Author: Charlotte Huff

Not losing talented women is only half the battle. Leaders at Booz Allen Hamilton have recently taken steps to reconnect with lost talent by offering recently departed employees–generally women at home with young children–short-term projects on a contract basis.

    Depending upon the project, the woman may work a couple days a week, during school hours or longer, says DeAnne Aguirre, a senior vice president and managing partner of the global organization and change leadership practice. Ideally, she says, the effort will coax some women back.

    “We have a tie to that person,” she says. “We are hoping what will happen is that five or six years from now, when they are looking to re-enter the workplace, they don’t even look anyplace else.”

    Booz Allen Hamilton is one of 19 U.S. and U.K. companies involved with the Hidden Brain Drain task force, formed last year in partnership with the nonprofit Center for Work-Life Policy. The group’s overall goal is to retain and nurture gifted female and minority employees. But that can’t be done effectively, Aguirre and other task force participants say, unless companies become better skilled at helping women manage pregnancies and other periodic timeouts that are likely to punctuate female careers.

    Aguirre recounts recently sitting at a table surrounded by powerful women–all partners at Booz Allen Hamilton. But few of their careers, they realized, had followed a clear linear path. Most listed eight or nine career interruptions as they strived to balance personal and professional demands. Aguirre describes her own story as a typical scenario. She’s had three pregnancies. (Her four children are all under age 8, including 6-year-old twins.) She’s attended business school. At one point, she moved to Brazil because of her husband’s job.

    “The male partners in the room, they are sitting there trying to think of one (career interruption),” recalls Aguirre. “Some of them moved offices. Other than that, they didn’t take time out.”

Hoping they won’t look
    It will take at least five years before the consulting firm knows whether the new initiative is recapturing previously lost talent, Aguirre says. But in the short term, the approach has provided the firm a cost-effective way to quickly tap a savvy talent pool, while simultaneously reaping a lot of good will, she says.

    “When we don’t need them (Booz Allen alums), we don’t have to pay them,” she says. “But when we are too busy, we call them and they do short projects–maybe three months and they are done. And they love it. And we love it.”

One-third of professional women drop out of the workforce at some point, most commonly for child care responsibilities, according to a survey of 2,443 women and 653 men sponsored by several members of the Hidden Brain Drain task force. They don’t stop working for long. The average departure is 2.2 years, but the evidence of bad blood is clear-cut.

    Just 5 percent of women surveyed–and none of those working in banking or finance– wanted to return to their previous employer.

    “They felt quite unsupported,” says Sylvia Ann Hewlett, president of the Center for Work-Life Policy and co-author of the survey’s results, published March in the Harvard Business Review. “They felt like they weren’t offered any flexibility. They felt like they weren’t valued as they left.”

    “One lesson to come out of this,” she says, “is that the terms of disengagement are very important.”

Time off for Olympics
    To both retain and rehire talented women, more companies need to offer some compromise between quitting and working on hyperdrive, says Hewlett, citing task force participant Ernst & Young as one role model. Since the mid-1990s, the accounting firm has offered a variety of flexible schedules, including reduced hours. By 2004, 24 percent of the firm’s managers and senior managers were boomerang employees–men and women who had left and rejoined the company–compared with 20 percent just five years before, according to Ernst & Young spokeswoman Ciara O’Sullivan.

    Since the early 1990s, Eli Lilly also has left the door open wider behind some departing employees, offering three years of dependent-care leave. The leave isn’t just offered for new moms, but for any parent with a child care issue, says Candice Lange, director of workforce partnering. One father requested the leave so his daughter could pursue Olympic training in another state.

    The pharmaceutical company, which also offers a variety of flexible work arrangements, doesn’t guarantee a job, Lange stresses. But officials strongly encourage former employees to reapply within the three-year window, Lange says. “We ask them to do two things: Keep their skills up, and stay in touch.”

    From 2000 through 2003, 470 employees have requested the family leave, according to Eli Lilly statistics. Of those, nearly one-third–141 employees–have returned. Ninety employees have permanently left the company.

