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Trust, but Verify

David P. Lind Benchmark“Fair and balanced.”

You hear this phrase from many different sources. It conjures up something within us that we all desire to have when making critical decisions. Understanding the pros and cons on any given issue is important to most of us. But do we really receive the “truth” or the “transparency” that will allow us to draw our own conclusions on the subject matter at hand? It really depends on the source of the information…so I believe.

The reason for this particular blog stems from a presentation that I recently gave at the “2012 Iowa Employment Conference” in Altoona. Much of my presentation focused on the health insurance trends in Iowa based on our annual studies. The trends by the way, are dismal at best, unsustainable at worst (another blog for later). When discussing potential solutions for employers, a few topics were breached such as consumer-driven health plans, wellness initiatives, and health reform measures. I mentioned that each topic will usually have many arguments (both pro and con), in addition to having both intended and unintended consequences. To know the subject matter well, I suggested to the audience to have a comfort level with their SOURCE of information (publications, media outlets, research organizations, etc.).

Much to my surprise, a hand was raised that followed with this question: “Which sources do YOU trust?” This question came out of the blue for me, but was asked in a thoughtful manner. I don’t quite remember my response that day, but since that presentation, I have had time to further reflect on this question. The word ‘Trust’ is defined in the Merriam-Webster dictionary as “assured reliance on the character, ability, strength, or truth of someone or something.” Another definition is “one in which confidence is placed.” I like both.

Regarding health care related stuff (including health insurance programs offered by employers), I TRUST a few particular sources. Each source has earned my trust over the years due to consistent research that attempts to factor out biases that typically are inherent in any type of research. Also, the authors of such research will generally disclose any potential outside influences that may mitigate the truthfulness of the results.

In no particular order, my short list of trusted sources is found below:

  • Health Affairs Journal – Many authors (national and international experts) write thought-provoking articles on highly researched thematic topics each month.  This is the gold standard because the information is fresh and relevant at all times. I also download their free podcasts and listen to them while I run in the morning. A subscription is necessary for this journal…but it is well worth the investment.
  • RAND Corporation – RAND provides objective research on many issues, including healthcare. Rand provides very innovative material…much of it can be found on their website at no cost!
  • Kaiser Family Foundation – Most information is at no cost…and there is a ton of information on many different health topics. A great go-to source!
  • Dartmouth Atlas of Health Care – The pioneer on the disparity of health care delivery in the U.S.

There are other sources that I highly value, but those sources (at least in my view) tend to be a level below the four mentioned above. Just know that the SOURCE of information is just as important as the content of the information being conveyed.

President Reagan adopted a signature phrase and made famous when discussing U.S. relations with the Soviet Union:  “Trust, but verify.” This phrase can also be applied to healthcare information and many other topics!

Health Care Consumers vs. Users

David P. Lind BenchmarkEver thought about what it means to be a health care consumer versus a health care user?

Health care consumers have skin in the game, money on the table. They work to protect their health and actively look for the best health care value—researching options and making educated choices.

Health care users pay their monthly premium, go to an in-network provider and that’s that. Oh, they pay copays, but  they don’t have an incentive or the information to seek out the best value. Sadly, most of us fit under this category much too often.

Employers’ efforts to manage health care costs are becoming more focused on getting employees to become health care consumers rather than users.

National studies, such as Kaiser/HRET, and local research, such as the Iowa Employer Benefits Study©, show that more employers are embracing two interrelated concepts when offering health insurance coverage to employees:

  • Consumer-Driven Health Plans (CDHPs)
  • Wellness initiatives

In Iowa, only 4.5 percent of employers were offering components of CDHPs in 2005, but this number increased to over 20 percent by 2011. Also, more employers show interest in implementing wellness initiatives, in some cases providing financial incentives for employees to participate.

Consumer-driven health initiatives:

  • Emphasize making healthy lifestyle choices—eating right, exercising, not smoking, monitoring health numbers, etc.
  • Encourage employees (and their dependents) to seek out the most cost-effective care when seeking health care services. (Unfortunately, consumers are not privy to the actual costs. This is a big problem. See Clueless on Costs.(Blog)

More and more employers are working on plan designs that offer incentives to facilitate behaviors that improve employee health and lower health care costs.


Nationally, large employers are embracing a philosophy called Value-Based Insurance Design (VBID), providing incentives to employees to utilize evidence-based medical services. Deductibles, copays and out-of-pocket costs can be less to employees (and dependents) if they adhere to particular drugs regimens and treatments recognized as the most medically effective, and more if they choose tests and procedures deemed “overused.” There are pros and cons to everything, and VBID is no exception.

Until we can find the elusive ‘silver bullet’ to reign in health care costs, employers will need to assess new opportunities to help employees become more effective consumers of health care. These are some of the tactics currently being utilized. Their actual impact on employee behavior and health care costs remains to be seen.