EP368: How to Successfully Roll Out New Benefit Designs to Employees and New Care Delivery Models at a Provider Organization, With Ashleigh Gunter

People are averse to change. It’s a thing. It’s a thing that affects even those of us who consider ourselves highly educated and/or very smart. Nobody likes disruption or, even worse, the prospect of disruption and the uncertainty that goes along with that. Nobody likes to feel like the rug just got pulled out from under them or that they’ve lost control of something, especially something important like their health benefits or how they care for patients.

Changes to health insurance and healthcare, from any angle, are fraught with stress. A big reason for this is because health and healthcare are filled with so-called “one-way-door” types of decisions and decision points. If I cannot get the care I need today, or if the care I want to provide today to a patient does not go as desired, I feel like the door is one-way: Once I make a decision, I cannot go back. I can’t click “undo” on that and go back through the door and arrive at yesterday.

Health decisions, therefore, have a very “you got one shot at this” kind of feel. And it’s that, right there, that just upped the ante considerably in the stress department for employees and then also for any clinician who is working with patients.

It’s life or death, and this is why making changes either to the insurance side or the care side of the equation feels like they will be so disruptive. It’s a big reason why some self-insured employers or even fully insured employers won’t mess with the status quo benefit designs or switch up their EBC (employee benefit consultant) or their ASO/TPA (Administrative Services Only/Third-Party Administrator), even if everybody in the entire company is currently complaining about the price and complexity of said status quo (it’s kind of like the devil that you know) and even if it’s possible to offer employees overall better-quality care at lower prices, meaning that everybody in the company could get a raise funded by the sometimes massive savings that could be had. I just heard a union leader the other day, and she said that every worker would have an extra $5000 in their pocket if their healthcare costs were what they should be.

So, for many employers, the prospect of disruption is just too much. It’s not in the CHRO’s (chief human resources officer’s) job description to open that Pandora’s box. Nobody gets fired for doing what they did last year—I guess, until they do (one straw or another is gonna break the camel’s back, after all). But in the meantime, we have this fear-induced festering inertia.

Let me just point out one thing: Implicit in everything that I just said is the notion that one day everyone will have their familiar insurance card snugly tucked in their wallet, and then the next day, it will be ripped from their bloody fingers in a violent and unexpected fashion.

Or, let’s talk about provider organizations now. Say one’s trying to move from the world of fee for service to the world of value-based payment structures with downstream risk, or direct contracts with employers. To do this well, let’s chat about one aspect of this that health systems seem to struggle with that’s been a topic of some conversation lately.

There’s an article cautioning that “practicing at the top of one’s license” and its attendant need for team-based care is a giant fail and/or a money grab, or it could be. And it could be both of these things, don’t get me wrong. Team-based care isn’t a homogeneous construct. It would be like saying that all movies are bad because Super Baby Geniuses 2 was such a dog.  

I mean, team-based care—pretty much like team-based anything—if it’s not implemented well, nobody on the team knows what they’re supposed to be doing and nobody is accountable. There’s no infrastructure supporting it. There was no testing or iteration or discussion about the intent. No one actually on the proposed teams was even consulted about the whole idea. And so, everyone starts to suspect, maybe rightfully or maybe not, that it’s all financially driven and a cost-cutting exercise.

On the show today, my guest, Ashleigh Gunter, warns about all of these exact things. You switch something up without going through the proper steps and stages, everybody gets very suspicious. And, nothing for nothing, their suspicion could be the least of the leader’s problems. The initiative’s ensuing failure maybe should be their biggest concern.

Which is a shame if something was done in the spirit of better patient care, for example, because there’s tons of research on the immense power of well-functioning teams as just continuing this one example. And there’s just as much research and well-proven case studies showing that innovative benefit designs can be a 365-degree win when they cut out wasteful spending and navigate employees and plan members to high-value care.

For all of these reasons and more, I wanted to get Ashleigh Gunter, who is an expert in change management, on the show to talk about how to succeed when you want to change something as touchy as healthcare and health insurance.

This all really goes back to the show with Matt Anderson, MD, MBA (EP266) and what Robert Pearl, MD, writes about all the time. It’s a skill we all need to learn to lead change. Many of us had to learn this the hard way because we see our vision so clearly and we want to make it a reality as fast as possible, but the result of our enthusiasm might be that we skip implementation steps that are really not optional.  

As Thomas Edison said (and I love this), “Having a vision for what you want is not enough. Vision without execution is hallucination.”

So, to transform anything effectively, we have to put as much effort into the implementation as we do into the strategy. If we don’t do that, then sadly, despite all of the best intentions, whatever we’re trying to do is not gonna work and it might be labeled disruptive.

So, I couldn’t be more pleased to have learned a thing or two from Ashleigh Gunter about change management that avoids this disruption label. Ashleigh Gunter is president of Translucent Healthcare Consulting. She also is an expert in change management as aforementioned and how to help align employees and staff so that an organization can move forward together.

According to Ashleigh, there’s five steps to effective change management that will ensure success:

1. Having great leadership
2. Creating a case for the change
3. Finding champions, engaging people who have to change so that they can contribute and be supportive
4. Overcommunicating
5. Measuring how things are going and also celebrating small triumphs

You can learn more at translucenthc.com. 

Ashleigh Gunter, president of Translucent Healthcare Consulting, combines her experience, an understanding of organizational culture, and a practical mindset to meet her clients’ needs. With over 30 years of management consulting experience, Ashleigh has deep expertise in advising in the dramatically changing healthcare market.

Ashleigh specializes in helping her clients drive change within their health plans, resulting in increased employee engagement, improved human resources experience, and reduced cost for both the employer and the employee. She believes in challenging the status quo by creating direct relationships between employers and providers.

Ashleigh has been a key contributor to several community-owned health plans in states from Washington to Virginia and has been credited with being key to employee participation and support of the plans.

In working for Andersen Consulting/Accenture, Deloitte Consulting, and The Gunter Group, Ashleigh has provided advice and consulting support to Fortune 100 C-suite executives over her career. She has an MBA with a focus in strategic management and organizational change from the University of Texas at Austin and a bachelor’s degree in business administration from the University of Denver with a concentration in finance.

07:46 How does change management go wrong in healthcare?
08:27 “Communication [of change] in and of itself isn’t change management.”
10:03 What is change management?
11:06 What does great leadership look like in change management?
12:29 “Leadership sets the tone.”
12:38 What makes change management so hard?
13:27 “What’s the company reason to make this change happen?”
15:57 What are change champions, and why do you need to create them when changing your benefit plan?
19:18 Why is it important to overcommunicate change?
22:46 Why is it important to measure your successes and communicate those after a change?
24:14 How does change management work on the provider organization side?
28:53 “You want to ensure you are educating the operational folks.”

You can learn more at translucenthc.com.