Anthony: Hi everyone This is Anthony Diaz with The #PopHealth Show and this show is for anyone that has a passion for making others in this world healthier. Really super excited today to have Eric Severson on this show. Eric is the Chief People Officer at Davita, and he has a really interesting perspective from a people process perspective, you know a variety of companies he's been with and this is a topic on the show we wanted to go deeper on. But I won't steal his thunder. Eric thank you so much for being on the show. It's great to have you.

Eric: Thanks so much for having me Anthony. I really look forward to the conversation.
 

Anthony: Thanks so much Eric. Yeah, I know this is great and you know obviously you know you've listened to the show and you're familiar with the story format. Most important part is origin stories and we love to hear about you know I would love to hear about your origin story. How did you get started? How did you get into the space that you're in.
 

Eric: Sure. It's nontraditional, so I grew up on a farm in rural Pennsylvania and a big part of my early life was caring for animals’ horses, pigs, etc. And I had made it my determination to be a veterinarian because I was really interested in how you could use science not only to help animals be well, but actually to get better performance out of animals. Because I also coached children on showjumping and make a long story short after interning at a vet's office and discovering that it was a lot bloodier and sadder than I expected. I turned my attention more to human development and ended up in business. And when I got into business I figured out that the part of the business that was really focused on helping people reach their full potential was what at the time personnel emerged into human resources and now we tend to refer to it as people operations or people services, help people services here at Davita. So that's how I ended up in this part of the business and I spent the last nearly 30 years focused on how in businesses you can create a virtuous ecosystem where all of the stakeholders involved. The shareholders customers or patients and the teammates can be better and better off because of their interaction together.
 

Anthony: Super interesting background and it's a blessing that you've been led into this space and you know to focus on people and whether it's people services Eric or just you know managing people or people processes what have you found to be the difference that makes a difference like with dealing with people and all the different constituents out there? Maybe you can share some of your mindsets and philosophies of what you've seen that makes a really good people service process.
 

Eric: Sure. I think it starts with viewing human processes as a virtuous cycle rather than a zero-sum game. So traditionally in business there's an assumption that any investment you make in the core business is subtracted from what you can invest in people and vice versa. So can you invest in people somehow takes away from your product or your service environment and that does not have to be true. So kind of my mantra in my whole career has been how might I help a business that exists to provide financial well-being for the stakeholders like shareholders. I'm always reminded shareholders are not just some incredibly rich people somewhere. Its every one of us who has a 401K account relies on appreciation in the market for our financial well-being and our future. So we have an obligation if you're a public company to your shareholders to help them create financial well-being for their investment. And how do you do that through creating teammates who contribute more and more value financially and otherwise. And so my contribution to that as the chief people officer is to help the leaders of the business define strategies and operations that operationalize the focus on teammates well-being. So many many years ago Series became famous for publishing its service profit chain concept. Which was that when you invest in the well-being and development of teammates, that translates to customer well-being, which translates to PML thriving. And it's been well validated over time and so simply my goal was just about how do I help the business continually find ways that our teammates here can say I am better as a person. I am a better teammate, I'm a better parent, I am a better spouse because of things I learned at Davita. Teammate who will say that well established are they contribute more discretionary effort; they stay longer, and they provide better service to your patients or your customers.
 

Anthony: Super, super interesting science there and you hit upon some interesting themes of contribution benefits well-being. Correlation to great well-being and health outcomes and productivity and profitability. But on some of these things or maybe outside of them what are some other themes in health or well-being that have you passionate today and maybe you can go deeper on a few elements that have you passionate these days.
 

