A Seat at the Table

I'm Beth Bierbower, President of the Employer Group Segment at Humana. These are my thoughts on the issues affecting professional women today, based on my career journey so far.
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Seeking treatment from the typical primary care physician practice conjures up images of white coats, a sterile environment and outdated magazines sitting on a battered table in the corner. The primary care office is a place to go when you’re sick. The objective is to get in and out as quickly as possible, and usually with a prescription in hand … or is it? As the concepts of wellness and management of population health continue to evolve, some primary care practices are dramatically changing their approaches to care delivery. Iora Health is a pioneer in this new world.

I had the opportunity to spend several hours in Iora Health’s Freelancers Clinic with the staff and co-founders Rushika Fernandopulle and Chris McKown. The meeting was an eye-opening experience into the way people should and want to engage with their primary care physicians. Nestled into a small building in Brooklyn, the practice exclusively serves members with Freelancers’ health insurance coverage. Members are eligible to come to the clinic without copayments as long as they elect the clinic as their primary care practice.

What did I learn from my visit about the new face of primary care?

  • The new face of primary care swaps a reception room wait for a welcome experience. When I walked into the practice I was unsure I was in the right place. The waiting room looked as if it came out of a Crate and Barrel catalogue with welcoming sofas and sunlight streaming through a large window. The traditional magazine pile was replaced with iPads that permitted you to surf the internet while you waited. The traditional glass window separating patients from staff was nowhere to be found. In its place was a small, round table with a laptop and a phone for the receptionist. And that receptionist might be one of several members of the practice who also serve as health coaches. Adjoining the reception area was a room for classes covering topics from anxiety to yoga, which seemed kind of cool, but it was empty and for a moment I thought, maybe this is just for show.
  • Providers practice a patient engagement mantra: listen first, treat second. The practice primarily consists of a Nurse Innovator, Physicians and Health Coaches; there are four coaches for every physician in the practice. Exceptional empathy and listening skills are imperatives for becoming a member of the team. Each morning the team discusses how better to engage their patients in their health. Role playing is used to help team members hone their engagement skills. I never once heard patients referred to based on their disease state. In fact, conditions and illnesses were almost secondary to the overall well-being of the patient.
  • Patient care is as much about planning for well-being as it is treating the illness. Each team member had a full schedule of patients with visits lasting approximately an hour. Team members wore regular clothing. Without an introduction, it was hard to tell the difference between the physician and the other team members, and that’s the idea. Every team member plays an important role and it takes a village to support an individual on her personal health journey. Conversations with patients are focused on their overall well-being. Team members work hard to understand the underlying issue that may be preventing someone from eating right, exercising or adhering to a treatment plan. And the team spends as much time thinking about how to get members who are not using the practice to come in … which is not an approach that that many associate with a fixed fee arrangement.

The practice has a patient advisory board, where the team solicits feedback on what’s working and what the team can do to improve. Patients refer to the clinic as “our practice” demonstrating a level of engagement unknown in most practices. With six practices across the country, the management team acknowledges that they are still very much in a learning mode, but their early results are impressive: high patient satisfaction and lower costs for the employers and sponsors they work with, and of course for the patient – better health and well-being. While we have yet to find a ‘silver bullet’ in healthcare that drives to optimal health and outcomes, as providers and health plans look to engage individuals in their health, the Iora Health model is a good place to look for some answers.

While we have yet to find a ‘silver bullet’ in healthcare that drives to optimal health and outcomes, as providers and health plans look to engage individuals in their health, the Iora Health model is a good place to look for some answers.

As I left the practice, I noticed that the activity room was full of individuals who were participating in a class led by one of the health coaches. I took one more look around to capture what the new face of primary care might look like in the not-too-distant future. I liked what I saw.

Speak loudly, step boldly!

Follow me on Twitter: @bethbierbower

Images courtesy of www.iorahealth.com

I read an article in Inc. magazine on how to have a productive meeting. For me, holding a productive meeting is not an issue. Rather, the problem is that I simply have too many meetings. Like many of you, my calendar is jam packed the entire day. Having lunch without an agenda is a distant memory.

I’ve always worked in organizations that prefer meetings to work through an issue. While this approach may be good for complex issues, it can also create a drag on the organization, resulting in too many meetings with too many attendees. How do you reduce the number of meetings? I chatted with some of my colleagues and have shared these thoughts below.

