What’s Ahead for Benefits

There’s a lot happening in benefits right now, and it’s exciting to see what’s taking shape.

In January 2016, we published a blog post outlining 6 predictions for benefits:

1. The spotlight would remain on benefits.
2. Employers would expand and tailor benefits programs to resonate with the increasingly diverse workforce.
3. Benefits teams would start to view their programs through a consumer marketing lens.
4. We would see explosive growth in health care apps, tools, and other on-demand products and services.
5. Employee financial wellness would become a priority for employers.
6. We would give up on the idea of consumer-driven health care.

We also hosted a popular webinar on the topic with industry gurus Mark Stelzner and Bob Merberg. Mark is the founder and managing partner at IA HR, and Bob is the principal consultant at Jozito.

Since we last spoke, a lot has happened in the benefits world. So we checked back in with Mark and Bob to recap the past 3 years and to talk about what’s trending right now.

We discussed technology, well-being, the ever-growing complexity of benefits, as well as the challenge of employee engagement and how personalization may not be delivering remarkable results.
 

Part 1: Recapping the Predictions and Taking a Personalized Marketing Approach to Benefits

Part 2: The Messy—and Sexy—World of Health Care and the Evolving Idea of Health Care Consumerism

Part 3: Financial Wellness and Holistic Well-Being

Transcript

Jen: Welcome everyone. Thanks so much for joining us. This is going to be a fun chat about Benefit Trends for 2019. I'm Jennifer Benz. I'm the CEO and founder of Benz Communications and as a little backdrop to this conversation, in 2016, we did a blog post outlining a bunch of predictions for what was going to happen in benefits in the next couple of years and we had a lot of fun doing a webinar with our two guests today, Mark Stelzner and Bob Merberg, and so today we're really going to be following up on that chat, seeing if we were accurate with our predictions and talking a lot about what's going on in benefits right now and what the trends are going into 2019.

Before we dig into the topics, I want to welcome our two guests Mark Stelzner who's founder and managing principal at IA HR. Mark thank you so much for being part of this talk.

Mark Stelzner: Hey, thanks Jen. Pleasure to be here. I can't believe it's been two years. Time's going really fast, but thanks for having me.

Jen: I know. It's going really fast and we also have Bob Merberg who is the principal consultant at Jozito.

Bob Merberg: Hi Jen, great to be here. It's good to be back with you and Mark.

Jen: Great. Well, thank you so much and Mark and Bob both have incredible views on what's happening in benefits and it's going to be a lot of fun to get their opinions and expertise in all of these topics. Mark, can you tell our listeners just a little bit about what you do and your view on the benefits world right now?

Mark Stelzner: Yeah, absolutely. Our firm, we founded about 13 years ago. We do three things for typically very large US-based multinationals. One is we build the business case to substantiate all facets of HR transformation. Secondly, we then rationalize the provider ecosystem to find those best fit providers who can accelerate to those strategic imperatives, and then third we help with a lot of change management and advisory help to help bring those solutions to life. In the purview of benefits, benefits accounts for roughly a third of our book of business and our median client just to provide context that we're supporting is about 65,000 to 70,000 thousand employees today.

Jen: Great, thanks Mark.

Mark Stelzner: Sure.

Jen: Bob can you share the same thing with our audience and you were in a different role the last time we had this conversation.

Bob Merberg: Yeah, that's right Jen. At the time I was the employee wellness manager for Paychecks where I served there for about 10 years and I've got more than 20 years in employee wellness, and I've since gone and started my own consulting company. It's called Jozito and I work with employers using fact-based strategies to achieve employee well-being and optimal performance. I've done a lot of work integrating things with benefits, been around benefits a lot but my comments on benefits as you'll see probably as we go along tend to be largely from employee well-being perspectives.

Jen: Great, thanks Bob and well-being a such a big part of the benefits conversation right now. I am excited to have your point of view on that, especially as we get into some of the trends and so forth. Let's dive right in. In 2016, the first prediction that we had was that there was just going to be a lot more focus on benefits and at that point, there was a big surge of interest from the venture capital community in benefits, just a ton going on of introducing new niche benefits, trying to meet the needs of different generations in the workforce, and this is absolutely still a big topic and particularly right now with unemployment at record lows, it seems that benefits are becoming a bigger and bigger part of the conversation around the employee value proposition and why people come to a company and why they stay there.

I actually really appreciated that Employee Benefit News just recently said that this is the golden era of employee benefits, that is the most exciting time to be in employee benefits right now. Do you agree with that Mark? What are you seeing?

Mark Stelzner: I waited 25 years for that to happen, so I'm thrilled that we finally arrived Jen.

Jen: I agree.

Mark Stelzner: Yeah. I think it's a very optimistic assessment of things. I do think there is a tremendous amount of energy, innovation, investment in the benefits domain right now. I also think with that comes a tremendous amount of confusion, a lot of challenges with rationalization and prioritization, and obviously the advent of new technologies in terms of how do you choose the right channel in the right medium to deliver the right value to the right individual at the right moment. What I'm excited about is that there is so much energy, focus, and possibility in the benefits world right now, but I think there's some challenges that come with all of the actors that are laser focused on trying to modify, deploy, and prioritize all four things that one can achieve in the benefits domain right now.

Jen: Yup, and that is a very long list of possible things you could be focusing on in benefits.

Mark Stelzner: Exactly.

Jen: Yeah. Bob, what do you think about this? What have you seen in your practice just around the focus and attention that benefits are getting right now?

Bob Merberg: Well, I think my perspective might be in line with Mark's in many respects and that I think it's optimistic to say that it's the golden age of benefits. I think that in theory it is. In practice, I see not that much significant change. I see some incremental change I guess. I think there certainly are some important things happening. Student loan repayment assistance I think was a big benefit that wasn't really well heard of when we first did our webinar and I think it's a big thing and a great development, and it's an example I think of how that low unemployment rate is driving so much intense competition for talent and benefits like student loan repayment assistance is really employee centric.

