The Changing Employer Perspective on Healthcare

If you don’t stand for something, you’ll fall for anything.

Alexander Hamilton

The Power of a Point of View

What shapes how we see the world? Our knowledge of it. Our assumptions. Our experience. These things frame our point of view. They encompass the span of reality as we see it and possibility as we imagine it.

Our point of view is self-limiting as it dictates how we receive and process information. Facts, opinions, and feelings, are put into our internal processor and produce our ideas, conclusions, and reactions. Sometimes we change our point of view based new inputs – new information expands our knowledge and can move us to different conclusions. However, we are slow to change as we tend to be hesitant to accept new facts.

Why would we be hesitant to accept new facts? Many reasons emerge. We might not trust the source of new information. New details may not be well communicated. Data may seem inconclusive based on sample size or polling approach. There are numerous rational explanations for hesitation, but often, we reject new facts or data because they do not align with our point of view.

Whether we recognize it or not, we hold points of view on pretty much everything we encounter: people, places, politics, religion, aliens, entertainment, etc. We also maintain a point of view on the work we do, the industry we work within, the players in our space, and the facts & assumptions of our business.

Healthcare Assumptions

Healthcare is a great example. Consider for a moment some conclusions held about healthcare and health benefits:

• Bigger is better as it creates economics of scale
• Healthcare is too expensive
• Healthcare is broken
• Costs are the biggest issue
• Healthcare can be fixed
• The safest path is with a BUCAH
• Large PBMs get better rebates
• Self-funded plan sponsors have limited options
• Self-funded plan sponsors have limited influence
• Self-funded plans sponsors have little leverage
• Hospitals are gouging patients and payers
• Change creates risk
• We need more regulation

Depending on where you live in the healthcare economy, you may share one or more of the conclusions above. Your conclusions, your assumptions – your point of view, informs every decision you make as it relates to your place in that healthcare economy.

What happens when we’re wrong? What happens when our point of view misses a critical piece of information, a new data point, a recent change, or something shifting in the sand on which we’re standing? Often, missed opportunities mean more cost or less savings. Sometimes, we make the decision to pass over an opportunity from a risk/reward perspective: the potential gain isn’t worth the perceived risk of disruption or uncertainty.

Shifting Risks

However, financial risk is only the simple and obvious side. What happens when our point of view impacts less obvious factors like recruiting, retention, or satisfaction? Or, at the far end of missed opportunities, what happens when our assumptions impact the well-being of an employee or her family? The growing regulatory pressure on plan fiduciary responsibility for members is highlighting direct risk in what is done as well as risk in what is not done.

Status quo approaches to plan management have created real “sins of omission” as they relate to the choices we make on behalf of our members. This is a world in which we may be guilty of the things we did not do as much as the things we did.

Aside from the legal/regulatory risks of living in the healthcare and employee benefits world, there is a growing sense of dissatisfaction with how it works and what it produces in terms of economics and health. More and more self-funded plan sponsors see a growing risk in the traditional approaches and feel a strong call toward stewardship as it relates to member health and related costs. Many are changing their point of view toward healthcare and their place in the ecosystem serving members.

Shared Barriers – Tactical Solutions

Looking more closely, we begin to see that self-funded plan sponsors and members share the same barriers:

The barriers inform the strategy and stakeholders are beginning to realize that there are options. Where do you stand in this new world order? What is your responsibility? Are you seeing opportunities for better stewardship of your healthcare investment and the health of the members it is supposed to support?

A New Point of View

As self-funded plans evolve amid the changing healthcare landscape, the notion of health stewardship is becoming a watchword as it captures the essence of both financial and member health journey responsibility for the plan sponsor. Recognition of the growing barriers related to access, cost, and complexity are redefining the self-funded plan sponsors role in helping members navigate options responsibly and effectively.

What are the elements of this evolving health stewardship point of view?

• Systemic healthcare problems of access, cost, and complexity cannot be “fixed” with a top-down approach. There is a growing understanding that regulatory and statutory intervention are exacerbating issues by adding complexity and limiting plan sponsor flexibility. Siloed fixes create new problems and generally serve the special interests sponsoring them.
• The massive, fixed structures currently operating as the backbone of American healthcare cannot make the changes needed to remove the barriers. Self-funded plan sponsors are realizing that the financial and competitive incentives to keep things as they are, work against plan and member interests and needs for something different.
• Existing systems and approaches to healthcare must be reimagined in new ways, centered on the needs of those paying for healthcare in the form of self-funded plans and their members, and incorporating fundamentally different models for access, experience, outcome, and payment. In this way, innovation will be led bottom-up by plan sponsors themselves and their demand for new options.
• Self-funded plan sponsors need effective points of influence to help members steward financial resources and personal health. Strong primary care is a key part of the equation but must be paired with the right health solutions horizontally coordinated rather than vertically siloed. Data access coupled with meaningful insights become the backbone to direct stewardship in this new healthcare world order.
• Plan sponsors and their members must be empowered in radically new ways to make better decisions and manage across less complexity for the overall production of better health. Digital technology is part of this but must be effectively integrated with the analog of high-touch healthcare and experience management.

Massive employers have already started much of the shift but they are still beholden in many ways to the fixed interests of the existing system. Less complex organizations have the advantage here as they can be nimble and iterate more quickly on ideas to find what works best. Scale brings some negotiating leverage but the most powerful assets for change is the point of view to see a better future the courage to demand something different, and the will to pursue it aggressively.

What’s the power of a point of view? Everything. Shifting our mindsets to see a different future is the first step in creating it. If we keep telling ourselves that it’s too big, too much, too complex, too frustrating, too fixed, etc., we will continue to be on the receiving end of someone else’s priorities and quarterly earnings report. In this journey, we are all stewards of the resources, talents, and lives of those we serve and support. Our duty is to be good stewards. Anything else is unworthy of us and our capacity to make a difference.

We are proud to feature Northwind Pharmaceuticals on the Granite List.