Earlier this week, Republican Sens. Joni Ernst and Mike Lee introduced the Child Rearing and Development Leave Empowerment Act (the CRADLE Act). It is a first step toward providing some measure of paid parental leave to American workers.
Yet, it has some serious flaws.
The Cradle Act would provide up to three months of consecutive paid parental leave benefits to new moms and dads following the birth or legal adoption of a child. It not only applies to biological parents and those that legally adopt children, but also those who intend to maintain the same abode as the child for more than six months of the year following the birth or adoption. Further, its coverage is much broader than the FMLA, applying to any employee that meets certain minimum Social Security contribution requirements.
How are the benefits paid? The Cradle Act would allow workers access some of their Social Security retirement income during the parental leave. For each month that workers access these benefits on the front end, they delay their Social Security eligibility by twice as many months on the back end. In other words, an employee who takes their full entitlement of three months of Cradle Act benefits would delay their later eligibility for Social Security benefits by six months.
In discussing this bill, Sen. Lee said the following:
Working families are the heart and soul of our nation. If young people can’t afford to marry and start a family, then the American dream literally has no future. Unfortunately, the cost of family formation and child-rearing today is higher than ever. …
But in today’s economy of working moms and dual-earner couples, we also need updated social insurance programs that support workers at different times of their lives, rather than just starting at retirement. The Cradle Act is a step in that direction.
He’s 100 percent correct. Yet, the Cradle Act has some serious flaws:
It will stress our already overstressed Social Security system.
It will require employees to delay retirement and work longer.
It offers no job protections for those who take leave. The Cradle Act’s coverage is significantly broader than the FMLA, yet provides no restoration or re-employment guarantees for employees not otherwise protected by the FMLA. Thus, an employee could take Cradle Act leave, yet lose their job.
It provides no protection against retaliation for employees exercising their rights under the Act.
There is no doubt that we need a paid parental leave solution. We are the only industrialized country that does not guarantee paid parental leave to our employees. We should be embarrassed. And while most agree that we need to provide paid parental leave, the rub seems to be how to pay for it. The Cradle Act is not the correct solution. Yet, anything the moves this discussion forward is a debate worth having.
Every day the spirits of millions of people die at the front door of their workplace.
There is an epidemic of workers who are uninterested and disengaged from the work they do, and the cost to the U.S. economy has been pegged at more than $300 billion annually. According to a recent survey from Deloitte, only 20 percent of people say they are truly passionate about their work. Gallup surveys show that nearly 70 percent of the workforce is not engaged, with an estimated 23 million “actively disengaged.” These employees have quit and stayed— they show up for work but do the bare minimum to get by, don’t put in any extra effort to care for customers and are a drain on organizational resources and productivity.
On the trust front, the findings are just as stark. Studies show that 50 percent of employees who distrust their senior leaders are considering leaving the organization, with 62 percent reporting that low trust causes unreasonable levels of stress. According to workplace consultancy Tolero Solutions, 45 percent of employees say lack of trust in leadership is the biggest issue impacting work performance.
Building and sustaining high levels of engagement is a critical competency for today’s leaders. In our technology-fueled, digitally connected world where new products, competitors and business models seem to emerge overnight, one of the few competitive advantages an organization possesses is its people. The level of skill, talent, creativity, innovation and passion in the workforce of an organization can mean the difference between mediocre and exceptional results.
Focusing solely on engagement is not enough to get us there. We must shift the focus from engagement to the creation of a high-trust culture where employees are passionate about their work.
From Employee Engagement to Employee Work Passion
Employee engagement is a broad and complex problem that organizations spend $720 million a year trying to solve, according to a Bersin & Associates report. Yet when it comes to engagement there isn’t even a commonly accepted definition of the term. Descriptions vary widely, with elements that include commitment, goal alignment, enjoyment and performance, to name a few.
We make a few critical distinctions between the concepts of engagement and employee work passion.
First, employee work passion is supported by a theory and model that explain how work passion is formed. We believe employee work passion is better understood by considering the influence of research on social cognition, appraisal theory, job commitment and organizational commitment. Therefore, it is a different and more expansive concept than engagement.
Second, the combination of relationship, organizational, and job factors influence an individual’s level of work passion. Whereas engagement is often linked to job satisfaction, employee work passion considers the cognitive and affective appraisals people make when assessing their environment and the meaning they ascribe to their thoughts and feelings.
Third, the literature on engagement usually describes three states of engagement: engaged, disengaged, and actively disengaged. This three-part description lacks a positive upper range of active engagement — distinguished by the concept of employee work passion, this passionate commitment comes from repeated involvement in self-defining activities. Employee work passion goes beyond simple engagement in various work activities to the incorporation of self-defining activities that become a central feature in an employee’s identity.
Creating Employee Work Passion
To understand how employee work passion occurs, one must consider the process an individual goes through when deciding to employ a specific behavior. As stated earlier, much of the research on engagement does not take the full scope of this process into account. Through deeper exploration of the literature, we began to incorporate significant ideas found in cognitive psychology.
Employee choices are driven by the understanding of how the experience or event being appraised impacts well-being. Since people are meaning-oriented and meaning-creating, they are constantly reacting (cognitively and affectively) to their environment to form judgments (appraisals) about how their well-being is affected by environmental events.
