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Beyond a Two-Week Window: 10 Ways to Make Annual Enrollment a Success in an Era of Health Care Reform


Benefits Communication Master Class Series #5

This session in our Master Class series is dedicated to the premier event on every benefit pro’s calendar: annual enrollment. While enrollment season is key to benefits success, so are the many months before and after. Gain proven strategies for year-round communication and engagement that will make an easy-breezy enrollment, including how to:

  • Use the external attention on benefits—such as health care reform and court rulings on same-sex marriage—to your communication advantage.
  • Frame tough messages around corporate change and cost shifting.
  • Build momentum for year-round communication.

This webinar was previously recorded. View the full transcript below.


Beyond a Two-Week Window: 10 Ways to Make Annual Enrollment a Success in an Era of Health Care Reform

Webinar Transcript:

Hello everyone. Thanks so much for joining us today. This is: Beyond a Two-Week Window: 10 Ways to Make Annual Enrollment a Success in an Era of Health Care Reform.

I'm Jennifer Benz, and I'm thrilled that you've joined us today. We've had a great response to these classes and I'm super excited about all the interest in making benefits communications more successful. If you've missed any of the courses or want to go back and review them, you can download all of the slides and watch all of them on our website any time.

We'll be continuing the conversation online through our blog, through LinkedIn and so forth so please continue to give us your feedback and thoughts and let us know how we can help you be successful with your efforts.

At the end of today's presentation, we'll have lots of time for Q&A. I'm hoping that some of you will share your tips and tricks for annual enrollment and things that have been successful as well. This presentation will be available to download after we are done.

Let's dive right in.

I'll start with the big picture of benefits. We know that benefits matter more than ever before. 20–30% of compensation spending goes into health care, retirement, insurance coverage, wellness programs, and all of the other things that make up benefits. These programs are in the midst of unprecedented change. So much change being driven by regulation, by the economy, by the changing demographics of the workforce, and so forth.

They're a critical part of the employee experience. Especially when you think about the way that benefits impact families as well as employees. This is an essential part of the employee experience.

These programs are complicated and important, and people feel unequipped to make health and financial decisions.

These are the quotes that we have pulled off of Twitter through the years:

"Open enrollment completed, I am never entirely confident of my choices."

"Now gotta go figure out my open enrollment choices, Einstein would give up on this one."

"Most days I feel comfortably intelligent. The day I have to read through open enrollment health care literature is not one of those days."

These speak to the confusion and frustration that people feel during open enrollment and just the overwhelming number of decisions they feel they have to make. There are dozens and dozens of quotes. We've pulled them off of Twitter the last couple of years and they're on our blog. It gives you a great insight into what the average employee is feeling and experiencing during this time of year.

This is a quote from EBRI that we've used in almost every one of our webinars: "There is strong evidence that employees simply lack the ability to successfully navigate the complex and technical nature of health care."

I say this now because it’s easy to look at the conversation on Twitter or the general frustration that the average employee has, and say, "Well, that’s because they're not trying enough" or "That’s because they don't care enough," that's just simply not true.

We have to remember that people are overwhelmed. They don't shy away from this because they don't care; it’s because the systems are flawed. In many ways, the systems are stacked against individuals. They're getting more and more complex all the time. We have to help people make sense of this complicated world of health care and financial services.

Unfortunately, health care reform just adds more and more to the confusion. You've seen these stats: 45% of people view Affordable Care Act (ACA) unfavorably. 50% have heard something or a lot about the individual mandate. The other half of people isn’t sure. 30% haven't heard about the health insurance marketplaces.

So much confusion, so much complexity out there about what health care reform means and what it is doing to your benefits as well as our health care system, overall. Unfortunately, the media is absolutely working against us. Headlines come from every point of view. They tend to confuse and oversimplify the differences between the group market and the individual markets. Then there’s the rising partisan commentary on anything that has to do with health care and health care reform. The Hobby Lobby decision last week was a great example of that.

Employees don't know what they're supposed to worry about, what they're supposed to be concerned about, and how things impact them. They need you.

Remember that employees need you and want you to help them make good health and financial decisions. Employers are one of the only trusted and reliable sources of good health care and financial information. That reason alone is why we love this work and we're so excited about the potential for benefits communications to make a big impact.

