Ten Takeaways from Health & Benefits Conferences [#BenefitsConf & #WHCC]

I recently attended the HRE Health and Benefits Leadership Conference in Las Vegas and the World Heath Care Congress in DC. I sat down after the two events and made some notes about what stood out for me. Here are ten takeaways.

Bob Merberg, Fran Melmed and I at the HRE Conference.

One: We Need to Agree on What Matters

There was lots of agreement that we need one set of measures about what creates value and indicates quality. And, agreement that we need good functional level measures for patients too. This is the discussion that kicked off the Health Care Congress and Rajiv Leventhal captured it well in this post, so I won’t try to recap it again here.

Eight Workplace Trends that Will Impact Our Work in 2013

This is our third annual workplace trends report. As part of our annual goal setting process for the human resources team, we brainstorm trends and observations that may impact our work. We use this exercise as a way to get us to a 30,000 foot level before setting our team goals for the year. These are the most interesting things we discussed. 

Created with Haiku Deck, the free presentation app for iPad 

1. Staffing -- There is a mismatch between the skill sets in demand and the skills sets of those who are out-of-work. Community colleges provide an opportunity for people to retrain for jobs that are in demand like lab technicians, radiation therapists, paralegals and machinists. · Employer branding becomes more purposeful and valued. · Employers look to hire innovators as we witness the success of innovation driven organizations. · Recruiters focus more on sourcing currently employed top talent instead of those who are actively looking. · Candidate assessments are back in vogue as employers become more sensitive to the cost of hiring people that aren't a good fit. · Employers focus more on the candidate experience as the competition for top talent gets stiffer. 
2. Health -- The quantified self movement continues to build momentum as more apps and gadgets are introduced. · CDHP's, consumer driven health plans,  continue to become more prevalent shifting more of the costs of care to employees. Better tools become available making the cost of care more transparent. · More employers implement wellness premium discounts. · There is more exploration of raising the medicare age. · The shortage of primary care physicians becomes more critical and convenience care centers play a bigger role in community health. · The aging of our population increases the demand for care coordinators. · There is more data about the cost of stress, but the focus shifts from stress management and balance to building resilience and happiness.
3. Learning -- Learning continues to evolve in a way that is more flexible and collaborative. · Content curation becomes more important and valued as people feel like they're drinking from a fire house when it comes to sorting through all the new information coming at them. · Professional communities where consumers serve as subject matter experts and help one another become more common. 
4. Engagement -- As employers recognize how much more an engaged employee contributes, they focus more on the things that increase engagement. One of the most interesting things I heard discussed at the SHRM conference last year was providing performance feedback in Twitter like terms. Just in time and in 140 characters or less. I haven't seen any tools to support this yet, but it's an interesting concept. · Employers also look to recognition programs to reward employees. Especially, since salary increases have been modest in recent years. 
5. Technology -- Cloud computing increases collaboration and leads to a decline in VPN use. This makes it easier for people to work remotely. Unless, of course, you work for Yahoo. (I am wondering if Yahoo's actions will prompt more discussion about managing from a distance which could be beneficial in many settings.) · Mobile apps continue to explode. · Cutting edge employers allow candidates to apply for jobs from their phones.
6. Financial -- Graduates find it difficult to dig out from mountains of college debt and this isn't a short-term problem. The debt burdens them for years. · Auto enrollment and auto escalation of 401k contributions become more common as employers try to help people prepare for retirement even as many people plan to work past their normal retirement date. See the NPR series Working Late. · The cost of commuting continues to rise and cuts into the paychecks and time of workers.
7. Societal -- Americans are more accepting of same-sex marriage. There are now nine states where marriage licenses are issued to same sex partners which impacts employee benefits and applies pressure to repeal the Defense of Marriage Act. · It seems the "storm of the century" has become an annual event. The disruption we've witnessed will cause more businesses to plan for disaster recovery. This also heightens the awareness of sustainable business practices and causes them to gain more respect and appeal. 
8. Information Sharing -- Most reporting has been based on historical metrics -- what happened last year. This has limited use for decision making. In the future, most historical metrics will be replaced by predictive analytics and focus on helping people understand what is about to happen so they can take action. · People will rely more on graphical depictions and video to communicate. 

