an israeli ad agency charged with getting drivers to pay closer attention to stop signs did so by slightly shifting what drivers expect to see. instead of the hand featured in the customary sign, they featured a hand with a raised middle finger. drivers probably stopped to confirm what they saw. (and to take a photo.)

communication bottom line: you can arrest attention with the slightest shift away from the routine and expected.

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hat tip: some signs can’t be ignored, osocio

regular employees and “people like me” are once again among our top three most trusted, credible sources, according to the 2012 edelman trust barometer. they’re back in the limelight after fading away last year, somehow losing ground to CEOs. but this year, things look much as they did in 2004, when regular folk vaulted to the top of the heap of credible spokespeople.

in health communication, the regular joe or jane has continuously held a starring role. while we defer to medical professionals for information about health treatment, susannah fox of the pew internet & american life project has written that we look to people in our shoes—people like me—for emotional support and empathy, encouragement and care. this is particularly true for those who are living with a chronic condition, are acting as caregiver or have experienced a medical crisis. it’s also true for those who have gained weight, had a pregnancy or quit smoking.

maybe steve jobs was right. he (in)famously said you can’t design for customers because they don’t know what they want. or if you design for them, they’ll want something new by the time you have your product built.

i’m wondering if there’s something to this, particularly when it comes to health. i was struck by this idea while reading about the brain-dead design of myplate. myplate is the government’s latest visual representation of what we should eat. and it’s pretty simple. it shows you proportionally what you should eat from which category.

but researchers have come out against it, saying myplate needs to include more. more details. more data. more guidance. just more. that’s what the people-on-the-street say in the video below, too.

they say my plate’s “not clear enough.” “maybe more details on charts” would ensure we ate our five fruits and veggies. maybe myplate should offer “numbers, data…how many servings we can have.”

but do we really want more data? we’re not so good with the data we have. those interviewed didn’t know the number of food groups. granted, some of  their recall error is the residue of previous food pyramids, but we’re stumped by too much data. we’re investigating simplifying nutrition labels and energy bills to make it easier, not more complex.

the current myplate is an image i can hold in my mind’s eye and work with. i may eat canned peaches in light syrup—not as good as raw fruit, of course—but i’d be eating fruit, because i know fruit makes up a big part of this plate. would statistics or portion sizes or any other data be necessary to make this requirement clearer?

maybe the government was following in jobs’ venerable footsteps. they decided we don’t know what we want. they just gave it to us. perhaps that’s an approach we should be considering more, not less.

we’ll be talking about giving employees what they need versus what they want during november’s cohealth tweet chat. join us on wednesday, november 16 at noon on twitter.

Untitled from Cliff Kuang on Vimeo.

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related articles:

• dr. marion nestle weighs in on myplate vs. harvard healthy eating plate
• sign, sign, everywhere a sign. do this, don’t do that, can’t you read the sign?
• can your cafeteria receipt change your eating habits?

a roundup of last week’s news that caught my interest.

1. worker costs rise. don’t expect salaries to

the connection between rising health care costs and stagnant wages and job creation is one you won’t frequently find discussed in corporate america’s messaging about health benefits. yet this causal relationship is critical for employees to understand. do your communications touch on it?

“The trouble is, this means employers are paying more for workers without actually paying their workers more. Higher benefit costs eat into profits without directly raising a company’s output in the way hiring more workers would. In fact, this can actually discourage hiring. And the more that companies have to spend on benefits, the less take-home pay goes to workers. This undermines the virtuous cycle of consumer spending and job growth needed to help lower the 9.1% unemployment rate.”

2. premiums, deductibles and cost sharing in employer health plans keep rising

i pulled a number of slides from the kaiser family foundation’s annual survey of employer health benefits for my post on walmart’s rollback. this article reviews the overall findings from this survey.

“But…coverage won’t come cheap, as premiums, deductibles and cost sharing continue to rise, sometimes even more steeply than in previous years. More employers are also moving to high-deductible plans that shift increasing expenses onto their employees, requiring them to pay more before benefits kick in. And companies are making it pricier to insure spouses and children.

“There is a bright spot, however: Employees who participate in the increasing number of company wellness programs can often reduce premium and other cost increases.”

 3. push for health-cost data

“gimme my damn data!” is the e-patient’s cry. e-patients know that having their own health data allows them to more successfully navigate the health care system and manage their care. this article shows how “gimme my damn data” is becoming the employer’s cry too. employers want pricing data available to their employees so their employees, in turn, can become better informed, better equipped health care consumers.

