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Hey Iowa, Nice Job Being a ‘Least-Stressed’ State!

More and more often, other states are catching on to the great things we have going on in the Hawkeye State1! Our state and communities continue to receive many national accolades from various publications, many of which are quite flattering, such as:

A recent national benchmark ranking, coming from WalletHub, suggests that Iowa is the fourth LEAST-stressed state when compared to all other states (including the District of Columbia). Iowa’s placement follows only (in order), Minnesota, North Dakota and Utah. For comparison purposes, Iowa was the third least-stressed state in 2017 (Minnesota and North Dakota were No. #1 and No. #2, respectively). There appears to be something magical about the upper Midwest.

To determine the rankings, WalletHub compared the 50 states (and D.C.) across four dimensions (and 38 relevant metrics). The four dimensions were:

  1. Work-related stress (7 metrics)
  2. Money-related stress (10 metrics)
  3. Family-related stress (6 metrics)
  4. Health- & safety-related stress (15 metrics)

As we know, stress is related to both external and internal factors that affect each of us. Sometimes we are unaware of how stress can impact our health. External factors may include our job, relationships with others, our home, other physical environmental situations, challenges, difficulties, and expectations we are confronted with on a daily basis. How we respond to, and deal with, the external stress-inducing factors affects our nutritional status, emotional well-being, overall health and fitness levels, and the amount of sleep we get. Each of us deal with stress differently, but if we are not careful, it can wreak havoc on our personal (and professional) lives.

For each of the four dimensions mentioned above, the state of Iowa ranked as having the 16th least work-related stress, sixth least money-related stress, fifth least family-related stress, and third least health- & safety-related stress. Metrics that relate to the work-related dimension, the lowest scoring of the four dimensions, include:

  • Average hours worked per week
  • Average commute time
  • Average leisure time spent per day
  • Job security
  • Unemployment rate
  • Underemployment rate
  • Income growth rate

The economy can have a big influence on this particular dimension. Iowa has a very low unemployment rate (2.9% in 2017), a factor that causes employers to struggle with finding qualified workers in jobs difficult to fill. According to the Iowa Workforce Development, the weekly wage increase in 2016 was below two percent (2017 data will be available very soon), showing that wages are depressed.

Iowa Healthiest State Initiative

To help Iowa avoid resting on its’ laurels, a wonderful ‘movement’ occurring in Iowa is the Iowa Healthiest State Initiative (HSI). Executive Director Jami Haberl, and her team are working to make a meaningful difference in how Iowa communities and employers can improve the daily lives of how we live, work and play. One HSI approach attempts to address the stresses we face in our environments, and will annually monitor this stress through our resiliency. Resiliency is an often-used term that describes the ability to overcome challenges of all kinds – such as trauma, tragedy, personal crises, everyday problems – and our ability to bounce back stronger, wiser and healthier. If you are not aware of the HSI resources, please check them out here.

Receiving national accolades are wonderful, but these don’t just happen out of sheer luck. It takes hard (and smart!) work and perseverance, coupled with the belief that implementing new initiatives and approaches to positively impact our communities and those living in it will be best for all of Iowa. 

As the saying goes, “Prepare and prevent, not repair and repent.”

Let’s keep it up, Iowa!

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1Sorry Cyclone fans, but the official state nickname for Iowa is ‘The Hawkeye State.’  Honestly, I’m trying to be as impartial as possible!

Iowa Employer Benefits Study© Returning in 2018

Many of you are aware that I took last year ‘off’ from conducting the annual Iowa Employer Benefits Study©, and instead, focused on how Iowan’s perceive the care they receive from Iowa caregivers – now known as the Iowa Patient Safety Study©. This off-the-road ‘excursion’ allowed me to focus on a subject (patient safety) that I’ve been keenly engaged in since the 1990s.

As a benefits consultant, employers would often ask me about what can be done to keep medical costs more affordable. Avoiding harmful medical errors was certainly one approach to help cross the cost ‘chasm,’ in addition to increasing the quality-of-care we all expect to receive, but often do not. Needless-to-say, we must not take our eyes off this ongoing public health crisis.