If you think we've overlooked something, leave us a note in the comment section below. 

The Power of Online Video from #SHRM12

When we identified the trends that will impact our work this year, we highlighted the use of video. 

Video is becoming increasingly important. Companies save time and money by conducting first interviews via Skype. Meetings and training are held by video conference. Employees look for "how to" videos instead of written instructions. Job Seekers look for "day in the life" videos to get a realistic preview of a jobs.  

We're still very interested in doing some "day in the life" recruitment videos, but we're not garnering the support we'll need yet. This compelling clip was shared by Lindsay Stanton in her session titled "Convergence of Video, Mobile and Social Media in Recruiting and Employer Branding" at the SHRM conference last month. Maybe it will help us make a stronger case.





In the meantime, I think we might make more progress focusing on some DIY video tools for open enrollment. 

Eleven Workplace Trends that will Impact Our Work in 2012

As part of our annual goal setting process for the human resources team, we brainstorm trends and observations that may impact our work. We use this exercise as a way to get us to a 30,000 foot level before setting our team goals for the year. These are the most interesting things we discussed. 

1. Employees are using their personal iPhones, iPads and other electronic devices to work. This brings up issues about where work is stored and whether it's tied to the business or the individual. Employees expect integration and a unified experience across platforms. Employers are using more web-based collaboration tools to support day-to-day operations.
2. Communication is focused on real-time interactions. Email is viewed as too slow and is beginning to go the way of the fax machine. People rely on text messaging and various social networks to communicate instantly.
3. Video is becoming increasingly important. Companies save time and money by conducting first interviews via Skype. Meetings and training are held by video conference. Employees look for "how to" videos instead of written instructions. Job Seekers look for "day in the life" videos to get a realistic preview of a jobs. 
4. Job seekers target specific employers instead of responding to advertisements. This makes branding a business as an employer of choice a higher priority if you want to attract the best talent. 
5. User built content becomes more prominent and more visual. Consumer behavior and attitudes are heavily influenced by connections in a social network. People look for tools to organize information that are not chronological. Think Pinterest. Reports show it's driving more traffic to company websites and blogs than YouTube, Google+ and LinkedIn combined. 
6. Companies continue to focus on controlling the cost of benefits. Many shift costs to employees in the form of higher monthly contributions and imposing benefit limitations like drug formularies. Consumer driven health plans become more popular and lead to the promotion of healthcare consumerism. Carriers have consolidated leaving fewer insurance options to employers. Healthcare Reform continues to have a significant impact. W-2 reporting requirements go into effect this year and lay the groundwork for taxing "Cadillac" plans in the future. Payer-Provider lines continue to blur as more insurance companies own providers. There is a shift toward bundled payment structures. Medical data will be shared more easily between providers and insurers. 
7. mHealth slowly transforms healthcare. I've written about reverse innovation as a healthcare trend before. It refers to developing products for emerging markets and then distributing them globally. There was another great example in this month's Fast Company -- As Smartphones Get Smarter, You May Get Healthier: How mHealth Can Bring Cheaper Health Care To All. The first example is about a MIT professor who created an app and attachment for a smartphone to measure refractive error -- a reading needed to prescribe eyeglasses. 15 more examples follow in the article. Many traditional service providers appear resistant to this trend. Many consumers seem interested in the ease of access and the affordability. 
8. Wellness efforts continue to focus on data integration and reaching out to people "at risk." Expect to see an increased focus on building activity into day-to-day routines as opposed to structured exercise. This trend may be helped along by new gadgets like the Fitbit, Jawbone UP and Nike Fuelband. There's lots of talk about gamification, but I'm doubtful it's going to be much of a game changer in workplace wellness. More employers are offering incentives and penalties to employees to improve their health. This may contribute to an increase in stigmatization and discrimination against individuals that are overweight. 
9. Emphasis is placed on blended approaches to learning that include gaming and apps. Organizations are making efforts to map informal learning opportunities. Employees seek more sources of feedback and personalized learning plans. Free services like the Khan Academy support online learning. 
10. Increase focus on transparency and disclosure. Regulatory focus will be on the financial sector. 
11. Leading an exhausted workforce. The economy has taken its toll and people are worn out from helping family members who have lost jobs and other financial worries. Maybe this at least partially explains another trend we noticed -- adults are reading teen lit. First there was Harry Potter, then the Twilight series and now the Hunger Games -- maybe people just need an escape. 