But we have to keep in mind that role—that ever important role as an employer—in helping people navigate the system, make good choices, and feel confident that they're taking care of their future needs.

Annual enrollment is absolutely the time for you to shine in all of that. We're going to talk through 10 ways to make annual enrollment a success this year amidst this crazy environment of change, of confusion, health care reform, and everything else that's impacting your employees and distracting from the messages.

We're going to talk about, starting with strategy, thinking like a marketer, telling a story, how to simplify, factoring in health care literacy, getting outside (of the firewall, that is), setting up a process to move into year-round communication, doing something unexpected, finding your target audience and then, of course, getting some help.

Let's jump in.

The first recommendation is to start with strategy. If you attended our other master classes or you've seen our approach, you know that this is critical to being effective with benefits communication. You have to make sure your communication efforts are aligned with your overall benefits strategy. Very few companies have a written benefits strategy or a written communications strategy. These don't have to be complicated, but connecting the dots between what you're trying to accomplish with your programs overall and how you your communications can get you there is key.

Focus on the specific and measurable behaviors that you're asking employees to do. Whether that's reviewing information, attending a webinar, going to a website, or if it’s changing their plan, reviewing their changes, using the decision support tools. Then set those clear goals for both the plan participation and communication engagement. Make sure you know how your communications efforts are going to push people toward action. That's key to being successful during annual enrollment.

The second thing is to think like a marketer. This is so important especially with the way the media is focusing on health care, the way the media is focusing on employee benefits in a way that they never really paid attention before.

You're competing with all of the confusion and misinformation out there. But you're also competing with everyone thing else in your employees' lives. Are your materials going to be more appealing to them than Facebook? Or BuzzFeed? Or looking at their phones for text messages? There's such an overwhelming amount of information out there and you have to really stand out from the pack.

The key to thinking like a marketer is to brand your material. Use your company brand; the look and feel, that brand identity, to make a strong impact and grab people's attention.

Have a point of view. Often we think that we need to present benefit information in a neutral way, but that's not effective and people want to know what's best for them. They want to know what you think they should do. What you think matters. Have a point of view, just like a marketer. That should come across strongly in your communication materials.

Promote the value of what you're offering and talk about unique features of your programs. Remember, you're now being compared to what's available on the open market. Health care is becoming a commodity more and more. How are they going to know what the company provides and what it's really worth? Particularly, if you have complex wellness programs that require a lot of steps to get an incentive or to get the full access to choice in your health plans, you need to justify why you're asking people to go through those hoops because they can now go out on the open market place and buy their insurance on their own with no barriers whatsoever.

Remember how to focus on value. You're being compared on what’s available on the open market for the first time, really, ever. Annual enrollment is an amazing time to promote underused and missed benefits.

We have the little graphic of “often missed benefits” on the right. We have those tip sheets and list on all of our clients' websites. They're one of the places that people go most often, one of the PDFs that are downloaded most frequently because people want to know what they're missing and they don't want to miss out. Use those behavioral economics triggers to get people's attention and pull them in.

Here are a few examples of very branded HSA campaigns. Using the employer's big, bold brand identity. This is key for enrollment, key to have something that stands out from the crowd that can really grab people's attention and pull them in.

Our next step is to tell a story. This is an extension of “act like a marketer,” of course. Use a human way to get your message across. You can play to peer-to-peer influence by using champions and storytelling; you can use testimonials and go through scenarios. Very common is to use “people like me” to make choices less daunting. It’s a form of storytelling: this is the employee profile; this is the decision process they went through; these are the choices that they made. You can also engage champions and leaders to talk about benefits and their value. You really want to engage people in what you're offering and inspire them to take action, to pay more attention, to feel like there's something of value there for them.

Leaders are fantastic for doing that, as are wellness champions. We've talked to a lot of companies that have a huge network of wellness champions and they're not using them in health care decisions or at annual enrollment time. That's a missed opportunity, especially when you have someone who can tell that story one-on-one.

This storytelling is critical with what's happening with health care right now and what’s going on with health care reform. You need to make health care a narrative. What's happening in the system overall? How your changes and your programs are connected to the bigger picture. There's a very long-term story to tell here in the ways that our whole health care system is changing and realigning. When you talk about the way that the health care system is changing and that your benefits are evolving to keep up, it’s a much more cohesive story.

