Some of you may remember exercise instructors such as Jane Fonda or the late Jack LaLanne. When I was a kid, my mom had Jack LaLanne exercise books.
By the time I was a teenager, she abandoned Jack in favor of an oft-used series of vinyl albums that featured an instructor named Joanie Greggains. In one of them - during a particularly challenging leg lift exercise - Joanie cheerfully shouts, "You grew it, you lift it!" Mother did her best to comply.
Although I'd be shocked to hear this phrase in a group exercise class at our onsite fitness center, Joanie's words send a clear, concise message of engagement and personal responsibility.
The current imperative for each of us as consumers of health care is just that: We grew it; we need to lift it.
All of us have contributed to the whopping 17% of U.S. gross domestic product attributed to health care. It is vitally important that we get and remain engaged, and assume personal responsibility for taking care of ourselves and using care and our benefits wisely.
Moving away from paternalism
So how do we get thousands of employees to engage and care about this? How do we move beyond our historic role as a paternalistic employer and remove the layers of insulation we've placed between employees and the true cost of health care?
At my company, on Jan. 1, we made some changes to our self-insured medical plan design - the biggest ones since 1996. We don't yet have a true consumer-driven health plan - the kind with a high deductible that is HSA-compatible - but that's coming in 2013. Welcome to our journey.
This year, as employee-consumers, my coworkers and I will pay higher copays and/or coinsurance. Getting treatment from a non-network provider will be more expensive than it's been in the past. The annual out-of-pocket maximum is higher. In short, we will pay more for health care this year than last year.
Communications count
The trick to engagement is getting employees to believe that these changes are not intended to be punitive or sneaky. We started communicating the upcoming changes last May and then followed up with several other pieces throughout the year.
Our employee newsletter includes features like "Improve Your Benefits IQ," in which Professor Ben E. Fit dispenses health consumer education, and "$ & Sense," which shows the real cost of various treatment options.
We also created "People Like Me" illustrations to show employees how the plan and six fictional employees would share medical costs for the various plan options. Employees could find the example that matched their situation and make a more informed choice at enrollment time.
Nearly 45% of employees picked the new, more consumer-driven option.
We continue to remind employees that their plan is designed to pay 100% for eligible preventive benefits to encourage their use. And we tell them why - we'd rather spend money now to keep them healthy later.
We highlight other plan features that are designed to encourage wise health care spending. Employees spend less for generic drugs, and we encourage use of mail order for maintenance drugs because it costs less than going to the local drugstore.
We have communicated our pre-certification services (which are never popular) as a way to help employees determine in advance whether or not a treatment is medically necessary.
In addition, we invest heavily in our wellness programs. Employees get a cash incentive for completing an annual wellness assessment and can earn even more if they meet the requirements for the wellness program award.
They can call a 24-hour nurse line in advance of going to the doctor, maybe avoiding the need to go at all.
Employees and their families may use online or health coaching resources to lose weight, manage stress or find self-care resources. Employees with chronic conditions get help and support from a disease management program.
Last year, we enhanced our tobacco cessation benefits and maternity care programs. In our home office, we've got two fitness centers that cost $10 per month for an employee membership.
For those who work in our other locations around the country, we just added a financial reimbursement for health club memberships.
Although I personally might not like all of the 2011 medical plan changes when it's time to pay my doctor bills this year, the reality is that if I have more at stake as a consumer, I'll be more likely to engage in purchase-of-care decisions and benefit elections up front.
Nobel Prize-winning economist Milton Friedman said this about our human nature: "Nobody spends somebody else's money as carefully as he spends his own." That certainly is true for me.
Practicing what I preach
So, how am I doing at practicing what I preach? Can I/will I engage and make wise health care purchase decisions? I recently went to the doctor for my annual preventive exam.
This is 100% covered, and I appreciate that. It also helped me earn points toward my annual $200 wellness award - an added bonus!
But afterward, I needed to go back for a follow-up visit, knowing full well the visit would be diagnostic and not preventive. But I made the appointment anyway. (It cost me over $400.) I've been asked to come back again in six months for a repeat check.
I might go, but not without talking to my doctor first to see if it's really necessary, waiting a few more months for my annual preventive exam - and definitely not without finding out what it might cost first. In my head, I hear Joanie Greggains saying, "You grew it, you lift it!" Of course, I do my best to comply.
Contributing Editor Cindy Bucher is the benefits and compensation manager for a Midwestern financial services company and has been in her current role since 2004. She and her staff serve more than 2,500 active employees and 650 retirees, as well as their families. She can be reached at
