The Employer Perspective
We sat down with Welborn, who has worked for large employers including Walmart and Wells Fargo, to talk about the role of the employer in the ongoing national healthcare debate, how employer and broker objectives align, and opportunities to promote quality, cut costs and innovate.
There has been a subtle shift away from a reliance on brokers and consultants, primarily with the cohort of employers who have been the most aggressive in implementing point solutions. There has been less reliance on brokers/consultants to drive strategy. There has been more conversation among almost all employers about the potential lack of objectivity that has been created due to known and unknown commission and payment schemes of both brokers and consultants that has seemed to grow recently.
Industry stakeholders is also a broad category which includes carriers, clinicians, hospital systems, pharma, pharmacies, as well as government and employers, not to mention brokers and consultants. So generally, the answer to your question of what they could be doing to listen to and leverage the employee perspective is to not think about employees as employees or consumers, but to think about them as people and patients with very different needs.
And as noted in the question below, most of the industry stakeholders do not have a direct line of communication between themselves and employees. Some may have communication with patients through the caregiving avenue, and we would look to see more time and money committed to engaging the patient in comprehensive dialogue about the whole person, not just the particular presenting concern. I believe the ability to listen to employees is—quite frankly—more difficult, but there is a lot that can be extrapolated from the point solutions that are becoming successful. There are some commonalities that are clearly the result of the innovators understanding the employee perspective. These are: keeping it simple—healthcare is just too complicated and health plans are indecipherable. Be able to communicate with me the way I communicate with everyone else in my life—through my phone or my computer. Be smarter than I am—take in additional information and provide me with insights I can’t easily get on my own. Make me want to come to you, not avoid you.
I believe, but can’t be certain, that many of the point solutions use design thinking to develop their solution, which requires empathizing with the user. Spending time with focus groups, current users, etc., is core to this approach and is clearly the most important thing stakeholders can do to increase their understanding of the employee perspective. Even asking employers what they think their employees think would be a step in the right direction.
There was an article in Harvard Business Review this March titled, “How Employers are Fixing Health Care,” written by Lisa Woods, Jonathan Slotkin, MD, and Ruth Coleman, which highlights Walmart’s experience in the Centers of Excellence program we developed. For example, 54% of the spine surgeries which were assessed in the Walmart COE program would have been done unnecessarily had they not been seen by the COE. Twenty percent (20%) of the joint replacements would have been done unnecessarily. And that’s just the tip of the iceberg.
Now that I’m not at Walmart (where they are continuing their quest for implementing more solutions for identifying and eliminating inappropriate care), I’m focused on the point solutions that are doing just that and helping them evolve their program/product so that it meets employers’ and patients’ needs. There are many in this category that I’m working with, such as Carrum Health, Grand Rounds, Embold Health, Centivo, Bind, Vivio Health, Vivante Health and others. I’m constantly looking for others and helping drive the dialogue wherever I go to bring this to the table. For years we thought the conversation was simply cost and quality. It’s not. It’s cost, quality and appropriate care.