You can really connect to that—getting the best care and managing costs requires effort now, and it will for the rest of your life. Telling that as a story and as a narrative is a much more effective way than just pushing plan design changes through or just blaming health care reform for the fact that you have to change your plans.

We know that blaming health care reform for plan changes is very tempting. It’s very tempting to blame health care reform for cost increases. It’s not inaccurate to blame health care reform for cost increases, but what you need to remember during annual enrollment is that that's not a motivator. We want people to get engaged in their health care plans. We want to get them paying attention to what you offer with your benefits and making good decisions. Just blaming health care reform and putting a negative framing on things isn't going to motivate people to be engaged or pay attention or feel like they have control over anything that they can create. Instead, speak to the continued value of what you're offering for that individual and their family.

Avoid that kind of company-centric speak that so often gets embedded into health care changes and talk about what's in it for an individual. This leads right into our next step, which is to simplify.

We talked about how overwhelming health care is in general and that’s never truer than during annual enrollment, where you're talking about changes, you're talking about costs, you're talking about decisions. Of course, employees wait until the last minute. They don't want to deal with this information. They're going to procrastinate. But if you make things simple for them, make it easy for them to find answers, really do the math on cost increases and plan design changes, it’s going to be easier for them to take those steps.

You also want to be transparent when there are tough messages, and we know that there are tough messages to communicate this year as there has been for the last several years. You can target messaging whenever you can. If a change impacts a specific population, target to that population. If something is an opportunity for a specific population, really reach out to them and target them to make that more prominent in the communication. I'll talk more about this in just a second.

Of course, avoid jargon. Make sure you're really speaking to people in a way that they want to be spoken to.

Part of simplifying is to really simply and clearly address the top questions:

  • What do I need to do?
  • What will it cost me?
  • When is this happening?
  • What's new this year?

Putting that loud and clear at the topline seems like such common sense but it’s so often embedded way deep in annual enrollment communication. Make sure that the top questions are clear and simple and easy. We actually just finished up an annual enrollment for one our spring enrollment clients and one our clients got an email from one of the VPs of the company (with a cc to their boss) saying, "Thank you for the incredibly simple and easy-to-follow communications this year. It took me 5 minutes to work through the mailer you sent home and understand what was impacting me and I felt really good about the decisions that I made."

If you can get that kind of feedback from employees by simplifying, that’s the goal. That's the Holy Grail. Putting these top questions front and center is a way to do that.

When it gets to things that are more complicated—explaining health care reform, explaining some changes—use short lists. This follows the way we see so much online; so much of shareable content is just these short lists with numbered items that are easy to grasp.

This is a piece we created for UC's student health plan about the Affordable Care Act last year. "5 things you need to know about the Affordable Care Act and UC SHIP." One page, visual, easy headlines to scan, a very simple way to communicate a lot of very complex information. Use this approach for so much:

  • 5 things to know about your HSA
  • 3 things to know during annual enrollment
  • 6 things to keep in mind about your benefits

Those types of list attract people, they simplify, and they're fun. They make communication more fun and inviting. 

Also, find opportunities to personalize content. This goes to the idea of targeting and segmenting. This is an example of a widget that's on one of our client's sites: "What are you interested in and do you have any big life events coming up? Let us show you what’s relevant for you."

People really want to know how things impact them, what it means to them, and how their personal situation connects to what's going on. Finding ways to share things in a way that's more personalized and more targeted is a perfect way to simplify.

In the simplification, you also need to keep in mind health care literacy or, really, the lack thereof. Most people don't understand the bare bones basics of health care and how health insurance works and how our health care system works. Enrollment is a fantastic time to educate them about how the plans work on a fundamental level, about what’s changing in our health care system overall, and how they can get better outcomes. It surprises me so many times when we do focus groups—it doesn't matter whether we're talking to call center employees or manufacturing employees or English is a second language employees or Ph.D. engineers who create the most sophisticated technology out there—people have the same misunderstandings about health care. They don't understand the basic terms and definitions.