Cognition and affect go hand in hand, happening almost simultaneously, over and over, as individuals make sense of a situation. The conclusions they reach about what is happening, what it means to them, how it will affect them, how they feel about that, what they intend to do, and — finally — what they actually do, are all filtered through the lens of who they are.
The model suggests that the appraisal process begins with an assessment of the organizational, job and relationship factors. During the appraisal process, an employee makes sense of how they feel about the extent to which the 12 factors are present in the work environment.
There are multiple steps in the appraisal process. First, individuals make cognitive (thinking) and affective (feeling) judgments of their environment: What do I think about what’s happening around me and how does it make me feel.
Next, an employee’s passion moderates, or shapes, those appraisals into intended behaviors. Passion can be categorized in two ways: obsessive and harmonious.
Obsessive passion can be described as activity individuals engage in because they “have to,” “must do,” or “needs to,” often to their own detriment (such as addiction, compulsiveness, etc.).
Harmonious passion are those activities that could be described as “gets to,” “wants to,” or “can’t wait to” perform. Harmonious passion is exhibited when people lose themselves in the flow of an activity. The final step of the appraisal process occurs when individuals form conscious intentions to behave in certain ways, as measured through the five intentions. These intentions ultimately lead to either positive or negative job and organizational behaviors.
Trust’s Role in Employee Work Passion
High levels of trust between leaders and employees foster engagement and vitality in an organization’s culture. The 2017 “Employee Job Satisfaction and Engagement” report from the Society for Human Resource Management showed the top two contributors to employee satisfaction were respectful treatment of all employees at all levels (65 percent) and trust between employees and senior management (61 percent).
Studies have shown that committed and engaged employees who trust their leaders perform 20 percent better and are 87 percent less likely to leave the organization, and that high-trust organizations experience 50 percent less turnover than low-trust organizations. Despite the amount of evidence pointing to the personal and organizational benefits of having a high-trust culture, however, many organizations lack an intentional approach to building trust.
Trust doesn’t come easy and it doesn’t happen by accident. One challenge in building trust is that it is based on perceptions — one person’s idea of what trust looks like in a relationship can be different from another’s. So, it is critically important for leaders and organizations to establish a shared definition for and understanding of trust.
A leader’s trustworthiness is composed of four elements that we’ve captured in the ABCD Trust Model. Leaders are trustworthy when they are:
Able: Able leaders have the expertise, training, and qualifications to perform well in their roles. They also have a track record of success as they demonstrate the ability to consistently achieve goals. Able leaders are skilled at facilitating work getting done in the organization. They develop credible project plans, systems and processes that help team members accomplish their goals.
Believable: A believable leader acts with integrity by dealing with people in an honest fashion; e.g., keeping promises, not lying or stretching the truth, not gossiping, etc. Believable leaders have a clear set of values. They communicate these values to their direct reports and use them consistently as a model for their behavior: They walk the talk. Finally, treating people fairly and equitably is a key characteristic of a believable leader. They are attuned to the dynamics of distributive and procedural fairness (see sidebar) and uphold those principles in the workplace.
Connected:Connected leaders show care and concern for people, which builds trust and helps create an engaging work environment. Leaders can create a sense of connection by openly sharing information about themselves, the organization and by trusting employees to use that information responsibly. Taking an interest in people as individuals, not nameless workers, shows that these leaders value and respect their team members. Recognition is a vital component of being a connected leader and praising and rewarding employees’ contributions builds trust and goodwill.
Dependable: Being dependable and maintaining reliability is the fourth element of trustworthiness. One of the quickest ways leaders erode trust is by not following through on commitments. Conversely, leaders who do what they say they are going to do earn a reputation of being consistent and trustworthy. Maintaining reliability requires leaders to be organized so that they can follow through on commitments, be on time for appointments and meetings, and get back to people in a timely fashion. Dependable leaders also hold themselves and others accountable for following through on commitments and taking responsibility for their work.
The trust one places in a leader comes in two forms: cognitive trust and affective trust. In relation to the ABCD Trust Model, cognitive trust is based on the confidence one has that a leader is able and dependable. This is trust from the head, where rational thought and experience rule. Affective trust, or trust from the heart, is formed by emotional closeness, empathy or friendship. It aligns with “Believable” and “Connected” in the ABCD Trust Model. Our research has shown a large degree of correlation between trust (cognitive and affective combined) and all five work intentions.
Next Step for Leaders
When looking to create a culture where trust flourishes and employees are passionately committed to their work, leaders should examine how the ABCDs of trust are modeled in everyday behaviors, and the extent to which the 12 factors of employee work passion are present. Leaders should ask themselves the following questions:
Does our culture allow individuals to find meaning in their work, their roles and our organization’s purpose?
Are policies, procedures, benefits and compensation transparent and equitably applied to all?
Does our organization provide growth opportunities? Do our feedback mechanisms allow individuals to improve?
Do individuals understand what is expected of them and have a reasonable amount of autonomy when engaging in projects and tasks? Does our organization provide opportunities for individuals to collaborate with others?
Are job roles balanced and reasonable, with enough variety to challenge people perform at optimal levels?
Does our organization have an intentional approach to building trust? And do leaders exhibit the ABCDs of trust in their relationships?
