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The Benfield Group
20 Allen Avenue,
Suite 345            Volume 7, Number 2, 2007
St. Louis, MO
63119                PERSPECTIVE by Chuck Reynolds
                     Principal and President, Employer Health Management Practice
tel. 314.968.0011

Other Locations      Key Take-Aways
Atlanta, GA
Chicago, IL          Efforts to develop revitalize or expand strategic health management initiatives can
Philadelphia, PA     benefit from the experiences and observations of parents; namely:

                        1. So Big! Help your company’s senior executives understand the total
                           economic value on the line due to health and productivity issues.

                        2. Baby Steps: Successful and sustainable efforts develop in stages.
                           Progress can be accelerated, but trying to skip key stages is ill-advised.

                        3. The “Why?” Game: Ask good questions, persist in getting answers,
                           and don’t fear counter-intuitive answers or answers that don’t seem
                           to be directly tied to health.

                     Our oldest daughter celebrated her 16th birthday about a month ago, and one
                     of the things we did to mark the occasion was to pull out old videotapes for a
                     quick trip down memory lane. Sitting there, it was a bit difficult to reconcile the
                     images surrounding me. On the screen before me I saw: Tape 1—a new born;
                     Tape 2—a cooing, babbling infant learning to roll over and scoot across the floor;
                     Tape 3—pulling to stand and first steps; Tape 4—Big Sis hugging her newborn
                     little sister and sharing the wisdom of her not-yet-two years of experience; etc.
                     Meanwhile, out of the corner of my eye, I saw two young women—smart, athletic
                     and beautiful in every way. My first thought: Clearly, they take after their mother.
                     My second: Man, have they grown up fast! How did this happen?

                     Fast forward a week. I’ve found myself at the Health and Human Capital
                     Congress. On the stage before me, seasoned professionals were sharing the wis-
                     dom of their experience as well as the challenges they faced to manage the health
                     and productivity of their companies’ human capital assets. In the audience, med-
                     ical directors, HR and benefit professionals, health industry suppliers and consult-
                     ants alike watched, listened and took notes to glean insights to help them grow
                     and develop.

                     In a moment of observation and reflection, I jotted down a note that has since
In a moment of observation and reflection, I jotted down a note that has since
evo l ved into the title and content of this Pe r s p e c t i ve The simple premise is that
there are experiences in raising children that can inform the process of “giving
birth” to and “raising” vibrant health management strategies. I’ll focus on three
experiences that bring to life important health management lessons.

So Big!

If you’re not familiar with this little game, it goes like this: 1) parent says to baby,
“How big is baby?”; 2) baby spreads arms out as far as possible while adult says
(in the high-pitched voice reserved for talking to babies) “Soooooo Biiiiiig!”;
3) parent moves in to tickle baby under its arms, causing baby to giggle
uncontrollably; 4) process repeats until it’s no longer fun for either party.

Ask a seasoned health management professional to recount their early days, and
somewhere in their story, they’ll likely talk about the first time they were able to
help a key executive at their company see the size and potential of the health and
productivity issue. Typically, the executive has been focused on only one piece of
the puzzle—medical or pharmacy expenses, for instance—but in that moment,
they begin to understand that the total economic cost of poor health is…well…”So

Helping executives understand the big picture of total healthcare economic burden
is a critical challenge in that it establishes the crux of the business problem. If
executives understand that the business problem is to reduce healthcare expens-
es, they will be interested only in solutions that promise to deliver that result. If,
however, they see that the business problem is to maximize the value of inve s t-
ments in the health and productivity of human capital assets, they will be open to
a range of solutions which, while they may or may not reduce direct healthcare
expenses, impact other important business outcomes.

One resource executives can use to dollarize health and productivity is
identified in the "Vital Resource" section of this newsletter. Blueprint for
Health is a FREE Web-based program developed by the Health as Human Capital
Foundation that gives users easy access to analytical methods and metrics derived
from a large data set of U. S. employers that can be applied to their workforce for
health and productivity cost analysis. Even better, Blueprint for Health can be
used by employers without expertise in data analysis, employers who don’t track
absence or productivity in a formal way, and/or employers who can only put their
fingers on estimated workforce data.