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Payer-Provider Lines Blur -- Another Trend in Health Care

Have you noticed that the line between payers and providers is becoming blurred? More insurance companies now own groups of providers. There are numerous examples, but I’ve been paying particular attention to UnitedHealthcare’s launch of hi HealthInnovations -- a fully owned subsidiary that is providing steeply discounted hearing aids to some of its’ Medicare members as well as offering direct to consumer sales. Other examples include Humana’s purchase of Concentra, a Texas-based provider of stand-alone medical centers. Wellpoint recently acquired CareMore, a health plan operator that owns a number of clinics in the Los Angeles area. CIGNA controls a Phoenix medical group. There are flip side examples too, Partners HealthCare System Inc, a large hospital and physicians network in Massachusetts, acquired Neighborhood Health Plan, a Boston-based nonprofit insurer with 240,000 members. I found this article on the topic particularly interesting, Managed Care Enters The Exam Room As Insurers Buy Doctor Groups.  

Why the shift? Healthcare reform is minimizing profits, so insurance companies are diversifying. The Affordable Care Act limits the portion of premium dollars that can go towards administrative costs and profits. This year, a provision requiring insurance companies to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs went into effect. In 2012, insurance companies will be required to provide a rebate to their customers if their profits exceed the mandated percentage.

Insurers are also under constant pressure from employers and other customers to minimize premium increases. If the insurance companies own the provider groups, they have more control over the costs. When I attended the United Healthcare’s Customer Forum last June, they mentioned that they were introducing a HMO in Florida at the request of some of the employers they work with. The thinking seemed to be that these employers would prefer to provide a limited HMO benefit to their employees than no benefit at all. Actually owning the provider groups doesn’t seem like such a huge leap from a HMO. Look at Kaiser as another example. And, isn’t that what is happening with the trend toward ACOs, Accountable Care Organizations. Some are being initiated by large physician groups, some by hospital systems, and others by health insurance companies. Humana, United Healthcare, and Cigna have all announced plans to form their own ACOs.

What impact will this have? Time will tell. Insurance companies controlling the providers might drive costs down, but ACOs could push costs up. As hospitals join forces with physicians and gain market share, they may have more leverage in negotiations with insurers. Benefits may become available to more people through delivery models like United's hi Healthinnovations, but consumer may have fewer choices of providers and durable medical suppliers. Americans typically place a high value on choice, but with 50 million people uninsured (16.3 percent of Americans) something has to give. Especially when you consider the fact that the percentage of people covered by employer-based health insurance has declined while the number of people covered by Medicare and Medicaid has increased.

7 Trends in Healthcare

While attending UnitedHealthcare's Customer Forum, I made note of some trends that were discussed. Here are seven that I think will have significant impact in the near future. 

Targeted Analytics = Targeted Solutions

1. Shift toward bundled payment structures like Accountable Care Organizations (ACOs) and integrated delivery systems. Payment structures that focus on value. Value being a combination of quality and affordability.  
2. Focus on primary care and care coordination. UHC is introducing a plan based on a gatekeeper model in FL. They said they've had requests from customers for it. (Yep, everything old is new again.) I'm still worried about shortages of primary care physicians. Maybe the focus on care coordination will help this issue bubble to the surface nationwide. 
3. Integrating data to perform predictive modeling -- Targeted Analytics = Targeted Solutions. (I wish this extended to the data customers maintain with wellness providers and other partners, but I think UHC is overwhelmed with integrating all of their own data right now.)
4. Reaching out to people identified through predictive modeling to minimize avoidable costs by putting personally appropriate interventions in place. UHC focuses on this with their nurseline. 
5. Steering insureds to preferred providers and centers of excellence for complex medical conditions. Definitely a win-win proposition. 
6. Reverse innovation -- This is the term used in the Harvard Business Review article, How GE is Disrupting Itself. It refers to developing products for emerging markets and then distributing them globally. (The opposite of how things have traditionally been done -- developing products for their home market and then adapting them for other markets around the world.) Two product examples, a $1,000 handheld electrocardiogram device and a portable, PC-based ultrasound machine that sells for $15,000. A conventional ultrasound machine was selling for $100,000 and up. These new products have the potential to replace much more expensive technology that is being used in the US. And, it could make tests that are now performed in radiology centers available in doctor's offices. 
7. Making information accessible through mobile devices. As susannah fox at Pew’s Internet & American Life Project said, “Information has become portable, personalized and participatory. Once someone has a mobile device, they’re more likely to use the internet to gather information, share what they find and create new content.” UHC had DocGPS to locate network providers when we started working with them. In March, they introduced myuhc.com.mobile. It allows you to see specific information about your plan; view, fax and email an image of your card; and check recent claims. Then, in April, they introduced OptumizeMe which has a social, gaming focus. Mobile health was the topic of this #co_health tweet chat I participated in recently and a good source of additional information. 