  1. Pick up the phone. Too many people rely on email to handle issues, which then escalate into a meeting request. Why not pick up the phone and chat with the individual who started the email chain? You’ll be surprised how quickly you can resolve most issues without holding a meeting.
  2. Who is accountable? We often include every possible stakeholder in the meeting. Identify who is ultimately accountable and speak directly with that individual about the situation first. Pitch your idea and if you get a positive response, then commit that you will move forward and report back on any major obstacles.
  3. Take advantage of staff meetings. Staff meetings are generally used for report outs. Our team uses these meetings for decision making only, saving a great deal of time on calendars.
  4. Require a description of the meeting before scheduling. With so many people trying to get on your calendar, you must be diligent before you take the meeting. Once you understand the request, you may be able to quickly resolve the meeting with a phone call. When contacted by a person outside your organization, make it clear you won’t consider a meeting until the individual sends you information, then provide your email address and end the conversation immediately. I don’t return phone calls from individuals who don’t provide their company name and a reason for calling.
  5. Prioritize your meetings. Tell someone she won’t get on your calendar for a month, and she will likely determine the issue is minor enough that it can be handled by email.
  6. Delegate the meeting. Once you understand the reason for the meeting request, you may be able to delegate it to one of your team members. You’ll soon realize that many meetings can happen without your presence (and some may even be more productive without you!)

Speak loudly, step boldly!

Image courtesy of David Wall

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You don’t have to be a company executive to know that healthcare costs are rising at unsustainable rates. According to a 2013 Kaiser/HRET survey, health insurance premiums have risen 80 percent in the last 10 years, while employee contributions have increased 89 percent.

And premiums are just one reason health care costs are squeezing employers. Every year, companies lose $60 billion to absenteeism and $160 billion to health-related lost productivity according to a 2009 study by Kalorama Information.

With health care costs affecting both the top line and the bottom line, companies are thinking differently and looking for cost-effective ways to reduce absenteeism and increase productivity. For most, that means offering some sort of wellness program to help employees improve their health and wellness so they can be more productive.

Today, more than 80 percent of employers with 50 or more employees offer wellness programs, and more than two-thirds offer financial incentives to employees who get health screenings, or take lifestyle or disease management steps to maintain and improve their health. The logic seems flawless: If workers enroll in a wellness program, they’ll become healthier and thus perform more effectively on the job.

There’s just one problem. Most employers believe their wellness programs don’t work. In its 2012 national survey, Kaiser/HRET found only 52 percent of employers believed their wellness program was effective in reducing their company’s health care costs. And according to a Rand Corporation study, only 44 percent of employers had actually evaluated the effectiveness of their program. Yet employers keep offering such programs, seemingly trapped in a maze of uncontrollable healthcare costs, reduced productivity, and ineffective solutions.

So what can you learn from the mistakes other employers make with their wellness programs? As you shop for a wellness program—or evaluate the one you already offer—consider these six mistakes most employers make:

