Several years ago in a board meeting, my colleagues and I were presenting a complex initiative with several moving parts. After quietly listening to the presentation, one of our board members chided me. He was looking for a tightly organized, crisp presentation with clear, actionable next steps, and felt that wasn’t what he got. He said, “I can’t approve this as presented; this reminds me of a dog’s breakfast.”
Woof!
The metaphor was so effective because it was so evocative. Anyone who owns a dog has had the experience of rummaging through the fridge to just throw together whatever is available for the pooch to eat. While the rebuke stung at the time, we have subsequently internalized this phrase—and it’s become a meme of sorts at Crossover—as well as serving as a vivid reminder of how important it is to think through concepts clearly and articulate them in such a compelling way that it inspires the confidence required for people to invest in your vision for the future.
We have seen how vividly relevant this concept has been in our work with employer partners as we review together their health benefits offerings. We certainly have an appreciation of and want to acknowledge the challenges faced by benefits leaders as they try to wrangle their ecosystem. Most of the ecosystems are a mix of well-intentioned efforts blended with a random sampler of pet projects (no pun intended), hastily approved initiatives, and an accumulation of inherited decisions that have been made over the years. Throw in a little point solution here, some insurance offering there, stir in some wellness feelgood, and pretty soon your gaggle of vendors, partners, and newfound complexity is yours for years and years to come. The employer benefits ecosystem is often perfectly and appropriately described as a “dog’s breakfast.”
It doesn’t have to be this way; and for those employers with the vision, the valor, and the “Veni, Vidi, Vici” attitude required, the typical “toss it all into the bowl” dog’s breakfast ecosystem can be turned into a five course meal instead. When built intentionally, the ecosystem can be a strategic, clearly thought through, compellingly organized, and beautifully architected masterpiece of how health should be.
The five key ingredients health benefits leaders need are:
- Have a vision for how health should be. Being a people leader is often a thankless, difficult job. You can hide for years with an incrementalist approach, creating as few waves as possible—but that is no way to live! HR leaders are critical thought partners to the business. They can create tremendous value for the organization and are the stewards of culture. Nothing brings this vision together like a crisp plan to take care of the most valuable asset (employees’ health) of the most valuable assets (employees). So, have a clear, compelling, and concise vision of what you want to do. And remember, “ Come on, hit me!”
- Start with Primary Health as the foundation of your ecosystem. For decades, health plans have been placed at the center of care navigation for members. More recently, care navigation companies have emerged to play this central traffic cop role. Unfortunately, neither health plan groups nor care navigation companies are as relevant to a member as their Primary Health care team. The care team has the most trusted relationship and is singularly focused on keeping the members healthy by involving the right resources at the right time along a strategic health arc that is supported over time. Care teams do this by building relationships with members, helping members resolve issues, and improving their lifestyle by empowering them to be accountable for their own health.
- Solve for lack of trust and context… A main reason members don’t access the different services within the ecosystem is because they don’t understand the services or how they could be relevant to them. Trust in general, and in the employer ecosystem partner structure specifically, is developed in each and every interaction over time. Members look to their Primary Health care team as the most relevant entity to turn to for recommendations on how to seek the best outside care. With this trust and relevance in place, Crossover can very effectively act as a quarterback to the other benefits ecosystem partners. We establish individual member’s goals as part of our Primary Health relationship, and then make the correct medical and health decisions together. The process helps our care teams understand what each member wants to achieve, and make the right referrals that keep them on the path towards their goals. As a result, nearly 90% of referrals from the Crossover care team are completed by our members.
- …and then simplify the ecosystem. When members trust Primary Health as the most capable orchestrator of care, it then becomes the natural foundation from which to build the rest of the ecosystem. When this happens, it not only provides the right organizing catalyst for care, it also enables the reduction of accessory vendors. You can streamline. You don’t need a separate navigation function. You don’t need separate condition management. You don’t need a separate telemedicine provider.. The other underappreciated advantage of Primary Health is that we appropriately refer (ah, the power of the pen!) to the right providers in the employer ecosystem as well as in the secondary care network. The result is a simplified system that enables the most effective use of the fewest number of anchor solutions to achieve program objectives.
- Demand value by holistically evaluating your partners, your spend, and your hot spots. Myopia is an all too common disease state for benefits leaders. Not looking holistically across your total spend by key categories creates the classic “shell game” misdirection that doesn’t allow proper healthcare cost calculation. This is where the “Allure of Care” turns into the “Illusion of Care.” There is no way around the “proof of work” of establishing relationships, delivering care, and producing results. Value is achieved through the same type of real work: Can you reduce total cost? Can you measurably improve health? Can you increase engagement? Who in the ecosystem is going to be accountable for bringing all of this together? Furthermore, can you now target the hot spots that create most of the cost, most of the frustration, and most of the inefficiency? Precision medicine shouldn’t just be a pharmaceutical term, it should become a health benefits term as well.
The five key ingredients above will set benefits leaders on the path to resolving the current dog’s breakfast found in most health benefits ecosystems. We have always believed—and continue to espouse—that “architecture is destiny.” It is up to employer health activists to not only identify, but also to appropriately mix in, the above ingredients. And for those leaders who do, they will shift their current “bow wow wow” health benefits ecosystems into a legitimate “Wow. Wow! Bow.”
Scott Shreeve, MD 