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The ‘Cost’ Diversion
Stuck in the Middle

Clowns to our leftRecently a song came on the radio that I have heard countless times in the past. But this time, it struck me in an odd sort of way. The song, ‘Stuck in the Middle with You,’ was a 1972 classic written and performed by Gerry Rafferty and his group, Stealers Wheel. The lyrics that jumped out at me?

….Clowns to the left of me,
Jokers to the right, here I am,
Stuck in the middle with you.

So what does this have to do with employee benefits? Well, most likely, not a darn thing!

However, when I think about our continued healthcare woes in this country, the song clearly resonates in the right side of my brain.

We are stuck in the middle of the same confusion eminating from the past. In my view, very little seems to change in healthcare. We appear to only re-label past concepts and initiatives and masquerade this as ‘progress.’

So what are these concepts and initiatives?

Managed care, integrated care, bundled payment for care, value-based care, accountable care, patient-centered care – get the picture? If these concepts are so important, and I believe they are, WHY weren’t they emphasized decades ago? Have we erroneously assumed that we were ALREADY receiving these wonderful ‘care’ packages from the bloated premiums (and taxes) we have been historically paying? In one word, yes!

We often confuse action with progress. The busier we appear to be can only indicate that meaningful improvement is being made, right? But if we are making progress in receiving quality care at an affordable cost, many national experts would agree this progress is glacial at best.

As a country, we remain so fixated on cost and coverage issues – necessary components to be sure – but we lose sight when these issues are most divisive with policymakers, political parties and the general public. This ‘diversion’ will only result in political gridlock. Gridlock is a great friend to the status quo, in addition to those who stand to prosper while little is accomplished. Obamacare has polarized the political process to the point that little can be accomplished in Washington due to a healthy dose of gridlock – a battle that has, at best, reached a stalemate.

Self admittedly, I also perpetuate this focus on cost by keeping it a focal point in many of my blogs – using our annual study results as the crutch. By taking our focus away from the real drivers of cost – unhealthy lifestyles, lack of accountability, poor care coordination, little transparency in cost and medical outcomes, patient harm due to preventable medical mistakes, healthcare waste – we allow the diversionary tactics to succeed at keeping the status quo intact for the foreseeable future. We are led to believe that to ‘fix’ our healthcare system, we must address cost, coverage and compliance components through insurance (and create mythical faceless villains to advance agendas) – all reliant on the political process – and gridlock.

Republicans want to repeal and replace Obamacare, yet offer few realistic specifics. Democrats appear to protect and defend Obamacare, and hint that “some changes need to be made,” – but what are they? Both parties are unwilling to address the key drivers because the huge elephant in the room continues to underwrite the cost of the status quo. Since 1998, four of the top seven spending lobby organizations represent the healthcare industry. Between the four, almost $1.2 billion has been spent ‘educating’ those who are elected. Gridlock causes uncertainty, but not for those who gain from this uncertainty.

The masquerade of containing medical costs has successfully distracted meaningful focus from the value we should be receiving in healthcare. Our country continues to play a high-stakes game of Poker, but in doing so, the deck has been stacked in favor of those players who control the game. We know healthcare is big business, and key players obviously feel entitled to our premiums and tax dollars.

In his televised farewell speech to the nation in January 1961, President Eisenhower openly argued that our country has a looming ‘military industrial complex’ that will suck up our money and resources if we fail to contain it. The same can now be said about our medical infrastructure – except this is so much bigger – and infinitely more serious.

We must reach beyond the endless discussion and distractions we have about who pays and how much. The cost, compliance, coverage and political discussions are no doubt important, but these are inextricably linked to the quality and safety of medical care we expect to receive, but in too many cases, do not. Cost is not the problem, it is merely the undesired outcome of the issues that we do not have the political courage to solve. By not having the public outcry for these changes to be made, we can only expect to receive the same pitiful results.

The national fixation on cost and coverage is perhaps the most successful diversional tactic used in our card game by the clowns on the left and the jokers to the right.

So here we are, stuck in the middle with each other.

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Listen With Your Eyes
Small Employers Beware!

Listen to your EyesPercentages can matter. But when depicted in bar graphs, they seem to matter more – or at least become more digestible to understand.

Do smaller employers receive larger premium increases to their health plans when compared to their larger counterparts? The short answer to this question is ‘yes.’ Being community-rated with other like-size employers certainly has a great impact, as does paying state-required premium tax for being fully-insured. Small employers have fewer options to alter their benefit plans and lack critical scale to explore various funding arrangements that are available only to larger employers.

