Health Benefits Survey This! (and That)

January 1, 1999
If you believe the reports that health care costs will double from $1 trillion in 1996 to $2.1 trillion in 2007, you've doubtless come to the conclusion that no company can afford to be spendthrift with its health benefits program. In today's rapidly changing managed-care industry, it's not paranoid or hysterical to want a head-to-head with your benefits carrier, but it may not teach you a tenth as much as a scientifically valid employee assessment survey.

"It's imperative that a good quality assessment program be in place to help employers gauge employee satisfaction and to refine the company's managed-care strategies," says Elliot M. Stone, executive director and CEO of the Massachusetts Health Data Consortium (HDC), a nonprofit corporation that collects and analyzes health care information. "And given how much time and energy surveys can take, it's equally as imperative that employers learn how to adjust their programs based on the results."

Stone co-authored an employee health benefits survey and users' manual for the Brookfield, Wisconsin-based International Foundation of Employee Benefit Plans, a nonprofit educational association serving the employee benefits industry. According to the manual's introduction, assessment surveys can provide rich information for employers in the following ways:

  • Characterize the health status of employees as well as their dependents.
  • Determine whether there's a need for change in one or more health plan options.
  • Specify the direction in which those changes should occur.
  • Renegotiate managed-care relationships by explaining current health care needs.
  • Identify employee behavior problems that can cost the company more money.

Right away, you can see a number of things that sound potentially great for human resources professionals about employee assessment surveys. And to many employees, it may be seen as a commitment on your part to maintaining a high-quality health benefits program.

But the information is only as "powerful as the questions you ask," says Ron Deprez, president of Public Health Resources Group (PHRG), an independent health care consulting firm based in Portland, Maine. "Let's say a large percentage of your employees have asthma. Unless you know this, you might not be inclined to pay someone to educate them on how to treat their allergies. The cost of preventative measures can be far less than the cost of hospital care. And the only way to answer these questions is with an employee assessment survey."

Design your survey with employees in mind.
The Chevron Corp. in San Francisco, California, conducted a national survey in July 1998 of roughly 10,000 of its employees and retirees with self-insured medical plans. "It's one thing to evaluate the finances of a company's health benefits program, what it covers and so on, but employers also should consider what their employees have to say," says Tanya Bednarski, manager of health and welfare plans for Chevron Corp. "Surveys give you a lot more than just anecdotal feedback."

Chevron used an outside third-party vendor to conduct its survey. "We structured it so that the same questions were asked for each and every health benefits plan we offer," says Bednarski. "That's helpful to us because now we can standardize the results."

Unless you've had experience designing surveys and interpreting the results, you're better off leaning on an independent third party to do the legwork. It helps to be prepared by focusing on the type of information your company will need and use.

Assessment surveys should be designed in such a way that you can mine the employee health data for trends. For openers, you want specific information about employees' health status and their preference for services, and how they use those services. Do healthy employees use the plan? Who are the heavy users? Are there any smokers? Does age or gender make a difference? What are their coverage priorities? Some employees may want coverage for chiropractic care, while others may want coverage for other alternative therapies. Most managed-care administrators encourage several open-ended questions regarding benefits.

Some employees may fear the health data information will somehow be used against them. "That's why you should never ignore employees' privacy," says Kimberly Wedell, principal with the Milwaukee, Wisconsin-based ROC Group, a human resources consulting firm. "Confidentiality is a must when conducting an assessment survey."

To that end, it's best to administer the survey in-house or by mail. Encourage employees to participate by posting a preliminary announcement indicating when and where the survey will be held. Make arrangements for absent or otherwise unavailable employees. Survey results should always be posted to remind employees they were involved.

Above all else, emphasize that it's not just about saving the company nickels and dimes, but also about employees' satisfaction with their own health plans.

Naturally, the value of any employee survey depends mainly on its validity and reliability, says HDC's executive director Stone. Through interviews with human resources managers and extensive literature review, the employee health benefits survey he designed yielded sample questions that pinpointed key employee health status problems and health care needs. These questions were then pretested and modified to ensure that the language was neutral and unlikely to stir up expectations for change. Terminology that could have biased the results was deleted. "You want to compare the results over time and to the results from other employee assessment surveys," explains Stone. "This type of rigorous surveying methodology ensures a high response rate and produces precise and unbiased results."

Adjust your program based on the results.
You should realize that conducting an employee health benefits survey is a huge waste of time, money and effort unless you use the data to customize your company's health benefits program. Gina Alongi is administrator for the Lexington, Massachusetts-based International Union of Operating Engineers (Local 4), a construction union of 2,900 heavy-equipment operators. Two years ago, members were surveyed about their views on the current self-administered health benefits plan. As a result, says Alongi, "several options were added to the existing program," including coverage for hearing aids.

To revise and enhance your health benefits program, though, you must be willing to adjust to the results, says PHRG's Deprez, who conducted the survey for the heavy-equipment operators. "You should also use the data to educate employees on better health practices," he emphasizes. "Depending on your workforce, you may have to educate them about cardiovascular disease instead of diabetes, mental health instead of asthma. This sort of attention gives you a healthier workforce, and who doesn't want that?"

Assessment surveys should also yield plenty of ammunition to renegotiate coverage with service providers. Let's say a number of employees last year had problems processing their claims. The information can be used to remind your plan administrators about meeting their obligations. If nothing else, it puts you in a better position to negotiate coverage in the future. Based on the results of an assessment survey two years ago, Chevron actually dumped one of its significant health benefits vendors. "We tried working with the vendor, but on the second go-around, our employees were still dissatisfied," says Bednarski.

If your company uses an HMO, you may not have to worry about surveys. The Washington D.C.-based National Committee for Quality Assurance requires that all HMOs that earn accreditation administer an annual members' satisfaction survey. Otherwise, PHRG's Deprez recommends companies evaluate their health plan effectiveness and performance with some kind of employee assessment survey. "If nothing else, you can make sure you're providing a good health benefits plan to your employees at the lowest possible cost."

Workforce, January 1999, Vol. 78, No. 1, pp. 93-94.