Professor Keller Webinar - May, 2013


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  • As health care costs rise, a growing number of companies are using wellness programs to persuade employees to make better lifestyle choices. An annual survey of medical cost trends by PricewaterhouseCoopers' (PwC) Health Research Institute indicates U.S. employers can expect to see health care costs rise by 8.5 percent in 2012. Three factors are responsible for the increase: 1) the formation of ACOs (Accountable Care Organizations) are predicted to reduce competition among providers and drive up payment rates, 2) Medicare and Medicaid payment rates are expected to decline relative to private payment rates, and 3) Higher claims for stress-induced illnesses, which are highly correlated to unhealthy behavior and adverse health conditions such as heart disease. To offset the increase in corporate health care costs, employers are shifting the burden of medical costs to employees through higher cost-sharing: High-deductible health plans were the fastest growing plan designs in 2011. Employers are also increasing deductibles; making it far less attractive for workers to use the services of physicians and hospitals that are out of the plan’s network. In some markets, payers are becoming more selective about which providers are in the network, choosing to exclude high-cost and premier hospital systems.
  • Professor Keller Webinar - May, 2013

    1. 1. Building Theories by BreakingBoundaries: Health and WealthChoice-MakingPunam A. KellerCharles Henry Jones Third CenturyProfessor of ManagementTuck School of
    2. 2. Rise in Corporate Health Care Costs2Three factors are responsible for the increase: The formation of ACOs (Accountable Care Organizations)are predicted to reduce competition among providers anddrive up payment rates, Medicare and Medicaid payment rates are expected todecline relative to private payment rates, and Higher claims for stress-induced illnesses, which are highlycorrelated to unhealthy behavior and adverse healthconditions such as heart disease.
    3. 3. Employee Inability to Retire has Increased3 Employment insecurity looms large: 42% identify job security as the mostpressing financial issue Twenty-five percent of workers in the 2012 Retirement Confidence Surveysay the age at which they expect to retire has changed in the past year. In1991, 11 percent of workers said they expected to retire after age 65, and by2012 that has grown to 37 percent. Worker confidence about having enough money to pay for medicalexpenses and long-term care expenses in retirement remains well belowtheir confidence level for paying basic expenses. Although 56 percent of workers expect to receive benefits from a definedbenefit plan in retirement, only 33 percent report that they and/or theirspouse currently have such a benefit with a current or previous employer.
    4. 4. The “Official Syllogism”More choice means more freedomMore freedom means more well-beingMore choice means more well-being
    5. 5. Too Many Choices Can Make People Miserable•Regret andanticipated regret•Opportunity costs•Escalation ofexpectations
    6. 6. ENABLE: Efficient-Novel-Active-Behavioral Levers6SegmentsBehaviorChangeInterventionsCase Studies
    7. 7. Nonchalants Key trait is lack of motivation to payattention to health message. They are unconcerned or detached fromattempts to change their behavior. They are unlikely to engage in any healthmessage processing or provide anyresponse to the message unlessprompted to deliberate. Desirability of taking health action ismore important than feasibility for thisgroup.7
    8. 8. Defensives They are motivated to change theirbehavior, but believe they are not at riskbecause they are unable to comply withthe behavior change recommendations. They engage in motivated reasoningbecause they have low self-efficacy. Suchmotivated reasoning may even take theform of lower response efficacy becausethey are unable to comply with therecommendations. Feasibility of taking health action is moreimportant than desirability for thisgroup.8
    9. 9. Status Quo Preservation Switching Cost Barriers Huh… I am fine… I like what I am doing… I have figured this out… I am chugging along… Don’t rock the boat… This works for me… I feel bad… I don’t know how… I have no self-control… It’s a habit… I will do it later… I will get less of somethingelse…9Two Groups of Behavior Change Barriers
    10. 10. Status QuoPreservationDeliberationPromptsSwitchingCostsImplementationAidsBehaviorChangeENABLE: Efficient-Novel-Active-Behavioral-LeversFramework
    11. 11. 11Deliberation Prompts
    12. 12. Automatic - Effortful: Sample Modified Web Page toEnroll in ReadyFill at Mail™Added button – “I prefer to order my own refills” – to require members toquestion whether the new behavior was more effortful.Deliberation Prompt Easy/Clear/Fast Accurate Advantages Trustworthy Reversible
    13. 13. More members enrolled when new behavior was lesseffortful than status quo12.3%22.3%ControlN=4,232Deliberation PromptN=6,950Incremental Website Enrollment: Lift OverControlDeliberationPrompt:79%more effective
    14. 14. CONTROL“Press 1 if you would like to betransferred to a Customer CareRepresentative now.”or“Press 2 if you are not interested.”“Press 1 if you prefer to refill yourprescriptions by yourself each time.”or“Press 2 if would you prefer us to doit for you automatically.”STABILITYOFPREFERENCESStable - Unstable: Modified Voice Recording to Enroll inReadyFill at Mail™Deliberation Prompt Easy/Clear/Fast Accurate Advantages Trustworthy Reversible
    15. 15. 103%more membersenrolled usingDeliberationPromptIncremental IVR Enrollment in ReadyFill at Mail™: Lift overControl15.8%32.0%Opt-InsN=5,491Enhanced Active ChoiceN=4,45922.1% 21.0%EnrolledDisenrolledMore members enrolled when reminded about unstablepreferences
    16. 16. Make the Default More Costly: Flu Shot RemindersOpt-In Opt-Out Active Choice Enhanced ActiveChoicePlace a check inthe box if youwant a reminderto get a FluShot.Place a check inthe box if youdon’t want areminder to get aFlu Shot.Place a check inone box.I don’t want areminder to get aFlu Shot.I want a reminderto get a FluShot.Place a check inone box.I want to remindmyself to get aFlu Shot.I want a reminderto get a FluShot.
