I’m going to share with you an approach that will have others calling you a forward-thinking benefits strategist, or a pain in the butt depending on their perspective.

You can’t be effective by reacting to your renewal each year by putting your plan out-to-bid. I have a four year plan on my bulletin board that is constantly evolving. In 2013, I put a lot of effort into getting a dialog going with our executive team. In the intro to Tom’s book, he suggests that the conversations about health care are occurring at the CEO level and HR folks have been slow to engage. I can tell you my experience has been just the opposite, in the organization I work for and the association community at large this isn’t what the CEO and other executives are talking about. You have to engage people before you can influence them. I outlined a process to broaden our thinking, set goals, generate options, negotiate, develop a plan, set trip wires, educate, introduce and evaluate. I shared recommended reading, facilitated many discussions, presented a timeline for decision making, etc… As a result we implemented an HSA this year. We’re also positioned to go self-funded in 2015. I’m not going to get into all the specifics here, but I believe there is value in staging some changes. For example, this year, I’d like to educate people and nudge them toward using higher quality hospitals. Next, I’d like to try to influence some of our local hospitals to report their safety data to Leapfrog. Then, I’d like to incent employees to use higher quality hospitals and finally, narrow our network to exclude some of the hospitals with abysmal safety scores.

First, from a benefits perspective people can’t value what they don’t understand. I’m baffled that companies will spend so much money on benefits and then not help people understand how they work. And, second from a care perspective -- I don’t know about the people you work with, but our staff will drive further for dinner than chemotherapy. When it comes to health care, they have traditionally chosen convenience over quality. As we all know, health care in the United States is changing. One of the positive outcomes of these changes is that more Americans seem ready to take an active role in health care related decisions. Some of this is being pressed on us with the introduction of high deductible health plans. We have planned a series of educational sessions and have been developing resources for our staff to help them be more savvy consumers: managing your HSA; using cost comparison tools; where to seek care; how to talk with your doctor about tests, treatments and procedures; using your HSA for retirement planning, and a sharing session where staff that have elected our HSA this year will share their experience with others. Consumer Reports has some good tools. You can follow our efforts in this regard under the healthcare savvy tab of my blog. http://www.insideworkplacewellness.com/p/healthcare-savvy.html

Years ago a colleague introduced me the the Kepner-Tregoe approach to decision making. The approach helps decision makers use weighted objectives to guide decision making, evaluate alternatives against objectives, and document recommendations by showing the structured thinking behind the decision. I’m convinced it helps us identify the best alternative to meet our needs and it makes it easy for me to explain or justify the decisions we make to others. We used it to select a health care provider in 2010, an online benefits enrollment system, and other things. I’ve outlined the steps we took in pretty good detail on my blog.

http://www.insideworkplacewellness.com/2010/10/selecting-new-health-plan-us...

Try new things. If they don’t work, shut them down and move on. I find that people can be very forgiving when you call something a pilot. It’s a clear indicator that you’re trying something new and seeking their feedback. It also avoids setting expectations that it will continue beyond the announced period of time. Just be prepared to describe how you plan to evaluate the effectiveness of what you’re doing.

I work with vendors that are good about providing reports and others that I have press to get them. This year, I sat down with a report on our health advocacy utilization and one on our EAP utilization. Our staff had 368 interactions with Health Advocate that cost us $22.42 per interaction and the anecdotal feedback from staff was positive. Our EAP reported 21 contacts with our staff in 2013. This made our utilization about 8% and it was highlighted as a positive by our EAP since that’s about twice the industry average. A quick calculation indicated that each of these contacts cost $295. April 1st I moved our EAP to Health Advocate. I’m saving $1.68 pepm and I’m hopeful that more staff will take advantage of the EAP services since (1) they’re already comfortable calling Health Advocate for help and (2) Health Advocate will have the opportunity to offer relevant EAP services to people that call about health advocacy. I’ve also asked United for a report of what hospitals our staff used in the past year. It’s not something they standardly report, but I want to use the information to help steer people toward the higher quality hospitals in our area.

There are things I remain leery of. For example, I understand enough about incentives from managing compensation to know you get exactly what you pay for, but we’re lousy at predicting what that will be. Therefore, I’ve steered clear of using incentives with our health and wellness programs. I’m sure you all saw the stories about Penn State. I’m convinced this has saved me a lot of grief. Don’t rely too heavily on your broker and vendors. Tom makes a good case for why you shouldn’t rely too heavily on your broker or consultant in Chapter 2 of his book. Build a broader network. Mine includes other brokers, consultants , and HR and benefit pros -- people I can contact to ask simple things like what they’re doing about e-cigs in their office or discuss complex issues like using data analytics to drive disease management.

I presented with James Sumortin from Twitter at the Health and Benefits Leadership Conference and he shared a chart that showed how they compare with other, much larger, high-tech companies like Apple and Google in the Bay Area. They know exactly where they fit in the mix and how to position themselves to attract the talent they need. You just have to remember that benchmarking is a lagging indicator, so you have to use other tools to look forward.

This has been a real challenge in the last couple of years because the playing field is changing so quickly. Just keeping up with what’s happening with the ACA could be a full-time job. Obviously attending conferences like this and the one I just mentioned provide good learning opportunities. I always try to select a variety of sessions to attend – things that prepare me for something I know I need to deal with, things that allow me to audit something I’m already doing, and things that get me to think out of the box e.g., last week in Vegas I spent some time learning about private exchanges. And, finally read. When I go to a conference, I start a “to read” list and jot down everything I hear people recommend.

As a starting point, I’ve put together a list of some things that have helped frame my thinking and included recommendations I've picked up from respected colleagues and heard mentioned here. I'll put it up as a blog post in the next few days.