Employees Speak Out: Findings from Benz/Quantum Health and Engagement Survey

Employees Speak Out: Findings from Benz/Quantum Health and Engagement Survey

Webinar Transcript:

Greg: Welcome. You have joined a webinar that explores employee engagement and the impact that a company's commitment to health and wellness has on that engagement. I'm Greg Harris. I'm the CEO of Quantum Workplace. I'm joined by Jennifer Benz, CEO of Benz Communications. We have some timely research to present today. Employee attitudes are changing. 36% of American workers say benefits were the or a major factor in joining their current employer. That's down from 8 years ago, but 49% of workers say that benefits are the major reason that they stay at their organization. That's significantly up from 8 years ago. We used to say that benefits were a talent attraction strategy not a talent retention strategy. We used to say that exit interviews rarely indicated that someone left a firm due to benefits offerings or benefits changes.

That's no longer the case. Benefits and the communication an employer does around benefits impact retention more than ever today. Before we get too deep into the data, let me tell you more about Quantum Workplace. We operate a technology platform for employee voice. We're best known for employee engagement surveys, exit surveys, and our best places to work programs that exist in 48 US cities. I'll hand it over to Jen Benz and let her introduce herself.

Jen: Thanks, Greg. Hello, everyone. Thanks so much for joining us today. I'm Jennifer Benz. I'm founder and CEO of Benz Communications. We're a boutique communication and marketing firm based in San Francisco. We focus exclusively on employee benefits and all of the fun and complicated things that comes with it when it comes to communicating and engaging workforces. We serve Fortune 500 companies, including many of the best places to work. I'm delighted to share this data with you today and to co-present with Greg. Greg's going to tell us a little bit more about Quantum and their engagement model then we'll dig into the data.

Greg: Thanks, Jen. For 13 years, Quantum Workplace has been measuring employee engagement. We have web-based tools that help companies drive that data into their organization and put it in their hands and tell a story to managers so that they can do something about it. We are also in the business of exit surveys. We just recently, in the last 4 months, launched a peer-to-peer recognition and a goal tracking tool that employees are using to set goals, track goals, and to create a spin on performance appraisal or to try to innovate the idea of Performance Management. We're going to talk today about employee engagement. Engagement sometimes means different things to different people. Before we get too far today, let's talk about what it means in the context of our conversation.

We look at engagement as the attitudes and the behaviors that commit an employee to their employer. There are 3 behaviors that we are putting a score on for every employee when we work with a company. There are behaviors around advocacy. How likely is an employee to brag about their workplace? How likely are they to go the extra mile? The employees that are high in discretionary effort are the ones that are thinking about work in the shower or on the drive into work in the morning. Then there is the age-old retention issue. How likely are your employees to stay? Those are the 3 behavioral constructs that equal engagement. To get at what's driving those 3 behaviors, we're asking hard questions about things like trust in leadership, manager effectiveness, career development, and team communication.

Those are the kinds of attitudes and perceptions that we're measuring to create this construct that we call engagement. This particular study, in addition to measuring engagement across about 5,400 organizations every year, we want to bring timely research to the marketplace. We teamed up this year with Jen of Benz Communications. We wanted to look at the connection between communication around benefits and employee engagement. To do that, we have to make sure that we have a pretty diversified sampling of employees in North America. We had 2001 employees participate in this survey. They represent a good myriad in terms of size of companies, in terms of age, and in terms of position level that they have in their organization.

We're seeing here with this visual that about 15 to 18% of the employees that participated in this event or this project were from companies with more than 10,000 employees. Around 40% were from companies with under 500 employees, so we run the gamut in terms of size. That's really critical in this kind of research because we can't have small companies who are also competing with big companies for good talent making excuses against one another. Small companies seem to think a lot of times that they can't offer the benefits that large companies can. Large companies are always jealous of small companies because they can't offer that cultural and familial social fabric that small companies do. Our research did skew females in this particular study.