  1. Many employers choose wellness programs that impose goals on employees rather than empowering them to set their own goals. Every employee is unique, yet most wellness programs present cookie-cutter program goals that may be out of reach, unwelcome, or immaterial for some segment of the employee population. By contrast, effective wellness programs actually ask employees what they want to accomplish. They encourage employees to set their own goals and design their own health and wellness pathway, which may include education, prevention, healthy living, and fitness and exercise.
  2. Too often employers offer goal-based incentive programs without guidance. People usually know what that they need to do to achieve better health, whether it’s losing weight, getting more active, or reducing stress. What’s missing is the how. Yet, most wellness programs offer little guidance on how to reach personal health goals. While the ultimate incentive is better health, employees need motivation coupled with positive reinforcement along the way. Unfortunately, many wellness programs don’t provide health coaching and only offer incentives for reaching program-imposed goals. By contrast, effective wellness programs offer incentives for both activity and achievement, rewarding progress toward goals that employees set and own.
  3. Employers make the mistake of selecting wellness programs that rely on their employees’ self-reporting rather than verifiable actions. In order to truly support employees in achieving their goals, companies can’t simply rely on self-reported data, which can give an inaccurate picture of employee activity. Most wellness programs only credit employees for signing up for a gym membership or a 5K run, rather than verifying and rewarding their workouts and the steps they are taking toward better health. By contrast, effective wellness programs rely on data that is 100-percent verifiable and automatically updated, leaving nothing to chance.
  4. Wellness programs commonly overlook the influence of family. The health behaviors of family members can either perpetuate bad habits and shortcuts or encourage good intentions, as Gallup’s Consumption Habits Survey and NIH research has shown. Yet, many wellness programs do not incorporate families and thereby neglect a crucial determinant of success for many employees.
  5. Not all employers have figured out that they should expect reporting from their wellness program on how it’s working, not just how it’s being used.  Many wellness programs have failed to demonstrate that they do in fact work. Few report what metrics they are targeting and what success factors they are measuring that clearly indicate a benefit to the employer and the employee. Even fewer have conducted multi-year studies to show how they impact health and healthcare costs. By contrast, effective wellness programs both promise and prove that they get results.
  6. Most employers don’t benchmark themselves in order to create a strategy based on company priorities.  Most companies go straight to the perceived solution—an off-the-shelf wellness program—without knowing where their employees stand in terms of health and wellness and what areas they need to prioritize in order to achieve strategic goals. By failing to benchmark their employees and determining which needles they’re trying to move, they miss out on the opportunity to craft a program designed for their unique situation and culture.  And how can companies gauge success once a wellness program has been implemented if they don’t know where they have started?

What Smart Employers Do

Americans today spend most of their waking hours in the workplace, leaving little time outside of the workplace to pursue wellness without infringing on other needs and interests. Smarter employers encourage employees to nurture their health and wellbeing around the clock, rather than in isolation outside the office. These employers recognize that more and more employees are bringing health into the workplace through mobile health apps and wellness devices, and they make it easy to connect that technology with their wellness programs. What does good look like? It’s where employers choose wellness programs that let employees create their own goals—and then verify that those goals are being met. And, very importantly, employers choose wellness programs that don’t stop at gym discounts but actually reward workouts over time. Smart employers choose wellness programs that support employees’ goals by giving them easily accessible tools and incentives that fit their lifestyles. These employers have learned to look for wellness partners that are able to engage and include family members.

Strong employers select wellness programs that can truly deliver evidence-based proof and even multi-year data, such as the results reported in this recent study from HumanaVitality. The study of over 16,000 HumanaVitality members concluded that engaged members had significantly lower healthcare costs (lower average PMPM) and higher productivity (few unscheduled absences) than unengaged members.

Wellness That Works

When it comes to wellness vendors, there are many look-alikes out there, and there are also examples of trusted vendors that are helping companies avoid the pitfalls described above. Look for programs that provide evidence-based measurements of impact and use wellness insights, like the importance of family or verifiable data.

As you evaluate wellness programs, remember this: Well-designed programs can deliver measurable results in terms of increased engagement and reduced healthcare trend, and they can offer the data to support their claims. Ask tough questions, insist upon proof, read the research and— most of all—avoid the mistakes that most companies make. The health of your employees and your business is at stake.

Speak loudly, step boldly!

Image courtesy of PhotoAtelier

We live in a world of connectivity. We are constantly in touch with our family and friends – online and all the time. We never really step away from our work and when we do, many of those hours are filled with texting, tweeting and scouring sites like Facebook and Pinterest to see what our friends are doing. All this connectivity can be exhausting.

On a recent Saturday, I took a few precious hours to go shopping with a friend. I was hoping to catch up on what was happening with her and maybe buy a few items for myself. I thought that a few hours of “me” time would be good for my well-being. Unfortunately, my well-being was not improved on that trip. I received so many texts and calls during that short period of time that I was embarrassed. And, when I wasn’t responding to texts, I was worried about a presentation that was due and I knew that others would want to see it over the weekend.

I felt badly not only because I didn’t have the experience I was seeking, but I did not get to spend quality time with my friend. I came back from that trip in a bad mood.

A few days later someone used the phrase “digital detox” at a meeting. My mind snapped to attention. What exactly was a digital detox and could I do it? The concept is simple enough – step away from technology for a period of time. “That is exactly what I need!” I whispered to a colleague who shrugged and replied, “Don’t we all?” I was determined to figure out a way to make this happen. My excitement, however, quickly evaporated when I realized that if I didn’t check in for a period of time, I would be inundated when I returned to the world of technology. My bad mood returned.