Home for lunch
    Companies also can reach out to talented alums in other ways, Hewlett says, such as pairing former employees with a mentor so that they hear about networking and training opportunities. “Women are absolutely willing to put some of their own dollars into this,” Hewlett says. The issue, she says, is more “about having access to these things, because they feel so isolated.”

    Ani Singh, a consultant, was pregnant with her daughter when she lost her job during a 2002 round of layoffs at Booz Allen. While she enjoyed her time with her newborn, she always planned to resume her career. Once her daughter neared her first birthday, Singh started to network through Booz Allen contacts and the company’s online job postings. Then last year Aguirre got in touch, telling Singh about a Booz Allen educational client just 10 minutes from her suburban Washington home.

    The contract position, Singh says, keeps her tapped into the firm. “It provides me the opportunity to make contacts with people should I want to go back,” she says. And the hours “aren’t bad–approximately 50 hours a week,” allowing her to zip home for lunch some days.

Officials at Blue Cross and Blue Shield of North Carolina knew that 55 percent of the health plan’s 3 million members were overweight and getting heavier, pounds that weighed down the plan’s bottom line as much as the physicians’ scales. 

    Still, they hadn’t isolated the precise dollars involved until 2003, when they scrutinized medical costs and claims data for one-third of the members. What they discovered was a mindblower. Treating obese members cost at least 30 percent more than normal-weight members; the price difference for overweight members was 18 percent. For 2003 alone, those excess dollars reached $83 million.

    The bad news didn’t stop there. A member survey highlighted a yawning gap between perception and reality. Nearly one-third of overweight members described their weight as “just right.” So did 5 percent of obese enrollees. In short, what didn’t appear to be broken couldn’t be fixed.

    That’s when the Chapel Hill-based plan, the state’s largest insurer, decided to wade into the high-cost, high-stakes world of obesity treatment, rolling out a benefits package that observers describe as one of the most comprehensive available. Depending upon the size of their waistlines and commitment to overhauling their weighty habits, members can qualify for a spectrum of services from nutrition counseling to weight-loss drugs to bariatric surgery.

    “The goal is not to have vast numbers of our members lose 50 to 100 pounds,” says Betsy LaForge, who oversees the health plan’s prevention and health education programs. “It’s really to have members not gain any more or to lose 5 to 10 percent of their weight.”

    In the process, though, Blue Cross and Blue Shield of North Carolina is taking a sizable gamble. Health policy analysts and business groups, even those intrigued by the obesity initiative’s public health potential, describe research as mixed on the question of whether these sorts of disease management efforts save money over the long haul.

    In October, a Congressional Budget Office analysis looking at disease management’s potential in the Medicare program found that “evidence on cost savings is limited,’’ with few studies available.

    For employers and health plans alike, there’s also the reality of turnover. Your newly svelte enrollee may reap lower health bills five years from now–for your competitor, that is. Meanwhile, self-insured employers who buy into obesity packages such as Blue Cross and Blue Shield’s are literally footing the initial bill themselves and assuming the risk that the payoff will occur on their watch.

The North Carolina plan is unusually gutsy in its move to develop an obesity package and promote it so aggressively, says Helen Darling, president of the National Business Group on Health. “A lot of companies don’t advertise what they pay for because they don’t want a demand.”

    The North Carolina plan is unusually gutsy in its move to develop an obesity package and promote it so aggressively, says Helen Darling, president of the National Business Group on Health. “A lot of companies don’t advertise what they pay for because they don’t want a demand,” she says.

    But Darling cautions that plan officials must still make their business case to employers by developing a scientifically rigorous study to track results. Given rising health care costs, “no employer is going to knowingly add to benefits unless they were confident that there was a trade-off in terms of lower claims costs later,” she says.

    Executives at the insurer, who say they are developing such a controlled study, won’t detail their return-on-investment projections for the 1.1 million members who are eligible for the obesity package–primarily individual members and commercial enrollees. They say one problem is that they simply don’t know how many people will sign up.

    They maintain, though, that long-term savings will far outweigh upfront costs. “We are going to see savings on the medical side, but it’s not going to be next month or next year necessarily,” says Dr. Robert Harris, senior vice president and chief medical officer of Blue Cross and Blue Shield of North Carolina. “But it will come to pass.”