Almost 70% were women over men and a diversified sampling of 2,000 employees. We'll talk now about what we learned from this study.

Jen: Great. Thanks, Greg. We have broken down this data into 4 big themes that we'll talk through. Again, all of these materials will be available to download after the webinar, as well as we have tip sheets, infographics, and so forth available online. There are lots of materials for you to be able to share these insights with your team and use them in your presentations to your leadership and so forth. The first big theme from the survey data is that people need to connect the dots between money and healthcare. Across diverse demographics and income levels, the workers that we surveyed say they have enough information to get the right healthcare, but they do not ask healthcare providers this question nearly enough: "How much will it cost?"

We know that those words could be the difference in hundreds of dollars of medical bills which can lead to a financial crisis and a huge issue in terms of financial stress and productivity for workers. From the broader HR strategy, we know that almost all companies are moving to consumer driven high deductible health plans that put more responsibility on an individual to make decisions when it comes to cost and quality of care. This transition to consumerism or consumer driven plans has been happening for well over 10 years. Almost all organizations are putting efforts into making employees better consumers of their healthcare, but there's still a big disconnect. We have a lot of work to do. When we looked at the data, among all of the respondents, 69% believe they have enough information to get the right healthcare for themselves and their families.

The right healthcare for themselves and their families, but only 48% always ask their doctor how much their care will cost. Clearly there’s a big disconnect between the confidence in getting the right care versus actually asking about the cost of care. When we look at the data as far as income, lower income folks are much, much more likely to ask about cost than higher earners. The numbers drop down significantly in terms of whether or not they're asking about cost for higher earners. Of course we can conclude that it's natural that when you have less income you're going to be conscious about cost.

This is important for employers because those higher earners are the ones that have the social capital and the influence. In theory, better relationships with their healthcare providers should be able to push forward this era of healthcare consumers that the industry has been trying to create for a very, very long time. When we look at the confidence in healthcare decisions, interestingly, parents, whether they're single or married are more likely than non-parents to feel confident in their healthcare navigation skills. We know that engaging families around healthcare benefits is a big opportunity for employers to build trust with those audiences. This is one of the great insights from this. Respondents are more likely to ask about medical costs if their employer provides resources about how to navigate the healthcare system.

This should not be a big surprise, but it really reinforces what we know. Employers are a trusted source of health and financial information and are in an incredible position to be able to educate people about their healthcare benefits. Employers can make them more confident and better consumers of those programs. In turn, this will help them appreciate the value of what the employer is investing in when it comes to benefits. With all that data and all of those insights, what can you do right now?

Here are 3 things to consider for your organizations:

Communicate health benefits year-round, not just during enrollment. We have a huge learning curve when it comes to folks being able to really confidently and accurately navigate through the healthcare system. Communicating benefits once a year during annual enrollment and piling on all that information in just a narrow window is not going to get us there. It's not going to help people change their behaviors and really make the best decisions when it comes to their health benefits.

Promote all of the resources from your health plans and other providers like transparency tools or health concierge tools. There are tremendous resources out there when it comes to patient satisfaction and safety, health cost estimators, and so forth. Employers have to really promote those to the employees and their family members and really make sure that the promotion of those and the access to those is part of that year-round communication strategy.

The Choosing Wisely Employer Toolkit. We were part of the team that helped create that toolkit. It's available on the National Business Coalition on Health's website, nbch.org. It's a free resource for employers. Choosing Wisely is a fantastic Public Health Initiative to get better quality of care and reduce unnecessary treatment in healthcare. Consumer Reports digested all of the recommendations from the medical associations and turn them into guidelines and tip sheets that the average person can understand. This is a tremendous resource. We know that just focusing on cost isn't going to change behaviors as much as having a more holistic conversation about cost and quality of healthcare. That's a great resource for employers. Lots of good stuff in the data.