It's something employees really want––it's something beneficial. I think it's good to see employers giving employees what the employees want and need, and not necessarily just what the employer thinks the employee should have, and that probably is driven by it emerging as a golden age of benefits.

Jen: Absolutely. That actually leads perfectly into the second prediction which I really want to dig into quite a bit, which is that one size fits one, that we really in 2016 saw that we're moving into a focus on how to meet the very, very diverse needs of this huge employee population that we're trying to support. We've seen this approach from well-being and wellness that for a long time was really solely connected to the healthcare, really span and broadened talking about financial wellness like you just mentioned Bob. There's a big focus on a total well-being and holistic well-being and a lot of niche programs being created to fit the needs of employees and different life stages, different demographics, different financial situations.

That's I think something that has definitely continued from when we first started seeing that in 2016. I'm curious, Bob, what are you seeing right now for how companies are creating niche programs and implementing them. What else beyond the student loan conversation are you seeing?

Bob Merberg: Well, I think a lot of the niche programs that I see are not that much dramatically different from what they have been in the past and that a lot of them really are oriented towards health, condition management, diabetes, metabolic syndrome, hypertension. Maybe some of the programs that there's been a spike in related to pregnancy and fertility have been are a little bit more focused on demographic, but with a lot of the employers that I'm working with, mostly small and medium, I would say this quite honestly that I hear a lot about niche programs and personalization from thought leadership at conferences and publications and on social media, but from what I'm seeing, that's not really what they're buying.

I see them buying fairly conventional things certainly in the wellness space. There's the hype of what's out there. There's the reality of what most employers are buying, and then there's this issue of what do employees want and do employees even want what employers of are buying. That's why I like the student loan repayment assistance because I think it fits all of those criteria, but I haven't always seen that the hype and the reality are aligned.

Jen: I think that's a very good point and also there's a huge difference in what employers are doing by the size of those organizations and by industry. Mark what are you seeing with some of the very large jumbo organizations that you're working with?

Mark Stelzner: Yeah. I think what's funny about it is that I think there's still a desire, competitively, because of the issues with talent attraction and retention that have always been pervasive but certainly with low unemployment becoming more acute, to try to have a litany of offerings that could appeal to any individual or any individuals dependent. I think that the challenge that we're seeing therefore, we're seeing great assemblies, we're seeing assemblies of assemblies, right? We're seeing a lot of acquisition activity. We're seeing preferred provider relationships among those that perhaps may own disproportionately the front door to access such as the administrative co-sourcing and outsourcing firms.

We're seeing portals are back. It's the mid 90s, right? It's the heyday of portals again, but the challenge and all that is program utilization and in two fronts, one is are we getting the right programs to the right individuals at the point of need or anticipated need and two, therefore how do we measure program throughput and consumption in a way that's applicable not across the entire population for that that segmentation of the population that truly needs those programs. It's funny we were working with a large organization recently and they characterized the behavior of their employees as choosers. Meaning, we have employees who are new hires or of qualifying life events or particular acute needs as choosers, they're coming here to choose something.

We have perusers. They just want to look around and see what's available to them, whether they're going to use it or not, and then we have users. We have people at acute point of need that actually need to use these information centers as a way to actually consume to the best of their ability. This desire of one size fits one is still providing a bespoke experience is then that further with tension that does the employer really in the strongest position to understand what is appropriate for Bob and Jen or is the employer simply going to create a space where Bob and Jen can self-attest what is important to them.

Then the last thing I'll add on this is that I think all enterprises, particularly even the large ones have underestimated the infrastructure that they need to drive utilization because there's so much that we hear and read about cool apps and interventions and BOTS and AI and machine learning and all the great wonderful things that can happen, but if an organization doesn't enable access channels and throughput channels to the individual employees, particularly their hourly associates let's say that or benefits-eligible, that consumption will drop materially. All of these factors are both headwinds and tailwind, but there's just a tremendous amount of choice how does one deconstruct, analyze, and promote or receive employee input to bring that one-size-fits one life.

Jen: Yup, absolutely and from what we see with our clients and organizations that I'm out there talking to is a tremendous desire to provide a wide variety of benefits that really are going to meet the needs of different employees at different stages and ages and so forth, but then a real hesitation to put the communication infrastructure in place that's actually going to drive utilization.

We talk a lot and we have a formula for how to do that, but it takes a big investment from leadership to say yeah, we are going to really communicate our benefits year-round to employees and their family members and make them top-of-mind, make sure that folks know what's out there when they need it, and that's a big culture shift for a lot of organizations that are still coming out of this notion of well we talk about benefits around annual enrollment and when someone's a new hire, but it's not a huge topic of discussion throughout the year to actually deliver on this one size fits one. You have to be talking about benefits all the time and using technology to get the right program to the right person, and that's a big lift.

Mark Stelzner: Jen, can I ask? I mean, and you too Bob. Do you find that that has more to do with optics, with budget, with resourcing prioritization? What's the headwind and I'm sure there's a number of them at every organization situation, but Jen what are you finding is the barrier to activating in that way?

Jen: I think the two biggest barriers that we see to really shifting to a truly year-round high-touch engagement strategy around benefits are budget and resources. It takes money to do that and it's an interesting thing that even though organizations are too with spending millions and millions of dollars on benefits, they're still reluctant to spend the money on the technology and the communications that will happen year-round. Then resources, I don't know a single benefits team that isn't delivering more with fewer people than they were five years ago, and so that's just a hard thing because no matter how many great external providers you have or external consultants or resources, someone still has to coordinate all of that and the benefits teams are really stretched then.