This year, we will undertake our 19th annual employer benefits study. Unlike previous surveys, where we have typically alternated years on surveying certain benefits (e.g. including group life, short-term and long-term disability coverages, but excluding paid time off and traditional leave components), we will include ALL key benefits offered by Iowa employers in the 2018 survey, including:

  • Group Life
  • Group Short-Term Disability
  • Group Long-Term Disability
  • Paid Time Off (PTO) and components
  • Traditional Leave components
  • Group Dental Coverage
  • Consumer-Driven Health Care components
  • Group Health Coverage
  • Do Employers Offer:
    • Health insurance for domestic partners
    • Retiree health insurance, pre-65 years
    • Retiree health insurance, 65+ years
    • Vision Coverage
    • Flextime
    • Employee premiums deducted pre-tax
    • Dependent care flexible spending account
    • Medical care flexible spending account
    • Wellness programs

As in the past, we plan to randomly survey at least 1,000 Iowa employers from a variety of sizes and industries. Doing so will allow us to benchmark employers against similar employers. As a side note, I was amazed at just how many employers reached out to me asking about the 2017 study and whether they could participate in the 2018 survey. This study appears to have a lasting presence and value for many Iowa employers!

If you happen to be an employer who was randomly-selected to participate in this year’s survey, we would greatly appreciate you taking the time to share your confidential data with us. Please know that your information will only be used on an aggregate basis and combined with data from other participating employers.

Though I was never really ‘gone’ from performing the benefit study, it is great to be ‘back’ working on a new survey that will provide insight on what changes have taken place since our last study in 2016.

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Healthcare – Time to Recognize and Confront the ‘Elephant in the Room’

Have you ever been involved with an obvious situation, either personally or professionally, that was largely ignored and going unaddressed? Perhaps a work scenario in which a manager who wields considerable organizational power was impacting the workplace culture in an extremely uncomfortable and unhealthy direction. Speaking up may cause one to lose his/her job or suffer long-term upward job mobility opportunities. Self-preservation is a natural powerful reaction when confronting a seemingly formidable opponent – we simply choose not to act at all.

The fear of speaking up is a metaphor for an ‘Elephant in the room.’

This is happening today in our healthcare delivery and payment environment. We frequently see or experience unacceptable situations that clearly require action to prevent it from happening in the future. As a reader of my blogs, you are keenly aware of the egregious nature of the medical establishment hiding their preventable medical error ‘indiscretions’ in the proverbial litterbox – covering up preventable mistakes that are not meant for public viewing. Yet, without being held accountable for their actions, the medical community will continue to repeat what should be un-repeatable.

The elephant exists in healthcare in a number of ways. Below are just a few prime examples.

Employers are Reluctant

Employers serve as the real payers of healthcare, yet oddly sit on the sidelines exhaustively complaining about the high cost of health insurance and how it adversely impacts their competitiveness in the markets they serve. Unfortunately, most employers are reluctant to bring up the inherent dysfunctional problems because hospitals and medical practices are considered to be ‘other’ large, recognizable community members that are off-limits to public correction. In fact, many business owners are board members at the local hospital, making it difficult to publicly speak up while serving in a ‘distinguished’ role. As real payers, employers can clearly climb into the driver’s seat to collectively initiate sorely-needed changes in how the healthcare establishment behaves. But to do so, they must firmly take hold of the steering wheel to begin the journey. Instead, the employers have historically farmed out this responsibility to the insurance companies.

Insurance Companies Lack Initiative

One can be equally mystified by insurance companies’ lack of initiative when it comes to medical errors. By default, these ‘third-party payers’ assume the purchasing role as an intermediary between the real payers and health providers. More often than not, employers assume that insurance companies are adequately vetting the quality-of-care their network providers are giving to their employees and family members. This is largely not happening. As a paid intermediary, insurers can play a vital role in determining whether their subscribers are receiving the best possible outcomes from the care being purchased through the insurers’ networks.