“But Web services that reveal health-care pricing typically have to be built using data that are collected by the health insurers, which are generally the ones processing medical bills for an employer’s workers. Some, such as Aetna Inc. and Cigna Corp., are sharing at least certain information with third-party firms when clients ask them to do so. In other cases, according to benefits consultants, vendors and employers, insurers are declining to let the information be handed over to the outside companies.”

4. investment guidance for employees long overdue

if you’ve managed or written financial communications, then you know most include a line that goes something like this: “X Company does not provide financial advice. be sure to review your personal goals with a financial advisor.” this lack of personal advice left many employees bewildered or among the ranks of nonparticipants. that’s changing, with a new law going into effect december 27.

“That’s what’s changing. Now companies, under the new exemption, can arrange for workers to get specific advice from the firm running their plan as long as the advice is based on a computer model certified as unbiased and as applying generally accepted investment theories, or the adviser is compensated on a ‘level-fee’ basis, meaning the fees do not vary based on investments selected by the plan participant.”

5. incentives & communication drive higher participation for marsh & mclennan companies

cohealth member ray goldberg explains how his company approached the design and launch of their wellness effort, healthy me. he offers many transferable lessons, like this:

“We offered a $150 incentive to colleagues, spouses and domestic partners enrolled in our health plan—but with a twist: To receive the incentive, participants had to complete the health assessment andcall to speak with a health adviser to discuss the results.

“Why did we do it this way? We had two objectives—to capture data on our health risks that didn’t show up in health claims, and to get participants to manage their health risks through coaching. In this approach, it’s easy for the participant to reach the health adviser—much easier than the reverse. And when they make that call, participants are expecting to discuss their health, so we expected they’d be more open to the idea of health coaching.”

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more and more employers are moving their benefits communications and enrollment process online. all things being equal, this makes sense when you consider the ease of updating, the number of homes with internet access and the number of americans who use a smartphone.

but all things are not equal. take a look at this map that compares internet speeds for residential customers. seconds might seem a minor inconvenience, until those seconds stretch into minutes stretch into crashes.

internet speeds in america

internet access plays an increasingly crucial role in how well we take care of our health. when people are online, they’re more connected, more engaged and more likely to actively manage their health. that’s why programs like comcast’s $9.95 internet access offer to lower-income families is a huge deal. (this offer was required for a merger approval. still, it’s definitely a case of the people winning.)

that’s also why employers need to think through their game plan for employees in rural areas, in particular. with slow or no access, increased prevalence of obesity and other health hurdles, these employees may never make the health strides they and their company want.

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this ad can be taken in all sorts of ways. that’s part of its cleverness. it gets you thinking and your tongue a-waggin’.

of course you can continue using stock photos and stock phrases. just expect to be mocked and pilloried.

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communications your employees crave is an ongoing series. if you have an ad worth sharing, email it to me.

when it comes to communicating about workplace wellness, there’s some debate about what the company’s message should be. some say a company should never mention costs. the messaging should focus instead on family, retirement dreams, being around to see the grandkids. “XYZ company offers health benefits to help you reach your dream—whatever that dream is.” sound familiar?

the logic is that employees aren’t really interested in their company’s costs. plus, they can avoid potential accusations of ulterior motives.

frankly, this logic falls flat for me and presents a few inherent problems.

it doesn’t give employees a heck of a lot of credit. employees understand what’s driving their employer’s interest in their well-being. they even feel something approaching empathy for their company’s situation. in a kaiser family foundation poll, two out of three employees said “they were offered the best coverage the company could afford given financial circumstances.”

it ignores that employees want the dots connected. employees are all for wellness efforts that help lower premiums. in this same kaiser poll, 68 percent said they’d participate in a wellness effort if it meant lower premiums. they understand that wellness is a business equation. it’s an investment like any other, with productivity, absenteeism, engagement, retention and lowered health care bills as the company ROI, flat-lined or minimized cost-shifting and continued career opportunity as the employee ROI.

it turns health communications into corporate spin. reading a message of “we care about your health” doesn’t pass muster when leaders aren’t ferreting out the cultural and environmental stressors that lead to poor well-being. it’s immediately questionable, and so is everything else along with it, such as health privacy—an assurance companies can’t afford to have questioned.

workplace wellness isn’t only about cost, and it isn’t solely about employees being alive to see their grandkids. it’s about all of this—maybe more virtuous, maybe less, depending on the company. the magic is in bringing together these two important messages in how companies deliver workplace wellness and how they communicate about it.