Bob Merberg: Yeah, I would share that perception. I find that the benefits teams are overloaded. My experience is that almost everyone in the work world is overloaded these days which is part of the issue. The recipient of the message doesn't really have time to receive it and the person that's sending it doesn't really have the time to craft it. I do think that honestly, I don't know how else to put this, but it provides job security for the three of us and I mean realistically it hasn't been that long since I've been working in a benefits department. For whatever reason, it's often easier to secure the services of consultants than it is to get new positions or headcounts isn't usually call them.

I think it's important for folks if they can do that to do it because you're really I think better off contracting for the services of a consultant a good one and getting things right than just letting it drop. I mean that's just a waste of everything to like you said Jen I mean to put great products out there and great services and benefits and then not communicate them year-round and service them and so forth.

Jen: Yep. Well, I'm glad three of us have good job security. That's been well-established. I want to think that we have an interesting view on the one size fits one. I'm located in San Francisco and we have a lot of Silicon Valley clients, both high-tech companies and then people who compete with high-tech companies in the Bay Area and it really is pretty mind-boggling the number of new benefits that many of them have been introducing in the last several years.

Every year the messaging is not about what's changing, but really what's new, and so we have one client who is actually I believe has about 40 different vendors just for their US population, and so that's just a tremendous number of programs to navigate through and to make relevant to the employee population, but there is a bit of a Keeping Up With The Joneses where if one company offers it then, everyone else feels like they need to as well in that very, very hot talent market. I know if you two are seeing that in any other sectors outside of high tech or some of these crazy talent markets like the Bay Area.

Bob Merberg: Well, I definitely see it perhaps not to that extent, but I see it with clients and again I've seen it in my own background that there's emphasis often on quantity. I think what you're describing might be a little bit more than quantity. It's also diversity, but what I see is an emphasis on quantity, which I think is naturally part of the culture of many organizations and when I'm working with clients now, what I often find my advice to them, a part of my advice to them is to do less and to do it better, which really goes back to what we were just saying about if you're stretched, each time you add something, the load increases exponentially.

I've always found that what is difficult to manage for a benefits team is usually going to be difficult to understand for the employees, so focus more on quality and less on quantity.

Jen: Absolutely, great point.

Mark Stelzner: Yeah, I agree. No, I would agree and I think we're seeing that geography is relative, so even if you're a Midwestern or a Southeastern, a Northeaster, an employer in a different vertical than that, you probably have technology––let's say, in your footprint. Every organization does, so you may still can be competing with that same Bay Area talent, Jen, regardless of where you operate, and so the expectation is almost by rule and then we get more bespoke to say what's the expectation to the individual, meaning where did I come from.

We're seeing a lot more activity around competitive benchmarking which is to say truly for the organizations that this particular employer believes is either in their pure group or whom they aspire to compete against, perhaps by business unit, etc, how do they carve up and narrowly cast their particular offerings to compete among those market segments and in a couple instances, some fairly clever approaches to say that perhaps our best approach in terms of a budgetary approach is to define what is truly a defined contribution and put a bucket of money together to say listen, I'm not in the strongest position to tell Bob what Bob may be interested in, I could create a shopping list of experiences that Bob may be interested in.

I could do the same for Jen and for Mark, but why don't we let them opt-in to those programs and let the data suggest how we may want to continue to manage that framework and manage those third-party providers on a go-forward basis. In some respects, put the controls into the hands of these employees but try to minimize the operationalization of some of these newer programs to wait and see where we can actually drive results. There's a tremendous amount of energy mindfulness right now. We're seeing a lot of really, really cool examples and interest, but in a 50,000 person organization––just pragmatically speaking based on availability or interest––if we see 500 or a 1,000 of those benefit eligible participants, deploy a mindfulness program or utilized mindfulness program. Is that a good metric?

I think right now people don't know what good is in terms of what we're trying to achieve for those 500,000 people, that's amazing. For the 49,000 people that didn't embrace it, it doesn't mean it's not an interesting benefit. It just may not be something they're interested in right now, so that open-ended wider programs to allow one to opt-in is definitely something we're seeing more of as well and I feel like across those geographies.

Jen: Absolutely, and that really leads us to the third prediction that we had in 2016 which was that benefits would meet product marketing and that benefits teams and leaders as well as providers would start to take a much more thoughtful intentional approach to the way benefits are marketed like consumer products are, and what's important to think about product marketing is it's not just about how you promote a product, it's how you design a product from the very beginning with that consumer in mind, so that it's something that they want and need and feel like is really relevant in their life.

One of the things that we were really excited about in 2016 was that this was a topic that was really coming to the forefront in benefits conversations, a lot more organizations wanting to do focus groups, user testing, using even in some cases the innovation techniques that they use in their own business for their benefit programs to figure out how they fit those niche needs and really drive engagement. I think this is an interesting topic and we see so many aspects of product marketing in the benefits conversation now particularly around behavioral economics and engagement strategies.

I'm curious, do you think that that is just a lot of buzz and a lot of thought leadership talk as Bob mentioned earlier or is this really taking hold and starting to become part of the way benefits teams really work and benefits providers really support employers? Bob, do you want to start with that one?

Bob Merberg: Sure. Well, I love what you said Jen about developing the product and taking the marketing approach to from the beginning stages of developing the product because I think that sometimes we do see employees putting the cart before the horse. I definitely see more interest and an active involvement with user input, surveys, focus groups, experience testing, all that and that is really good. I think employee participation in decisions that affect them is always a good thing and actually all the research on organizational behavior and well-being I'll say it's fundamental, but I especially think about this a lot when it comes to healthcare coverage. We look at marketing but the question for me is “have we developed a good product?”

I've always been concerned about the complexity of healthcare benefits and I'm of the opinion that really hardly anyone understands their healthcare coverage outside of the benefits realm and there's data to support that very few people really do. As I talk to young people entering the workforce and I actually have a son and daughter in that situation about their benefits and I'm just reminded of how like wildly complicated and counterintuitive the whole thing is. I do think that benefits directors need to bring a sense of urgency to plan design simplification, and maybe this will come out of some of that you user input.