I'll hand things over to Greg to talk through our next section about the way that companies and managers promote healthy living together.

Greg: Thanks, Jen. My guess is that those that are joining us on this webcast don't have to be persuaded further that the workplace culture should impact health outcomes, but that isn't a universally accepted principle from everybody. There are still people that will ask why. There are still people that will say "What should a workplace, what role does the workplace have in supporting health decisions, and actually moving the needle in health outcomes?" The highest level answer to that really is simply pointing to the social nature of humans. We are the formation of our habits, and our habits are most greatly impacted by those we spend the most time with. Here at Quantum Workplace, we work really hard, and we probably spend more time with the people that we work with than we do with anybody else and we have fun doing so.

We're social creatures and we are impacted by the habits of those around us. Our habits have a tremendous impact on those that we are working with. We asked the question, "What can your workplace do to inspire?" Or better yet, "Does your workplace inspire you? Does your workplace culture inspire you to make healthy decisions?" 60% of workers that have access to wellness programs say yes. They are inspired by their culture to make healthy choices. Those that do not have that program, of them only 15% are inspired by their workplace to make healthy choices. To put it simply, the existence of the program impacts behavior. Sometimes when we talk to leaders, we get hung up on participation rates.

We get hung up on engagement rates of a particular program. Maybe 60 or 70% of our employees are registered for a certain program. We're bummed out about that but this data is telling us that the 60 or 70% that are participating are actually getting results from that communication. Maybe that’s the side of the coin that we should focus more on. When we look at those that say, "Yes. My workplace culture inspires me to make healthy choices," there are differences in who is answering that question. Counter intuitive perhaps, but a larger share of those without a college degree say yes to that. That's 60% versus 52% that have a college degree say yes to that question.

If that tells us anything, it tells us that the workplace may be one of the most important sources of information on health to a large population of the American Workforce. 90% of the American workforce says that they are inspired by their culture to make healthy choices. Among those who are inspired by their company culture to make healthy choices, 80% are engaged. It's not coincidental that 80% of those that pull that inspiration and pull that meaning on health from their workplace are also engaged. That means they are answering favorably to those items that we talked about earlier like trust in senior leadership and management effectiveness. Of those, only 10% are not inspired by company culture.

Of the 10% that aren't, only 44% of them are engaged. There is a connection to those that are receptive to wellness initiatives and those that are engaged. Just as Jen did, let's get tactical. What can managers do? 70% of employees get frequent communication about health and wellness and 55% say their leaders model healthy behavior. That question itself gives our managers tools on what they can do about it. They can first communicate about health and wellness opportunities. Sometimes, that's not a program. It could be as simple as a conversation between a manager and employee about personal things in their lives, their health and wellness, their well-being, as well as modeling that behavior. 70% of employees get frequent communication about health and wellness and only 55% say that their leaders model healthy behavior.

What can we do specifically? First, we can add benefits and add questions about benefits satisfaction to your engagement survey. The questions should be about very specific tactics or percentages or offerings that are available and make sure that benefits offerings are tailored to the actual needs of your people. Second, is to create simple tip sheets that managers can use because managers probably want to have these conversations and want to be a resource but may not know how. Creating tip sheets and how-to’s are going to help and simply looking for easy ways to support healthy choices. That could be placards around the office or advising people to take stairs instead of elevators. Maybe it's simply being more selective about the snacks you put in the break room or the lunch that you bring in.

Less pizza, more salads perhaps? Don’t underestimate the role that team outings can have as a wellness offering. A 10K or a 2-mile run doesn't just affect the behavior of the day of that event but rather the behavior of people preparing for those kinds of events.

Jen: That's great. What we have seen over and over is that it’s the simplest changes in a workplace can make a huge impact on health and wellness and the connection to health in the workplace, whereas companies often look at these very complex programs to implement and drive participation. Sometimes, it's that simple connection to the manager and other simple things around the workplace that could make a big difference in that connection. The next section really digs into some of the themes that Greg started us out with. This tremendous connection between engagement, retention and health benefits. The next section will really talk about how much employees remain attached to company sponsored health benefits despite the wider options that are now available.