The idea of a digital detox swirled around my brain for a few days and then someone reminded me of Metcalfe’s Law. As defined by Wikipedia, Metcalfe’s Law states that the value of a telecommunications network is proportional to the square of the number of connected users of the system (n2). In other words, the more people that ‘join in’, the more value. What if I used the concept of Metcalfe’s Law in reverse and asked as many people as possible to “disconnect” and join me in a digital detox? My mood improved.

I started by asking my own team if they were willing to disconnect from email on the weekends. They all quickly agreed and we established some rules:

Rule #1: Disconnect from email between 6 p.m. on Friday through 6 a.m. on Monday (One of the team members thought 6 a.m. Monday – 6 p.m. Friday sounded better but we thought that approach would result in a career limiting move for each of us).

Rule #2: You can work off line if you want; however, try to focus on non-email activities as much as possible. We wanted to make sure that when we arrived Monday morning, that our inboxes were not overloaded, which currently happens even when we do work all weekend.

Rule #3: Try to become as efficient as possible during the week. Determine a way to reduce the number of meetings we attend as well as the number of emails we send. We knew we needed to stop some of the communication and not just try to jam more into the week.

Rule #4: Spread the word about the digital detox with as many team members as possible (Metcalfe’s Law) so they too can take advantage of the digital detox.

Even before the news was shared widely, I began to receive positive emails on the topic (how ironic). We began our digital detox weekends over Memorial Day and plan to carry this concept through to the end of summer. My hope is that we’ll continue this habit going forward. So far, I have enjoyed every minute of my digital detox and my mood? Very much improved.

Speak loudly, step boldly!

Image courtesy of Jemimus

I’m a die-hard hockey fan and generally enjoy this time of year because it’s play-off season. The games are much faster and more intense. Night after night I am on pins and needles, glued to the television, hoping my team will win. Unfortunately, and despite wearing my ‘lucky shirt’ way too many days in a row, both my teams were eliminated. While the backstory as to why I root for two teams will be saved for another day, I do want to share how my two beloved teams handled the defeat.

The Columbus Bluejackets team will be entering its fourteenth season, which is very young in a league that has been in existence for almost 100 years. The team has advanced to the play-offs only twice and this year was one of those times, and faced a really strong opponent — my “other team” — the Pittsburgh Penguins who unfortunately, eliminated the Bluejackets in the first round.

Despite the play-off loss, I was so proud of the Bluejackets. Watching these young men play each game as if their lives depended on it was amazing. Individual players brought everything they had into each game, at times battling back from a deficit to play yet one more game. The sportscasters and writers alike were blown away at how well the Bluejackets played, even when they lost a game. And after their season ended early, articles recanted the Bluejacket’s spirit and drive, indicating that this team was truly competing at the same level as other top teams in the league. At the end of the day, the fans in Columbus felt really good about how their team played and look forward to a new season with excitement.

On the other hand, the Pens moved on but were eliminated at the end of the second round. All season long, the Pens were heralded for their talent and strong play and were viewed as a contender for the Stanley Cup this year. The Pens have talent on their team that other coaches would die for. They have fans that not only pack their arena each game, but also come out in droves to cheer the team on regardless of the city in which the game is played. While I and other Pens fans were not happy with their early elimination, I was more disappointed in what happened with the team after the season ended.

Rumors began swirling around possible causes for the team’s failure to deliver. The media reported that the coach had “lost the locker room” and was ineffective at motivating the players to perform. Star players complained that the coach was too critical of their play and a television clip showing the captain arguing with the coach during a game was played over and over much to the shock and dismay of the fans. Other players complained about long practices and said they weren’t having fun anymore. Oh, I see, it’s all the coaches’ fault.

Excuse me?

I don’t profess to understand what has been going on in the locker room for the past seven months. Maybe the coach did turn into a jerk, or maybe the team just didn’t have sufficient fire in their bellies to put it all on the line, the way their competitors did. Many of the players on the Pens have won a Stanley Cup before so maybe they just didn’t have the level of passion that translates into the type of play that earns you another cup. Maybe the practices were long and not always fun, but who hasn’t faced that in their job? I would think that making millions of dollars a year might serve as stronger motivation for these young men compared to the average Joe who earns a pittance in comparison, and who more than likely puts in a lot more work hours than these hockey players, but apparently I am wrong.