Because the medical community will not admit their playful litterbox games, an appropriate opportunity for safety-conscious insurers would be to randomly survey their members after they have been discharged from a hospital to learn about their experiences – specifically as it relates to preventable medical errors. Doing so could be a great branding opportunity for innovative, forward-thinking insurance carriers. Over time, when enough patient feedback has been collected and analyzed, insurers can then become a more engaged advocate for employers and their employees when vetting network providers. Why are insurers not performing this difficult but necessary work on behalf of their members? Great question. They should.

Medical Community Touts Economic Strength

The medical community, specifically hospitals, spend a good deal of our[1] money to help perpetuate their economic value in the communities they serve. Recently, the Iowa Hospital Association purchased airtime on at least one local television station to help educate Iowans about the “economic impact” hospitals have in Iowa, including:

  • Number of hospital workers employed in Iowa
  • Benefits hospitals provide to the communities
  • Number of additional jobs created by hospitals

Similar to a certain species of cicadas, which are insects that remain underground from 2-to-17 years before emerging to be seen and heard, the hospital community will annually reveal themselves to promote their substantial workforce and economic growth – but remain curiously silent on the indiscretions buried deep inside the litterbox. Apparently, this marketing scheme successfully elevates their status as the elephant in any room, whether it be in Iowa or some other state. This diversional tactic makes it difficult for others to honestly speak out about the associated problems the elephant causes within our communities. After all, who doesn’t want jobs? No one wants to be ridiculed as a ‘naysayer.’ Unfortunately, honesty may come at a great expense.

Joe Gardyasz of the Des Moines Business Record recently wrote an insightful piece (subscription required) about healthcare jobs in Iowa. Even though jobs in the healthcare sector have surpassed U.S. manufacturing and retail sectors for the first time in 2017, Iowa’s manufacturing sector – at least for now – still outpaces healthcare jobs in our state.

Why healthcare has become the most dominant sector in our country

Other than rising demographic trends of an older population requiring more healthcare services, the most plausible reason for more healthcare jobs is likely due to gross inefficiencies in an inordinately complex environment. As mentioned in my previous blog, “Healthcare Billing Process – The Cost of Doing Business,” non-healthcare industries might typically employ 100 full-time equivalents to collect payment for $1 billion in services, but healthcare employs 770 full-time equivalents per $1 billion of physician services. Keep in mind, healthcare is now a $3+ trillion-dollar industry – which primarily explains why healthcare jobs are soaring past other more-efficient sectors.

Put another way, if non-healthcare sectors wish to tout their economic dominance in their respective communities or state, they would need to become bloated with inefficiencies that would inflate costs, revenue and increase employment opportunities. Thankfully, largely due to powerful market forces that are embedded with price and quality transparencies, those sectors are forced to act efficiently by offering reasonably-priced products and services that are of the highest value. The healthcare industry, it seems, is oddly immune from having to play by these transparency rules. According to Warren Buffett, “Healthcare is the tapeworm of the American economy.”

Through our entrenched relationships (e.g. family, work, business and community), we are too often reticent about changing the status quo when it might possibly ‘threaten’ the comforts of doing nothing. Employers, insurance companies and the medical establishment are each capable of making the necessary changes, but at times, must be ‘nudged’ to do so. The late Stephen Hawking made a great point by writing, “I have noticed even people who claim everything is predestined, and that we can do nothing to change it, look before they cross the road.”

What IS the Elephant?

Regarding healthcare, if each of us fails to recognize, acknowledge and confront the elephant in the room, we too become complicit in this persistent, serious and increasingly costly and harmful problem. If we continue to sit on our hands and do nothing, we eventually enable the elephant to become even larger and more undisciplined.

So what is this elephant in our collective “healthcare room?” John Atkinson of Wrong Hands developed a ‘chartoon‘ about this metaphor, whether the elephant appears in healthcare or elsewhere.

Isn’t it time to begin “eating” this elephant one bite at a time? It starts by recognizing and acknowledging the elephant in the room, and then crossing that road to initiate necessary improvement.

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[1] For the services they provide, hospitals are predominantly recipients of our tax dollars, government-related grants, philanthropic donations, insurance premiums and personal out-of-pocket payments.