“Don’t pull the knot tight,” the philosopher Ludwig Wittgenstein once warned, “before being sure you have got hold of the right end.” Those who hope to sort out the tangle of health care spending would do well to heed his advice.
Clearly, there’s been no lack of solutions put forward since the Clintons first put health care atop the national agenda more than a decade ago. But with health care spending still rising at twice the rate of inflation, few have made any real and lasting impact.
Employers (who still pay the lion’s share of health insurance premiums here in the U.S.) know, of course, that keeping employees from getting sick in the first place—and minimizing the severity and duration of their illness when they do—is the first step in reducing this unwelcome “growth sector” of our economy. They understand, for the most part, that healthier employees equal not only lower healthcare costs but reduced absenteeism and greater productivity for the economy as a whole.
Hence they’ve tried, with varying degrees of success, to engage employees proactively in such programs as risk assessments, biometric screening, disease management, wellness programs, exercise facilities and the like—all of which have the effect of lower health insurance premiums via reduced consumption. And, as an incentive to engage employees in this effort, they’ve offered various financial incentives, including health reimbursement accounts (and the tax savings these generate for employee and employer alike).
Yet for all the ingenuity of these initiatives, they’ve yet to make a much of dent in the budget for the companies that have introduced them, let alone for U.S. health care spending as a whole. Like so much of 21st century medicine, the cure can be as complex and debilitating as the disease. The challenge and complexity of administering the effort’s many components—information systems, social networks, HRA accounting, planning tools and a plethora of wellness options—can be enough to quickly overwhelm capabilities of even the largest H.R. organization.
Moreover, even when employers do succeed in pulling all these loose ends together and delivering them on the company’s web site, the user experience is often the Internet equivalent of a 4 a.m. visit to the emergency room—and just about as enjoyable. Navigating the mishmash of screens and web tools can be difficult for even the most web-savvy of employees. Worse still, internal surveys often reveal that a majority of employees have no idea they even have access to such functionality. Indeed the same companies who spend millions to provide simple and satisfying e-commerce solutions to their customers often have little clue how to deliver the same level of user experience to their own employees.
In their best-selling book, Made to Stick, Chip and Dan Heath set out to answer the question of why some ideas “stick”—are embraced and endure—while others don’t. Their answer? A successful, “sticky” solution is one that makes an audience: (1) pay attention, (2) understand and remember it, (3) agree/believe, (4) care and (5) be able to act on it. Any solution that fails to meet these five criteria—regardless of its intrinsic merits—is likely to fall by the wayside.
If these principles sound vaguely familiar, of course, it’s because they’re the same ones that designers have been using for years to develop successful, category-creating products from the Volkswagen Beetle to the Apple iPhone. People embrace these products passionately, with a zeal that sometimes borders on religious devotion, because they speak their deepest needs, not just functionally and intellectually but emotionally as well. If the user experience is simple, understandable and, above all, emotionally satisfying—whether we’re talking about a heart-rate monitor or a web site—people will be apt to embrace it again and again, to make room for it in their lives.
What this means for health care—and corporate health benefits management more particularly—is that design needs to integrate with technology in a way that dramatically improves the user experience. (Ask yourself: When was the last time you had a really great experience involving health care?)
If the web experience is simple and easy to navigate (think Amazon) then employees (think consumers) are more likely to embrace it and make it their own. (For me, this is more than simply an intellectual argument; it’s a business strategy to which my company, eBDS, has devoted many months of research and product design, the fruits of which will be introduced in the coming months.)
It can be argued that the foundation of modern commercial civilization has been built on successful design—in architecture, fashion, transportation, telecommunications and any number of consumer offerings, from Frisbees to Facebook. Why then should health care be the exception?
I leave that in the form of a question to the readers of this blog.Alistair Rock is CEO of eBDS, a Pittsburgh-based healthcare technology solutions provider for self-funded employers and a Highmark BCBS subsidiary.