When the Affordable Care Act was signed into law in 2010, just over 5 years ago, many experts predicted that the law would break this familiar and accidental coupling of employment and health insurance. This is not materialized yet. It definitely is not something that workers want right now. What we saw in this survey is that employees report a strong attachment to employer sponsored health insurance and by extension, their employer. Among the respondents, 70% say that they value their health benefits. That is a tremendous number and something that all employers should be patting themselves on the back for. 89% say health benefits play a part in staying at their current employer.

That gets us to what Greg mentioned about the retention connection to benefits right now that ties into the workplace benefits. Of that group, 48% of them said that benefits play a major part in staying at their current employer. I think that number is significant. Almost half of employees say that benefits are a major part of why they stay at their company. There is tremendous opportunity to a build on that trust and build on that connection. Among those who say their benefits are an overriding factor in keeping them at their company, 82% gave their benefit package high marks. Contrary to that is when benefits are not a factor, folks don't believe that their benefit packages are as valuable. There is an incredible connection here between the value of benefits and retention of employees.

When it comes to health benefits, only 5% of the folks that we surveyed think that they can get a better deal on the open market. This really speaks to the belief that employees have something better through their employer than they can get anywhere else. Whether that is true or not, that's certainly something that we can build on to create loyalty and connection to the employer. Along those lines, employees are willing to leave a company over their health benefits. 90% said that they would be less satisfied if their company dropped health insurance and 73% would not work for a company that had no health plan.

Three quarters of employees say they would not go to a company that didn't have a health plan. They really want to stay attached to those employer-sponsored health benefits. What can you do now with this data? The first thing is to continue to promote the value of health insurance and the great benefits that you provide. More often than not, employers are shy about communicating the real value or they feel like when changes are happening or when costs are rising that they can't speak about the value of benefits because it will feel insincere. This is not the case. Take credit for what you're already doing for employees and they're going to be more engaged and they're going to have more trust in the organization. Then work on communications that will engage employees in their benefit programs.

We've seen this connection between effective communication and the perceived value of benefits with our client work as well as in great data from MetLife and other researchers. How engaged employees and families are using those programs and how much they feel their employer is trying to help them with those programs make a huge impact on how employees perceive how employers value of them. It's often not the companies that have the best benefits that get high marks in terms of benefits satisfaction but really the ones that educate their employees and get them engaged in the program.

The challenge for a lot of companies is to navigate through the compliance requirements and really produce communications that will engage people and show that value. Put the energy into that and it will pay off. Don’t be shy about making changes to your plan design. A lot of employers still tiptoe around employees when it comes to making any change to health care but clearly, employees are very committed to health benefits. They over value them right now and changes, especially when they're properly communicated and they're done in a way that employees understand are not going to detract from that value. Look at the opportunities to push out changes to be aggressive in doing some of the leading edge things with your healthcare benefits.

Don't worry that employees are going to panic over that. They're still going to see the value in those plans.

Greg: Jen, we've seen that play out firsthand before. It wasn't long ago, maybe a year and a half ago where we were working on engagement initiatives for two competing professional service firm that were both fairly good size, between 1,000 to 2,000 employees. One had about 45% favor scores in perception health benefits measuring with the same questions. The other had about 75% favorable attitudes towards the benefits that their company offered. 75% in our world is a very favorable result when it comes to employee perception of benefits. We thought that was astounding. These two firms were very similar and were competing for the same talent. They had talent bouncing back and forth between the two companies.

We learned that the benefits offerings and the percentages that the employers were paying was almost identical. We came to realize that that 30% difference between the two was the difference between how, when, and how frequent the organization were communicating about benefits. People don't know what they have until they have resources inside the company that are helping them figure out how to make those decisions. We have real world evidence of the priority that you are describing in your Action Number 2 there.