Eric: So I’ll kind of start with three and they're progressive for me. There's one that I think is well established today and we're very focused on it here at Davita and that's integrated health and well-being. Second is predictive health so it's using big data advanced analytics to help avoid catastrophic health events. Which creates well-being both financially for organizations as well as for patients’ individuals and that's starting. But a little bit more in the future and then finally I think it's farther out establishing what the mind body connection is and really focusing many more resources, time and effort on Healthy Minds which lead to healthy body. So I'd start with integrated health and say that I think this is a concept that's pretty well established however not ubiquitous and as an organization that provides dialysis care to patients and a number of countries around the world, we're very focused and having for many years on how we can provide integrated care for our patients and I’ve had a number of initiatives over the years to do so in partnership with the Center for Medicare Medicaid Services and others producing really substantially positive and statistically significant health care outcomes for patients. And it's basically the idea that if a patient is going to come and sit with you as ours do generally three times a week four hours at a session, it's the opportunity to be able to treat that patient as a whole person and everything she might be presenting and all comorbidities. Whether it might be cardiac disease or diabetes or hypertension etc. And the data is well established that integrated approaches to medicine as opposed to segregated ones tend to produce better outcomes and we take the same approach with our teammates. So increasingly we've been investing over the years in ways that we can help teammates be well and mind body spirit and emotions. And it shows up at a lot of different programs. So for example we have a program called Village vitality where our teammates can actually reduce their medical premiums simply by engaging in healthy preventative behaviors like screenings etc. We have a program we've been running for 10 years called match the mayor, where our CEO who is he may be familiar with Davita we call ourselves the village in our CEO is our mayor and the mayor leads every year a well-being challenge and teammates can participate in any way that's meaningful. It can be a meditation challenge; it can be a physical exercise challenge. It can be a nutrition challenge and teammates engage through an app where we're all encouraging each other to reach our goal and we track steps in the many millions of steps to the cause of well-being in the village. What's important about that program is it is a good example of how leadership, sponsorship of health and well-being is important to create well-being outcomes in organizations like ours. So there are many other things like that, where they are testing an app right now called Pongo that will help teammates make smarter eating choices and there are many additional things. But I think that the point of the conversation is that organizations and in general and organizations in particular who are providers of medical benefits have a lot of influence in teammates lives and can use that for the positive by providing many different avenues for different people with different life choices to change their habits of living in a positive way.

Anthony: Yes super exciting and very innovative and creative and not just the execution of the integrated in my body, spirit connection and the predictive components you're doing through your people and for obviously for your clients. You know and so you definitely feel like, it feels like you're on the forefront of a lot of employer well-being dimensions. We have a lot of listeners that are like Chief Employee Experience Officers, chief people officers, chief human resource officers, head of benefits. If you were talking to those people directly and they may have struggles in you know taking their employer or well-being programs to the next level, what are some pieces of advice or mindsets that you would do. I think you've touched on a few of those already. But what are what are some other prescriptive things that you would want to uncover in giving advice to others that are really taking, trying to take their programs to the next level?
 

Eric: I would invest in getting a deep understanding of root cause. And by that, I mean the root cause of lack of well-being in your workforce and root cause of well-being. And that means harnessing in today's world the power of predictive diagnostics and predictive analytics. In Davita, we accomplish that a number of ways. So one is through our partnership with an outside consultant who helps us look at all of our claims data. And we're self-insured like most large companies and we manage close to half a billion dollar of risk a year. And inside that risk number is a whole lot of data points about all the people who had claims of any sort from prescriptions to hospital visits to doctor visits that we can't look at on an individual basis. That's private health information. However, as big data IS anonymized, third parties can help us understand ways that we can help teammates make better decisions that are better for them and better for the whole to beat a village from a financial perspective. Because one of the things that's true about teammate wellbeing and health within companies who provide medical benefits is that most of the time in almost all cases reducing costs overall by reducing claims is not only good for the bottom line of the company, it's good for teammates. Because high claim costs equate to bad outcomes. So the largest claims in a medical claims profile are from serious things like heart attacks and incidences of cancer etc., teammates don't want that, and we don't want that. So by reducing those, it's good for the whole system and predictive analytics allow you to look at big data sets and figure out are there indicators that someone could be becoming sick where you can alert them earlier and intervene at a point where the treatment options are more favorable. Where they could head off a heart attack or they could head off development for diabetes and I would say just an example for myself I entered a program 10 years ago that screened in a number of different kinds of age related disease management factors and discovered that I was developing diabetes and had no idea. Didn't show up in a regular screening that I was doing, as a result have managed to hold it at bay and never fully move 100 percent from high blood sugar into full on diabetes and I am confident that that would not have happened to but for that intervention. So I'm a big believer in using the power of analytics to be able to help people become healthier earlier before they encounter a serious health crisis. So I would say my answer is if you're not really knowledgeable about big data and advanced analytics, it's not that hard to get knowledgeable. Listen to podcasts, read articles, make some demo appointments with vendors. We work with vendors who help us identify opportunities. One of them for example called Levi not only helps us identify trends in the data that we can use to help teammates change their behavior, but it also will personalize messaging directed to specific teammates based on their use of health care to help them make better decisions. For example, it will the app can potentially know for instance if somebody is developing a certain condition. We won't know but the app can know, and it can provide them with marketing communication to let them know about programs that will benefit them. If someone is for example potential to become a new mother, it can let her know about half a dozen different programs we have. Baby program, our little star program for new mothers etc. etc. that will benefit them
 