I had the opportunity of trying to explain to my son who works for a cool visionary company household name and I had to explain that he can have a high deductible, fortunately have an HSA that seeded with money to offset that deductible and then keep the HSA money, choose another plan that has an FSA, but they have to use that money and they can't have an HSA and FSA and his eyes get glazed over it and it's just all so counterintuitive, and even for people that have been in the work world for a while. When employees do those focus groups, I'd say ask people about the difference between a copay and coinsurance or to explain their out-of-pocket max and how the individual max relates to the family max see and why it's important, and no one knows.

I think like the marketing and communication is important especially because we have what I consider just a terrible, terrible product, but it's not going to solve the problem the best marketing communications for healthcare coverage the way it's designed. I would say it’s like putting a lipstick on a pig and again I really would love to see benefits directors and them urging their consultants to bring urgency to improving the product.

Jen: Absolutely. Mark what would you add to that?

Mark Stelzner: Yeah, I agree with everything that you all have stated. I think it's interesting and we've had some really interesting conversations with the collision, if you will, between the marketing organizations and the benefits organizations on this very topic and one of our large clients, marketing unfiltered advice is selling the outcome, not the program. Benefits does an amazing job selling programs, discrete programs, right? We've launched this, we've launched that, and so their point is listen, we're never selling a product for a product say, we're selling to a market that has an acute need and the good news is that every employee and every dependent an organization has an acute need for healthcare, whether they're aware of it or not or they have an acute need for any facet of well-being.

Let's focus on those outcomes and part of it is how do we create awareness that these programs even exist, and Jen this goes back to your earlier point around how do we ensure that this is a year-round consumable asset across the enterprise like any product would be. Then, Bob to your point about language, I was just laughing as you were going to your description because the marketing's other feedback is this needs to be based on natural language. If you think about unpacking how consumers behave, you have to speak at the level that consumers behave and when you add all the wonderful benefits speak that we speak in every single day, you add all the ERISA compliance that comes with it so 14 pages of size five fonts disclaimers that come with each of these programs.

Then these are all certainly compliance issues, but there are also barriers to consumability and if we can meet people truly where they are in terms of language and readiness, the technology thankfully has improved in a way that we can use natural speech, real natural speech or natural language of its typed in as a way to try to guide somebody to an outcome that is actually consumable. And that's the third piece: do we have a product that's easily consumable? There's so much energy as you evolve seeing around the digital experience, right? That's our buzzword in the last two months and of course that comes out of marketing, so then you start to do journey mapping and you start to really unpack all the different components that are either barriers or accelerants to consumability.

We're working with a large organization recently that was talking about wage and our compliance concerns, means that they won't deploy the mobile app to their hourly workforces because we don't know if we have to pay them or not. Okay, so you just took the greatest features around push through text through a native app and you said it's an absolute non-starter to potentially 75% of our population; we just can't get it to them. We have others that say well video would be great, video consumption's up. Well, guess what, we don't have enough throughput bandwidth in our remote locations to actually push video.

We know so far the programs are designed to choose all these wonderful features and technologies and capabilities to check all the boxes on the digital experience map, but at the same time just basic things, like we literally do not have enabling devices and access rights to these populations. It's not totally considered until the very end, so that's part of, again, meeting the employee exactly where they are through the medium that they're frankly permitted to access regardless of their choices or preferences. It's really, really messy and I'd like to see more. And then, that the last piece I'll leave you with, is there's chargebacks.

We have found that when organizations are even trying to embrace their centers of expertise around digital experience and try to take on what product marketing or their online teams are deploying if they're an ecommerce provider, those organizations are charging back their benefit schemes for that expertise and that thought leadership. I go back to your point, Jen, which is then we've got limited resources and budgets and then it gets deferred for another year

Jen: Yep.

Mark Stelzner: It's not a lack of interest, it's not a lack of potential capability, it's not even a lack of knowledge in some cases. It's just too much for many organizations to take on at what time which goes back, Bob, to your point which is less is more where there's a couple things you can do well.

Jen: Yeah, yeah, and I think that's the challenge is it's really exciting that we're starting to understand that we can't just throw benefit programs out there and expect people to use them and we need to be more sophisticated in the way they are designed and marketed, but there's a reason that the biggest consumer companies that do this stuff really well have huge product marketing teams and huge product design teams and so forth, and the benefits teams are not going to be able to get all of that expertise in-house. It's a challenged between that desire and reality of being able to execute for organizations of all sizes, and that is a really good set up to one of our other predictions which was that healthcare will continue to be sexy and very, very, very messy.

That's what we've said in 2016, and we've certainly touched on this a lot with the complexity, the number of solutions and so forth. What we were seeing in 2016 was that all of the sudden, the venture capital community had woken up to the notion that employers were this huge market for new technology, particularly new healthcare technology and there was just this explosion of companies trying to market to employers particularly large employers, and that trend has just continued. The funding of health-tech companies was at an all-time high in 2016 and it's gotten even higher.

There's just so much activity in the space and while it's very exciting and there's some really awesome products that are being developed that serve real needs, employers are bombarded by potential solutions that are out there and trying to figure out how to integrate all of them. I'm curious maybe Mark you can start with this one. What have you seen with just this explosion of healthcare technology and how our employer is able to navigate all that and choose what's right for their population.

Mark Stelzner: I think it's really exciting and I think I've seen some new players, new innovations, some fresh point of views, and great ideation in this space is always warranted, but my struggle with it is just as you said the consumability of all of this in a way that can be substantiated, that can still prove ROI, whether soft or hard ROI, and can really be something that can be brought to the forefront without the need for new integrations. If we think about the from a Darwinian standpoint, whomever owns the front door to the employee experience is really in the catbird seat now because there is less and less interest, in my opinion, from what we're seeing and having carve out programs.