Greg: Let's talk a little bit about the relationship between the frequency of communication and the overall feeling of trust within an organization. We know as researchers and scientists in the area of workplace culture that trust is the foundation that cultures are built on. We found a very intriguing relationship in this data between the amount and the quality of the communication around benefits and overall trust. It's not a surprise that people want leaders that are straight shooters. They want people that are going to communicate early and often. The more that employees hear from their managers and company leaders, the more trust they have in those individuals. The more uncertainty we have about the environment that's affecting us, the less likely we are to want to communicate.

When the Affordable Care Act comes into the picture, we don't know exactly what that's going to look like from an employer’s perspective. We don't know exactly how that's going to impact our employees. Our tendency a lot of times is to close doors and to communicate less. Our research shows that's exactly the wrong thing to do. We learned that 49% of employees that have high trust already in their company leaders. Of those, 49% believe that the frequency of communication is right on track. Those who have low trust in company leaders, only 28% agree that the health communication that they received was frequent enough and of high quality. There's a relationship between trust in leaders overall, the community, and how I perceive that communication to be happening.

We learned that with managerial communication, the more accessible managers are, the more open door our policies are about employees communicating with managers and the more value employees see in workplace wellness initiatives. We ask a lot of questions in our engagement surveys about open and honest communication. It's critical in any kind of Democratic environment where we want the voice and we want the inputs of all people. That's what we call engagement. It's imperative that we give them the autonomy that they need to be able to voice their concerns when they can. We learned that 83% of employees that believe that wellness communication is frequent also say that communication in the workplace is open and honest between employees and managers.

When the reverse is true, only 43% report that an open and honest dialog about benefits is driving employee perceptions about communication overall. Specifically with the Affordable Care Act, we call it the elephant in the room. We're 5 years into this legislation right now. We're just getting our first glimpse of what the impact has been. Only 26% out of these 2,000 employees say that their benefits were impacted by the Affordable Care Act. Rewind 5 years ago, we probably would have predicted that number to be higher and that the employee perception was going to be that change. The media led us to believe that this was monumental change.

26% feel like they experienced change, but of those 26%, three quarters of them perceive that change as negative. Not very many employees overall witnessed change but those that did all looked at it with the same negative glasses. That's it. That's an indicator, to those employee populations, that we dropped the ball. We missed an opportunity and that could also be feeding into some of the data that you mentioned, Jen, about our perception of the exchanges out there and awareness of the quality and the pricing of those plans. 52% believe that changes, as we are going into ACA, were adequately explained. Of those that didn't, 15% said that changes were not explained.

That 15% is 10 times more likely to be hostile employees. Now hostile is a title afforded to only the grumpiest of employees in our spectrum. We go from highly engaged to engaged to contributing to hostile. Hostile are those that are the naysayers in the organization. Not only grouchy about the organization but they're evangelical in their grouchiness. They don't stop until they see other people be just as grouchy. There's a connection between those that were viewing the ACA changes as negative and those that were hostile overall. What do we do about that section of data? It goes back to frequency and communicating. As with any kind of organizational change, as leaders, we feel like we're communicating enough.

At that time when we feel like we're communicating enough, we probably need to communicate a little more. That communication has to be tied to our overall business goals. That communication has to come from senior leadership. The more communication is being done by senior leadership, the more buy in you're demonstrating that they have in those changes. Lastly, simply think critically about the company's approach to hard messages. I like how you positioned that a few minutes ago, Jen. We can't be afraid to make tweaks and changes. Employees are expecting tweaks and changes but we just have to understand. We have to communicate what priorities we're solving for. If cuts are made, we might be making cuts in order to preserve jobs.

If benefits are being added or swapped out, we have to communicate. We have to persuade and say, "Hey. This is a better option." Change for the sake of change, if not put into a value based context, makes people assume that change is bad. We have to inform them. We have to influence that context that they put in by telling stories about those hard messages.

