Guest Blogger: Insight on Navigating Health Care

I (Amy) am pleased to introduce our guest blogger, Judy Sulick.  Judy is a pharmacist and has been working in health care for nearly 30 years. With almost two decades of executive corporate positions, extensive travel and career focus, she has shifted her attention to a local health benefits management position. She resides in Dublin, Ohio where she balances a fulfilling position with her talent for art, gallery displays, commission painting and passion for all things creative. I have personally known Judy for nearly 20 years and I just adore her. She is like the sister to me that I never had. Judy jumped at the chance to be a guest blogger which doesn’t surprise me given her giving, creative personality. It is my pleasure and with great honor to introduce our audience to Judy and her take on navigating health care. 


As a health care professional, I notice that friends, family and colleagues discuss personal health matters with me and even solicit guidance in navigating health care resources. It can be an illness, an injury, a procedure or preventive health care appointment. I also notice that aging family members are more likely to look to us for support, often for health related matters. As family members are aging, try to be proactive in anticipating their needs and understanding what choices are possible with health insurance plans.

The complexities of commercial health plans and Medicare plans can be overwhelming. In the future, health care exchanges could become options through the Affordable Care Act. At some point, we may be called to make decisions or assist in deciding which plan offers the level of access, cost and quality of services for our or a loved ones’ needs.

Here are some things to consider and a few resources that might help:

•       Medicare:

o   Medicare is a federal health insurance program for U.S. citizens (or permanent legal residents for 5 continuous years) who:

•       Are 65 years of age or older;

•       Are under 65 and disabled and receiving benefits;

•       Have end-stage renal disease; or

•       Are eligible for Social Security Disability Insurance and  have ALS (Lou Gehrig’s disease)

o   When a person turns 65, it’s important to assure that they’ve enrolled in Medicare. Medicare Part A addresses inpatient insurance. Medicare Part B addresses medical outpatient insurance. In a nutshell, Medicare pays primary and another commercial plan can pay secondary for medical claims.

•       Medical: In addition to Medicare, medical plans are offered through various commercial insurers. Some people have access to medical insurance through their retirement plan. Others are able to enroll in individual or group plans. In choosing among various plan options:

o   Consider the current status of health and whether you anticipate frequent visits to the doctor. There are options where if you anticipate good health and infrequent need to see the physician, you may be willing to risk a higher out of pocket limit in exchange for lower monthly premiums throughout the year.

o   Some medical insurers have a specific network of physicians that are considered ‘in network’. If your physician or local hospital is not in this network, there will likely be a different member cost share for the service. Consider travel and ‘snowbirds’ with extended temporary residence. Are there providers within network in those areas?

o   Home Health Care: With the trend toward hospitals decreasing the length of inpatient stay, long term care or home health care is often needed to continue recuperation or rehabilitation. Look at the scope and duration of services available within the benefit. What qualifies the member for Home Health Care after a hospitalization or for hospice?

o   How much can you spend? There can be a deductible where the member is required to pay up to that amount before the plan requires only the established copayment/coinsurance. Also, evaluate the maximum out of pocket payments required until the plan covers more of the expenses. Think about the member’s overall monthly budget, including pharmacy costs.

•       Pharmacy: These benefits are often bundled with the medical plan enrollment. If the member is enrolled in Medicare and a plan that offers prescription benefits, it is likely a Medicare Part D plan.

o   Medicare Part D was established by Title I of the Medicare Prescription Drug, Improvement, and Modernization Act. The goal is to provide prescription benefits to Medicare beneficiaries whereby anyone with Parts A or B is eligible. Typically, plan sponsors or insurers leverage government subsidies in Part D plans to offset the cost of premiums for members.

o   Typically pharmacy benefits offer both a mail service and a retail pharmacy benefit. Some retail pharmacy benefits have a specific network of pharmacies and different member cost share for out of network pharmacies. Mail service pharmacy is reasonable for prescriptions where the medication dose is stabilized and chronic in nature (i.e. Blood pressure medications). Retail pharmacy is reasonable for prescriptions that might not yet have consistent dosing or short-term in nature (i.e. Antibiotics). Overall, plan sponsors use mail service pharmacies to leverage better pricing, thereby offsetting the cost of premiums to members.

o   As with medical plans, consider the deductible, copayment/coinsurance and maximum out of pocket expenses required by the member until the plan covers more of the cost.

•       Dental and Vision: These benefits are typically offered with premiums separate from the Medical/Pharmacy bundle.

o   Consider the need for glasses, contacts. Also consider the potential for needs such as glaucoma screenings or ophthalmologic care secondary to diabetes. Evaluate the insurance plan contribution toward services and frequency with which the services are allowed.

o   Evaluate the coverage around dental procedures, dentures, reconstructive or preventive care.

•       Long Term Care Insurance:  When available, premiums are often more affordable the younger the enrollee. Look at the potential dollar benefit paid to the member per month as well as the necessary qualifications to enact the benefit.

Many resources are available to help you understand how to navigate health care options. Some are through commercial insurers, while many are through government program websites. Here are a few:

·         http://www.staysmartstayhealthy.com/watch?v=26

·         http://www.smartmoney.com/plan/health-care/how-to-choose-a-health-care-plan-1304876592678/

·         http://www.webmd.com/health-insurance/choosing-using-health-plan

·         http://www.medicare.gov/

·         http://medicare.gov/homehealthcompare/search.aspx

Essentially, medical and pharmacy benefits drive access to and choices about our health care. Our benefits drive our comfort and confidence in having the resources at hand to address the issues.