Anthony: Super, super interesting. So yeah congratulations on the success of like implementing you know there's so many like Chief People Officers and so many companies that know you know you need to get deeper on the claims and analyze them and apply predictions and programming. I guess for those out there that are able to get leadership involvement right. And so you have the mayor and village concept so let's just say you know other chief people officers can get that level of engagement with the leadership, the support, they are analyzing their claims and maybe they have some inklings of predictions on where the claims are coming from. When it comes to taking action and programming you guys have some really cool innovative programs. Some would say there's still like humanity that gets in the way. So like how do you get employees to engage in all these programs, understand them and nudge them to do the right things at the right time? What are some other like you know differences that make the difference you've seen in employer Wellbeing Programming?
 

Eric: One I would say is really getting knowledgeable about evidence-based change programs. There are countless apps you can buy to help your workforce change behavior. But unless your teammates are really motivated to adopt them, it's not going to make any difference. So increasingly there are some evidence-based programs that go beyond just information and knowledge and gamification to more high touch management. So for example we have a program called O'Mara for teammates who through biometrics have identified high blood sugar and a risk for diabetes and what O'Mara does it's a combination of a cohort approach where teammates are in a team with other teammates with a coach for a multi week program and there's measurement. So essentially research has shown that when someone has a health condition and you combine giving them continuous access to how they're doing, in other words like data on their phone that shows, "you lost two pounds this week or your blood sugar improved by five points." People are more likely to stick with it. It's also proven that when people go through that program in a cohort with others, they do better when they're on their own. Thirdly that when they have a real human coach and not simply an app they do better. It's a combination of things that for us has yielded very specific and statistically significant quantitative improvement and outcomes for participants. That obviously improves those teammates lives. They lose weight, they don't progress in their blood sugar elevation and for us that means that we're improving our overall claims costs so that we can redirect money towards prevention and other things instead of high cost treatment claims. I think that's just a good example it's doing your homework on what's evidence based, not just what's well marketed
 

Anthony: Right. Right. Now it's super interesting, yeah very familiar with the model. And you know I’ve met the CEO a couple times really big fan of what they're doing and now it's super super exciting to hear about the programming that you guys are doing. But most importantly the formula on how you're putting this recipe together and getting your leadership a champion as well.

Eric: The only thing I would add Anthony to that is advice would be to it really experiment with performance guarantees in your contracts with providers. We increasingly are using performance guarantees in well-being related contracts to say all right in order for you to get your full fee, for us for your service, your app, our population, our target population must achieve these health outcomes or those claims cost reduction. So it must see an overall reduction in blood sugar of X or a weight of Y or it must cover a whatever have a million dollar claims cost reduction or something like that and the value of that is that you're making sure you are using products and services that work and it puts the pressure on the provider to make sure they work and on yourself. Which is really important. You don't want to waste your teammates times with things that are really lots of bells and whistles but aren't going to really help them.
 

Anthony: That's interesting on the performance level. What about participation and engagement? Do you tell your vendors you know hey you're one we need to see, because obviously if the funnel at the top isn’t full it's you know improving outcomes on just 5 percent of the Davita employees isn't going to maybe move the needle too much? But what are some reasonable expectations for a vendor that is supplying health engagement in terms of participation or engagement expectations that one should consider?

Eric: It's hard to give you an average. Because it will vary based on the type of application in the population you're targeting. What I would say is good performance guarantee targets include engagement rate, biometric improvement, cost reduction and then you would set the targets based on usually on unexperienced right. So how many people are in the population you're targeting, based on other programs you've had that are similar, what kind of participation rate did you get. Do you have reason to expect you'll get more, it's not an exact science but what you can do is improve it. You know what we generally do is we might ask for improvements in a year two, or year three of the contract that are incremental.
 

Anthony: This is super key, and this is greater. I think you've given some really good boundary lines of things to consider strategically for any anyone hat you know isn't responsible for well-being processes within people services in their company. These are some good dimensions for us to know that you've given us here. Let me ask you a little bit about the future. Tell us your vision of the future and when it comes to people services well-being. What has you excited about this space, maybe even some things that you believe that haven't been proven yet or somewhat think are crazy? So just love to hear your vision of the future.