Early intervention
The plan has garnered significant publicity for the Cadillac end of the obesity package. Weight-loss drugs, after all, can approach $100 a month, and bariatric surgery can easily cost $35,000 to $40,000.

    But executives at the insurer argue that it’s the plan’s basic framework, with its emphasis on prevention and early intervention, that drives their confident, albeit confidential, projections. To enroll in the program, members must not only provide details about their height and weight, but also answer questions designed to assess their willingness to revamp their lifestyle, says Dr. Don Bradley, the health plan’s senior medical director.

   “Some people aren’t ready to do that,” he says. “Then it’s really wasted time and money.”

There’s no clear-cut answer at this point in time on how to manage weight because everyone is different. There are so many things that affect it (weight loss).

    During the pilot phase this past summer, 30,000 letters of invitation were mailed to members with diabetes and other high-risk conditions. By early November, 2,600 people had enrolled. Most are individually insured or employees in smaller businesses, as Blue Cross and Blue Shield had just started selling the plan to larger, self-insured employers.

    Once members demonstrate a commitment to weight loss, they will be mailed a package of health information, including a food diary and a personalized health assessment that will outline the potential risks associated with their body mass index and waist measurement, among other factors.

    In his first two months of participation, health plan member Robert Amato shed 31 pounds from his 378-pound frame. Using the food diary, he says, has helped keep him honest about what he’s putting into his body. The invitation “just came at the right time,” says Amato, who runs a small business. “I’m 64 years old. I’m overweight. I know from reading many things that I’m cutting years off my life.”

    By midyear, the program, Healthy Lifestyle Choices, will be made available to all 1.1 million eligible members. Additional medical benefits will kick in over the course of the year, with the exact dates depending upon the employee’s benefit cycle. In addition to the obesity surgery and weight-loss drugs, the plan will pay for four doctor visits annually to discuss obesity issues, along with dietitian counseling.

    Seven physician practices, with a total of 12 surgeons, have been designated as bariatric surgery centers of excellence in an effort to curtail rising complication rates.

The Obesity Train Wreck
    Employers and health plans aren’t just worried about today’s employees. The health profile of tomorrow’s workforce is even more dismal. More than 15 percent of adolescents are overweight, compared with 5 percent in the late 1970s.

    In 2000, overweight and obese Americans cost the U.S. economy an estimated $117 billion, according to a 2001 U.S. Surgeon General report. Of that total, $61 billion covered direct medical costs; the remainder accounted for indirect costs, such as lost work time, disability and lost income due to premature death.

    At this point, obesity intervention efforts have been more likely to fall under the umbrella of health improvement initiatives, such as fitness programs, says LuAnn Heinen, director of the Institute on the Costs and Health Effects of Obesity, part of the National Business Group on Health.

    Still, there has been a shift in the past year or so, with more progressive self-insured employers interested in covering weight-loss drugs and bariatric surgery, says Stephanie Pronk, a senior health care consultant at Watson Wyatt. One option for high-turnover industries, such as retail, is to design a benefit package that doesn’t pay for costly obesity interventions until the employee has worked beyond the typical turnover window.

    That way, Pronk says, “employers don’t feel like they are throwing money away and people are moving on.”

    Also, employers that have made more of an effort to tackle obesity–Heinen cites Union Pacific Railroad as one example–have high retention rates, with some companies hiring employees’ children and grandchildren, she says.

Weighing the Options
    Aetna, which is rolling out a pilot obesity program that includes its own workforce, already provides reduced-rate access to on-site fitness centers for its own employees. In 2003, those who made an effort to stay fit–using the centers at least twice a week–had pharmacy and medical costs that were $28 less per month than employees who didn’t use the centers but had a similar demographic background, says Jane Hopkins, Aetna’s director of benefits.

“If you’ve got an employee who is 10 pounds or 20 pounds or 30 pounds lighter three or four months down the road, that’s an immediate impact on morale and productivity.”

    A National Business Group on Health survey released last year found similar bottom-line fitness benefits. Twenty-seven percent of the 84 large companies reported that fitness initiatives helped reduce health care costs. The survey also revealed that jump-starting physical activity is far from easy. At two-thirds of the companies, less than one-fourth of employees participated.