Meaning, very specialized programs that require a tremendous amount of technical or functional integration that steals from the opportunity cost of the benefits organization. The notable exceptions to that would obviously be anything associated with acute programs where we've got a specific medical need, where there's always energy frankly to look at a better mousetrap to bring the right solutions preventatively or reactively to those populations have pointed me, but outside of that, it really comes down to how easy is it for a given employer to assemble and deploy those programs within the existing solutions that they offer today.

Mark Stelzner: Some of that requires dependency on HCM solutions, others to portal technologies, others to benefits administration co-sourcing and outsourcing providers, and then obviously then most organizations now are global. Then you factor in mobility and that's the messy part, that's the sexiest part in my opinion about this is really looking at opportunities to look at employee mobility as a way to hyper-localized healthcare provisioning and healthcare servicing to where they are for that moment, literally physically at that moment in time, whether it be a 6-week assignment or an 18-year overseas position, but what can be provisioned locally, what can be provisioned remotely and don't underestimate integration as something that's an immovable object because everything else that's going on in the HR technology landscape is frankly a barrier to some of these new techs being able to be brought forward in a measurable and an immediate way.

Bob I'd love to hear from your point of view as well.

Bob Merberg: Well, I'll address it from the wellness perspective and that industry and that marketplace and certainly wellness managers and benefits directors responsible for wellness are bombarded by products and by vendors.

Jen I think you mentioned to me, I wonder if it might have been in the last webinar when I was working as a wellness manager and you said Bob, you must feel calls from vendors all day long and the answer was yes except that eventually I just stopped answering those or replying to those emails because that wasn't my job to spend all day doing that, but what I found was important and what I think is important for all employers when it comes to wellness is to have a plan and a vision and a strategy for the next year, the next few years and even if you are stretched and realistically can't put that strategy, can't manage like an operating plan to have one, even if it's just outlined, but let's just say that, and so that you're making decisions about services and products and vendors strategically and generally going out and seeking the services that solve the problems that you have as opposed to just being sold things.

Then the other piece of that that I think is really missing in the wellness industry and it shouldn't be is doing what you can to stay aware of research and evidence. I'm a big proponent of evidence-based approaches to wellness and actually to all aspects of management when possible, and one thing I've read and that I really come to believe is that if you're participating in a fad or a trend, you're probably not paying close enough attention to evidence. And evidence doesn't mean to ignore what people want. I mean there are different realms of evidence that includes taking into consideration what people want and what the cultural context allows and supports, but I do think we need to be wary about fads and trends and to stay aware of basically to understand our problem, I'd say, and use data including employee input and your financial data to make those decisions strategically, and not just be sold.

Jen: Yeah, that's a great point and I would add to that that I think a lot of organizations do not have a very clear strategy around their benefits with very specific goals and a knowledge of how their efforts tied to business results. In a situation where you're getting calls from dozens and dozens of vendors a day who have the shiny new object, it's easy to get distracted by something that looks really cool, but may not be aligned with your strategy or how you really create business results, and I think the evidence is a great point because it's not to say that every solution that's deployed and benefits needs to have some clear marker to reducing healthcare costs or financial stability, but you need to be intentional about what does and does not.

I think particularly when it comes to meeting the needs of such a diverse population, there are going to be some solutions that just feel good to employees or are cool, but they might not have a clear health outcome and that's okay, you just need to be specific about that. And then others that really do have a clear tie to a health outcome or financial outcome, you better really be putting the plan in to drive to that, otherwise you're not going to get the results that you're expecting. It's an interesting thing to navigate really how to make decisions when there's so much new stuff out there.

Mark Stelzner: Which I think requires capacity and, Bob, a lack of capacity to your point is no excuse, right? As you said Jen, you have to be intentional, but I am finding that our wonderful benefits clients that all of the support are overwhelmed.

Jen: Absolutely.

Mark Stelzner: And finding time to get out of the whack-a-mole hole of inbounds, whether it's participant or executive or provider or consultative, it doesn't matter who's hitting them over the head at this particular moment, but literally finding the quiet space to potentially go off-site, get eyes up, get eyes forward, and find a place and a time to strategically plan in a very intentional way using those data-driven outcomes that you're both advocating for, it's waning, in my opinion, because the firefighting is dominating capacity right now, and that may start with leadership––I mean all facets of leadership need to decide that being that second-largest spend to payroll just to spend alone should warrant a more strategic and thoughtful consideration.

I'm not finding that it's a lack of desire on behalf of these benefits leaders to do this good work and to bring those good graces forward. I'm finding that they're struggling just to find a safe space to do it.

Jen: I would agree, and one other thing I want to add on this topic­­—and Bob and I have talked about this­­––and I'm sure you see this to Mark is the sophistication of some of the new players in the space in terms of understanding how employers really work and the complexity of integration and what it takes to drive engagement with employees. That sophistication is sometimes not there with the new players and benefits, and they might have a product that is absolutely amazing when it gets into the hands of the right employees, but they don't have a good understanding of the complexity of integration or the complexity driving engagement.

Jen: I can't tell you how many conversations I've had with new players in the space when I ask them how they're going to drive engagement with employees. Their response is well we're just going to email all employees and they'll all sign up. It's like oh if only it worked that way.

Mark Stelzner: Yeah.

Jen: Go ahead.

Mark Stelzner: I would agree and yeah, I presented recently on how to build a business case for HR transformation because that's what we do, right? How do you get the c-suite and the board's to free up CAPEX, OPEX and opportunity cost to pursue these types of initiatives that we're discussing. It was funny and one recently a couple months ago, I had five different providers in the audience and I couldn't keep their hands down because they didn't understand that if you can provide fractional time savings for an employee or fractional value to an employee, you literally can't add up those hours times their average pay and say that's the ROI, like a CFO is going to run you out the door, right?