Using results from our last six Iowa Employer Benefits Studies© (2010 – 2015), we found the three smallest employer size categories (2-to-9 employees, 10-to-19 employees and 20-to-49 employees) were more likely to receive annual double-digit increases from their insurance vendors when compared to the other three-size categories (see below).

Average Increases 2010-2015 Iowa Employer Benefits Study

From 2010 – 2015, the average annual increase for each size category demonstrates the divide between the largest and smaller employers. Employers with fewer than 20 employees averaged premium increases each year of 11.5 percent, while employers with 250-to-999 averaged premium increases of 6.3 percent. Employers with over 1,000 employees were most ‘fortunate’ by experiencing average increases of 5.6 percent.

Average Premium Increase 2010 - 2015

Over this period – and prior to making health plan adjustments – the smallest employers received premium hikes of 69 percent. The largest of employers received a cumulative increase of 33 percent, more than half of what the small employers received.

Overall Premium Increases 2010 - 2015

The implications of rising health premiums are unsettling for all employers, but especially for the majority of employers in Iowa with 2-to-19 employees, which represent 94 percent of all Iowa organizations.

Seeing is believing, so listen with your eyes.

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Making ‘Mentorship’ a New Employee Benefit!

Mentorship - An Employer Benefit StrategyMost of us can name at least one person in our lives that served as a ‘mentor,’ whether it was to help guide our career(s), aid in specific work projects or provided general life advice.

Oftentimes, this mentorship process is informal. It’s derived from the trust we have in the person due to his/her relationship, experience, knowledge, integrity and sense of altruism selflessly demonstrated to guide our own personal or professional development. The mentor simply wishes to share their knowledge or expertise with the mentee with the noble intent of “paying it forward.”

Mentorship is a commitment that requires valuable time and attention to assure the mentee’s goals are progressing as desired.

I have been extremely fortunate and consider both my parents cherished mentors, for many obvious reasons. They each held a ‘positional power’ on an adolescent boy who was very impressionable by their actions, not just by their words. They consistently demonstrated the value of serving others without seeking recognition. What I learned from them goes well beyond this blog.

Another immeasurable mentor was my father-in-law, a gentle and unassuming man who had incalculable wisdom for all who knew him. At times, the world can seem cold, dark and threatening, but his ultra-positive approach would magically lift my spirit with his infectious smile, humor and his approach that one must not take himself/herself too seriously – regardless of the circumstances. He shared applicable (and comedic) stories, using advice, wisdom and know-how, uniquely drawn from his vast business knowledge, both as an inventor and business owner. Invariably, he would end our discussion by saying, “This too will quickly become yesterday’s news – have patience and move forward!”

Finding a trusted mentor outside of personal relationships can be tricky. However, many successful organizations cultivate formal mentor programs internally to serve a variety of specific objectives that include grooming new potential leaders, acclimating new employees, developing skills, enhancing diversity and retaining employees.

The benefits of having a formal mentorship program can include:

  • Career Development – Aligning organizational goals to personal career goals. Feeling engaged and respected, the employee is given the ability to advance professionally within the organization, leading to higher retention rates.
  • High-Potential Mentoring – Retaining top-talent employees who have leadership potential and stay engaged within the organization.
  • Knowledge-Transfer Mentoring – Transferring specific skill-set knowledge to younger employees.
  • Diversity Mentoring – Bringing in new ideas by empowering diverse employees to share ideas, knowledge and experience to expand and innovate cultural awareness within the workplace.
  • Reverse Mentoring – Younger employees mentor older generations about new trends, allowing senior employees to see things from a fresh and different point of view.

Offering a workplace mentorship program is akin to offering another key benefit to employees. This benefit is definitely a win-win for both the organization and its employees.

Evolving technology now allows organizations to effortlessly connect employees with mentors. Past challenges, such as employee location, is no longer a barrier. In fact, smart technology serves to disrupt the ‘path of least resistance’ mentality of simply doing nothing.

MentorString™, a cloud-based software platform developed by Urbandale-based Prositions, Inc., is doing some very clever (and intuitive) things within the employment mentorship world. The usability features found within MentorString are straightforward and quite simple to use. Some of the features include visualizing how people are connected with one another by using a revolutionary tool called String Diagrams. In addition to many other carefully-designed accoutrements, users have access to individual action/development plans, discussion groups, media and file sharing. Prositions CEO Frank Russell and his team are constantly finding valuable approaches to mask the complexities organizations face in the ever-evolving employment world.

As the unemployment rate continues to move downward, a greater need develops for organizations to embrace mentorship programs. As I write this, I realize that offering a formal mentorship program should be yet another benefit to monitor in our annual Iowa Employer Benefits Study©.

A powerful benefit, no doubt!

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