    And footing the bill for drugs is no guarantee of substantial weight-loss success. A July 2004 report by the Agency for Healthcare Research and Quality found evidence of only modest success with orlistat (Xenical ) and sibutramine (Meridia), the two drugs covered by Blue Cross and Blue Shield of North Carolina. The weight loss attributable to the medications after 12 months was less than 13 pounds, a figure that nevertheless could be clinically significant, according to the report’s authors.

    Since the early 1990s, Union Pacific Railroad has offered a $2.5 million health promotion program to its 48,000 employees, along with their spouses. The program, which provides written information along with phone counseling, has reduced health claims related to lifestyle choices from 29 percent in 1990 to 18.8 percent in 2001, says Marcy Zauha, Union Pacific’s director of health and safety.

    But the company has only taken limited steps to cover weight-loss drugs and surgery. Self-insured plans for managers do cover surgery, but there’s no coverage for weight-loss drugs, and the HMO option doesn’t cover surgery either, according to a Union Pacific spokeswoman.

    More data is needed, Zauha says. The company participates in several weight-related studies, including one that’s following 225 employees who’ve been prescribed a weight-loss drug along with receiving behavioral modification. “There’s no clear-cut answer at this point in time on how to manage weight because everyone is different,” Zauha says. “There are so many things that affect it (weight loss).”

Surgical route
    Blue Cross and Blue Shield of North Carolina has covered bariatric surgery for at least 15 years, but the surgery’s popularity has surged only recently. In 2003, 495 surgeries were performed, compared with 75 just two years before, according to the plan’s claims data. During the first six months of 2004, 340 patients underwent the procedure. By the year’s end, nearly 700 patients were expected to have gotten the operation.

    When analyzing their own claims data, health plan officials also identified a significant correlation between a surgeon’s volume and results, says Bradley, the plan’s senior medical director.

    High-volume doctors, who averaged 35 surgeries in the previous year, had a 6.4 percent readmission rate within 60 days of a patient leaving the hospital, he says. Those with a limited track record, averaging just four surgeries, had an 11.7 percent complication rate. “This doesn’t mean these are bad surgeons,” Bradley says. “We view this as a learning curve.”

    The surgeons’ records were a significant part of the criteria used to develop the health plan’s list of centers of excellence. A physician advisory panel started with a list of 19 doctors who had performed 100 surgeries in the previous year for Blue Cross and Blue Shield patients, as well as members of other plans, according to spokeswoman Gayle Tuttle.

    The panel members also assessed the physicians’ ability to identify good surgical candidates. They visited their offices to gain insight into their sensitivity, Tuttle says: “Are the chairs big enough? Are the gowns big enough?”

    If the surgical results from the seven centers of excellence prove to be better, the plan then may provide financial incentives to steer patients to those practices, Bradley says. The hope is that other doctors performing bariatric surgery will improve their own results so they can be a designated center as well, he says.

    In making their case for the surgery’s health benefits, Blue Cross and Blue Shield officials cite a recent meta-analysis of 136 studies that was published in October in the Journal of the American Medical Association. The morbidly obese patients involved not only lost a lot of weight, often dropping more than 120 pounds, but also saw improvement in diabetes, blood pressure and sleep apnea. The diabetes benefits alone were particularly dramatic: Three-fourths experienced a complete reversal of the risky health condition.

    Employers are not necessarily convinced. In 2003, 52 percent of employers didn’t cover bariatric surgery at all, according to Mercer Human Resource Consulting’s annual survey of employer-sponsored plans. An additional 18 percent required criteria to be met.

    Some of the bariatric surgery debate boils down to a difference in perception, says Watson Wyatt’s Pronk. When obesity is not viewed as a disease, that influences employers’ thinking.

    “We cover coronary bypass surgery without blinking an eye,” she says. “That surgery costs roughly twice as much as bariatric surgery. If people don’t do the right thing (healthwise) after bypass surgery, in seven to 10 years they will be back in for another $40,000 to $50,000 procedure, and we never question that.”