Jen: Absolutely. On the topic of communicating more frequently, Greg, you really spoke to the importance of that when it comes to hard messages or when it comes to things that are challenging. What we have seen in some other research that we've done with our inside benefits communication survey, we actually saw a decrease from 2012 to 2014 in the frequency that employers were communicating about benefits. My hypothesis is that decrease happened because of the uncertainty of the Affordable Care Act and what employers were going to need to do with their strategy. The real challenge for HR and benefits folks is to be communicating frequently when there is so much uncertainty and so much up in the air. Employers have been in a wait and see mode.

That's the time that you have to communicate more often and tell employees that you don't know all the answers. This actually builds trust. There's a big opportunity especially with these big changes like the Affordable Care Act. When you do have that consistent communication, especially when it's coming from senior leadership, you can build trust even in times of tremendous uncertainty.

Greg: Yes, agreed. Well said.

Jen: We have some questions coming in. You guys who are on the line, we appreciate the questions so far. To answer a very frequent question, you absolutely will have the presentation emailed after the event as well as access to all of the other resources we have with this data. We have a series of tip sheets. We have infographics and some articles as well. There are lots of resources that you can use that you'll have access to. Greg, can you speak a little bit more about what's unique about the employees that we surveyed versus the typical American worker? How are companies that compete for the best places to work a little bit different than the average company?

Greg: That's a smart question. We showed the diversity of the employees that participated or that the 2001 employees that completed surveys but they are unique. I didn't call them a random sampling of all Americans because they are represented by companies or they are part of companies that are participating in a best places to work program. That's how we enlisted them in this process. They've been invited to certain research events throughout the year. They do work for companies that are self-selected into a group of what essentially are the top and second quartile employers. This data can probably be thought of as data from best practices companies.

If this were a random sampling of everyone, some of these percentages and engagements might be a little bit lower but still, very diverse group of employees but come from companies that are working really hard to fight this talent war and that don't have to be persuaded about the value of engagement or the value of culture. These are companies that are already getting that.

Jen: What about engagement being all about workplace culture versus benefits and total rewards as engagement drivers? What are you seeing in the data? Can you speak a little bit more about what's changed in the last several years regarding that?

Greg: Yeah. The biggest change that we saw is the change that we opened up with. It’s well documented about the cost of benefits escalating so dramatically over the last 10 years. The line item on our income statements has become so big that everything that we do, every change that we make with regard to benefits requires a big change initiative and is involving the CEO and the CFO and all of the employees. Because of that, the communication that we do around this is strategic by nature. This may have not have been the case. It was 5 years ago, that may or may not have been the case. Again, the shift seems to be where employees are asking harder questions about their benefits than they are in the recruitment process.

That's the exact reverse of where we were 10 years ago where nobody left an employer because of a change to their benefits but they were very smart and almost judgmental. They were very evaluative about making a switch in their career based on the details of health plan. That has shifted where the employees that we have are asking harder questions now. It's more of a retention strategy than a recruitment or an attraction strategy. Overall, I think where I was going with that idea about the cost escalating so fast is it's part of our culture. The benefits are a symbol of the investment that employers are making in their employees. That is something absolutely universal and absolute critical in shaping a culture. An employee perceives the workplace as something that invests in talent and that is committed to the development of that talent.

Employees equate that development with the financial investment that their employer makes. That's probably why it was showing up in our data that employees said I would think about high organization differently if that was ripped away even if it was logical. We'll take courage for those companies. There was a lot of talk a couple of years ago about certain small organizations saying they were canceling all their plans and shoving their talent into paying the exchange fees. There was a lot more bar than there has been bite. We don't see organizations doing that mainly because of the perception that we reported a few slides back.

