Are Your Workers Ingrates, or in the Dark on Benefits?

John Commins, for HealthLeaders Media, November 17, 2008

HR can be a thankless task. You bust your hump adopting value-based benefit design programs that save your employees money and provide better care options with healthier outcomes, and what do you get in return? The thanks of a grateful workforce? Hardly! More like vacant stares and suspicions that you're poking into their private lives, trying to embarrass them, harm their careers, and save the company money at their expense.

Well, I hate to pile on, but if your employees don't understand that you're actually helping them save money and improve their lives, then it is your fault.

For the last two years, Midwest Business Group on Health, a nonprofit coalition of 96 large, self-insured employers, has surveyed employers in its coalition to measure their readiness to adopt value-based benefit design strategies that emphasize changing employees' unhealthy behaviors and to create a culture of health at the workplace. This summer, MBGH spoke with nine focus groups of more than 50 employees from three coalition companies to determine their understanding and reaction to value-based benefits. The results were disappointing.

Larry Boress, president and CEO of MBGH, says the central premise of value-based benefits—higher quality care at a lower cost—is simply "counterintuitive" to many employees. "The major disconnect is that, in general when people go into the marketplace to buy goods and services, they are accustomed to getting what you pay for: higher quality for more money," Boress says. "That idea is not necessarily true in healthcare. In fact, a high-quality physician might be more efficient and might in fact cost you less out of your pocket. A generic drug might be better for you because there is proven evidence for you."

The problem, Boress says, is that HR departments—generally speaking—aren't doing a good job communicating the goals of programs to employees. "It's all tied into communications and how it's presented," he says. "People often think 'if the employer wants me to do something, it is probably to reduce their costs.' What this tells us is that employers need to better educate employees about differences in quality healthcare and prepare employees to make quality choices and improve their health. Great care must be taken in communicating value-based benefits programs or employers will not only find a lack of participation, but also mistrust in their intentions to improve the health of their employees."

One size does not fit all
Different groups of employees provide different sets of challenges. "There wasn't one level of misunderstanding that everybody had," Boress says. "Managers tended to believe what the company said, but they didn't necessarily want to take a call from a disease management consultant telling them what to do. People who weren't in management were less-trustful of what the company was saying but more likely to listen to health information from an outside person."

Boress says employers who spent more time educating their employees about their benefits programs had the most success. He recommends beginning that education process anywhere from six to 18 months before the rollout. It also helps to use employees as peer advisors to explain and promote the benefits packages with their coworkers.

He said one particularly successful company uses volunteer employees who organize company-sponsored health and wellness programs and set up activities and intradepartmental friendly competitions like "The Biggest Loser" for weight loss. "We found that people don't want to be outliers. If they see that others in their organization, people they are working with, are all participating in something they are more likely to participate than even if the employers are paying an incentive," Boress says.

What you can do
What can your HR department do to promote value-based benefits?

  • "First of all, you have to take the time to understand your workforce, understand what their real lives are like, the pressures and limitations they face," Boress says.
  • Next, provide a lot of information ahead of time. "Explain why it's important to be healthy, how health can improve their quality of life, not just their productivity but their opportunity to see their grandchildren," Boress says. Reframe the discussion about quality so that employees know they can get better, more efficient care at lower cost.
  • Provide program choices. "Don't just offer one thing because employees don't want to be steered toward one thing," Boress says.
  • Reach out to spouses. "Spouses have a huge impact on whether or not somebody participates," Boress says.
  • Make sure your employees are health literate. "People often don't understand some of the terminology we use. What is value-based? What is an HpA1c score? You need to talk to them in ways they can understand. And we found that people don't want to be told there is a 'counselor' available. They'd rather be told there is a 'coach' available."
  • Stress that the process is strictly confidential. "People are always going to be mistrustful. When employees are asked to fill out health-risk appraisals they may feel that 'the employer is going to see what I've got and it's going to impact my future here.' They have to be told that is not the case. That is really key," Boress says.

The common thread here is communication. If you design a cost-effective benefits package for your employees, they won't benefit from it if they don't understand it. And they won't understand it if you don't explain it.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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