I've been in a focus group of Ph.D.s that couldn't tell you the difference between copays and coinsurance. Breaking things down, really making things simple, and keeping in mind that “we are experts in this and your employees are not” is really key. 

This topic really inspired us to create what you're getting a little bit of a preview of right here, which is an infographic that we're going to have out in the next couple of weeks about all the key health care terms. This graphic will be something available to you to use in your enrollment communications, use in all of your other communications. We're breaking down the eight or so key terms that confuse people and overwhelm them about health plans and how to navigate through health plans. Just a simple: "What’s a deductible? What's a copay? What’s coinsurance? What are my premiums? What is an out-of-pocket max?" Those bare basics get in the way of people making good decisions all the time.

Another component of health literacy is really how to be engaged in the health care system. How you can take action to improve the quality of care and create better health outcomes. The Choosing Wisely campaign is a huge benefit for you all to have that conversation with employees. We worked with the National Business Coalition on Health (NBCH), the Pacific Business Group on Health (PBGH), and Consumer Reports to create the Choosing Wisely employer toolkit. You can download it for free on NBCH's website. It is a rich resource for having this conversation about how to get engaged in the health care system. How to have conversations with doctors, how to ask about what you really need. This is truly a skill that needs to be taught and employers are the perfect ones to teach people how to do this. If you haven't already, please go check out the Choosing Wisely campaign. Download the toolkit and find some ways to start that conversation during annual enrollment and, then, throughout the year.

Our next tip is to get outside. In this instance we're talking about getting outside of the firewall. If you've attended our early master classes and follow our blog, you know that our number one recommendation for companies of all sizes is to invest in a company benefits website that is outside of the firewall. This is a key part of the employee experience in making the benefits ecosystem simpler.

We all know that there are dozens and dozens of plans and program carriers and administrators that make up your benefits offerings. You need one destination, a one-stop shop for all that benefits information that then links out to all of the carriers and providers. This is an amazing branding opportunity, so when we talk about really marketing your program, this is the way to do it. It provides simple, 24/7 access for employees and their family members.

The new sites that we're building are done with responsive web design so it’s a beautiful experience—whether you're looking at it on a mobile phone, on a tablet, or on a desktop. It’s an incredibly valuable resource for recruiting and new hires.

Just before this webinar I was on the phone with a company that doesn't have a site like this—a huge organization, tens of thousands of employees—and the first thing they said was, "Isn't that a really legally risky thing to do?" Let me just say again: there are no legal risks for having your benefits information outside of your firewall. This is the marketing information, the education information that is key to getting people engaged. Keep all of the personal information on the administrator's website, safely guarded behind passwords, but make your education and marketing information easy to access.

Enrollment is an amazing time to launch a site like this and be able to generate momentum to get people to use it year-round. What we often have clients do is they'll launch a microsite during annual enrollment to get the key information out there and start to establish the behavior with employees of going to that new resource for benefits information.

This is the home page of a microsite we launched for NVIDIA last year. Then that site evolved into a comprehensive benefits website over time and become that one-stop-shop, that cohesive, all-inclusive, everything-in-one-place resource. It’s an amazing investment and amazing enhancement to the employee experience, and absolutely our number one recommendation for companies of all sizes.

The website is also a great way to help you move into that year-round communications mode. If you're not yet communicating throughout the year, use annual enrollment as an opportunity to start to create the new channels that will support ongoing communication. That could be your website, it could be email, postcards, videos, tip sheets, text messaging. There's so many ways to have that ongoing dialogue with employees and their families.

The key is to not have a benefits communications calendar that looks like this. This is very typical: everything about benefits and communication stacked into the three-week window around annual enrollment. No wonder people are confused and overwhelmed. It’s too much to digest. What is better is to pepper people with information throughout the year. Give them bite-size bits of information and make sure they have a resource to access anytime they want to know more. This is key to getting people engaged in their health care and wellness programs, but it’s also just very simply the way that adults learn. None us learn new things by cramming it in at the last minute. We learn in little bits of information, being able to engage with lots of different types of media, lots of different forms of communication.

We need to get people to pay attention during annual enrollment and we need to get them to make good decisions. But more important, especially with the current benefit plan designs, is to get them engaged year-round. Take open enrollment as an opportunity to launch a new channel or to do something that will enable that year-round communication.