They're taking furious notes––like, well, wait a minute that's our whole pitch of how we do it is we're going to save 30 minutes per person times the average salary, isn't that $30 million. It's like now, but that's not how this stuff works and your budget not everybody has any mode dress. Oh really, why not? You're right, the maturity and then you're having to spend all this time trying to unwind what is it potentially a great solution because their level of situational awareness or enterprise readiness, they'll never make it past the introductory call Bob that you've never returned their call to your point because it could be interesting, but intellectually you don't want to have to train them on how to bring it to life on your client organization, so anyhow.

Jen: Mm-hmm.

Bob Merberg: Yeah, absolutely. I frequently get contacted by vendors often entrepreneurs, sometimes individuals and sometimes small companies that are trying to run their product by me or seeking some assistance and really consistently I feel like they're out of touch with what's going on in the work world and some of it is like to their credit maybe because they have so much passion about what they're doing. Often like so for example such-and-such vendor says oh, we're going to do this, we're going to email everyone and tell them to watch this 15-minute video and it's like no, no one's watching 15-minute videos at work. And to your point––again, yes, you're right not everyone has email, not everyone speaks English.

There's really obviously diverse population of employees out there, but I think one of the big things is that vendors––maybe again because of their passion and their zeal––they think that when their product is going to be introduced, that it's going to be the number one source of attention for everyone who sees it. And, in reality, you're lucky to get a sidelong glance from an employee because everyone's busy. To your point Mark, it's actually funny who gave it an example that brought up a disturbing memory for me of when a colleague and I were visiting with a CFO in our organization to help this person log on to the Wellness portal that we had introduced and it was a very convoluted log-on process and very error-prone, I'm sorry to say.

Jen: I know.

Bob Merberg: I'm not proud of this, but it was like one of these things where you needed your employee number and people didn't know their employee number, so they have to go look up their employee number and a really, really complicated process. When he got through, he calculated exactly how much it would cost based on average salary for certain percentage of our employees to go through that process and he was not pleased. I mean it was an important lesson for us, but yeah I mean organizations see that type of thing and CFOs certainly see that type of thing, and we should see it as well.

Jen: Absolutely. And that connects to one of our other predictions and especially as we're talking about how we make things easy, how we can actually get things into the hands of employees, and we spoke earlier about just the complexity of healthcare and the complexity of benefits and how the average employee is just completely at a loss for how all this fits together. One of the other predictions in 2016 was that we will slowly give up on the idea of the consumer of healthcare and consumerism in healthcare has been something that has been a headline almost my whole career that in the first HSA plans were introduced around 2004, 2005.

We've had this big shift to high deductible health plans and this belief that oh well if we just make the consumer more empowered, somehow they're going to help transform the healthcare system. In 2016, we were starting to see that that was shifting, that idea was shifting and being replaced with more high-touch concierge models, and I think that has continued to grow over the last few years. High deductible plans are certainly still out there. HSAs are still growing and their tie as a retirement vehicle.

We're seeing a big focus on in many of our clients, but this idea that we're just going to empower the individual and they're going to figure out how to navigate the healthcare system and they're going to improve the healthcare system along the way seems to have lost its luster and folks are really focusing on these very high touch programs that are helping take some of that decision-making out of the individuals hands and help them be more successful. I'm curious maybe Bob if you can start, how does that fit into what you see with some of the challenges that in healthcare and are you seeing some of your clients move to a bit more of a high-touch model and help people in new ways make good decisions and navigate through the system?

Bob Merberg: That's a good question Jen, but I think that if it's alright I'll defer to Mark or to Mark and you, not really something that I've encountered a lot, but I know it's out there.

Jen: Great.

Bob Merberg: Mark do you have any thoughts about that?

Mark Stelzner: Yeah, I mean I think absolutely these high-touch programs are gaining traction and it goes back to our earlier prediction about this notion of the market of one. It's really interesting to me, I'll go back to the example of you talking to your son Bob. I think there are so many new choices, we can focus on things like narrow networks, right? Narrow networks are getting promoted materially, particularly in the private exchange constructs as a new way to provide disruption to the legacy programs and health plans. We've got universities creating their own health plans if they're in high population centers.

It's just adding more and more and more choice, and therefore the idea that there's a proxy, whether it's an advocate or a concierge service, it's been around for a while and perhaps originally it was reserved for executive populations or high-value participants. I'm finding that now the promotability of that is to bring it to the masses. If we don't trust that you the individual Mark Stelzner are going to figure this out on your own, we tried to walk you to this, we've tried to use everything in our toolkit to educate you along the way, then the next thing we can do is get you to someone that can maybe explain this to you or guide this to you in a very, very different way, and that those high-touch programs and the concierge programs or advocacy programs are the only way to draw the connective tissue between what you're eligible to do and what we think is perhaps the right fit.

Then again using natural language programs to demystify this in a way that actually promotes recommendation engines to you. This is what we know about you we think, can you validate it, this is what you've continued to tell us about you, this is your behavior, is this behavior indicative or was it a one-time occurrence, and then from that, what can we derive to try to give you some form of guidance to drive an outcome because we don't trust that you the individual can get there yourselves. We're going to use every possibly can to get you there and Jen I'm not sure if you're seeing that as well, but that's just a couple thoughts.

Jen: Yeah, absolutely and I think this is one of the more exciting things that's still going on is really putting programs in place that are going to create a more high touch experience and reduce some of the potential bad choices that people make when it comes particularly to healthcare. We know what folks need when it comes to healthcare and there's a lot of bad choices that can be made in terms of going to lower quality providers, getting unnecessary services, not engaging with the healthcare system at all.

I think this is great and we've certainly seen it as something across our client base, both the sexy talent focused high-tech employers, and then also the universities and public employers and so forth that have a big ask to get people engaged and be using the healthcare system more effectively. And I think it really gets to the last prediction I want to talk about which is the focus on financial wellness, but with healthcare as well, I think there's an appreciation that it's hard to make good decisions and the folks that are creating that experience for the employee do not always have that employees best interest in mind when it comes to saving costs or reducing unnecessary treatment.

