Speaker 1: Hello, this is Dr. Eric Bricker and thank you for watching A Health Care Z. Today's topic is employee engagement and its effect on employee health and employee health plans. Now, many of you are familiar with the Gallup organization. So Gallup has been doing a poll of the employee workplace for over a decade now, it might even be two decades. They've been doing this for a long time. Now for their most recent poll for 2022, they released that 33% of, and they classify it as North America, so it's mostly US, are engaged employees, 33% of their surveyed employees are engaged. Well, that begs the question, what does it mean to be engaged, right? Well, they broke it down into three categories. So you could either be engaged or you could be not engaged or you could be disengaged. So and they define in the back of the poll what engaged is. So engaged means you're like enthusiastic about your job. That means you're like putting in elbow grease. Now not engaged means that you're kind of checked out. Now you're just kind of going through the motions, if you will. Now disengaged is where the employee is actively working against their employer. They are working to subvert what the employer is trying to accomplish. They are trying to actually make things harder for their fellow employees. They're actually trying to make it worse for the company to accomplish their goals. So I kind of equate this to like cleaning a window, right? So if you're engaged, you're like using elbow grease, you're focusing on the corners, right? You're going to get a clean window, right? Whereas if you're not engaged, it's like, you know, you're spraying the Windex and maybe you're wiping, you're like, okay, next, and like, you know, you're not going to get a very clean window if you're not engaged, but they're still trying to clean the window. Now disengaged, they're actively putting dirt and mud on the window. They're actually trying to make the window dirtier, okay? Now interestingly, the Gallup poll back in 2013, 10 years ago, they used to also release the non-engaged and the disengaged employee statistics. They don't do that anymore. They just say 33% are engaged and then the rest are something else, right? So when the last time they actually released these statistics in 2013, 50% of the employees were not engaged. In other words, they were just checked out and 20% were disengaged. Now at that time in 2013, it was only 30% were engaged. So the percentage of employees that are engaged, it hasn't changed that much in 10 years. It's gone from 30% to 33%, right? So really, now we don't know for 2022 if it's 50% non-engaged and like 17% disengaged. We don't know that, but we can probably hazard to guess that these numbers haven't changed dramatically if the actual engagement number hasn't changed dramatically as well. Okay, now what's my point here? As it relates to employee health plans and employee health programs like wellness programs or all the other programs that employers try to put in place to lower healthcare costs, increase quality, improve the health of their employee population, what's the A number one problem of all of those programs? What's the bane of their existence? Low utilization. All these programs sound great, but if people don't use it, if there's low utilization, then the program will not work. And I've talked about this before in A Health Care Z, there was actually a study in the Journal of the American Medical Association that looked at the wellness program for BJ's wholesale stores. It's kind of like a mini version of Costco up in the Northeast of the United States where they did a wellness program and they actually compared it to like controls across their various sites across in the states where they're located. And in their sites where they had wellness programs, they only got 36 to 45% participation, like utilization of the wellness program, and they were paying them money. They were giving them financial incentives and they still couldn't even get half the people to participate. And then when they compared the people who participated in the wellness program to people who didn't participate in the wellness program, there was zero difference in the outcomes. They looked at 27 different behaviors. They looked at different things like your cholesterol, your blood pressure readings. They looked at healthcare costs. There was zero difference between the control group and the intervention group. And they could only get 26 to 45% of people to even be involved in the wellness program. So what does that mean? The point of this video is, is that if you are trying to put in any type of employee health plan program, then the actual engagement of the employees themselves is a huge impact of the success and utilization of that health plan program. The underlying engagement of the employees, are they enthusiastic about their job? If they're enthusiastic, they will be more likely to participate in the employee health plan program. Do you think somebody who's just going through the motion or an employee who's actively trying to subvert their employer is actually going to participate in any of these things? Probably not. So what I've done here is I've drawn a three by three matrix to show how a employee health plan program then matches up with the engaged, not engaged, and disengaged employees. And what we have here in the rows is how we convince people to change their behavior and to do something new. And it's a combination of the ethos, the pathos, and the logos, right? It's a combination of the credibility of the company, the empathy that the company feels for the employee and vice versa, and then the actual logic of the program itself, right? So I've made previous A Health Care Z videos on this as well, right? So if it's an engaged employee, look, the ethos, like the company has credibility with the employee. Pathos, the employee feels like the company cares about them. Now in terms of the logos of the logic of the actual health plan program, et cetera, that requires an effective communication strategy. So even if you have engaged employees, you're not going to get 100% of the 33% to participate in your wellness program because they might just think it's irrational, right? I think of people like in the IT department. You could have somebody in the IT department who's totally engaged, right? And then you could be like, but we want you to do this. And they'll be like, I think that's irrational. And they won't necessarily do it. They're like, they don't think badly of the company about that, but they're just like, I'm not going to participate because I don't think that's rational. Or maybe there's just a lack of a communication strategy. Like they just don't even know. Like