It starts with the CEO. Studies confirm that the single most important determinant of successful workplace wellbeing programs is the active, passionate, and persistent involvement of the CEO.
The CEO is taken very seriously. When the CEO wants something, people notice. When the CEO is passionate about something, it gets elevated to extreme importance. The sort of paradigm and cultural change needed to create a culture of employee wellbeing simply cannot occur without the full, passionate, focused, and persistent involvement of the CEO. I was a CEO, and one has to have been one to understand the full implications of CEOship. It IS different. This is not elitism. It’s fact.
While I was CEO of Blue Cross & Blue Shield of RI, I made my singular focus ethics and integrity. Why? Because my predecessor became top-of-the-fold news, and our organization quickly gained a reputation for unethical behavior. We had to change that, and I made ethics and integrity part of every speech, virtually every piece of written material I sent to employees, a part of fully half of my weekly newsletters to employees, etc. And over time, it worked. No cutting corners; full compliance; a strong reporting system, etc. And we became recognized, rather quickly, for having ethics “in our DNA.”
I wish I had brought the same passion to the wellbeing of my employees. I didn’t, and now part of my mission in life is correct that by inspiring CEOs, Boards, and C-Suites to do just that.
A somewhat cynical CEO might ask: “Why is this my responsibility?” Or, “Why can’t employees just do what they should be doing?” Or, “Am I also supposed to cure world hunger and take on the responsibility for employees’ happiness?” “Where does it end?”
These are understandable questions. The short answers are, yes, this is your responsibility for many reasons, the chief of which is that it is a strategic imperative for operational success. It’s also the right thing ethically and morally. And no, employees often need help, and the workplace is the best venue to give and receive such help.
What do employers want more than anything? Healthy, engaged, productive, energized, and thriving employees who provide great customer service and high quality products. What they have is all too often the antithesis of that.
This article is about why and how to move away from “wellness” to “wellbeing.” Wellness is one dimensional—the absence of illness. But for employees to thrive, they need so much more. The essence? They need to be happy with what they are doing and where they are doing it. Without that, good physical health, engagement, and productivity are almost impossible. It’s as simple as that, and with happiness comes success on multiple levels for the employee and the employer. And yet the all too many of today’s American employees are dreadfully unhappy with their jobs and bosses. It’s time for that to change.
The companies that successfully address the deteriorating health (both physical and mental/emotional) of their employees have a huge competitive advantage, and not just from reduced healthcare coverage, but in cultivating more enthusiastic, productive, and engaged employees which drive competitive and financial success through better products and better service.
Dee Edington confirmed this in his book Zero Trends when he wrote: “Our mission is to create shareholder value. We create shareholder value because we have innovative, creative, and quality products and services. We have innovative, creative, and quality products and services because we have healthy and productive people.”
This is, as we say in Massachusetts, “wicked important.” Yet most American CEOs do not yet see it as even rising to their level of attention. That is nothing short of astonishing given how much they pay for healthcare coverage and the truly poor value they receive in return. Starbucks pays more for employee coverage than for coffee. GM pays more for coverage than for steel. Businesses don’t realize it, but they are truly in the healthcare coverage business whether they like it or not. And that doesn’t even begin to total up the costs of disengagement, absenteeism, and turnover.Continue reading…
A recent article posits that an Anthem company, Blue Cross and Blue Shield of Georgia (BCBSGA), is poised to “punish” its members for “unnecessary” emergency room (ER) visits by charging subscribers the entire bill for unnecessary ER visits. This is a variation on a theme which has been playing out in virtually every state and every insurer: how do we reduce the number of unnecessary emergency room visits?
Of course, expecting a lay person to be able to parse out what is medically necessary for ER care and what is not is probably expecting too much. Example: I’m playing softball, slide into third base (at my advanced age), and jam my leg. I’m not sure if it is a bruise, sprain, tear, or a break. But it hurts like hell. It’s 7:30 PM on a Tuesday. What are my options?
Option A: I could limp home, medicate with ibuprofen and a few beers, and hope it gets better. When it does not, or next morning when I awake and am unable to ambulate out of my bed, what do I do then? But of course, the pain might subside over a few days also. My mom’s healthcare advice of wait and see might work.
Option B: Call my primary care physician (PCP), who is closed for the day with a message that “if this is a medical emergency, dial 911.” That’s helpful.
Option C: Seek a free standing urgi-center and go there. They likely will order x-rays, etc. Is BCBSGA saying you can’t go there? Unclear.
In 1991, William Strauss and Neil Howe wrote the book Generations. It was recognized then and today as remarkable. The authors posit the history of America as a succession of generational biographies, beginning in 1584 and proceeds to the children of 1991. Their theory was that each generation belongs to one of four types, and that these types repeat sequentially in a fixed pattern.