Selling the Plan
    In November, Michael Roach and his team of 35 account managers started selling the new Healthy Lifestyle Choices program to the plan’s self-insured clients. In meetings with more than 200 businesses, including about 20 Fortune 500 companies, they will outline the obesity costs of doing business.

    For example, the health plan can compile a company’s diabetes-related claims and show how obesity drives up those costs, says Roach, vice president of national accounts. They also are discussing potential incentives for the program’s pioneers. One possibility would be to waive the administrative costs for the obesity benefits when a company signs on, Roach says.

    Frontier Spinning Mills, a North Carolina manufacturer with 950 employees covered by Blue Cross and Blue Shield, was among the first self-insured employers to express interest. Employers can’t ignore the escalating cost of chronic, obesity-related illness, says Jim Powers, Frontier’s human resources director.

    True, some employees will inevitably move on, he says. (Frontier’s 2003 turnover rate was 18.2 percent.) “But I think that (the turnover issue) is a narrow way to look at it,” Power says. “You’ve got 18 percent of people who may leave, but 82 percent are going to stay.”

    For companies a little too cynical, or cost-strapped, to buy the public health argument, Roach points to more immediately visible results. “If you’ve got an employee who is 10 pounds or 20 pounds or 30 pounds lighter three or four months down the road, that’s an immediate impact on morale and productivity.”

    With no sign of a slimmer American workforce in sight, academics and health purchasers already know the weighty cost of inaction. The only question is which initiatives and what companies will forge the way.

Workforce Management, January 2005, pp. 47-51 — Subscribe Now!

In October, Aetna officials launched a pilot weight management program to determine if intensive education and support motivates hefty employees to shed pounds.

    The heaviest participants will be contacted at least 29 times a year, primarily by phone, with nutritionists, weight-loss counselors and nurses at the other end of the line, Aetna spokeswoman Susan Millerick says. Those who only need to lose a few pounds will hear from Aetna about half as often.

    Participants will also be provided pedometers and discounts to community weight-loss programs. The pilot initiative is being marketed to 35,000 employees working at Aetna and building materials manufacturer Owens Corning, Millerick says. In the first eight weeks, 400 people have expressed interest.

    “I look at obesity as causing so many other problems in our health care costs,” says Jane Hopkins, Aetna’s director of benefits. “If we can get people to manage that weight and be physically active, we are going to see decreases in medical costs.”

Uncovering other conditions
    Hopkins acknowledges that self-insured companies like Aetna face inherent risks when they aggressively treat obesity.

    A recent Congressional Budget Office report looking at the potential cost-effectiveness of disease management highlighted that dilemma. Most current studies don’t include the financial hit of unearthing other, heretofore unknown, medical conditions, the report’s authors wrote.

    Still, Hopkins would prefer identifying employees’ obesity-related health problems sooner rather than later. “If we happen to stumble across the fact that they have diabetes and hypertension, that’s a good thing. If we don’t find that, then they will have the stroke or heart attack and they will be more expensive down the line.”

Return on investment
    It’s too soon to speculate about the pilot program’s potential return on investment, Millerick says. Aetna officials plan to track both the program’s costs and clinical outcomes. But the real-life benefits of disease management are not necessarily limited to medical savings, she says.

    Aetna’s congestive heart failure program, for example, has a strong medical return on investment, with $3 in health costs saved for every $1 invested in the disease management program, Millerick says. On the other hand, the asthma program breaks even, with $1 saved in health costs for every $1 invested. But savvy employers understand the added value of boosted productivity, she says.

    “You have (asthmatic) children who are feeling better, so parents are at work,” Millerick says. “You have employees who are breathing better, who are at work. You will in fact have that employee in that chair that day.”

Being a great place to work  has long been part of the mission at London-based Eversheds. Now leaders of the international law firm, with some 4,000 lawyers and staffers across Europe and Asia, want to encourage their employees to enjoy a better life, too.

    In 2002, Eversheds introduced a flexible work program, called Lifestyle, that’s open to all employees. It allows employees to flex their weekly schedule, as long as they can make a business case that their job responsibilities can be covered. Job-sharing, reduced hours or a compressed week are among the options, says Elaine Aarons, a labor attorney who heads the employment team in Eversheds’ London office.