With that we also encourage you to use annual enrollment as a way to do something unexpected. This is key. If you've been doing the same routine for annual enrollment every year for the last however-many years, mix it up. Find something that's going to surprise employees or that's going to feel new or unique.

That could be online polls or something that's interactive. It could be a donation to charity as an incentive for people doing things together. Maybe it’s a challenge or scavenger hunt or something that's unique and a fun part of your company culture. Anything unexpected. Mix things up a bit. Don't just take last year's communication calendar and plop it into this year.

There are so many different channels you can use. You can use the traditional channels like the guides and newsletters and postcards, employee meetings, and so forth. There's a breath of online and interactive channels, whether it’s your intranet, hopefully your benefits website, email, social media, videos, webinars, decision support tools. So much you can do online and interactively that can be high-touch, engaging, fun, and interesting. We've been having a lot of fun with webinars recently, doing very short, focused, high-energy webinars on specific topics, and giving folks the chance to sign up for as many as they want.

There are so many ways to mix things up. If you're not using any sort of social media yet, you can throw that into the mix. It’s a great low-cost tool for communicating throughout the year.

Then there's so much that you can do that's unexpected: You can do infographics—I'll show you a couple those next. You can do electronic cards, where you have employees send cards to each other or to their family members, reminding them about key features of the benefits. Text messaging, of course, is a way to get people quick reminders. Podcasts. Large-format installations—you can take your corporate headquarters and plaster it with huge posters or put floor decals as people walk into the building. Then there are tons of ways to use peer champions in ways that are unexpected.

Really—anything that you can dream up, you can do for your annual enrollment communication. I really encourage you to do something unexpected and fun.

Here are a couple of examples of fun infographics. People love these and they're shared so much online. If you've never done an infographic, a visual treatment like this—whether it’s of a new plan, or what's changing, or key dates—it is going to be great.

Videos are fantastic and another thing that people absolutely love. We've been doing just dozens and dozens of animated videos. You can get that message into 1½ or 2 minutes. Give people something that's interesting and fun to look at. You're going to get better engagement. This, again, speaks to the way that adults learn. Some people are going to want to read it, some people are going to hear it in person, some people are going to watch a video, and some are going to do all of the above. Give them something that's going to really help them learn and help them feel engaged.

The next step is to find your target. We have a whole webinar just on this topic of targeting and segmenting benefits communication. Annual enrollment is a great time to do this. One size probably doesn’t fit all when it comes to your communication. Especially with complex health care decisions and complex changes. Look for opportunities to use targeting to make the communications more relevant and more focused.

There are lots of ways to target communications to specific audiences. Whether that's splitting content up online, or sending different versions of postcards. There are so many different things. If this topic interests you, definitely see our last master class, which goes into this in a ton of detail.

We'll talk a bit about the key opportunities to use targeting during annual enrollment. One of these is making plan changes simple. What is the impact of these changes? Who can benefit the most from the new programs? How are you going to understand really what it means to them and their situation?

Maximizing the high-deductible plan with the health savings account (HSA) is another great way to use targeting during annual enrollment. If you're launching a plan, are your employees more likely to be spending their account every year or saving it? How do you target the messages and target the focus of that education accordingly? Are people missing catch-up contributions? What do you know about 401(k) participation and the number of people that are maxing out their 401(k)?How can that go into targeting HSA education?

There are so many opportunities around consumer-driven plans to use more focused and specific targets. Another one of our master classes is all about making consumer-driven plans a success and ways to dig in to those opportunities.

Let me show you a couple of examples of targeting. This is a postcard series that went out to introduce a new health plan change during an enrollment. Everyone got a different version of a postcard, based on the current plan they were in, with a side-by-side comparison of the new plan that was most similar and how to factor things in. A great focused way to distill what would have been pages and pages of information into a simple postcard.

This is an example of another mailer that went out. This is a six-panel piece, one page with different versions for each person based on their current health plan enrollment—that side-by-side comparison: this is what you have now, this is what you're going to have going forward. That's what encourages employees to really take the minute to focus and understand what's available to them. If you can say, "This is what it means to you" rather than, "Here's everything that's changing and you need to sort it out," you're going to have a better employee experience. You're going to get much better feedback on annual enrollment.

