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A Sticky Solution to a Sticky Problem

“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.

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Carl Parisien Natick MAJohn R. GrahamPeterK. H.Blake Zenger Recent comment authors
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Carl Parisien Natick MA
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Carl Parisien Natick MA

Carl Parisien Natick MA but what do patients have to spend? its the expense piece that is missing

Nate
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Nate

I owned a PPO and have done plenty of contracting. That doesn’t change the fact this statement is incorrect;
“so that patients don’t even have the option to pay out-of-pocket.”
A patient can go out of network and pay out of pocket to receive the service. Further I would suspect those limitations are in a minority of contracts. far from being the norm.

John R. Graham
Guest

Most readers likely know, or realize upon reflection, that the share of your health-care expenses that your employer pays is zero, plus a friction cost for administration. Imagine if the government imposed taxes so that we got housing from our employers, like it has with health benefits. Employers would be trying to figure out how to co-ordinate housebuilding and maintenance between architects, contractors, carpenters, electricians, painters, plumbers, etc., and deluding themselves into thinking they would someday be able to figure out what the residents wanted. We need tax reform so families can buy their own health insurance, and we needed… Read more »

Peter
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Peter

“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.”
Because it all comes down to work and no amount of “stick” will take away the work. It’s work to control eating habits, work to exercise regularly and work to adopt any cultural change that will provide benefit. People don’t like work. So let’s make it simple, tax bad habits and put that money into the healthcare system.

K. H.
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K. H.

“Employers are in business to make $ which is ok by me. Get them out of health care. Far too important to nest in risky corporate American.” So are healthcare providers…clinicians as well as medical suppliers, pharmaceuticals, hospitals, ambulatory surgical centers, labs, etc. Profit unfortunately drives most if not all of the players. Employers, at least, are one of the few players that are advantaged by reducing utilization and cost. Too many other playeres win as costs increase. “Only a single-payer approach to healthcare reform will END THE INHUMANITY OF OUR FAILED HEALTHCARE INSURANCE SYSTEM, WHERE PROFITS ARE MORE IMPORTANT… Read more »

Randall Oates, M.D.
Guest

Nate… if a physician is contracted with an insurer to be “In Network” then the physician is obligated to abide by the terms of the provider agreement with the payer. To take a direct quote from a letter from an insurance company to a provider… “These services (i.e. 99058, 99444) are considered incidental to other services provided (evaluation and management services, surgical services, and laboratory services) and separate reimbursement will not be allowed.” Unfortunately, it is often the case that “other services” that can be billed are not actually provided. So, the contracts insurers have with providers usually precludes the… Read more »

Blake Zenger
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I don’t believe the Mr. Rock’s comments were limited to employer solutions only. What I took away from his blog was something that I have been writing about for some time. I believe the technologists, in general, tend to overestimate the ability of users to efficiently navigate the tools they create. They tend to overemphasize the power of their product, and under-emphasize the usability of their product. A timely example is EHRs. I was at a conference in Boston recently where the primary topic was EHRs. One of the particants asked an intriguing question. “What role does ‘design’ take in… Read more »

Nate
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Nate

“I have observed an increasing tendency for payers to state the use of these codes are “not allowed,” so that patients don’t even have the option to pay out-of-pocket. This limits patient choice, quality of care, and raises the costs for hundreds of thousands of patients on a daily basis. ” No plan in the country but Medicare can prevent a patient from receiving a service and paying for it out-of-pocket. The way you write seems to imply private insurance companies do this, which is not possible, your either talking about Medicare or NHS in Britian but surely are not… Read more »

rbar
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rbar

I am a little surprised that no one finds this post self-serving, maybe even deceptive. Tell me if I am misreading the article, but doesn’t Mr. Rock insinuate that today’s grave health care problems in the US could be solved or at least adressed by making employer based solutions more “sticky”? I have no problems with the stickiness itself, but I am afraid it will help little. But in order to curb the health care cost explosion, it is more important to tackle the issue of overutilization of HC services (both a doctor- and patient problem) and, to a lesser… Read more »

botetourt
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botetourt

Mike S. above–you hit the nail on the head–and the reason is that our country has raised two generations of citizens who have allowed themselves to believe that ours is the best healthcare system in the world, and that their physicians and pharma industries will cure whatever ails them when the time comes. We don’t need better or more interesting software or websites, we need culture change. I believe it is starting to occur, and would cite the relative success in the reduction of smoking, and the negative social stigma now associated with smoking. If we spent more money to… Read more »

Mike S
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Mike S

If providing people with accurate information was enough to change behavior, then as the number of books, tapes, DVDs and magazine articles on weight loss skyrocketed in the past 20 years, the obesity of Americans would have dropped. But it’s RISEN in proportion to the amount of information. Changing people’s behavior is really hard and there’s little, credible research showing that the kinds of programs offered by employers prevents illness let alone improves health. I once heard a noted psychologist say that the greatest advancement in medical science, the one that would save the most lives and prevent the most… Read more »

inchoate but earnest
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inchoate but earnest

To abstract Brian K’s post, the setting of healthcare – particularly of routine, monitoring & information-exchange-intensive care events – quite likely has a lot to do with how readily such settings are engaged. I’ve heard a few skilled clinicians express the observation even more broadly, to the effect that 80% of useful health care has nought to do, really, with health care. And while “employer-based or not?” has indeed gotten lots of attention at THCB, it’s worth noting that whether or not health care is “based” (ie, paid for) principally as a function of employment relationships, employers will have an… Read more »

Randall Oates, M.D.
Guest

It is difficult to make any innovation “sticky” if there are financial disincentives for patients. Correct me if there is evidence to the contrary, but most of what I have seen supports that a majority of patients usually need some at least a financially neutral offering in order to take advantages of innovation. However, I continue to see more evidence of health care payer disincentives rather than incentives toward innovation in the meeting of patient needs. So, until there is some means to overcome the tyranny of the payment system, innovation is largely thwarted in a majority of settings. For… Read more »

ICH GCP
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I have checked the blog Guru. Nice definition!

Healthcare Guru
Guest

Last week, we wrote the definition of healthcare system at a macro level on our blog. May be it might need more input to make it complete.
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