Eric: I'm really excited about the potential in mind body connection and a lot of people say, well we all know that there is one etc. And I would agree with that and I would say that is not at all baked into how we manage health, how we incentivize health, how we pay for health and what's becoming increasingly clear is that most of the major medical conditions that drive most of the suffering and most of the cost in organizations and more broadly in society are outcomes of psychological and treatable psychological impairments or ailments. For example typically in many companies and it's true for us as well, our top claims, top high cost claims come from obesity. They come from mental health and they come from osteo related things. And in many of those there is a mind body connection. A very high incidence of depression and anxiety broadly in the culture and it's well established that those two conditions alone. Have a significant impact on the progression of heart disease and diabetes for example. And what I don't think is well established yet. And I would like to see much more rigorous work going on it is, what that connection is and how you design health plans to better treat those underlying conditions that accelerate the progression of the physical disease. I think we're regarding to see a lot of applications, a lot of programs trying to get at the problem but systemically I don't think it's well-established yet.
 

Anthony: Right. No, it's very interesting. Yeah, I agree with you totally. You know I started my career off working for managed mental health care company and got to see from a data perspective very early on. That connection of the mind and the body it all starts with the mind and I can imagine Eric you're like me you know you look at a lot of things like mindfulness and meditations and probably even the design around defeatist campuses on you know are there adequate spaces for you know breaking away or meditation areas and things like that. But anything along those lines, you know there's calm, there's headspace, there's yoga, there's resilience programs right, employer wellbeing programs specifically focus on resilience. Any specific programming elements or environmental things that you're seeing some promise to that maybe if you systematized them that they could amount to be something.
 

Eric: Sure. I mean all the things you mentioned are things that we do. So we use programming as part of our wisdom and curriculum, we call it here and the corporates mindfulness into many of our development programs. At our headquarters locations we have Zen rooms on every floor where teammates can meditate or get back to other mindfulness practices. It's core in many of the things we do we offer teammates access to applications that have meditation as an offering among other mindfulness practices. It's part of a set match the mayor and many other things. It's deep in our culture and I think that's important, it sends the right message to teammates that we value that. And I think especially in our business because the majority of our teammates are caregivers and that's very of right at times and I think we're doing all of that. And I would say the structure of how health care is provided in the United States. Is far far from treating mental health care with parity.

And so I think as an employee you do the best you can to make up for that deficit through the kinds of programming we are talking about and you can only get so much done until the system shifts and changes. When asking about the future that what I hope for the future is that there is some significant legislative and regulatory change that happens in the future to recognize the need to provide more funding and a different structure for how mental health care is provided in the US.

It's also something that's the least sort of systematized treatment of mental health. It's very regional, it's very local. You have virtually no sort of national providers of mental health services with evidence-based practices. And that's something that's that desperation like worked for or work on a board of a behavioral health provider for 15 years that specializes in evidence-based treatment of schizophrenia and bipolar disorder and what I observe firsthand when I was there is the dramatic difference in outcomes. I'm talking about really quantifiable things like hospitalization rates, high incarceration rates for example of those patients who had been through our evidence-based protocol vs. The standard protocol. And it really gave me passion about wanting everyone to have access to evidence-based treatment like that which is not the standard of care in the United States.
 

Anthony: It's super exciting and I definitely appreciate what you're doing and then and then obviously being in charge of people's services that obviously seems like you can get an interesting you know voice of the employee as well with other processes to understand the investment you're making in the space, not just hitting from a client's perspective. So, Eric I could probably talk to you forever. But we always want to give our listeners the morsel of the episode here says, apologies if we're going a few minutes over. But this has been very powerful. I appreciate your time. And you know one thing I always do with you know is you know for listeners out there that want to be able to engage with you or you connect with you, what's a good way for people to connect with you?
 

Eric: Sure. I think you can reach me at LinkedIn and it's "Eric Severson HR" LinkedIn and I look forward to engaging people there in an ongoing conversation on this topic.
 

Anthony: Great. Great. Eric thank you for being on this show and we love to have you back you know as you go throughout the year as you implement you know continue to grow and grow your programs and what you're doing, love to always hear about you know obviously what you're working on. Thank you for being on the show Eric.
 

Eric: Thanks so much Anthony. It's been an honor to participate.
 

Anthony: Great. Great. And to everyone out there, this is The #PopHealth Show. Thanks for listening.