In a (now) fascinating passage in the Preface, they discuss the Boomer Generation, saying (remember it’s 1991) that “You may feel some disappointment in the Dan Quayles and Donald Trumps who have been among your first agemates to climb life’s pyramid, along with some danger in the prospect of Boomer Presidents…farther down the road.” Later in the same paragraph: “Perhaps you already sense that your Boomer peers, for all their narcissism and parallel play, will someday leave a decisive mark on civilization quite unlike anything they have done up to now.” Spooky huh, as we embark on a Trump Presidency?
Generations, even that early, suggests that Millennials will be a uniquely impactful generation, mostly in a positive way, much like what they call the “GI” Generation and most of us call the “Greatest Generation.” Well… they fall in the same ordinal slot as the Greatest Generation given the following dates of birth for each generation: Greatest Generation (1901-24); Silent Generation ((1925-43); Boomer Generation (1943-60); Gen-X (1961-81); and Millennials (1982-2000). They have Boomers starting earlier than the traditional view, a position I very much agree with having been born in 1945.
Earlier this month, an article appeared in the Boston Globe titled Millennials Aren’t Lazy, They’re Workaholics. That didn’t quite fit with my impression, so I started digging a bit. I of course went on line and found a definition in the Urban Dictionary:
Special little snowflake.
Born between 1982 and 1994 this generation is something special, cause Mom and Dad and their 5th grade teacher Mrs. Winotsky told them so. Plus they have a whole shelf of participation trophies sitting at home so it has to be true.
They believe themselves to be highly intelligent, the teachers and lecturers constantly gave them “A”‘s in order to keep Mom and Dad from complaining to the Dean. Unfortunately, nobody explained to them the difference between an education and grade inflation so they tend to demonstrate poor spelling and even poorer grammar.
I can recall it like yesterday. It was 2004, and I had become the CEO of Blue Cross & Blue Shield of Rhode Island. I was in the middle of my annual physical with my long-standing primary care physician, Dr. Richard Reiter (true). Dick Reiter is my age and is an old school doc. He caught my cancer before it got too serious, and had been yelling at me about things like cholesterol, stress, and exercise for years.
During a lull in the exam, I turned to him and asked, “Dick, I’m the CEO of Blue Cross. What do I need to know?” He paused, looking down. Then his cheek started to twitch. I actually saw him lose his temper for the first time in 25 plus years. “Jim, you want straight? What the bleep are you doing to us? A monkey can do a colonoscopy and yet they make four times what we primary care doctors make. What you are doing is a disgrace.” He was some pissed!!
I then had lunch with Dr. Al Puerini, a highly regarded PCP of 30 years with a full practice. I asked him how much he netted before taxes, and when he told me, I was appalled. He made some aside about it not being about the money, but it IS in part about the money. He also told me about how difficult it was to recruit new PCPs in RI.
Those two encounters started me down my path of alarm about the future of primary care. Rhode Island is a small (40×30 mile, one million population) microcosm of the country. While we have our accents and quirks, and people still think we’re overrun by the mafia, we’re not all that much different. Just wicked smaller. Our PCP population was aging and shrinking rapidly. The best and brightest from Brown Med School and others of its ilk were decidedly not swarming into primary care. Practices could not recruit new members. We were, and still are, in a crisis that is nation-wide.
And it didn’t stop with just the poor PCP reimbursement. PCPs cannot survive financially without untoward volume. This has all sorts of negative consequences. Moreover, on the totem pole of respect, PCPs do not seem to rank high for reasons that I simply cannot fathom. It seems that the more “miracle machines” a physician uses, the more respect he or she gets. While the poor PCP does what we in the billing world refer to as “E&M” (Evaluative and Maintenance). The look-you-in-the-eye, known-you-for-years sort of thing. In other words, taking basic tests and extrapolating health trajectories. Wading into gray areas. Knowing the patient and her family, and making informed prognoses. All difficult stuff. Not something that shows up on an LED screen. Ahhhh….judgment and perspective.
Eric Jones, the CEO of a large hospital, is at the end of a long day. It’s 10 PM, he’s very tired, and has had his maximum of three drinks. He’s checking his emails and sees one from Ralph Smith, CEO of a small community hospital, rejecting Jones’ offer to joint venture hips and knees. The small hospital has rated tops in those categories, and Jones had hoped to achieve a quality and marketing coup by joining forces, perhaps as a prelude to acquisition. This rejection was the last straw, particularly since Smith and Jones never had gotten on very well. Immediately, Jones whipped off an email excoriating and libeling Smith and his hospital, misrepresenting what happened in negotiations, and threatening to “go to war” and “destroy” him and his hospital if they don’t “play ball.”
Think that far-fetched? Nope. Things worse than that have happened with astonishing regularity. Assume that when Smith opens and reads that email the next morning, he then forwards it to his senior staff and the hospital’s litigation lawyer. The lawyer confirms that it’s not only actionable for libel, but could constitute a violation of antitrust law, where damages can be trebled and attorneys’ fees recovered.
With no apology offered, I will be venturing into a very subjective realm, namely, a characterization of today’s healthcare dialogue and what, in my opinion, might be an improvement.