Finally, our last tip for making annual enrollment a success is to get some help. You do not need to go at annual enrollment on your own. Use our resources, lean on your vendors and consultants, get internal support from your HR groups, from your managers, from your leaders. Make sure you are using all the resources at your disposal to make this a good experience for your employees and also for your team.

Really, make your communications strategy work for you. Look at your strategy, not only from how you're going to create the best employee experience but also how you're going to make something that's manageable for your own team.

A great example of this is how you stagger or cascade information. A lot of company communications plans or initial drafts of communications plans have little bits of information going out, a little bit of information about a change with the details to follow. The minute you talk about the change, inevitably, a portion of employees is going to want to know everything that's happening at once. Save yourself all of those questions and that reactive nature and make sure that when you do that initial announcement, you have those questions answered. That you have all that information at your fingertips so you don't end up having to answer one-on-one questions about something you had planned on communicating to everyone a couple weeks down the road.

With managers and leaders, you probably don't want your managers answering specific benefits questions, ever, but you do want them to know the context of what's changing and where to send employees for resources and for answers to their questions. Make sure you give them a heads’ up and they can help direct employees into the right area and make sure there's a cohesive message about the communications.

We have tons of resources to help you with all of this on our website: our white paper, our blog has lots and lots of details on health care reform messaging in particular, and we have a series on health care reform that will be starting in the next week or so, our other master classes, all of the resources around how to use social media for benefits communication. Please take advantage of what's out there and make sure that you're leaning on all the available resources to make annual enrollment easier for your team as well as a great experience for your employees.

We're just about ready for Q&A. It looks like there are a handful of questions that have come in. Ask any questions in the questions module, and if anyone has any of their own annual enrollment tips to share, I'd love to share them with the audience.

Finally, just to wrap up, the 10 ways that we went through to make annual enrollment a success are:

  1. Start with a strategy—make sure you know what you're doing and why you're doing it.
  2. Think like a marketer in terms of how you brand materials, how you promote value, how you tell a story.
  3. Make sure you are telling a story about health care reform that’s holistic and talking about the bigger picture—about what's changing in our health care system, not just about what's changing in your benefits.
  4. Simplify materials—make it easy for employees to get good information about what they need to do and where they need to go.
  5. Remember that health care literacy is a barrier to people making good decisions and you can use annual enrollment as a way to get people engaged in understanding health care overall.
  6. Get outside of the firewall.
  7. Find opportunities to move into year-round communication.
  8. Do something unexpected, something that is going to catch employees by surprise and give them a little smile on their face when they see it.
  9. Find ways to target.
  10. Use all the resources that are at your disposal.

To wrap up, I just want to say again, and we say this all the time: effective communication pays for itself. It will help you reach your strategy goals. It will improve satisfaction with benefits, even in times of change. Especially with as much as is changing, you can use effective communication to build loyalty to your company and engagement with your employees. I hope that these tips will give you some ways to invest in that employee experience in making things really successful. 

Let me take a look at some of the Q&A.

Q. Good ideas but I run into the problem with benefits managers in the team that has the attitude of "We've never done it that way and I don't want to change."
A. I think as far as the attitude of "We've always done it this way," I always ask the question, "Well, has it worked? Is that effective?" It’s not. Very few companies have truly high satisfaction with benefits and high engagement with benefits. Very few companies have been able to do everything that they want to do with their benefits programs. Simply, the way things are working so far is often not very well.

If you're in an environment where you're trying to change that attitude, focus on what the goals are, what you're trying to achieve, and if you've been able to in the past. If you haven't, then you need to change things up.
If things have been successful enough so far or you've been skirting by doing things the old way, then look at the opportunities: The opportunities for more engagement; the opportunities for savings when people are moving into high-deductible plans or being better engaged in wellness programs; the opportunities to focus on the value of the benefits and other programs. Position things in terms of how simple it would be to get to a much better outcome.

The traditional ways of doing benefits communication are very labor intensive and very one-time. You really see this when you move from an environment that's heavily focused on print to online. Print materials just take a tremendous amount of effort to create, especially print reference materials like benefits guides. Changing that investment into something that's accessible year-round, an ongoing resource, can be a very simple kind of return-on-investment (ROI) equation. Hopefully those will help you tee up some ways to have that conversation around changing the ways things have been done before.

