1. How bad is employee motivation and engagement as revealed by the Exhibit?
2. What actions can management take to increase motivation?
3. Should management focus on intrinsic, or extrinsic, motivators in attempting to enhance the motivation and engagement level of these HMO workers?

Peggy Bates is the CEO of a regional HMO (health maintenance organization) with 25 local offices serving business and nonprofit organizations. The competition for business has become more intense in recent years as organizations continue to look for ways to reduce costs for medical and dental insurance.
A particular concern is that a given company might shift to another HMO if that healthcare provider can offer lower costs. Peggy expressed her concern at a meeting with the management staff in these words: “I think our HMO could provide better service and lower costs if our employees put in more effort. A lot of the employees I have seen are so laid back, and almost indifferent. They don’t seem to have a sense of urgency.