Ever since David Foot wrote his 1996 best seller, Boom Bust & Echo, we’ve all wanted to become demographers and be able to explain "two-thirds of everything". The thought that we could begin to forecast consumer behaviour has a certain appeal, but is fraught with error, even for experts. For example, Dr. Foot forecast a weak housing market and high unemployment – both indicators have been steadily improving almost ever since.

 

In benefits, the state of mind of the plan member has been the subject of some knowledge, and much guesswork. The sanofi-aventis Healthcare Survey polls 1,500 Canadian benefit plan members each year. It is one of the very few sources of "fact" in this matter, as much as perception represents fact. The 2005 Survey said that plan members seem to have a split personality – there is both an entitlement mentality, as well as an emerging sense of ownership of the benefits plan.

 

The truth is, we need to understand who uses the benefit plan, how, and when. Plan sponsors need to reinforce certain positive behaviours, and change some others. We need to know and resolve the illnesses and injuries that drive benefit plan use. We should be planning at least two years into the future, but often decisions are too much "in the moment". We have relied on plan design and co-pay decisions that are blunt instruments, and they’ve generally run their course.

 

We know consumers come in different shapes, different generations and cultures, with different health conditions and expectations. This means their benefit plans must meet different needs. Consumers vary significantly in "health literacy", with Statistics Canada saying only about half of all Canadian adults have the necessary literacy and numeracy skills for daily living. The challenge of educating employees is daunting, and to get them to change their behaviours even harder. No wonder achieving important changes in plan design and attitude are so tough.

 

To understand the plan member mind, four essential steps must be taken:

 

The first is simple, but oh-so-hard to do: just ask. Relatively few plan sponsors have undertaken a systematic, high quality employee satisfaction survey that will reveal employee attitudes across many workplace dimensions. Survey results can be paired with structured employee meetings or focus groups to flesh out ideas and direction.

 

Second, if you want to understand the health risks that drive benefit plan costs, use a health risk assessment to collect objective, aggregate data. There are several good HRAs available. GSK’s HealthEvidence is another proven tool that combines data from various plans to estimate the burden of illness (cost) in an organization.

 

Finally, when programs are being developed, consult with employees to identify priority needs, and design initiatives to ensure a solid approach to evaluation is built right in. You’ll need to assess unmet needs, preferences, and attitudes, the processes and outcomes to know your time and money went to the right things.

 

In the end, while we know benefit plans and health-promoting programs are very important, the larger context of a supportive organizational culture and an "I love my work" attitude is far more closely linked to good health and productivity. This where many employers fall down, even though there is a solid body of international research to validate this approach.

 

Under the spotlight, employers will admit to many, often conflicting, attitudes about their plan members. They are generous and penny-pinching, paternalistic and empowering, aware and confused about what works best to sustain a healthy and productive workforce. They are often risk-averse, especially in tight labour markets, so change is cautious and incremental. But change is necessary, and it must be managed to serve the needs of both the funder and the user.

 

Finally, establishing a good two-way system of communication is essential for building trust and engagement. Both sides benefit when they know what the other is thinking – or at least two-thirds of it.