    17. 17. Employees Had Higher Flu Shot Intentions45%60%Opt-Ins EnhancedActiveChoiceIncremental Flu Shot Reminders: Lift OverDefaultsEnhanced ActiveChoice:50+%more effective thanother options52%ActiveChoiceOpt-Outs93%
    18. 18. HWA Compliance: Opt-In vs. Active Choice Message• Visit the Health and Wellness Assessment (HWA) website to develop an action plan tomaintain or improve your health. Now, or whenever you are ready, you will have freeaccess to powerful online coaching tools for success.• If you have already completed or plan to complete the HWA, you will receive an annual$200 off your bi-weekly or monthly health insurance contribution cost.• The Health and Wellness Assessment is administered through HealthMedia and isconfidential. Results from all HWA responses will be summarized, without identifyingindividuals, to determine trends in employee health. I prefer to take advantage of this free tool to maintain or improvemy health and save $200. I prefer not to take advantage and decline this opportunity to gethelp in maintaining or improving my health and wellbeing.18
    19. 19. HWA Compliance: Lift over Control and Control withFinancial Incentives10.0%27.0%No FinancialIncentiveJan-Sep 2010Financial IncentiveOct 201030%Active Choice,Financial IncentiveNov-Dec 8 2010Bundled HWAwith Commitment:100%increase with noextra financialincentiveHWA Compliance: Lift over Control and Control with Financial Incentives19
    20. 20. Status QuoPreservationDeliberationPromptsSwitchingCostsImplementationAidsBehaviorChangeENABLE: Efficient-Novel-Active-Behavioral-LeversFramework
    21. 21. 21Implementation Aids
    22. 22. 1. Select a 30 minute time slot right now to complete the online contribution toyour Supplemental Retirement Account (SRA) during the next week.2. 3 minutes. Check to see if you have the following materials: a) worksheetin your benefits packet _√_, and b) the name and social security number of abeneficiary _√_.3. Select the amount you want to invest for 2007 (minimum: $16/month,maximum: $1,292/ month), even if you don’t know your take-home pay in yourfirst month. If you want, you can change this amount at a later date. Thisvoluntary contribution is tax-deferred, you will not pay taxes on it until youwithdraw the funds.4. 5 minutes. Select a carrier. If you do not select a carrier, Dartmouth will investthe non-voluntary portion of your college funds in a Fidelity Freedom Fund, afund that automatically changes asset allocation as people age.5. 5 minutes. Now you are ready to complete your worksheet. Complete theworksheet even though you may be unsure of some options. You can changethe options in the future.6. Take your completed worksheet to a computer that is available for 20minutes. If you like, you can use the one in the Human Resources office at 7Lebanon Street, Suite 203.7. 15-20 minutes. Log on to Flex Online and complete your online SRAregistration within the 20 assigned minutes. Be sure to click on theinvestment company (TIAA-CREF, Fidelity, or Calvert) to complete theapplication. You need to set up your account – otherwise your savings will notreach the carrier.We have outlined 7 simple steps to help you complete the application.Implementation Plan to Prompt Implemental Mindset22
    23. 23. Dartmouth Employees Share Stories about How TheySave for Retirement 23
    24. 24. SRA Compliance: Lift over Control and ImplementationPlan20.7%31.0%Seven Steps(no video)2006-2007Video NewEmployee OrientationJan – June 2008Simple Plan280%more effectiveVideos of EmployeeStories:55%more effective thanSeminar/NewEmployeeOrientation FileSRA Compliance: Lift over Control andImplementation Plan7.3%Control2005-200624
    25. 25. Implementation Aid for HWAIncremental EnrolleesLift over control30.0%58.0%ChampionLetterMail withHow- ToInstructionsIncremental EnrolleesLift over control – 93.3%25
    26. 26. Implementation Aid for Biometric Screening2640.0%51.0%ChampionLetterMail withBarriersIncremental EnrolleesLift over control – 93.3%
    27. 27. NYSE: Financial Fitness Toolkits
    28. 28. NEFE: Employee Well-Being
    29. 29. ENABLE: Efficient-Novel-Active-Behavioral Levers29SegmentsBehaviorChangeInterventionsCase Studies