While it may seem daunting to address and incorporate the ABCDs of trust and the 12 factors of employee work passion into the workplace, organizations that do so will be rewarded by trustworthy and passionate employees dedicated to creating devoted customers, achieving sustainable growth and increasing profits for the organization.
I can’t do any better of job than the EEOC did in describing the parade of horribles that one supervisor wrought at Sys-Con, a Montgomery, Alabama, general contractor:
According to the EEOC’s lawsuit, from December 2015 to May 2017, a supervisor at Sys-Con’s worksite at the Hyundai manufacturing plant in Montgomery, demanded sexual favors from two non-English speaking Hispanic female employees and watched pornographic videos in front of them. The EEOC further charged that the supervisor sexually assaultedone of the employees and subsequently taunted her, asking whether she “liked it.”
Thereafter, the EEOC said, the supervisor threatened to fire both his victims and their husbands, who were also Sys-Con employees, if they reported his harassment. When one of the employees refused his sexual advances, the supervisor terminated her.
For all of this, the EEOC settled the claims against Sys-Con for (what I consider to be) a paltry $70,000.
Folks, if you employ a supervisor who not only sexually assaults one of your employees but then taunts her about it after the fact, you might be the worst employer of 2019.
My favorite television show is airing its final episode in a few weeks.
“Crazy Ex-Girlfriend” follows the life of Rebecca Bunch, a wealthy New York lawyer who has a mental breakdown and, when she runs into her high school boyfriend on the street, decides to follow him to West Covina, California. The show does a lot of things well including dismissing the sexist “crazy ex-girlfriend” stereotype and showing the nuances of how people deal with mental health problems like depression and alcoholism — all while being a musical!
Some of the best songs include a parody of the “La La Land” tune “Another Day of Sun” called “Anti-Depressants Are So Not a Big Deal,” a romantic Fred Astaire-Ginger Rogers-inspired number called “Settle for Me,” and “This Session Is Going to Be Different,” in which a therapist sings about her frustrating patient in a song that sounds very much like Liza Minnelli’s “Maybe This Time” from the movie “Cabaret.”
One of the best parts of this show is how is deals with Rebecca’s eventual diagnosis, borderline personality disorder. I never knew much about BPD, and “Crazy Ex-Girlfriend” has taught me a lot about it. I learned about the many misconceptions about people with personality disorders. Also, I got to see how a person with BPD manages their symptoms and goes through the ups and downs of recovery and treatment.
According to the National Alliance on Mental Illness, it’s estimated that 1.6 percent of adults in the U.S. has BPD, but that number could be as high as 5.9 percent. Experts believe it’s underdiagnosed in men.
As employers increasingly address mental health in the workplace, it’s worth learning about BPD and how it could potentially impact an employee.
BPD is “a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness,” according to the Mayo Clinic.
Online resource Verywell Mind goes through some of the symptoms of BPD at work. One major one is unstable interpersonal relationships. A person with BPD tends to see the world in a very absolute, black-and-white way. A job or a coworker is either completely good or completely bad, with not much room for nuance. They may enter a new job loving and idealizing everything and everyone. The idealization phase eventually disappears, leaving basically the opposite scenario, with the employee seeing nothing positive about anyone, “instead experiencing them as hostile backstabbers.”
BPD also causes people to have intense reactions to rejection or perceived rejection, potentially leaving a person prone to abandonment issues.
The Women’s Centre for Health Matters suggests ways in which managers or coworkers can help an employee struggling with BPD. Stable environments are important for people with BPD, so providing the employee as much consistency is their job as possible is helpful. This excerpt explains more strategies:
It can be a challenge interacting with individuals with BPD so it is essential to set limits clearly and stress proper workplace conduct, remind about completing assigned tasks and take consideration of coworker’s feelings. An explanation of the appropriate time and place for different interactions such as meetings, problems and complaints may be necessary. Also be prepared for protests and the possibility that the employee will be mad with you for unknown reasons. Demonstrate validation of emotions and stay civil. You don’t necessarily want to validate an employee’s perspective, instead validate the feelings attached to this perspective – “I hear you” or “I understand the way you feel.” Do not cross boundaries and try to document everything.
The Women’s Centre also lists 20 potential accommodations for employees with BPD, including:
Encourage attending counseling or psychotherapeutic appointments and allow flexible work scheduling to fit the appointments.
Provide confidential weekly/monthly meetings with the employee to discuss workplace issues and performance.
Allow telephone calls or phone breaks during work hours to therapists and others for needed support.
Offer appropriate praise and reinforcement for positive work interactions.
Consider a program that allows employees to work from home on some days.
I want to stress that I’m not a medical expert, but I did get this information through trustworthy research. Also, there are realistically resources out there for safety-concerned employers who don’t want disruptive employees to cross any lines — for example, this 2010 guide from the Australian Human Rights Commission.
What I can say from my own point of view, based on years of reporting on health and benefits issues, is that you may very well come across an employee with a physical or mental health issue. Just because it takes some accommodations to ensure they can get along in your workplace, that doesn’t mean you should dismiss them as viable candidates.
As one article stated, “While BPD symptoms can make things more complicated, many people with BPD go on to have very successful careers.”
Consider and compare the following workplace civility policies:
Commitment to My Co-Workers
I will accept responsibility for establishing and maintaining healthy interpersonal relationships with you and every member of this team.
