have taken a proactive approach and involve their employees as a cornerstone of managing health and wellness.

The average employer’s healthcare cost management strategy is to manage premiums. We bring our broker in once a year and tell them that the cost is too high. In many cases we reduce coverage, change carriers, cost shift to our employees, or other techniques that do little if anything to address root cause issues. For many small employers they are reaching a point where they simply can’t afford to provide employee sponsored health care.

The really interesting thing to me is that as aggressively as we embraced TQM, lean manufacturing, and other models as reducing costs as a means of increasing margins how reluctant we have been to use those models in healthcare. In manufacturing we work closely with our suppliers to lower inventory, build quality in, etc. We refer to them as strategic partners and attend joint workshops, and strategy sessions. Why do we protest so much about our role in health care?

The reality is that healthy engaged employees are a competitive advantage. Engaged employees take less sick time, spend less per capita on health care, and much less on mental health and other related services.

Once again Obamacare is in the spotlight largely because of the mandate for employers and individuals to be covered by some kind of a plan.

I personally think that Obamacare does have flaws, the biggest being that there is not enough health related education and incentive for employees to fully engage in the management of their own health. We are largely trying to drive the behavior change through penalties on the employer.

I do believe employers have an important stakeholder relationship in the equation. We have advantages in our ability to communicate and educate employees and their families in a manner that neither government nor the health care provider community does- they work for us. We can expect/require them to come to meetings. We can build incentives for appropriate behavior into our delivery models.

When I read that some employers are “punishing” employees who are making life style choices that are clinically proven to affect their health I am a little perplexed. If you choose to participate in high risk behavior why should your employer be required to subsidize it?

To me it is similar to the employee who after training and receiving feedback about performance deficiencies chooses not to comply with the employers expectations; should the employer really be required to keep them on the payroll?

So what is my point? I would argue that employers can involve themselves in the health care issue in a number of ways.

The first is bluntly education. We need to talk to our employees about the costs of providing care and the controllable issues like lifestyle, fitness, and other factors that are within their control. We need to help them recognize we make choices; dollars spent on healthcare are dollars not available for other things.

Secondly, we need to work with our health care providers on managing costs not premiums. We do this by identifying what our health care cost “hotspots” are and working with them on targeted interventions around those hotspots- some examples are smoking cessation, weight loss, stress management and others. We pay much of the premium, that gives us the right to have the discussion and we have the access.

Thirdly, we need to bring personal competency rights back into the workplace. We need to expect our employees to participate in improving and managing their health and the health of their dependents. We need to treat them like adults and partners, not dependents. I expect employees to perform up to my expectations, make good decisions, and generally perform like responsible adults. I have to give them the tools and the information to do so.

I have used this model successfully, it works. It is part of an engaged workforce and a balanced positive relationship with our employees. The government isn’t going to solve this problem. Let’s step up and do our part.

Obamacare is never going to provide a complete solution.

In a time where employers and human resources executives are indicating that attracting and retaining talent is their key priority and employee engagement is hovering around the low thirty percent this seems like a great time to change our plan.

The 57 employers who were recognized at last week’s event get that and I applaud them. I hope next year there are a lot more employers competing for that honor…


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