Q. I really like the Choosing Wisely piece, like “5 questions to ask your doctor.” Is it or will it be available on an app?
A. That is a great question. The Choosing Wisely campaign is an incredibly robust resource from Consumer Reports, and they have an unbelievable resource out there with tons and tons of information. It is not yet its own app, but you can take that information if you have a benefits website, or you have any sort of mobile site for your employees, and put that information on it yourself.

I also just learned yesterday (and just saw yesterday) that iTriage has the Choosing Wisely recommendations built into their app, into their blog now. So Choosing Wisely is starting to appear all over the place—in different apps and so forth. Some of the transparency tools have the recommendations built directly in. There are definitely ways to get that at employees’ fingertips.

Q. Any good suggestions for locating good benefits graphics to use in communications?
A. Unfortunately, there's not a big library out there of graphics and those kinds of things at your fingertips. That's a bit of what we're trying to do with the tip sheet that I mentioned about all the health care terms. That will be something that you can just grab the graphics and grab the content and use it for your pieces. I think, for the most part, you have to either look for internal graphic design resources or to your vendors or an external firm to really create sophisticated, branded graphics. There aren't that many shortcuts in creating good communication, but there are a few things out there that are at your fingertips. The Choosing Wisely toolkit also has a set of PowerPoint slides and some graphics that you can use and pull into materials.

Q. Are “people like me” stories effective if the company wants to promote just one plan? In other words, every story ends by picking the same plan?
A. Yes, they are effective. The way I would tee that up—if you're really trying to tee that up and drive people into a high-deductible plan and all the “people like me stories” end up with the high-deductible plan being the best choice—is to be very transparent about that up front. I would say, "For every scenario, the high-deductible plan is going to save you money. Here are five examples on how that works out." Do the math for people.

But if it's not true that in every scenario the high-deductible plan is the best answer, then be honest about that. Be up front about that and say, "Okay, in a very unique situation, if you have a family, and only one person needs care, maybe the high-deductible plan isn't going to be the best pick." Be honest with the “people like me.” Do the math for folks and they can absolutely be a great way to get people to a high-deductible plan.

I also would encourage you, if you have priced your plans so that’s its just completely obvious—the cost on the high-deductible plans are just so much cheaper in every scenario—then it might be time to just rip the Band Aid off and go for replacement. A lot of companies are chugging along with hanging on to an old PPO plan just for the sake for having it there but they're pricing that so it’s outrageous for employees to stay enrolled. Employees are going to hang on to that plan because it’s familiar. We've been in focus groups where people have said, "I know that the high-deductible plan will save me money, but I'm not going to change because I know the PPO will only be around for a little while longer." Be honest with your plan design on what that means.

Q. We're thinking about offering an incentive to enrollment by allowing the employees to dress casual from the day they enroll during the two-week enrollment period. What other incentives do people offer for enrollment?
A. That is a really unique one that I've never heard of. Letting people dress casual from the moment they enroll during that two-week period—that is a very cool, interesting way to play on an incentive within your culture.

Other incentives to offer for enrolling: iPad giveaways; any sort of gift card giveaways for people who enroll early, you can say something like, "If you enroll in the first five days of enrollment, you'll be entered into a drawing for x, y, and z."

I really like the idea of offering incentives that are charitable contributions.—something like, "For every 100 employees that enroll within the first week, we're going give x dollars to a charity that's very important to us, that's aligned with the company.” There are lots of clever things to do with that. You can, of course, always do contests between locations and get a kind of peer, competitive nature going with that. You know: the first location that has everyone enrolled gets some sort of prize or a big party or anything like that. I would just encourage you to make sure that any incentives are aligned with your culture and really what you want people focused on.

Q. We did focus groups this year and realized that our employees prefer in-person communication during open enrollment (OE). Any recommendations on what should be a priority during the in-person time and what should be left to online resources?
A. That is fantastic. If you ask most people, they would prefer in-person communication. What I would recommend with that is that you look at the time. Both that you can feasibly get employees away from their jobs but also that they're going to be able to stay focused on something that's complicated. An hour-long PowerPoint presentation with 100 slides is never going to be an effective way to get people to make good decisions or to understand things. If you can, condense it to a shorter amount of time and then ask for Q&A. I would focus that time on the areas where there are the biggest opportunities or the biggest misunderstandings.