I will talk to you promptly if I am having a problem with you. The only time I will discuss it with another person is when I need advice or help in deciding how to communicate with you appropriately.
I will not complain about another team member and ask you not to as well. If I hear you doing so, I will ask you to talk to that person.
I will be committed to finding solutions to problems rather than complaining about them or blaming someone for them, and ask you to do the same.
-vs-
Blogging
Blogging outside of the hospital must not include … disparaging comments about the hospital.
We conclude that the Commitment to My Co-workers document is a lawful civility policy. … [T]here is a distinction between regulations on what employees can say about their coworkers as compared to what they can say about their employer. … [W]hile protected concerted activity may involve criticism of fellow employees or supervisors, the requirement that such criticism remain civil does not unduly burden the core right to criticize. Instead, it burdens the peripheral Section 7 right of criticizing other employees in a demeaning or inappropriate manner.
Balanced against the minimal impact on Section 7 rights of these types of civility rules, employers have significant interests in maintaining such rules. These interests include the employer’s legal responsibility to maintain a workplace free of unlawful harassment, its substantial interest in preventing violence, and its interest in avoiding unnecessary conflict or a toxic work environment that could interfere with productivity … and other legitimate business goals.
While the latter was unlawful:
A rule prohibiting disparagement of the employer has a significant impact on NLRA rights Concerted criticism of an employer’s employment and compensation practices is central to rights guaranteed by the NLRA. A general rule against disparaging the company, absent limiting context or language, would cause employees to refrain from publicly criticizing employment problems, including on social media. Such criticism is often the seed that becomes protected concerted activity for improving working conditions, the core of Section 7.
The entire memo is worth reading for a lesson on how the NLRB analyzes work rules under Boeing. And, if you haven’t had an employment lawyer review your handbook or other work rules in the past few years, this is as good of a reminder as any that there is no time like the present.
Employers are doing everything they can to curb health care costs.
Sure, and if you believe that you may also believe in unicorns, the Loch Ness monster and Bigfoot roaming the Pacific Northwest.
Cutting health care costs is the elusive white whale for many businesses. Employers indeed may be putting forth a good faith effort to cut their health spend but oftentimes the results just aren’t there. It’s like the arcade game of whack-a-mole — try one new fad and miss, and another pops up followed by the same result.
In the meantime, health care costs have soared. In 1999, the average annual premium (both employer and employee contributions included) was $2,196 for an individual and $5,791 for a family, compared to $6,896 and $19,616, respectively, in 2018, according to the Kaiser Family Foundation 2018 “Employer Health Benefits Survey.”
What are the myths of health care costs?
Among the myriad solutions employers try, there are overriding myths about cutting costs that don’t save money, provide a nonexistent ROI or are just plain ineffective.
We’ve asked several leading health care experts to offer their thoughts on what we’ve determined are four prevailing myths to cutting employer health expenses. There are others, but this is a good start at peeking behind the wizard’s curtain.
MYTH 1: LOWER PRICES! SAVE MONEY!
A big misconception in cutting health care costs is that employer expenditures rely on addressing what costs the most, said Jaja Okigwe, president and CEO of First Choice Health, a Seattle-based national health provider network. In fact, sometimes cost control doesn’t rely on addressing employee benefits at all. There’s a link between health costs and environmental factors like how employees are treated and how they think about their job, he said.
“Those things carry over into the potential for more serious illness. And there aren’t very many companies who have an easy time at getting at that,” Okigwe said.
There are some companies that have acknowledged the direct relationship between environmental factors and health and done something about it. It’s a positive step when employers decide that “we’re going to do things that create an environment that allows our employees to be their healthiest and most productive, and that’s going to spill over into our health care cost,” Okigwe said.
Utilization of Health Care Services
Health Advocate’s Arthur “Abbie” Leibowitz, chief medical officer, founder and president emeritus at the national health advocacy, patient advocacy and assistance company, also believes that companies can’t control costs by controlling price. Rather, health care costs are driven by utilization.
This brings up a different problem for employers: Motivating employees to use the health care system effectively and efficiently.
One thing that employers can do is help employees connect with trusted medical professionals and offer a path for employees to foster a consistent patient-doctor relationship, Leibowitz said.
This does not necessarily mean that employers should encourage employees to see the doctor for a physical every year, he added. In fact, that can be a fallacy because there’s little reason for the average person to see a doctor annually. “The likelihood of discovering a problem you didn’t know about at a visit like that is so low that it makes it almost [impossible],” he said. Instead, employers can promote getting in touch with one’s doctor when the employee actually needs help.
Promoting the idea that it is good for patients to connect with a trusted physician is smart because many plan designs now don’t require a patient to choose a primary care physician, Leibowitz said. When HMOs were more popular, a patient initially needed to select a primary care doctor in order to access the health system, but fewer models require that now.
“So, in that regard, employers can encourage people to select a doctor even though their plan design may not require it,” he said.
“It’s the attitude — people call it a culture of health — that the employer creates within the work environment that is the best trigger to getting people plugged into a physician relationship that will come in to pay dividends if not immediately then down the road,” he added.
Okigwe offered suggestions to establish a culture of health other than promoting the doctor-patient relationship. For one, companies can have regular walking meetings, since research shows 30 to 40 minutes of walking a day changes one’s risk of heart disease over time.