Ten Workplace Trends that Will Impact Our Work in 2011

As part of our annual goal setting process for our human resources team, we brainstorm trends and observations that may impact our work. This year we came up with a particular interesting mind map. I’ll summarize what we discussed.

1. Candidate Selection & Facilitated Learning -- Many sources are reporting that there will be fewer workers with the necessary skills and education for today’s jobs. We’ve seen an increase in candidates misrepresenting their qualifications which we catch during background investigations. We’re using more employment tests during our interview process and looking into doing anonymous reference checks. During tough economic times, spending on training and development always seems to wane. We predict a shift back to facilitating employee learning to fill in gaps in necessary skills and to help people keep their skills current in quickly evolving marketplace. 
2. Caregivers -- More people caring for elders and children while working full-time increases the demand for flexibility. 
3. Communication -- We’ve noticed a trend for information to be presented more visually like the infograph resume. We’ll probably do more to build on what we learned in Slide:ology last year. There are more and more avenues of communication. We used to simply email staff. Now we also use our intranet, Facebook, Twitter, text messages, etc... There is also a trend toward and even an expectation of more personalized communication. For example, there has been a lot of interest in United Healthcare’s personalized online tools from our staff. 
4. Data Security -- Greater emphasis is being placed on protecting employee, member, and customer data from identity theft. There may also be more support offered to help employees deal with identity theft when it occurs. Organizations are also investing more in services to protect data in the event of a disaster or cyber attack and setting higher security expectations for the vendors used. 
5. Disabilities -- More employees with disabilities in the workplace increases the need for accommodations. 
6. Green -- Employee, customer and member expectations for sustainable and green business practices are growing. 
7. Healthcare -- With healthcare reform, the changes are too numerous to list, but a couple of key things we expect to see include provider shortages and an increased sensitivity to cost. Services like Health Advocate that help people identify providers may become more valuable to employees. Cost shifting may result in employee backlash and lead some employees and their family members to put off medical intervention and eliminate or underuse prescription drugs. People also need help screening information for reliable sources. There’s an interesting post about this on our ASHAsphere. 
8. Retirements -- Baby boomers are retiring, so there is an increased need for succession planning and a process for transferring knowledge. On the flip side, many people are also working beyond when they expected to retire because their retirement savings is insufficient. 
9. Technology -- People are developing meaningful virtual relationships and using technology for social learning. Information comes at people quickly and from so many different sources that they may need help developing systems to review, store and retrieve it. Employees are increasingly expected to be available in the evenings and over weekends to respond to work issues. Smart phones have led to an expectation that responses will be almost instantaneous. And, people expect information to be formatted for Smart phones. Many people feel they have no “off” time since they’re always connected. Work often occurs in short bursts. Text messages and other alerts increase the number of interruptions people receive and make it harder for people to fully engage in what they’re doing. More metrics on usage allow us to know how many people we reach, reveal knowledge and experience gaps, and many other trends. 
10. Wellness -- Everyone seems to be predicting an increased focus on employee wellness and it is becoming more common to take an approach that includes family members in wellness initiatives. We expect to see an increase in chronic health conditions in the workplace including depression. We are interested in focusing on more targeted wellness initiatives and looking into using our claim data for predictive modeling, so that someone can intervene before serious problems occur.