Jen: We have a couple of questions about the exchanges that we can dig into. I think there definitely was a lot of talk of employers quickly dropping health insurance. That hasn't materialized for a lot of reasons. One just being the maturity of the individual market and the options that are available and how confusing that is. Employers have a big stake in the productivity of their workforce and creating scenarios where employees have the chance to make really bad decisions about insurance. They are going to come back on the employer's plate regardless of whether they are the ones who are offering the insurance or not. I think there's a lot of factors that have slowed down that excitement and that huge push to the exchange.

We have a great question that came in around whether the survey captured data regarding the new private exchange model and whether employees would be satisfied with that vehicle for offering benefits versus the usual process. What matters to employees? I'm curious, Greg, for your point of view on that but I'll start in saying that there's a lot of different models when it comes to exchanges for health benefits. Many of them feel like it's just a different version of benefits administration for the employee. When it comes to the employee experience, they're just going to go somewhere else that is still sponsored by their employer and still connected to their employer. They still perceive that value coming from their employer.

I think the model where the exchanges is a different flavor of benefits administration is interesting. You don't have the risk of losing employee satisfaction with plans as much as employers taking an arm’s length view of health insurance and having the approach of now, “We're going to just give you some money so go over here and figure it out for yourself.” I think there are some very different models that are emerging under the umbrella of the exchanges. The ones that still keep the value of the benefits with employment value proposition are going to be better served based on this data and based on how much employees value that employer sponsored insurance. Greg, what's your take on that? What are we seeing with the exchange and how does this data connect to it?

Greg: Yeah. This data indicated that we're not so far. I would have been in the same camp 5 years ago that said, "This whole legislation could start decoupling benefits from the employment experience." Generations, even the millennials, weren't that much different. There wasn't that much difference in the results that we were seeing when cut by age. Even the youngest members of our workforce still are expecting those benefits plans to be provided by their employers. Until that turns, you won't have the tightness of the labor market. I know we've gone from 11% unemployment to 6% and that's good. Even when we were 10 or 11%, we're still in for the talent, a very tight talent for the right kinds of companies that are growing and working really hard at their culture.

They are afraid of that message. They are afraid of the perception their employees have. Even if they started taking small steps in that direction, it’s about there being a possibility. I see a lack of courage from the employers about taking that step. I see a lack of open mindedness on the part of employees, which is strange because that's counter intuitive to what we're learning elsewhere in the market place that we have a larger share of the workplace that's contingent, that's 1099 or this or that. The attitudes and the behaviors are entrenched over the last several generations. We don't see a lot of open mindedness on the part of the employees.

Jen: Yes, on the exchange topic, there are two data points to keep in mind from this survey. First is the point about only 5% of employees thinking they could get a better deal on the open market. That just really speaks to the lack of awareness about how health insurance works outside of the employer relationship. I think that's a good thing to look to for anyone who is going to go for a more hands-off exchange model. That education process is going to be challenging. The second point is that so few employees believe that their health benefits change because of the Affordable Care Act when in reality, we know that pretty much everyone's did even if it was just adding some of the new benefits requirements and that those perceptions were largely negative.

There still is this negative association with anything that's happening regarding the Affordable Care Act. We talk a lot about companies needing to be cautious of blaming Obama Care for the benefit changes because it's not a good way to get folks engaged in benefits. I think this data speaks to that, too. The tremendous negativity around that and the disconnect between what really did change versus the perception of the change. We had a great question come in about how deductible health plans and consumer driven plans. It says, what else can we focus on to make the plan sound good besides paying more premiums or adding more to the HSA? That's a challenge for sure. Consumer driven plans are high deductible plans that are either paired with HRA's or HSA's. They put a lot more responsibility on the employee.

Many times, this exposes the employee and their family to a much higher out of pocket cost in exchange for a much, much lower premium. A couple of things to help employees is to help educate about out of pocket cost versus premium equation and explain that with that lower premium, you are more often than not going to be saving money in this plan. Then I would also really focus on what is free, the preventive care benefits, and the tools and resources that are provided in your plan to help people make good decisions and help them navigate through the system. It's a big behavior change to get people from thinking in that $10, $20 copay mindset to managing costs.