“Yet sometimes employers don’t think that’s really their job,” he said. Rather, their focus is on the bottom line and employee productivity. But small investments in making the workplace healthier to work in can pay off.
Long-Term vs. Short-Term Costs
It’s hard for most employers to think long term with health care costs, Okigwe said. “I do think the vast majority are looking at the annual spend and trying to figure out how to reduce it in one year, and that’s just very difficult.”
But thinking long term is something that could help with health care costs. Employers and employees alike may have to pay short-term expenses in order not to have the shock of major medical expenses in upcoming years. “In general, we tend to think of any spend as being bad,” Okigwe said, but that’s not an accurate way to view health care costs.
It’s almost as if employers believe employees want to spend money on health care, he said, while in some cases what causes costs to skyrocket is that they don’t want to. There needs to be some sort of balance on spending a little bit on the care and activities that deter crises from happening down the line.
Employee cost concerns aren’t necessarily founded in reality in some cases, according to Leslie Michelson, chairman and CEO of Private Health Management and author of “The Patient’s Playbook,” a book about how to become an effective health care consumer.
“People are always concerned that the best care is the most expensive care, and that’s just not true,” he said.“In the rest of our economy there’s a pretty tight coupling between cost and quality. In health care there isn’t.”
About 80 percent of the U.S. population lives within an hour’s drive of at least one large city where there is at least one major medical academic center. Virtually all of these centers are in-network for most carriers. Patients could access specialists on complex conditions here, and care at these facilities is likely to cost less than going to an out-of-network provider.
Michelson’s organization works with patients who have medical problems and identifies for these patients the most advanced doctors with promising and cost-effective interventions.
“If you want to address the cost bar, what you need to do is sweep in a supportive way to help people who are going to become expensive cases, identify the top experts for their care, educate them about the treatment options available, and provide a coordinated, integrated support system to channel them to the best doctors and to ensure they’re getting the care they need,” he said.
The key to controlling health care costs is addressing this small subset of patients with the most expensive cases, he said. Ten percent of patients represent 65 percent of health care costs, and 1 percent represent 25 percent, he said.
“If you aren’t doing something that meaningfully addresses that very small portion of the cases, you’re not going to have a significant impact on the costs,” he said.
Bad Incentives
One health care myth related to costs is that quality and prices aren’t improving because of cheaters in the system, according to Rob Andrews, CEO of the Health Transformation Alliance, a nonprofit group made up of 47 companies whose goal is to fundamentally transform the corporate health care benefits marketplace.
Of course, he said, there are some in the health care system who have committed wrongdoings, but they are rare.
“The problem isn’t that insurance companies are bad, or that drug manufacturers are bad, or that hospital systems are bad or that government regulations are bad. Some of all that is true. But the main problem is that incentives are bad,” Andrews said.
Over the past 60 years or so, he said, a system has been built where incentives aren’t aligned with what’s best for people’s health, giving the example of two hypothetical practices. If there are two radiology practices — one that does 1,000 images a week and produces wrong results 5 percent of the time, and the other that does 500 images a week and only gets incorrect results 1 percent of the time — the first practice would make more money under Medicare. That’s because Medicare rewards are based on the number of procedures done, not how well they’re doing.
Not to say that medical practices or insurers are incompetent, he said. This problem exists because the incentives aren’t aligned correctly in the health care system.
“What we aim to do in the HTA is align the $27 billion a year our members spend on health care with value.” Andrews said. “We want to identify and reward the producers who produce the best value.”
“We chase the shiny object — the price — but we need to be focused on the real issue of value,” he added.
MYTH 2: WELLNESS WORKS
Creating a successful wellness program isn’t as simple as offering one and watching the savings roll in, said Gary Kushner, president and CEO of benefits consultancy Kushner & Co.
Workplace wellness programs have gone through numerous iterations in the past severaldecades. While there have been health-related work programs dating back to the 1920s, it wasn’t until the 1980s and ’90s that wellness programs took off on a much larger scale. The first iteration of this more recent workplace wellness boom is what Kushner called “An Apple a Day” wellness. If an employee eats right and exercises, health care costs will drop. This was not successful, Kushner said.
The second iteration took the original idea a step further, with organizations subsidizing health club memberships and contracting with nutritionists to show employees how to prepare healthy meals. This also didn’t work to reduce costs because the types of employees taking advantage of these subsidies were the ones who already worked out regularly and had healthy lifestyles, Kushner said. The habits of employees who didn’t go to the gym remained the same.
The third iteration of wellness features employers who target their own workforce based on the health needs of that specific population. An employer with a large population of employees with type 2 diabetes may track things diabetics should be doing — like A1C testing and eye exams — through their health plan and encourage at-risk employees to get appropriate testing done.
This type of program, which is more altruistic in nature, has slightly better results. Still, “Every CFO I’ve talked to with these employers keeps coming back to wanting to see savings in the health plan. And they’re having trouble quantifying those. They’re not seeing the difference,” Kushner said.
Where Art Thou, ROI?
Investing in employee wellness is a good thing, but it’s not a short-term policy, said David Henka, president and CEO of ActiveRadar, a health care analytics and patient education company based in Gold River, California.