Often the providers, the hospital systems, and so forth, their incentive is to over treat someone because that's how they're getting paid and that is a big shift that's happening right now in terms of really changing that dynamic. I think it ties very much to the financial wellness conversation which is an appreciation that most people are super, super stressed by their finances and there's a lot of bad actors in financial services that are taking advantage of that stress. Employers can provide programs that are helping people get to better outcomes in a way that really has their interests at heart and certainly in 2016, financial wellness and financial well-being was a huge topic of discussion and I think that has just continued.

What I see is an even broadening of the understanding of what financial well-being includes. We've touched on student loans, certainly retirement benefits. We've even seen a focus on education benefits and then family support benefits such as backup childcare that are all adding to that financial security picture that an employee has to just reduce that day-to-day stress. Bob, you touched on this earlier in the call, what else do you want to share about financial wellness and what you're seeing as its focus and where there can be some good value?

Bob Merberg: Yeah. Well, certainly some of the things you mentioned Jen. I really often felt that the best strategies for financial wellness are things like student loan repayment assistance, good healthcare coverage, income protection like disability insurance, and I love backup day care and in many cases, I'd say even secure scheduling like in the case of retail workers who often need to know their schedule because not only do they need to arrange for childcare, but sometimes they need to work a second job and secure scheduling is something that's been in the news last couple of years. I think that that's an important development that relates to financial wellness.

As for the tools that are being sold, I've seen some very slick ones, but I think financial wellness is here to stay. It's important to the employee and for the employer not just in terms of productivity and reducing stress, but also it doesn't really do an employer any good to have its employees or to be featured on the news because a large percentage of its employees are on public assistance. We've all seen that happen and so in addition to it being bad for the employee obviously the priority, it's also a PR and a talent acquisition nightmare. I think we've seen some really good products out there.

I'm sorry to say that there are some in the financial wellness field, some actors that I would consider bad, personally, but we're still in the early stages of this and I do know some product and development that's going to incorporate more gamification and social support that I think could be a really important part of what's available out there for financial wellness, so more to come.

Jen: Mark what would you add to that?

Mark Stelzner: Not a thing. I think you all did a great job. Thank you.

Jen: Okay, fantastic. Well, that gets through all the predictions we talked about a few years ago. What did we miss? What has surprised you about the benefits conversation in the last few years, and what are you excited about going into 2019? Mark do you want to start with that?

Mark Stelzner: Yeah. I think anything that goes to data derived personalization I'm finding has way right now, so there was a lot of energy to look at underlying claims data for employers to try to walk that fine line to the extent that they could between using claims data as a predictor of ongoing behavior. I'm finding in some cases a wholesale rejection, on two fronts.

One, for privacy concerns that employers are getting much more concerned about what they can and cannot gain access to, and even with a statistically significant sample size, that the perception in a competitive labor market is that does this somehow impact my employment with the organization and the amount of energy that an employer has to even put into trying to convey that no, we can't see it and we can't use it and it's here for your own good and it's only runs by another vendor, they're questioning whether or not there's intrinsic value and employers having anything to do with that data at all, which then requires a different form of predictive and behavioral modeling which is attestation based.

I'm not sure if you all are seeing this, but many of the employers that were really either early adopters or felt like claims-based data would be a the bellwether for things to come in terms of hyper personalization, they've pulled back materially.

Jen: Interesting.

Mark Stelzner: That's the only thing that I'd same that that I feel like is anti-trend against what we were maybe thinking a couple years ago.

Jen: Yeah, that's interesting and what I would add to that is I think that the cultural expectation around does the employer have access to this, does it feel too intrusive and so forth, that is a big challenge, but also just getting people to engage with the platform that might have that data and serve it up in a way that is really useful is a challenge. If you have this really sophisticated recommendations engine that's digesting all this data behind the scenes but employees only look at it once or twice a year or only 20% of your employees look at it once or twice a year, how is that actually moving the needle and can you get to higher levels of engagement with things that are less intrusive and just simply feel better to your workforce.

I think that's an interesting balance right now with the push and pull of the technology possibilities.

Mark Stelzner: Mm-hmm.

Jen: Bob any comments on that or anything else you've seen that either surprised you or otherwise in the last couple years?

Bob Merberg: Sure. I have a few things come to mind that I don't know some surprised me and some are things that I think are coming up. I mean I think that a big thing is an aging population that will affect employers and benefits folks by 2024. One in four employees in the United States are going to be 55 or older and I know there was a SHRM Survey done after our last webinar in 2016 that show it's really not on the radar of most employers and some are starting to talk about it, but there's not much action on it yet. It's sort of interesting because there's been so much attention on millennials, but I suspect that the aging population is going to have a more tangible impact on employers.

Something that I've been very pleased about this past year and the well-being space is increased emphasis on mental health.

Jen: Absolutely.

Bob Merberg: Yeah, so that's really good. I mean I don't think that we have all the solutions figured out, but I think that that's actually good not to jump to solution but to study it and understand it first and build solutions that are effective. I think there are some good things out there but that's really, really important. For employers that are interested in physical health and healthcare costs, I don't know why I believe this, but I do think that musculoskeletal disorders are going to become more prominent in the well-being space. I think that there's more potential there to make a near-term difference in outcomes for health and business outcomes.

Jen: And the musculoskeletal also has shown to have some nice technology solutions that can help, like with virtual physical therapy and some of those solutions that get that provider and care more readily in the hands of folks who need it.

Bob Merberg: Yeah, yeah, definitely, so that'll be something to watch. In terms of benefits, I don't hear a lot of talk about paid sabbaticals. I'd love to hear more talk about it. Certainly there are some companies that do it and actually getting back to mental health, one thing I'd say––listen, I could go on forever––I'll make this last thing. I don't know, I always felt like employers need to be more demanding of their EAPs and involve them and motivate them to be more proactive about mental health. I find a lot of the EAPs ... Well, I feel like they've gotten a free ride because they act mostly as a glorified referral service, and really they can be so much more.