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i’ve stumbled across some fantastic health communications lately. here’s one. this is what your employees see every day…outside of the office.

it’s time to put away the goldfish and telescope, people. let’s grab employee communications by the nuts.

i’ll be sharing great communications as i come across them. if you have one worth sharing, send it to me at fran [at] contextcommunication [dot] com.

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p.s. i can vouch for kind bars. they are tasty.

helena and theresa were telling me of a woman who’d recently suffered a major loss. a nuclear family member died, and this woman was grieving. theresa was working with the woman to manage her diabetes; helena to cope with tobacco cravings. neither knew of her loss. it wasn’t until a scheduled call with helena that the woman shared this information. she was concerned that her grief and stress would undo the work she’d done to quit tobacco. helena offered to connect the woman with a behavioral specialist while they crafted strategies to help her stay steady, tobacco-wise. the woman agreed to the suggestion. then helena told me how, behind the scenes, she connected with the behavioral specialist and looped in theresa, and how together these three brainstormed ideas and prepared for their next coaching call. this woman had a team thinking about her different but connected needs. possibly even more important at this particular time, she only had to tell her story once.

it’s this level of care, compassion and coordination that makes the IPHT stand out. the IPHT brings together nutritionists, fitness experts, psychologists, social workers, nurses, and case and lifestyle managers to form a health posse that works one-on-one with employees. this health posse helps employees recover more quickly and safely from surgery, quit tobacco, ease stress, eat better or come to grips with a chronic condition. but it’s real strength is in supporting employees when several of these threads come together, or unravel.

i met with theresa, helena and several other IPHT coaches when i was onsite at cigna’s eden praire location. i was there to manage a photo and video shoot with the coaches dedicated to my client. we’re creating several communication pieces to introduce employees to the service—more specifically, to the coaches. they’re the real stars of the show, and we made them just that during our amazing shoot. (our photographer can make your handsome aunt agnes look better than kate moss. i’m still pondering why i declined my turn in front of the klieg lights.) we also wanted to capture their stories—who they are, what they love about coaching, who’s touched their lives—so employees see the human side of cigna.

that human side interests my client. so does the business side. and there’s a real business side to providing integrated health services. in bringing all of the cigna health partners under one roof, cigna makes it easier for an employee to use these services—and more likely to use them as well. an employee can call the IPHT, or the coaches may reach out to an employee directly. during a first call, a coach creates an employee’s health profile and then crafts a plan that may involve several specialists over time. the employee’s always in charge and can decline a service, but through the scheduled, regular calls it’s more likely that an employee will build trust and expand his or her work with the team. jane davidson, a cigna clinical consultant, shared that the IPHT approach has led to:

• 72% of those with chronic conditions were open to additional health improvement programs and support
• 24% of those identified as having chronic conditions go on to engage in coaching
• 96% of those participating in coaching took action to improve their health
• 72% of those people met or progressed to their goals
• 2 out of 3 of those with chronic diseases choose to focus on additional health priorities

in turn, the action leads to results. when compared to those in a more traditional approach to health management, employees who worked with the IPHT are twice as likely to shift from high- or medium-risk to low risk. they’re also more likely to be medically compliant. employees being coached for obesity were 10% more likely to adhere to glucose testing. employees with diabetes were 7% more likely to get their HbA1c testing. as the coaching lowers health risks, it also lowers the need for high-cost health services. employees working with the IPHT have a:

• 12% reduction in the use of all non-primary care services
• 3% reduction in the number of ER visits
• 2% decline in overall hospital admissions

that’s a benefit that pays back cigna, my client, the employee and the employee’s family in immeasurable ways. cigna launched their integrated personal health team in 2008 to provide a more holistic approach to health, not solely a treatment for illness. i’d also say it’s a more human approach. the women i met in eden prairie are passionate, knowledgeable and dedicated. they put a new face on insurance. and we want to show that face…beautifully.

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i’m at j. boye philadelphia 2011 today. i’m there to learn about a better user experience and ehealth innovations from my friends, beth gleba and jane sarasohn-kahn and other similarly amazing, smart people. i’m also there to give this presentation.