Although there’s value in wellness programs, he said, that value is not a financial return on investment. Wellness companies often cite huge ROIs for their programs. But academic research reveals that wellness programs do little to reduce health care costs.
A University of Illinois at Urbana-Champaign study published in June 2018 found that workplace wellness programs don’t change employee behavior much or save money on health care costs. Similarly, a University of Pittsburgh clinical trial whose results were published in JAMA in 2016 found that the use of monitoring devices and wearables — often a hallmark of corporate weight loss programs — may have no advantage over traditional weight loss strategies.
“As an employer, if you go into the wellness space thinking you’re going to get an ROI, then you’re going to be greatly disappointed,” Henka said. “But if you go into it by saying it’s the right thing to do for my employees because I want them to maintain healthier habits or lifestyles, then I think you’re tracking along the right frame of mind.”
The realistic value of wellness is more cultural, he said. Wellness companies claiming big returns are not accurate, but it is the right thing for employers to do. It lets employees know that the company values them, he said.
Many employers are not holding wellness providers accountable for the results of their programs, said Cheryl Larson, president and CEO of Midwest Business Group on Health. There are reliable wellness programs on the market, but unfortunately the average employer only pays attention to what the vendor tells them, Larson said.
Employers need to know the right questions to ask wellness vendors and the best way to research their options. Simply asking fellow employers about their programs is one way to conduct research.
Another way to improve vendor services is only agreeing to terms that suit both parties, Larson said.
“I would say if you ask [the vendor] for things, and they say, ‘We’re not going to do that’ — and you’re being fair, you’re doing industry standards, yet they still won’t do it — maybe that’s not the right vendor for you,” Larson said.
Henka suggested providing flu shots as a clear way to show ROI since the flu accounts for lost productivity and absenteeism in the workplace. As last year’s flu season showed, it can be deadly. According to the Centers for Disease Control and Prevention, 80,000 Americans died of the flu and its complications in the winter of 2017-18.
Wellness Done Right
First Choice Health’s Jaja Okigwe addressed potential issues with health screenings — a common component of wellness programs.
One staple of preventive care is annual health screenings and checkups. But the younger a person is, the less likely they are to need regular screenings, according to Okigwe. It’s not until they get older that they need annual screenings.
“It’s a big production to take off time from work and do your screenings,” he said, especially if a patient also has to do something additional like fast for a certain amount of time before the screening. “From a person’s [point of view], there’s a barrier to do it, and then in the end you get this set of information that you probably already knew.”
Companies such as Chicago-based Visibly and Tel Aviv-based 6over6 Vision allow people to get an eye exam using the camera in their phone. The process only takes about 15 minutes, and with results that are 95 to 98 percent as effective as the results they’d get at the optometrist’s office, it’s beneficial for employees who simply need a new prescription for glasses, Okigwe said. While a virtual test can’t diagnose glaucoma, it has a clear benefit for a specific need. A patient who doesn’t need a glaucoma test won’t need to take an hour out of their day to see an optometrist.
“I’m at the age where I wear two pairs of glasses. And sometimes when I’m in that in-between zone I get headaches. Updating the prescription becomes very important and allows me to be more productive,” Okigwe said.
MYTH 3: THE CONSUMER RUMOR
Employers often turn to the consumer-directed health care plan — commonly referred to as a high-deductible health plan — in part to make their employees smarter health care shoppers.
These organizations have a lofty goal when they seek to turn employees into sophisticated health care consumers. Although the goal itself is admirable, the reality is that the health care delivery system is too complex and patients don’t touch it with enough frequency, said Brian Marcotte, president and CEO of the National Business Group of Health.
An employer might have a comprehensive program that gives employees treatment options and resources when they face a surgical decision. But that may be a decision a person has to make once a year or lifetime. “It ends up being a resource that’s out of sight, out of mind,” Marcotte said.
The idea that giving employees more resources and price transparency information would make them more sophisticated consumers did not pan out like employers thought it would, he added. Employers started rolling out HDHPs in the early 2000s and ramped up the strategy when the Affordable Care Act was passed with the Cadillac tax provision. Since health care is generally not part of most people’s regular spending routine like grocery shopping, organizations need to find a way to fit it into employees’ everyday lives.
The Growth of Virtual Solutions
One way organizations are trying to make health care more a part of employees’ routines is through virtual solutions. While people today can find basically any product or service on demand, what is lacking in health care is the ability to get on-demand service, Marcotte said.
The promise of virtual solutions is that they open up avenues to access, convenience and quicker response times from medical professionals.
Virtual care covers a lot of bases including chronic disease management for conditions like diabetes, lifestyle coaching and virtual second opinion services.
However, virtual care can create complicated issues when a patient has to rely on an outside care team rather than the primary care physician with whom they might already have a strong relationship. “The challenge for all these virtual solutions as well is, ‘How do I integrate them back into care and get it within the delivery system itself?’ ” Marcotte said.
Barriers to Health Care Navigation
One reason for the “rampant confusion on how these plans work” — which unfortunately sometimes leads to employees avoiding care — is that “the industry has never done a good job teaching people how to shop for coverage,” said Kim Buckey, a health compliance expert and vice president of client services with benefits compliance company DirectPath.