As I stated previously, I don’t know what happened in that locker room, but here is what I do know and it applies to leaders and teams in business as well as sports. It takes more than the leader to lose the confidence and support of a group. Team members must share in their responsibility for contributing to the problem through either action or inaction. Passion and dedication wane from time to time even with the most dedicated employees. It’s important for not only the leader to recognize when this waning is happening, but it’s also important for employee to recognize it and work together to get the team back on track. Work isn’t always a picnic (for me that would be budget time) but effective teams work together to find a way to get the job done. At the end of the day, when you’re part of the team — leader or employee, coach or player — it’s always about something bigger than you — whether it’s your fans, your family or your customers. And something that big can only be achieved together.

Speak loudly, step boldly!

Image courtesy of Getty Images

I attended a meeting in New York last week where the book – “The Power of Habit” – by Charles Duhigg was mentioned. The brief overview of the concept intrigued me so much that I downloaded the book when I arrived in Texas later that evening. This was a mistake from a sleep perspective because I found it difficult to put my ebook down. While I have only read half of the book – a little thing called work got in the way this week – I have learned a lot already.

The book’s premise is based on complex brain science but Duhigg presents these ideas in a very simple way. I’ve heard bits and pieces of this concept in the past, primarily through the teachings of the many diet programs I have tried, but Duhigg pulls all the pieces together in a way that helped me understand the ‘why’ behind some of the advice I have been given over the years and also why I deviate from my routines.

Simply put, cues trigger our behavior. We have a routine that follows that cue and we receive a reward after we have completed the routine. The author shared an example of a mid-afternoon routine of getting a cookie in the cafeteria. His cue was the time of day, the routine was getting the cookie and the reward was the satisfying taste of the cookie.

What I learned was that we first have to identify the real cue. The author’s cue occurred mid-afternoon but he needed to understand the real driver behind the cue. Was he really hungry? Was he bored? Did he simply need to get up and move? Duhigg decided to change his routine and substitute a cup of coffee and a conversation for the cookie. He found that he was satisfied.

Upon understanding the first three steps of the concept (more to learn as I read on), I became acutely aware of my cues. For example, if I get up at 5 am on a week day, I will faithfully exercise for an hour. But if I get up later, the chances I will exercise decrease because 5 am is my cue to exercise. If I sleep in later, I believe my mind tells me I have missed the opportunity for “me time” and that I must get to work. Weekends are worse but not because I sleep in later. If I go directly to my elliptical machine I exercise for an hour. But if my husband and I decide to go to breakfast at the local Bob Evans, my workout routine is shot.

Duhigg fills the pages with interesting stories of real life celebrities like Tony Dungy and Michael Phelps and not so famous people such as a man whose contributions to science came at the expense of his retirement years. I highly recommend this book to anyone who really wants to understand how to change their routines to exercise more or eat better.

Speak loudly, step boldly!

Image courtesy of Charles Duhigg

Thank you to the editorial board of Today’s Woman for the nomination for Most Admired Woman 2014. I am honored to be considered among such a talented group of leaders who represent a cross-section of Louisville’s empowering women.

I have a confession to make. I enjoy “messy” conversations. Over the years, I’ve discovered that some topics fail to be explored deeply enough because the participants either don’t feel safe expressing their opinions or the meeting structure and facilitation process aren’t conducive to this type of discussion.

A messy conversation involves frank (and sometimes heated) dialogue, requires participation from all attendees and at the end, those involved make significant progress as a team in moving an initiative forward or making a cultural change. The format must allow for a deep dialogue on the specific topic while being careful that the conversation does not veer off track. For example, if you are seeking agreement on a concept, you’ll want to make sure that the attendees refrain from diving deep on specific tactics. You may also have to push the participants to go deeper in discussion to ensure you are thoroughly exploring the concepts.

The messy conversation approach should be used sparingly because they are not effective for the majority of meetings. Overuse will result in the inability to productively manage meetings. For example, a typical staff meeting focused on updates, and requiring decisions where consensus can be easily achieved is not the place for messy conversations. I find myself encouraging messy conversations when the topic is ambiguous and/or sensitive and needs to be thoroughly vetted.

