Connecting Cost and Care

Success with Wellness

There is no silver bullet for increasing engagement in wellness programs. However, successful programs with higher than average participation have common elements. 

5 Elements of Successful Wellness Programs:

Offer choice so that you meet people where they are at on their journey for better health.
Working out should simply be time for everyone to do something physical and enjoyable. Offering choice is the easiest way to meet people where they are at on their journey to better health. Many corporate wellness programs make it easier for employees to move throughout the day by implementing walking meetings, standing desks and treadmill desks. Personal trainers, including Harley Pasternak now believe that people can get lean in life just by standing more and walking at least 10,000 steps/day which is about 5 miles/day. 

Lean is not enough. People also need to be strong [and flexible]. Some companies are encouraging employees to workout at their desks or wherever they feel like it because just 5 minutes of resistance training each day improves health over time. Others are offering on-site classes, access to company gyms or contributing to workout related expenses by adding a fitness benefit

Make the healthy choice the default choice.
Subtle changes in what you offer and how you offer it can have a big impact on choice and waistlines without causing mutiny. Target makes the healthy choice the easy choice [aka default choice] by giving employees an extra discount on healthy food and workout clothing purchased from their stores. Other companies such as IDEO are finding success simply by putting the water on the top shelf and soda on the bottom shelf in company fridges. Employees are now drinking more water than soda. 

Reflect your cultural values in your program
Think about what your company does, who your company serves and what the company values for ways to link your wellness program to the core mission. Target successfully aligned their business with their social mission to reinforce their cultural values of wellness in the communities where their employees live and work.

Engage people who can inspire healthy changes and support the program
Dayton, Ohio RTP [Fat Bus Drivers] took a risk by adding a health coach and it paid off over time by reducing healthcare costs. The “secret” to their success is that they truly care for their people and it’s reflected in everything they do from privacy to celebrating milestones. Having a boss that has walked a day in your shoes probably helps too. Mark Donaghy, CEO of RTP shared at the recent FitBit Captivate conference that he started as a bus driver and to this day still identifies as being a bus driver. Can you imagine having a boss that not only relates to where you are now but also shows you the path to a more successful life? That’s powerful.

Reward Healthy Behaviors
Share the healthcare savings with employees who participate and meet their goals. The Dayton Ohio RTP program rewarded employees who participated with enough money to cover the increase in premiums each year. Doing so reinforced the fact that healthy behavior lowers healthcare costs for all.

Successful wellness programs do more than lower healthcare costs. Publicly traded companies with wellness programs are outperforming their competitors with better recruitment, retention and productivity.

About the Author: Shannon Smith is a healthcare strategist with over 15 years of helping companies achieve greater success and the founder and CEO of Hello Workout, Inc.

Connecting Dots

Is there such a thing as too much when you’re sick…too much knowledge, too much care or too much money?

I recently read an article written by Lisa Rosenbaum, MD in the New Yorker called The Problem with Knowing How Much Your Health Care Costs.  She used her own experience of delaying medical treatment as an example of how cost can impact a patient’s decision to seek care.  The examples used that reportedly affected her decision seemed like exceptions rather than the norm in healthcare finance, but the issue she highlighted is real.  Cost information may deter some people from seeking care especially in the absence of reliable information.

Providing an estimated cost in advance of care to patients is nothing new to me and something that I have been working with facilities to do for more than 10 years.  It is not as easy as some may think for complex services such as broken bones because there is usually more than one provider involved.  In the case of some Emergency Room (ER) services, the issue is even more complex because of the nature of the service.  However, given my own ER experience the issues seem to point to a bigger issue than cost alone.

Too Much Knowledge
Like Lisa, I was lucky to have had health insurance and a healthcare savings account when I experienced stomach pain so severe that I ended up in the emergency room.  I knew something was really wrong as I left a lunch meeting because I recognized the pain.  Something had ruptured – but what?  I called my mom who was a nurse and knows my medical history better than anyone to ask whether or not to go directly to an ER.

Cost weighed on my mind in the moment but there was something else too.  In the industry, we often talk about the high cost of care in ERs and how much of that care can be delivered in lower cost settings.  It was the second part of that statement that left me wondering whether my condition was serious enough to warrant an ER visit.  After conferring with my mom, I went home to see if the pain would pass.

Both Lisa and I attempted to triage our care in a similar way which makes me wonder… how does an average American decide whether or not to use an ER when they are sick or in pain?  Does everyone try to triage their own care or should there be some more formalized way to help triage care?

Too Much Care
By the time, I got home it was clear that the pain wasn’t going to pass.  A friend took me to the closest ER and stayed with me through all of the testing.  I’ll spare you all the details but there was one notable difference from the process used to diagnose my appendicitis.  My care this time started with something my physician described as one of the meanest things they do to patients followed by a CT scan rather than a physical exam.  When the images didn’t reveal the problem, the physician did a physical exam which revealed the location of the pain and a probable diagnosis.

The next day, I saw a specialist who did a physical exam and then ordered an ultrasound.  Something had ruptured but fortunately, nothing that needed further medical treatment.  While it was good news especially in light of the initial diagnosis, the whole experience was still upsetting.  During the ultrasound the technician mentioned that she was on call for the ER but wasn’t called.

I couldn’t help but wonder whether the ER visit was all for not.  Could the ER physician saved time and money by starting with a physical exam or was, as my friend described it, his “process of elimination” necessary given the nature of the issue and/or lack of medical information about me?

Too Much Money
The bill for the ER visit was more than I expected and my portion was also more than I expected.  The out-of-pocket maximum on my health plan was more than my deductible and the maximum annual HSA contribution.  I paid the bill but it didn’t feel right given the misdiagnosis, the testing that may or may not have been needed and the stress of it all.

Admittedly, when you are really sick or in pain, there is no such thing as too much money – cost becomes irrelevant and more care somehow seems better.  However, after the fact is another story especially if the value of the care received isn’t clear.  Billing clerks, for the most part, can say what was done when but few, if any, can explain why.   Connecting the dots between what and why without a medical degree and/or understanding someone’s thought process in the moment is almost impossible.

The only one that can truly connect all the dots needed to understand the value is the physician providing the service. That’s why I have to wonder …should physicians be connecting the dots (what, why and how much) for patients who are stable?

Safe to Say
There is always more to an issue than what meets the eye or what can be learned from an experience or two.  However, it seems like there is opportunity to enhance the way patients are triaged and informed during the treatment process to help connect the dots between cost and care so that the value of the care provided is clear.

It’s just human nature to take time to connect the dots.  But I also know there can be a day of reckoning, when you wish you had connected the dots more quickly.   -Al Gore


About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She has successfully led the transformation of ASCs and hospitals, advised technology and device companies on product development and commercialization  strategy and advised other professional firms on transactions.