Consumer-driven plans are a great thing to talk about in person. People have lots of questions. I would save things like the mechanics of all the insurance programs or all the voluntary programs—let that be online or let that be a single slide to say, "These are all of the other benefits we offer, and here's where to go for information on those."

Really use that in-person time as a way to focus on what's critical and what's changing. I would also encourage you to maybe supplement it with some webinars. If you're going to do something in person that's an overview, or the five top questions about your benefits and you're going to focus on that in person, then repeat that on the webinar that can be posted online, and people can listen to if they miss the in-person session. Then, also dig into more detail in more focused webinars. Maybe you take a webinar and you go into more detail on the health savings account (HSA) versus the Flexible Spending Account (FSA), or more detail on how you can use the HSA for long term, or more detail on other aspects of the plan. Using that mix can be really helpful.

Q. Do I have a recommendation on whether to have a passive enrollment or active enrollment?
A. If you're making a plan change or introducing a plan for the first time, always make an active enrollment. That is going to drive more participation. It’s going to encourage people to act, and it’s going to encourage people to make a decision. If you want to be really bold, when you introduce a new plan—especially if you're introducing a high-deductible plan—have an active enrollment and default everybody who doesn't actively enroll into the new plan.

Send the message to say, "This is the best plan and you need to opt out of it rather than opt in." It also makes it very clear that people need to make a decision and make a choice. You're going to get a portion of folks who move into the plan just because they let inertia take over. I would always encourage an active enrollment.

Even if you don't have an active enrollment where you're changing the default or you're sweeping people into a new plan, you can position your communication like they have to enroll rather than encouraging them to just let their elections carry over into the next year.

Q. What are the next, best emerging benefits communication approaches that employers are using to engage employees?
A. I think once you have the baseline of having a website that's available outside of your firewall—that's available on mobile devices, that's a good-quality user experience, and you have the baseline channels where you're educating people throughout the year, and you're getting people information when they need it throughout the year, (that might be through email, postcards that go to people's homes, text messages, videos, and so forth—once you have that established as the baseline and that foundation of communication, then the thing that we're seeing emerging as a more sophisticated approach is really all around targeting and segmentation: getting people very focused messages that help nudge them into that next step or help them take that next step to a better decision or a better use of the plans and tools. I think that's really where benefits communication is going and where we see all of our clients moving, especially ones that have had websites in place for many years and have had those ongoing channels in place for many years. Now it’s about, “How do we personalize? How do we make things more accessible, more engaging, more relevant and more meaningful?” Targeting and segmentation is always the way to do that.

Along that line, enhancing the website: making that website a consumer experience with videos and interactive content and all of the bells and whistles that you would see on a consumer site. There are tons of things you can do to make that site an enjoyable place to spend time. Lots of ways to use the simple communication technology that's all around us.

Q. When you recommend to clients that they create an external website, who handles the hosting, who designs it, how do you work with IT departments, what's the overall process?
A. There are many ways to build an external website. Your IT department or your marketing department may have the internal resources to build an external site that's outside of your firewall. Or your company may have a partnership with a web development firm that's building websites for your company all the time. Or you might want to work with an outside firm that specializes in it—like us, or one of the other many talented benefits communications firms out there—to build the site.

Most often what we see being simplest for the benefits team is to hire an outside firm to fully build and manage the site. That outside firm would coordinate with the IT department like we always do, to make sure that things follow any sort of IT standards and that they are in the loop and they don't feel like they've been excluded. We also coordinate with internal communications and corporate communications to make sure things are aligned, and that they understand the strategy and why you're having a new resource for employees and their family members. Then, that firm most typically would handle the information architecture, the design, the web development, and work with a hosting provider.

Hosting is always kind of a separate piece of having a website and there are dozens of hosting providers out there. Some companies host their own websites and that's one of the simpler parts of the equation. Really, the design and development and the content is where the most resources go in building a site like that.

I'd be happy to answer any other questions about websites and the technicalities about that offline if anyone has more questions.