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Benefits Column

The Things We Think and Do Not Say

Unguarded debate and an honest discussion of successes and failures in the world of benefits have never been the norm. Far too often, there's been a tendency to manipulate how results are measured to justify the investment. But a new day is dawning.

Monday, July 30, 2012
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I am part of a growing crusade -- a movement, if you will, to openly discuss the things we think are true. It's not that I've lied to clients and audiences in the past. I simply left out some information.

Sometimes I conducted research where the results didn't fit the hypothesis. Rarely were those outcomes made public. Or, if they were, we emphasized the information audiences craved and minimized the rest. It's a phenomenon known as the "file-drawer effect."

Other times, I was part of a company's development of new programs, products or services, which had great potential to positively impact customers. But, time -- and something called "the decline effect" -- taught us that the long-term outcomes didn't match our initial results. We simply didn't know how to tell you. Instead of being applauded for risk-taking, we feared we'd lose our credibility and your support.

I am not alone in my desire for unguarded debate and honest exchange of successes and failures. However, to paraphrase Jack Nicholson in A Few Good Men, we think you may not be able to handle the truth.

But it's a new dawn.

Wendy Lynch, a colleague I met in the mid-1990's during the formation of the Institute for Health and Productivity Management, mirrors my experience. After evaluating hundreds of wellness, prevention and health/disease management programs, Lynch related, "It was rare to find a single program that engaged enough people or produced results that delivered even 1:1 ROI -- nevermind 3:1 or 6:1."

What concerned Lynch most of all was, in order to justify investment in these programs, people felt pressured to manipulate how they measured results.

Once Lynch realized that 30 percent to 40 percent of healthcare utilization was unrelated to the burden of illness, she looked for a better way to impact workplace financials. She now advocates HR policy changes at the corporate level, which effect compensation and bonus structures, time off, training and "not getting in the way of employee health."

If you're active in social media, there's a host of people trying to speak plainly. These leaders include Gary Schwitzer, Howard Luks, Bob Merberg and a medical expert simply known on Twitter as Medicalskeptic.

There's also a drive -- called "fail + learn" -- designed to encourage people to talk about their failures so others can avoid repeating their mistakes. (On Twitter, look for posts with the hashtag, #flearn.)

In August, I'll participate on a conference panel called, "Off the Record: A Provocative Conversation on Key Issues Impacting Work, Health and Productivity." The participants will encourage HR and benefits leaders, insurance companies, HR vendors and benefits consultants to share their insights on various topics, including wellness, disease management and outsourcing versus insourcing absence-management programs.

The panel moderator, Jim McConville of MetLife, says, "What keeps vendors up at night is employer expectations -- for example, around the timing of program changes such as outsourcing employee-leave management -- that are unrealistic."

Ninety to 120 days is often not sufficient lead-time to yield a smooth transition for either the employer or the carrier. And larger employers generally need a longer timeframe to produce good results.

Juxtaposed against vendor concerns are employer realities. HR and benefits executives are being held to delivering solutions in short timeframes that address issues such as compliance, common enterprise strategies and substantial reductions in costs or definable metrics such as employee absence.

Tracy Messineo, vice president of total health and productivity management at Sutter Health, faces a balancing act when it comes to employee health and wellness.

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"We're faced with a lot of moving parts," Messineo explains. "How do we quantify outcomes and explain to senior leadership that it can take three to five years to see any results -- and those results depend upon employee engagement?"

Even more vexing for leaders like Messineo is explaining the lack of outcomes, especially when HR executives can't control human behavior and younger employees' health profiles are approaching those of their 40- and 50-year-old colleagues.

Kimberly Burkey, Verizon's HR manager, hopes that outsourcing a component of the company's absence-management program will help her better address the complexity associated with employee leaves.

Much like Messineo, Burkey manages leadership's desire for short-term impact against what she knows is a need for stable HR policies that are given the time to produce results.

In my own work, what I've found is that wellness and prevention programs to date have no statistical impact on employee absence.

Further, work/life and employee assistance programs do not alter whether an employee takes time off. However, the mere presence of an EAP shortens the duration of worker absences -- whether the employee uses the work/life program or not. It is pure speculation, but this outcome may be related to the larger intangible of the workplace environment. We need more open examination to understand this effect.

Another bright spot on the horizon when it comes to employee absence and productivity is that companies that land on lists like Fortune's Best Companies to Work For experience fewer and shorter employee absences and higher rates of productivity than businesses that do not.

My hope is that HR executives will join people like Messineo and Burkey and lead the way to more frequent discussions about their successes, failures and frustrations -- as well as the things they think and do not say.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.

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