at Compass, we worked with companies where they had highly engaged employees. I mean, these are wonderful employees and wonderful management, wonderful executives. And like they just had a really hard time just communicating with the employees. Like if the employee doesn't know, then there's no way that they could participate in the whatever health plan program it is just because they didn't know. Now if you take a non-engaged employee, listen, they're checked out. They don't feel like the employer doesn't really have any credibility with them. The employee doesn't feel like the employer really cares about them. And so here, not only do you have to have an effective communication strategy like you have with the engaged folks, but you have to clearly show and convince the non-engaged employee how it is specifically in their self-interest. And this is where when you talk about like financial incentives, like, you know, we're going to give you money or you're going to get money in your HSA account or your deductible is going to go from $1,000 to zero if you go to this center of excellence to get your surgery done. Or if you go to this onsite clinic, it is zero out-of-pocket costs. You have to very specifically talk about the self-interest of the individual with these non-engaged employees because they frankly have no interest whatsoever with helping the employer. And similarly here with the disengaged employees, of course there's no credibility, the company has no credibility with them. Like of course the employee doesn't feel like the company cares about them at all. Now interestingly, like don't even try to engage with them or don't even try to communicate with them because if you do try to communicate, again, they're disengaged, they're actively trying to subvert your activity. Like if you communicate a wellness program to them, like all they're going to do is badmouth that wellness program and work to convince their fellow workers around them to not participate in that wellness program and to try to convince them that it's frankly a trick. So again, they're trying to actively put dirt on the window that you're trying to clean. So this column here, the fact that you even have it all organized, when Gallup's pulled these people, it was anonymous, the fact that they're upwards of 17 to 20 percent, upwards of one-fifth of an employee population that is actively trying to subvert their employer, like yeah, good luck getting any sort of employee health plan to work with that part of the population. So you just have to understand that, you know, right, wrong, or indifferent, like those people are there. Okay. Now interestingly, Gallup also look into why were the employees engaged? Why were the employees not engaged? Why were the employees disengaged? Guess what they found was the reason why? It was their direct manager. That was the reason why. The direct relationship between the boss and the people working for the boss that they, Gallup said that created, that was worth 70 percent of the total value of being engaged, non-engaged, or disengaged, 70 percent of that came from your direct manager. So what specifically was it about the relationship with the direct manager that led to engagement, non-engagement, or disengagement? It was around issues of fairness and favoritism in their work, nothing to do with their employee health plan, but like if the manager, if their manager is unfair, if they're showing favoritism to one employee and another employee just can't do anything right, then they'll be non-engaged or disengaged. Likewise, time pressure and unrealistic workloads, essentially, if the manager is just there browbeating them and push, push, push, push, push, to get them to do more, to be quote unquote more productive by cramming more work into less time, guess what? You're going to get non-engaged and disengaged employees. And so this is not only a video for employers and not only a video for brokers and benefit consultants, but if you work at a digital health company that is engaging with employers, you are not going to change the management dynamic at that company. You're not. But what you can do is as you are going through the sales cycle with employers, you can be like, listen, is this going to be a company that has a higher, you can't know the number exactly, but is this going to be a company that has a higher percentage of engaged employees and a lower percentage of non-engaged disengaged employees or vice versa? So at Compass, we had over 2,000 employer clients. I've had a fair amount of experience meeting with the employees. I did over 200 open enrollment meetings myself. I mean, I was literally with the employees presenting our Compass program to them. So I talked to the executives and I would talk to the employees and I saw situations where the employees were engaged and I saw other situations where the employees were totally checked out and I absolutely saw situations where I had subversive employees at these open enrollment meetings. I'm laughing because it shocked me when it was happening. So well, interestingly, a question that I started asking the executives as we were kind of going during the sales cycle was, hey, what's your employee turnover? Because obviously if the employees are non-engaged and disengaged, if they don't like where they're working, they're more likely to leave. What was an interesting answer that I got? The majority of the employers that I spoke to, they didn't know. They didn't know what their employee turnover was. And I'm talking with the HR people. I'm talking with people who've got the data. They can figure that number out. Or they would say things like, well, it's high or it's low. Well, shoot. For some employers, high is 20%. With convenience stores, their turnover rate could be 80%. And other places like, oh, our turnover is low. It's only 30%. Right? So high and low are a relative number. I'm like, what's the exact number? And they couldn't tell me. I'm like, well, just give me the ballpark. They couldn't give me the ballpark. Aha. That right there told me that even if they knew what their turnover was, that meant they at least had the time and the attention and the skill to recognize that turnover was an important metric for them to measure. And frankly, if they didn't even measure turnover, then the chances are that they frankly had a very high level of non-engaged and disengaged employees. So there's a little trick for you. Ask about turnover. See if the employer's got an answer. Listen, employee engagement. No healthcare vendor is going to solve that for their employee or customer, but you can vet in advance to find out what their engagement is. And that's my point for today. Thank you so much for watching.