Be proactive. Be informed.

Guest Blogger,

Judy Sulick, R.Ph., M.S.

Assistant Director, Pharmacy Benefits and Health Care Enrollment

State Teachers Retirement System of Ohio

sulickj@strsoh.org

Guest Blogger: Performance Management, Appreciation, and Motivation in the Era of the Skinny Chicken

Today I introduce to you, Amy Ambrose.  Amy and I have worked together for the past 10 years and she has become a close friend of mine.  Amy runs the operations for our region with 80+ employees under her sphere of influence.  Amy brings a level of creativity to our team that is unmatched, she is always thinking outside of the box.  She inspires change which is a constant in today's workplace and is amazing at implementation. This woman can get stuff done!  And she does all this with a great sense of humor that keeps you grounded in that "its just work, don't take yourself too seriously" type manner.  Amy's ability to communicate is something we can all learn from, thus why she is going to share some thoughts on Performance Management and Appreciation. 

The Urban Dictionary defines Skinny Chicken as: to offer little or nothing; to shaft; to be cheap

The phrase, “the skinny chicken” is used around my house to express dissatisfaction or a general feeling of getting “the scraps”.  While this might not be a common expression in the office, I think many leaders feel that performance management and accompanying compensation process leaves them nothing to offer most of their employees, even at times, their best employees, nothing but the skinny chicken.  After completing the annual performance cycle in my division of 80+ employees, I’ve given some thought to the performance review process and how to avoid feeling that we are only serving the skinny chicken to employees.  I find that the answer is demonstration of genuine appreciation, not as the “runner-up” prize, but the true Blue Ribbon winner.  

Employee motivation and high organizational performance and profits go hand in hand.  The Gallup organization found that when all of an organization’s employees are highly motivated and performing at their peak, customers are 70% more loyal, turnover drops by 70%, and profits jump 40%.  Appreciation is the foundation for motivation.  However, Tom Rath and Donald O. Clifton of Gallup document that 65% of American workers received no recognition in the workplace last year.  

The Leadership Experience by Richard L. Daft offers a Simple Model of Motivation that begins with a Need (money, recognition, achievement) which leads to Behavior, which leads to Rewards.  Rewards can be intrinsic, or “self-satisfaction” or extrinsic, which are rewards given by another person, typically a supervisor, such as a pay increase or promotion.  Intrinsic rewards appeal to the “higher” needs of employees – a sense of accomplishment, feelings of competence, growth, fulfillment, and self-determination.  Extrinsic rewards appeal to the “lower’ needs of individuals such as material comfort and basic safety and security.  

Maslow’s Hierarchy of Needs can be applied here in that basic Physiological and Safety needs are likely met in most organizations – Base Salary, Safe Workplace, Benefits – which gives leaders the ability to focus on the Belongingness, Esteem, and Self-Actualization Needs.  However, too many times we neglect to take this view and focus on emphasizing salary increases (basic need) over the true motivators of being a part of an excellent and challenging work group, recognition, increased responsibilities, autonomy, and creativity.  

Frederick Herzberg builds upon Maslow’s theory regarding factors that affect worker satisfaction.  Factors that negatively impacted or showed a neutral impact to employee satisfaction were Working Conditions, Pay and Security, Company Policies, Supervisors, and Interpersonal Relationship.  Factors that led to Highly Satisfied employees were Achievement, Recognition, Responsibility, Work Itself, and Personal Growth.  

Current thought leaders have devoted significant research to appreciation and motivation.  A few that come at the topic from different angles but all arriving at the same conclusion are Dan Pink, Tony Schwartz, and David Horsager.  In Pink’s book Drive he states “science has shown that we have achieved a higher plane where motivation is achieved as much intrinsically as extrinsically.  For example, researchers have found that we do our best work when motivated from within, when we have control over our work, and when we feel a deep sense of purpose.  Under such conditions, we can achieve a real mastery over what it is that we do.”  Tony Schwartz and The Energy Project talk about the need to have fully engaged and motivated employees through renewal of four energy needs – one of which is Significance or Purpose.  Finally, David Horsager’s book, The Trust Edge, introduces the concept of magnetic people being connectors.  Leaders are connectors.  Horsager states that “One secret and irresistible quality of magnetic people is that they’re grateful.  They are genuinely grateful and it shows in their interactions with others.”

My challenge to you as you prepare for your next performance or compensation discussion is to put aside crafting a message which makes a Skinny Chicken look like a plump, Thanksgiving turkey, and instead think about how to show appreciation and gratitude to the employee which will translate into motivation.  Don’t waste time fulfilling “lower” needs and view “higher” need rewards as the consolation prize to a smaller or non-existent monetary award.  Many times we miss everyday and “annual” opportunities to show appreciation and provide motivation that appeal to an employee’s fundamental desire to be appreciated.  

A quote from Maya Angelou sums it up well.  I’ve added context in parentheses to illustrate my meaning.

“I’ve learned that people will forget what you said (performance feedback or rating),
people will forget what you did (salary increase or bonus),
but people will never forget how you made them feel (appreciation and recognition).” 

Guest Blogger, 

Amy Ambrose