If you're an employer I'd ask, is your EAP reaching out to new moms and dads or people going to other life events to employees out on disability? I'm working with the client now where we're looking at adding to the EAPs contract and performance guarantees tied to mental health outcomes to help spark the EAP to be more proactive. Actually I think that a lot of employers can push all their vendors a little bit harder quite honestly and that can help address their capacity problem. Sometimes I sit down with employers and their consultants and their vendors, and it's hard to tell who's the customer. Yeah, so employers need to need to take the driver's seat there and make all their vendors work for them.

Jen: Absolutely. The one thing that I would add that we did not have as much on our radar in 2016, and maybe we should have in hindsight, and it's something I've been very pleased to see, which is our big focus on family benefits and how the benefits can better support an employee taking care of their family, and sometimes in a very large definition of family. Kids of course, but also aging parents and we've seen a lot of new programs come in that are supporting people, whether it's with fertility and pregnancy and having young children as well as thinking about as kids grow up and need to go off to college and college coaching, education benefits and so forth, care for aging parents and even how to navigate the idea of aging parents, is something where I think there's some neat new programs being created.

Then of course leave and actually having decent amounts of leave that people can take for both the happy and the sad life events. I think it's been really nice to see that big focus and I think it ties to the aging population certainly the need to take care of your parents as they age, but then also a bit more of an understanding that we're all going to be working for a really, really long time, and that six months out to take care of a family issue should not be a make-or-break for your career when that career is going to be very, very long. And that's something I've been I've been very happy to see.

Mark Stelzner: To both your points, I'm seeing CEOs take some direct accountability for some of these issues to when there were some high-profile suicides earlier this year. We had one CEO of a very large fortune 100 firm put out a call on mental wellness and mental well-being and basically promote from his office the fact that we are here for you, set up a private line that he would personally commit to respond to if there are questions or concerns, and thousands of employees responded.

I agree with everything around stronger vendor management, stronger pressure and bringing some of these things forward from your third-party providers, but you can't outsource the accountability for your people and I think the strength of these programs and really getting outside the four walls of HR and moving into the c-suite and the board to say not only is this a permitted conversation, this is a critical conversation and we believe this is such a critical conversation, whether it be the family programs, Jen, that you're advocating for and that we're seeing increased throughput on words or it's mental or financial or physical well-being or any combination they're in, there's something about that message coming from the top of the house that fundamentally is game changing around perceptions of the safety of exploring these topics and conversations across these enterprises. That's what I'd like to see more going into 2019.

Jen: Yeah, I absolutely agree, and I think that we need to be thinking about well-being and especially the conversation around holistic well-being as much broader than just what the benefits team or the wellness team is responsible for. Mental health is a great example.

It doesn't matter how good your benefit programs are if people have horrible managers and horrible work expectations and are in a toxic culture. And those things are much, much bigger than what the benefits team has typically been responsible , but I think benefits leaders can be a great advocate for the employee and elevate those topics up to the c-suite and particularly when there's such a demand for employees and we're looking at how our organization's going to compete in the next five, 10, 20 years, being able to be that employee advocate and have a much, much bigger role around really making the workplace work for employees not just the benefit programs work is an exciting area of exploration.

Mark Stelzner: Yeah, and much like our consumer conversation earlier, it is taken from the playbook of influencer marketing, putting the Payless Shoe example aside, but basically saying if we have senior executive influencers where they're leaning right into these topics or they're exposing some of the challenges that they're facing even at their level where some employees may perceive that to be beyond their capability. No one's immune from these, no one else––regardless of their pay, regardless of their seniority and the vulnerability that that senior executives can show, and therefore the influence that they can garner and making these conversations bringing them to the forefront, bringing them into the active hold of the organization is where frankly it's going to help market any marketing effort that one could contemplate.

I'm excited to see organizations garner more courage and I'd like to see more total rewards leaders really pushing those executives to bring those stories forward, and protecting the privacy but have been in a safe way that shows that it's safe to say.

Jen: Absolutely.

Mark Stelzner: Great.

Jen: Bob any thoughts on that?

Bob Merberg: Yeah, Jen I'd love to piggyback on what you were saying because it's really a favorite topic to me. What’s very close to my heart is the workplace itself, how the organization is structured, management practices and the design of jobs. It's interesting with HR in the US… I get the feeling that there's not a whole lot of understanding of what we know about good job design and there's a lot of work when you look at mental health strategies in other countries including like that the EU and Australia and Canada. When they look at mental health and well-being overall, the focus is on the work and things like workload, the demands, the amount of social support, the amount of autonomy is a common thread.

Bob Merberg: There's great research on that and I really believe that that's the heart and soul of how an employer can support well-being. Behaviors and behavioral change are important, but I think it's good for employers to look inward and I think that it's hard for benefits folks to relate to this because it's pretty far outside their comfort zone. Again, job security fairness which an organizational behavior is called organizational justice, work-life balance, flexibility, employee participation, those are all the things that lead to employee well-being and to better business outcomes and to employee engagement which we didn't really even talk about. To me, well-being and engagement or are parts of the same thing.

Jen: Absolutely. That's great and I think a great point to end on just this is so important and the reason that I love this work so much is because employers have such a huge role to play in helping people be successful in their lives, and it absolutely is an exciting time with lots of evolving conversation about how to do that best. Mark and Bob, thank you so much for sharing all your expertise and great ideas with us today. This has been a fun conversation and clearly we can keep talking for another couple hours, but we will wrap up and leave it at that. Thank you so much thank you.

Bob Merberg: Thank you.

Mark Stelzner: Thank you both. Really enjoyed it, bye-bye.

Jen: Bye.