I would suggest we have fallen into the trap that was partly enhanced by email and blogs, namely, that we can say outrageous things impolitely and without consequence. With email we tend to be much blunter and impolite than we would be face to face. On blogs, we can be positively toxic. It’s like driving in a car with a tinted windshield that no one can see through. You are anonymous and therefore can act less responsibly.
Another vignette. I grew up in a very small upstate New York town where everyone knew everyone else. You used your car horn to beep “hi” or to warn, and not in anger, ever. When you waved at someone, it was with all five fingers. And so on. I think you get my point.
The healthcare debate always has stoked emotions like almost no other. It is intensely personal, and the stakes are high. We’re all involved and engaged.
As I’ve written in the past, I first earned my stripes as a lawyer representing my local Blue Cross plan in rate hearings. These rate hearings always started with “public comment.” The comment ranged from pure outrage to controlled anger to discontent coupled with suggestions. What did we pay the most attention to? Of course, the latter.
The fact that I was once the CEO of a health insurer may cause you to read this with some skepticism.
I invite and challenge your skepticism. And I will do my very best to keep this piece strictly factual and not stray into the ambiguities that necessarily accompany complicated matters.
So bear with me.
Health insurers are not popular. No one wants to go to the prom with us. We have been vilified by no less than the President of the United States. Heady stuff. Let us see if this vilification and what I call the cartoonization of insurers has served us well in the healthcare debate. I think it has not, because for reasons I hope to make clearer, it has taken the focus away from the real causes of our cost and quality nightmares.
Health insurance started in the Depression with the Blues, although they were not at first called that. They typically were formed by hospitals (the Blue Crosses) and physicians (the Blue Shields), so that some payment for services rendered might be, well, “insured.” Provider self interest cloaked in the public interest. Perhaps there was alignment. And there was a Depression going on after all.
At first, the role of the health insurer was strictly financial. The insurer financed all or a portion of covered health services, and far, far fewer services were covered then than today. That’s all an insurer did or was expected to do. It was not there to manage doctors or hospitals or patients or anything else. Originally, this financing was done through “indemnity” plans, which allowed patients to see anyone they wanted, and paid a set dollar amount per service or per day of hospitalization (e.g., $50/day of hospitalization). Thus, if you chose a more expensive provider, the difference was on you. Insurers back in the day did not negotiate reduced fees with providers (“fee discounts”). It was much more civil then.
In 1729, a bold and innovative thinker named The Very Reverend Jonathan Swift made “A Modest Proposal,” the subtitle of which was “For Preventing The Children of Poor People in Ireland From Being a Burden to Their Parents or Country, and For Making Them Beneficial to The Public.” One more thoughtful suggestion by Sir Jonathan was that Irish children, if prepared properly, made fine eating, having been assured by a “very knowing American…acquaintance” that at a year old, they are delicious, “whether stewed, roasted, baked, or boiled.”
While that suggestion never did catch on, it did represent a different insight as to a possible solution to a seemingly intractable problem, and it provoked quite a discussion. We have a new such problem, and it has to do with physicians. Today’s physicians, in their quiet moments, usually admit that their profession and they are in deep trouble. Physicians too often work too hard for too little; they spend too little time on what they consider to be the “practice” of medicine; they believe they are disrespected by hospitals and insurers; primary care docs envy specialists; specialists despise hospitals; and worst, they just flat do not like their day jobs to the point that there is rampant burnout, anger, and depression. Not quite Marcus Welby.
It starts after med school, if not during. The plight of newly “minted” physicians is dire. Unless they come from families of wealth or get some miraculous form of a free ride, they end their education and training with debt often exceeding $200,000. And given the length of time it takes for them to start making decent income, they will have lost at least 8 years of saving and investing, plus the time they need to pay that debt back. They also have to purchase exorbitantly priced malpractice insurance. Meanwhile they do things like get married, have children, and buy houses and cars, like many other professionals. Their plight is well described in a recent article which should cause even the most idealistic young man or woman to think twice before entering medicine. The burnout and depression statistics of practicing physicians today are astounding.
It was 1993, nearly a generation ago. President Bill Clinton had delegated massively to the First Lady the task of putting meat on the bones of his ambitious healthcare announcement. Ms. Clinton, in turn, undertook the task of drafting and then selling to Congress what was titled the “Health Security Act of 1993,” but what is remembered as “Hillarycare.”
No one doubts Ms. Clinton’s intelligence and determination. That she was so completely derailed and the way it happened is nothing short of remarkable. In many ways, we were then so ready for reform. Many things were aligned, including a newly robust economy that lasted for over 7 years.
There are many reasons why Hillarycare failed back then, not the least of which were the AHIP sponsored television ads, Harry and Louise, who became famous for their very effective skewering of what was loosely represented to be the effects of the Act. The entire debacle became a cautionary tale about how healthcare IS different and is extremely resistant to change.