    The law firm hadn’t been opposed to flexing hours previously. Aarons, also a partner, has been working a four-day week for 15 years. But the program formalizes the work option, Aarons says. Nearly 600 employees work a flexible schedule, half of them enrolling after Lifestyle was announced. “It’s really about insuring that we have the best talent,” Aarons says. “We think as time goes on, flexibility is an area of increasing importance to people.”

“We think as time goes on, flexibility is an area of increasing importance to people.” –Elaine Aarons

    In the first year, attrition among male and female employees declined from 21.5 percent to 17 percent, Aarons says. It’s also believed that more women are returning from maternity leave, though precise numbers aren’t available, she says.

    The schedule requests are handled by human resources, rather than direct supervisors, to make sure they’re evaluated uniformly. And employees aren’t required to specify why they’re requesting a new schedule, Aarons says.

    As the program moves forward, the firm is learning new ways to measure employee productivity beyond just billable hours. An attorney may have fewer billable hours because he or she is more efficient, Aarons points out. And thus the firm reaps increased client loyalty–feedback that can be picked up on client surveys.

    Europeans pride themselves on a family-friendly working culture, but a 2004 survey by the magazine Legal Business found that only 68 of the 3,600 partners at the top 10 U.K. law firms worked part time. Nineteen of those 68 are at Eversheds. “I thought U.K. law firms were more progressive than U.S. law firms,” she says. “I wasn’t so sure when I saw that (article).”

    Aarons, who lives the juggling act, concluded this interview after 10 p.m. London time. The mother of three had spent the evening with her children and was clocking in a few more hours before retiring for the night.

Workforce Management, May 2005, p. 66 — Subscribe Now!

Disease management programs, ranging from telephone reminders to quit smoking to home visits to assist high-risk pregnant women, have been touted as a home run for public health and corporate bean counters alike.

    And new programs like Blue Cross and Blue Shield of North Carolina’s obesity initiative continue to be launched. In 2003, 58 percent of employers provided at least one such program, compared with 41 percent in 2002, according to a survey on employer-sponsored health plans conducted by Mercer Human Resource Consulting.

    Still, the cost-savings question remains unanswered at best.

    In October, the Congressional Budget Office was lukewarm about the ability of disease management to curb Medicare’s rising costs. Studies so far have primarily focused on medical outcomes, such as blood sugar readings in diabetics, the report’s authors wrote. When the numbers were crunched, not all of the relevant medical costs were included.

    A study of Texas patients, reported at the American Heart Association’s annual meeting in November, found that a congestive heart failure education program extended patient survival by two months, but didn’t save any money.

    “It made people feel better. But it did not keep them out of the hospital or the doctor’s office.” says Dr. Autumn Dawn Galbreath, study author and director of the disease management center at the University of Texas Health Sciences Center in San Antonio

Galbreath is quick to acknowledge that her research, as well as the Congressional Budget Office analysis, involves older and generally sicker patients rather than the typical employee. Even so, she says, “people just need to be realistic in their anticipation of savings.”

    One problem is that disease management encompasses such a grab bag of programs that it’s difficult to draw any broad conclusions, says Kenneth Thorpe, chairman of the department of health policy and management at Emory University’s Rollins School of Public Health in Atlanta.

    Rather than debunking the overall concept, energy should be focused on finding the most effective approach, Thorpe says. He recently completed a study showing that 27 percent of the nation’s ballooning health costs from 1987 to 2001 could be attributed to obesity.

    Referring to the increasing pounds Americans are gaining, Thorpe says, “Right from the get-go, your workers are sicker than they were 20 years ago. If you are going to manage these chronic (health) conditions, you have to manage people’s behavior.”

    Cigna HealthCare’s efforts with diabetes patients are an example of a success story. Research published over the summer in the journal Health Affairs tracked the results of more than 43,000 members enrolled in the company’s diabetes disease management program from 1998 to 2001. When participants remained active in the program most of the first year, their average medical costs declined 8.1 percent from the previous year.

    Even transient interest in the program appeared to have a demonstrable impact. Medical costs for all participants, including those involved just a month or two, declined 5.3 percent.

Workforce Management, January 2005, p. 49 — Subscribe Now!