A person can’t be a good consumer if they don’t know the prices of services, and there’s no easy-to-read or readily available price list, said Buckey’s colleague, Bridget Lipezker, senior vice president and general manager of advocacy and transparency at DirectPath. She referenced what she called the “myth of transparency.”
“The lack of control the consumer has over what they’re paying for something, or even understanding what they’re paying for and what their level of responsibility is — to me, consumerism becomes a myth because of the that. Because you don’t have choice,” Lipezker said.
Another barrier to employees is time.
Patients can call their doctor and ask for options and prices, Lipezker said, but finding this information is a difficult and time-consuming process, and, as Buckey pointed out, most doctors are only available during business hours, so employees need to find the information they need while at work, adding to their stress and cutting into their productivity.
“Some employers are taking the bull by the horns and are offering advocacy and transparency services to their employees to give them a source of support where they can turn over these issues to someone else to fight on their behalf,” Buckey said.
Socioeconomic Issues With HDHPs
Socioeconomics also is an important factor that employers must consider in health care strategies. One problem that HR has, according to technology-led business process services company Conduent’s Bruce Sherman, is that “we design benefits for people like us,” thus isolating people with different benefits needs and life experiences.
Low-income workers have been especially impacted by employers’ attempt at cost containment through HDHPs. According to the February 2017 Health Affairs article “Health Care Use and Spending Patterns Vary By Wage Level in Employer-Sponsored Plans”— which Sherman co-authored with Teresa B. Gibson, Wendy D. Lynch and Carol Addy — cost shifting in benefits plans has meant a 67 percent increase in deductibles since 2010. That’s six times more than the rise in workers’ wages (10 percent) and inflation (9 percent).
The article explored patterns of health care usage relative to employee wages and found that workers in the lowest wage group ($24,000 or less a year) were the most likely to have (had) an avoidable emergency visit, while the highest earners ($70,001 or more a year) were the least likely.
“It may be helpful to ask employees in different socioeconomic groups what benefits they’d like to have,” said Sherman, a longtime researcher of health issues. “This opens the door for information sharing and doesn’t obligate the employer to provide what employees request.”
While more employers are talking about establishing a “culture of health,” oftentimes they also fail to address social and economic determinants in that culture of health, he said, suggesting that employers review organizational policies and practices and keep that perspective in mind to give themselves a broader understanding of where there’s opportunity to improve workplace health for different groups of people.
Some employers offer hourly employees a half day every year specifically to see their doctor for preventive care services, he said. Other employers offer paid sick leave to all employees, including hourly workers. And other employers have ditched “just-in-time” scheduling practices and opted for fixed work hours for all employees — a perk for hourly employees since variable scheduling limits predictable income for employees living paycheck to paycheck.
Some organizations are utilizing wage-based cost-sharing arrangements to address socioeconomic disparities, according to the National Business Group on Health’s 2019 “Large Employers’ Health Care Strategy and Design Survey.” According to the survey, 34 percent of employers offered a wage-based premium contribution in 2018, with 32 percent of employers planning to do the same in 2019. Similarly, 8 percent of employers offered a wage-based cost-sharing arrangement through deductibles or out of pocket costs in 2018, compared to 7 percent planning to do that in 2019.
MYTH 4: WE’RE DOING ALL WE CAN ALREADY
Many employers are doing a lot to help employees with health care costs. But in actuality they demand more from insurance companies and other providers, said DirectPath’s Bridget Lipezker.
Employers comprise the largest group of payers for health care in the United States. According to 2017 National Health Expenditure data, private health insurance accounted for 34 percent of health spending, beating out Medicare (20 percent), Medicaid (12 percent) and out-of-pocket (10 percent).
Employers have a responsibility to do more and they carry a lot of clout. But there are many barriers hindering that influence, she said. It takes a lot of time, energy and focus, and most organizations don’t have the luxury of hiring a person solely focused on benefits.
A majority of small- and midsized businesses only have one person managing HR, and oftentimes HR isn’t even their primary responsibility, according to HR platform BerniePortal’s 2019 “HR Today and Tomorrow” report.
“I think that employers do try to act in the best interests of their employees, at least in my experience. But they don’t always have the expertise in-house or the dollars to hire consultants to help them figure it out,” Lipezker said.
Disruption Will Cut Costs … Not
Counting on disruption to save on health care spend (think major policy changes like the Affordable Care Act) is a strategy, but it’s a poor one for plan sponsors, said ActiveRadar’s David Henka. Employers need to be proactive.
There’s only so many levers employers can pull to affect cost, Henka said. With trends like the consolidation of health systems and influential health care industries like pharmacy benefit managers clashing with employers, organizations have limited options to influence costs.
The most valuable and accessible lever is at the pharmacy, Henka said. Pharmacy costs and formularies are decided on a national scope, unlike hospital and provider networks, which are often decided on locally or regionally. This adds an additional challenge for an employer with offices or employees in multiple states to trim costs.
The lack of transparency in pharmacy benefits is noteworthy, Henka said, and the reality is that for many drugs, there are alternatives that have the same therapeutic benefit for a fraction of the cost. For example, the brand name drug Lipitor has an average cost $184 while Atorvastatin, the generic version with the same active ingredients, has an average cost of $36, according to Henka.
He suggested reference pricing programs, with which costs go down in the short term and, in the long term, patients became more compliant with drug treatments. Reference-based pricing uses complex algorithms to identify the most expensive drugs used by the employee population, highlights more cost-effective alternatives and then encourages members to switch to the most affordable drug.
