The case study was developed by Janet McNichol, the director of human resources at the American Speech-Hearing-Language Association (ASHA) in an effort to craft a new health plan.
Workers were split up into small groups to discuss what types of care they valued most and least as well as what they were willing to spend. Guiding their discussion was a game board including 12 categories of health care (maternity, mental, primary care, etc.) along with different levels of service (good, better, best).
They were also provided “markers” that served as currency. To provide “best” level coverage in all 12 categories would require 72 markers, but the participants were only provided 55, forcing them to make decisions about which type of care they valued most.
The employees were first asked to design a health plan for themselves, based on what they desired most in terms of care. Next, they were put into a group of 12 to 24 people and asked to develop a consensus on the best health plan for the group.
Comparing the individual plans to the group plans, it’s clear that many employees were willing to reduce a benefit that they valued personally in order to boost a benefit that is critical to their colleagues. For instance, while many employees prioritized vision care in their individual plans, all of the group plans assigned vision care the lowest value. Similarly, while roughly half of individuals said they only wanted “good” maternity care, the great majority of group plans decided on providing “better” maternity care.
Surveys taken after the activity show that 91 percent of employees were satisfied with the individual plan they created and 82 percent were happy with the plan crafted by the group. About half said they would be willing to spend more per month—$38 on average—to enhance their benefits.
“This analysis provides an empirical example of an employer successfully engaging its employees in a discussion of both population-level and coverage-level tradeoffs,” wrote McNichol and her co-authors in Health Affairs. “This type of consultative and deliberative process, appropriately modified for different circumstances and beneficiary groups, could be useful for broader discussion of health care spending tradeoffs.”