Isn’t it fascinating how benefits have evolved and morphed to fit with the latest fashion and trends? What I have not understood is why Corporations have lost the edge on providing the best selected benefits to pull in the talent that they most want. I got a study in last week (yes, another one) which busily showed me that over 75% of bigger companies are all offering almost the same things to everyone.
Stuff like this should look familiar (thank you to EBRI):
The vast majority of the employers surveyed said they provide certain health and wellness-related benefits to some or all of their employees, including dental benefits (99%), employee life insurance (99%), long-term disability insurance (98%), employee assistance programs (97%), flexible spending accounts (95%), spouse/dependent life insurance (94%), shortterm disability insurance (94%), preferred provider organization (PPO) medical plans (87%), and/or high-deductible medical plans (80%). In addition, more than three-quarters (77%) of respondents said they offer health savings accounts (HSAs), immunization clinics or promotions (79%), and/ or biometric or wellness screening (77%); while smaller shares indicated they offer health maintenance organization (HMO) plans (38%) and/or health reimbursement accounts (HRAs) (31%).
The survey also found that most of the employers polled offer certain health related benefits as part of their health plans or as standalone benefit programs, including prescription drug plans (100%), vision plans (98%), behavioral health plans (90%), and telemedicine services (81%). The results further indicated that more than twothirds (67%) of respondents provide child care and/or elder care referral services. Among the other wellness programs offered by large shares of respondents are tobacco or smoking cessation support (83%), fitness club membership discounts or subsidies (71%), weight management programs (70%), and nutritional counseling (68%).
So, where is the benefit to the company?
If all of the benefits are a competitive match to the competition, then all that has been achieved is to create an exclusion list for the thinnest list of benefits. So, when your big group goes head to head with another one, without any clearly articulated benefit strategy that actually creates any particularly strong attraction, then recruiting on this level is simply “me too”. Even worse than that, if half the benefits have no particular value to a candidate, then perhaps that is not even a value in selection and is therefore a waste of corporate money. In “More Than Money: Motivating Physician Behavior Change” an excellent study of ACO behavior changes, it was found that where monetary rewards were scarce in terms of “payoff” for behavior changes; that the ACO’s got a great deal of mileage out of mastery of craft and social purpose. The problem most often faced by the large organizations was that there was dispersed managerial attention to particular programs. Physicians found the diversity of programs and complexity of programs interfered strongly with focus on any particular one of them.
With so many mandates and issues, fragmentation was a “state of being”. The facts on the ACO’s seemed to be that while they promised financial incentives, individual Dr.’s did not normally see those, they accrued to the program and not the individual physician. Not only that, those program payoffs were often half a year out of phase with the work being done today. What did apply to the individual physician today was the burnout and fatigue with which we are more familiar. Having said all that (this Study is a good read by the way) Physicians still want to be rewarded for meeting goals. As found in the study: “Overall the unpredictability of performance within the ACO programs led all case study sites to consider the financial incentives to be a gamble and as a result did not consider shared savings as an effective motivator for change. One primary care physician at site A summarized it as: “Spend some money, take some time, and if it works you’ll get that money back and if it doesn’t [it’s a] ‘thanks for donating’ kind of a concept.”
Clearly the intrinsic value of extra effort on positive change is being shortchanged on the reward side. One of the most powerful motivators for high performing highly educated persons has been and remains the notion of mastery of one’s craft, peer recognition, the innate joy of learning and improving not only oneself but the team and group that you work with –not to mention the results visible in your patient population. Wouldn’t it be interesting if we could create a financial reward structure that directly addressed funding the desire of mastery of one’s craft to the individual physician and not “the contract”. Contract conditions which at best are not transparent or are utterly obscure seem ephemeral to day to day doctoring. Perhaps the medical organizations could create that linkage directly which would craft a more favorable ecosystem for positive results.
None of that learning and sharing opportunity is built into most physician recruiting and retention programs. Maybe that kind of culture shift within medical organizations, where very accurate and transparent data is used in a consistent manner to continue to teach and encourage physicians into best outcome practices in a collegial fashion is indeed a significant job benefit.
What if those overlays were structured to be long term and of some high value? Perhaps a culture change backed by highly focused individual compensation could now work together. Perhaps how we pay and reward and how the payroll is structured for both short term and long term benefits to the organization could be better aligned with real and measurable targets. Some organizations are now taking on student loans which are a very large motivator for new Physicians, and tying a tuition benefit to organizational changes in behavior might not only relieve Doctor Life stress but encourage adherence to well-conceived corporate cultural programs. Few environments are as generally complex as the Hospital and Medical topography. Perhaps we should take a look at some nontraditional benefit structures and rewards that should be better recognized and linked together. When corporate culture that supports the highest aspirations of the Physicians becomes real, then we have created a very powerful benefit that has duration and is not on everyone else’s list. Now that is really interesting challenge. Make the culture self-supporting and targeted to the Physicians highest aspirations and compensate for that behavior so it can be seen, understood and acted upon.
They key takeaway here is that perhaps the emerging best benefit is the corporate culture being modified so as to best accomplish everyone’s goals, and forcing different programs to become more cohesive to the Physicians mastery of craft, desire for best outcomes and social factors on teams and groups. Perhaps that indeed is what we should be focusing on, and targeting resources towards, while reducing and streamlining too many conflicting requirements and programs. So here is to finding the right Physician, and providing an environment where the entire corporate culture revolves around helping him thrive and be rewarded for providing patients with the best possible outcomes. Which leads us to, could it be, that the very biggest benefit of all is our organizations themselves if optimized for the joint mission?
Authored by: Paul Finestone, an Insurance Consultant and non-qualified benefits specialist, says we don’t always see the forest for the trees. 747-233-4805