Baby Steps

I’m no child development expert, but through observation I think the process
of learning to run goes something like this: rolling ove r—scooting/sliding along—
crawling—pulling up on tables and chairs to a standing position—taking first
steps—walking—running. Each stage is both an accomplishment and a necessary
plateau required for the development of strength, coordination, skills and
knowledge that are required to advance to the next stage. While some children
move more quickly than others through the process, there is no skipping the
process altogether.
The path for development and growth of a successful health management
strategy—while more varied—is also a process with steps that represent both
achievements and necessary building blocks. It might be helpful to consider
three stages of development.

   1. Establish Evidence that Management Matters: A critical first step in
      many companies is to prove that health and productivity challenges can
      be managed—that meaningful progress can be made by dedicating time,
      strategic focus and financial resources to address problems. Examples of
      this first step include: a) successfully reducing work-related accidents and
      injuries through education, incentives and the establishment of a “culture
      of safety; b) ”improving health measures among a population of employees
      in a facility or plant location; and c) achieving results in a specific health-
      related intervention, such as flu shot participation.

   2. Leverage Success to Expand or Extend Management Efforts: Success
      (even small wins) can earn both trust and the support needed to take on
      additional challenges. It is somewhat common that employers who have
      been successful in managing Workers’ Compensation will seek to attack
      non-work-related disability with similar management systems. Further,
      success at one plant/location can be a beacon of success that may spark
      competition among other plants/locations to better manage health.

   3. Opportunistically but Deliberately Establish Structure and Infrastructure:
      More advanced health management initiatives have integrated data and
      management systems to put data-driven insights to work in policies and
      programs. Leading programs also have some level of formal or informal
      organizational integration among benefit silos that improves decision-
      making and execution of programs and policies.

Typically, organizational structure and infrastructure changes happen over time
through a strong leader (or team of leaders) that understands clearly what must
be done, and is opportunistic to take action when the moment is right for growth
or change.

The “Why?” Game

With children, this game can have a multitude of starting points, but—in our home
anyway—it tended to end the same every time. An abbreviated example:

Q: Why do dogs have big noses?
A: So they can smell things better.

Q: Why?
A: Because dogs need to be able to find food, and smelling it is one
   way they can find food.

Q: Why?
A: Because dogs can’t just go to the grocery store and buy food.
Q: W hy ?
A: Because dogs don’t have money, and even if they did,
   they don’t knowhow to count.

Q: W hy ?
A: Because that’s the way God made them!

End of game

Successfully managing health and productivity requires employers to become
good at playing the Why game. *This means: 1) asking good questions to begin
with; 2) being persistent/hard to satisfy in asking Why (or who, what,
where,when, why and how?) with each answer; 3) being fearless in digging
into answers that are counter-intuitive (because that’s where you may find
your most promising answers); and 4) looking for answers that don’t have an
obvious direct link to health.

The preceding points three and four may benefit from explanation. Value-based
benefit design (e.g., Pitney Bowes pharmacy benefit) is a good example of the
third point. The thought of lowering prescription co-pays to improve health and
reduce overall costs no longer seems counter-intuitive, but it was at the time.
It is good to challenge conventional thinking in searching for solutions.

As to the fourth point, it is essential to understand that an individual’s health is
only one dimension of their human capital. The other two, according to the Health
as Human Capital Foundation model that we believe is accurate and astute, are
attitude and skills. Consider absence as an issue. While it is true that a person
may fail to show up for work because they are sick, they also may not show up
because they don’t like their job, because they don’t think they’re being paid fairly
or because they know they don’t have the skills needed to perform their job safely
or well. Many, many more examples could be given. The point is, don’t assume
that health will be at the root of every problem.

While organizations with better information (integrated health and productivity
databases) have an advantage when playing the Why game, excellent data is
no guarantee that an organization will ever understand the forces and factors
that are driving their biggest problems. Many companies pay hundreds of
thousands of dollars annually for slick information systems that, if truth be told,
they don’t know how to use to get the answers they need.

Whether you consider yourself a seasoned professional with a health management
strategy up and running, someone working to get a health management effort
on its feet, or someone trying to put new legs on an old initiative, it’s important
to remember the key lessons reviewed above: 1) be able to show how big the
problem is; 2) take small steps that build on each other; and 3) get good at
playing the Why game. Why, you ask? Don’t get me started…

* The Why Game—a.k.a., root cause analysis

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