Messy conversations can’t take place without complete trust. Ensure that the team has a safe environment, agree that the conversation stays in the room and reinforce that commitment when someone slips. I like to touch base with individuals after a messy conversation, thanking those who have been bold enough to raise a sensitive topic and encouraging others who demonstrated progression in their thinking.

Why not give a ‘messy conversation’ a try and see if it doesn’t lead to some deeper consensus and alignment on your team.

Speak loudly, step boldly!

Over the years I have taken many different personality assessments including Meyers Briggs (INFP), DISC (influencing is off the chart) and others. My personality has been tied to colors (red – go figure) and animals (a lion – hear me roar Katy Perry!). I always find these tests to be helpful if not somewhat repetitive. Recently, I took yet another personality test. This one is called the Hogan. For the most part I didn’t learn anything new, with one exception. The following statement really hit me between the eyes: “You tend to become disappointed with people.” Ouch! Even more painful was the realization that this statement was accurate.

I have always placed a great deal of confidence in people, wanting those that have exhibited talent to succeed and expecting them to do so – every time. I often assumed these individuals would always know what to do and that they would continue to move forward with little assistance. My view applied to individuals at every level of the organization but I was even harder on those with higher level positions. I fully expected that, at a certain level in the organization, an individual would have all the talents needed to do their job well – and when he or she failed, I showed my disappointment. I do not have a poker face.

I don’t know why I didn’t see this facet of myself more clearly before. Often I’ve been asked if I’m afraid to fail and I have always responded consistently. I am never afraid to fail – my only concern is that I might disappoint my manager.

I must have to admit to being a bit hard on myself. I have worked through the years to be less “tough” on my people and have come to realize that even those with deep experience in their roles can’t be perfect all the time. The world is changing too quickly and the variables and unforeseen influences are too great for any individual to always know what actions to take.

My approach these days is to think, and act, like a coach. Coaches support their players, building on and optimizing their strengths and helping them face and improve upon their weaknesses. Like sports, the game of business is always changing. You’re never quite sure what your competition will do and you have to be ready to alter your strategy on the fly. Talent is your organization’s greatest asset and as with any asset it requires continued investment. And remember, even the greatest player needs a good coach!

What’s the best or worst piece of knowledge you have learned from taking a personality assessment?

Speak loudly, step boldly!

To say that this winter has been tough is an understatement. Subzero temperatures, flight cancellations and school closings have become the norm. We’ve had to juggle covering child care and reschedule meetings. We tried to keep up with our conference calls and email with children carrying on in the background. Our list of weekly chores has expanded to include snow shoveling and our home entry ways are cluttered with boots, scarves and mittens. Never has it been more apparent that we live at the whim of Mother Nature. On some days, I found myself checking The Weather Channel app more than my email.

Dealing with the fallout of bad weather can create angst and frustration. The work doesn’t go away, deadlines aren’t postponed and the expectations are that we’re checking our emails and texts every few minutes, never mind the toddler hanging on to your leg begging for attention.

During one of the most recent weather crises, I decided to shut down for the day and the feeling was great. I also decided to spend the day focused on me and only me. I refrained from housework, taking care of personal matters for me and my family and even avoided phone calls and texts from friends. I really hope my boss is not reading this particular blog!

I enjoyed every single moment of that day. I exercised for an extra half hour, took a long bubble bath and read part of a fiction novel. I played solitaire, watched a ‘chick flick’ in my pajamas and took the time to make a healthy meal. I went to bed early and awoke refreshed and rejuvenated the next day ready to tackle anything that came my way. I was more productive because I took some time to work on my personal well-being.

While we rarely have the opportunity to take a full day off – even when we’re on vacation. My brief respite reminded me that we have to make time for ourselves and although we are well past the time for making New Year resolutions, I have committed to taking some time every day just for me. Whether it’s reading before bedtime, sitting quietly with a cup of tea or watching a mindless television show, I’m committed to letting go of the day’s stresses and restoring a bit of myself.

Please share your secrets to self-restoration.

Speak loudly, step boldly!

Image Credit: Daniel Mihailescu