The frequent and ongoing communication that is really important about helping people understand how to navigate will make the plans’ value go up even if it's not what everyone would love.

Greg: I see a question scrolling all the way up about that very point. Someone said, what's the magic about asking how much?

Jen: The magic there is in employees and their families starting to become more aware of the huge cost differentials in treatments. The huge variables and where you can get the same type of service. We know that in any city, you could have a $400 MRI and you could have a $4,000 MRI just based on the facility that you go to or the provider that you go to. Even with complex surgeries and things like hip replacements or knee replacements, you can find an equal quality provider that is often a third of the price of the higher priced provider. There's just tremendous cost differential and part of employees being in these consumer driven plans is that awareness about cost and helping them make good decisions about costs. The other piece I would add is that there's a tremendous amount of unnecessary care in the system.

One of the big aims of the Choosing Wisely campaign is to reduce the unnecessary care because clearly, the best way to save cost as well as prevent harm is to make sure that all the health care that's given is the right care at the right time. That cost as well as necessity conversation and feeling confident to have that conversation with doctors is a big behavior change in health care. Something that employers are uniquely equipped with is to give their workforces resources and an education to start to move down that path. Great. Just a couple more questions. Greg, I would love to hear a little bit more from you on where you've seen employers make the biggest change and engagement with their population. When things were in bad shape, what types of efforts did they put in to improve engagement?

We talked a lot about frequency of communication, trust in leadership. What are some of the other tactics that employers are using to improve engagement with their populations?

Greg: Yeah. Probably the most common. and it's common in a bucket but not common specific to tactics, is culture related events. Trying to create fun and trying to create excitement in an employee. Sometimes that’s workspace, sometimes that's building space into offices for share time, and for non-work time. We're seeing a turn back from open to close. There seems to be this 20-year cycle of which type of workplace, what type of office environment seems to engage people the most. 20 years ago it was small offices. 10 years ago, it was open office. Now we're probably going back again or the tide is turning a little bit on that. Probably where employers experiment the most is events and trying to create levity in the workplace. They’re trying to build the emotional attachments between their people.

That's probably the most positive sign that we see. 5 years ago, that might not have been the case. 5 years ago, we'd give a talk in front of 1,000 people. People would come up to us and say, "Well, okay. I understand trust in senior leadership and manager effect and this almost seems like you're measuring. What do I really do? How many flavors of tea should I have in my break room?" That's when we realize that they're not getting our message. That engagement happens when human relationships are tight within a team, whether that team is a 10-person startup or whether that team is a 10-person team within a company that has 100,000 employees. Those relationships create the filters that we use to judge everything that we observe in our workplace.

Employers are figuring that out. They started to invest in those social experiments and team competitions, outings, incorporating family, and offering flexibility. We're seeing a lot of headlines about companies going away or withdrawing from any idea of work from home that they might not have sold a few years ago. What they determined was work from home isn't as important as workplace flexibility. People want to know. They still want the social environment, the social fabric that happens from working in proximity with people but they want to know if they need to hit the DMV over lunch or they want to go to their kids' track meet at 3:45, that they can do that. They don't have to always be cheating from the family side versus the work side.

That's the bucket. That's how I would describe probably the area that employers are most experimenting with when it comes to driving engagement.

Jen: Great. Lots of connections to the health and wellness side of things.

Greg: Yeah, absolutely.

Jen: That wraps up our questions. There's one final comment that I just want to repeat that someone typed in with their question that they would like their CFO to see the presentation. I'm glad to see that. I hope that this is great data and great information for you all to be having great conversations with your leadership and building plans internally. We would love your feedback on that. Any questions that you have, any ways that you're using the data, we'd love to hear all those stories. We really appreciate your time today.