While reference pricing is trending in parts of Europe, it’s mostly gaining traction in the U.S. among large employer groups, Henka said. He added that many employers think that by switching to a generic-mandated program, they’re doing enough — but they can do more. They could save money by switching from one generic to a different, more cost-effective one.
The types of U.S. organizations mostly adopting these programs are union trust funds and private employers, he said.
The second largest health care purchaser in the country, CalPERS, is also a proponent of reference pricing, he added. Second only to Medicaid, CalPERS purchases health care benefits for employees in the state of California that work for school districts and other public agencies and covers about 1.2 million lives. They have “already implemented reference pricing for a number of medical procedures and are in serious discussion of implementing it for their pharmacy program as well,” Henka said.
Enter the Chief Medical Officer
A conversation that is gaining traction among employers is working to get more control of health care costs in unique ways, said of First Choice Health’s Jaja Okigwe.
Cable and internet provider Comcast was among the first companies to hire a chief medical officer. In 2005, it hired Tanya Benenson to have an expert solely focused on health care outcomes. Similarly, Google hired David Feinberg, former CEO of Geisinger Health, in November 2018 to lead its health strategy, and banking giant Morgan Stanley hired David Stark as its first chief medical officer in October 2018.
“The novelty of Comcast’s situation was that they were taking charge of crafting the whole benefit program and experience for their employees,” Okigwe said. “This is typically done by carriers and benefit consultants.”
The role of the chief medical officer varies by industry, said DirectPath’s Kim Buckey. In a hospital, that role likely will oversee clinical outcomes, while at an insurance company the position is responsible for decisions on what should be covered, or to help develop health and wellness programs. For organizations like Comcast, a CMO will identify opportunities for savings, oversee the organization’s health vendors to control costs, lead negotiations with providers and analyze claims data.
Large employers can afford to have someone in this position, Buckey said, but most are “a ways away” from the chief medical officer being a common corporate title.
Boss just threatened to fire me and another co-worker because we were discussing a raise we both got- what should I do?
We both got pulled into a group chat over the app our work uses, and the first message reads as follows;
Hey I don’t want to here about your raises with the other crew members we talked about this before, other places have strict rules either termination or reversal of the raise this is not okay, Don’t turn something we tried to do nice for you too into a pain for us.
Which, uh, what the fuck?
I’m pretty fucking sure everything in there is MASSIVELY illegal.
AriesAviator wins the labor law Kewpie doll.
Policies prohibiting pay-discussions among employees, or retaliating against employees who discuss how much they make, are per se illegal under the National Labor Relations Act.
Don’t just take my word for it. Here’s what the NLRB said on this very issue in Boeing Co.:
Rules that the Board … designates as unlawful to maintain because they … prohibit or limit NLRA-protected conduct, and the adverse impact on NLRA rights is not outweighed by justifications associated with the rule. An example … would be a rule that prohibits employees from discussing wages or benefits with one another.
So, AriesAviator, to answer your (albeit crassly asked) question, your employer’s response is 100 percent illegal, and, if you want to make a big deal out of it, jaunt over to your local NLRB office and file an unfair labor practice charge. It’s a pretty open and shut case.
Employers, if you have such policies in your handbooks, or have made such statements to your employees in the past, stop. It’s as easy of an unfair labor practice into which you can stumble.
Fueled by relative economic strength around the world, all signs point to a prolonged talent shortage that will plague global businesses for the coming decade.
As companies of all sizes grapple with how to attract and retain outstanding employees, more organizations are recruiting internationally and expanding opportunities for current employees to pursue a variety of internal roles.
This is good news for job seekers and employees who are looking to grow their careers and seek out fulfilling work/life experiences. But it remains a challenge for employers, many of which are struggling to get up to speed with this “new normal” where a strong mobility program — both internal and external — is now a critical business strategy, not just for expanding to new markets but for addressing both acute and long-term people resourcing challenges.
Mobility, also known as global mobility or talent mobility, refers to the movement of employees across borders for business purposes. This could be employees relocating globally or domestically, taking a temporary assignment outside their home office, or even business travel or cross country or state commuting. Mobility, regardless of its form, requires modern tools and support to tackle everything from tax and immigration complexities to being paid in multiple locations.
Mobility will become a key differentiator in the war for talent, enabling businesses that get it right to overcome staffing challenges. Here are just a few examples of why organizations should prioritize mobility in the coming year:
To retain talent. More than 20 percent of employees say they’ve quit a job after being denied a relocation opportunity, and worse yet, 40 percent say they aren’t even aware of mobility offerings within their company. With global talent shortages, this should be terrifying news! Companies that offer internal mobility must do a better job of communicating and internally publicizing relocation opportunities when these roles become available. Make it clear that if you have the skillset, we’ll get you there through a seamless process that emphasizes employee satisfaction, lifestyle and family needs.
To enable fluid career paths. In previous generations, employees joined an organization and stayed there for their entire career, following a relatively predictable career path from junior level to senior management. But millennials and others are looking for faster progression, which includes lateral moves. When the average tenure at even tech giants like Google is two years or less, employees’ careers are now less tied to the organization and more tied to their personal brand and personal growth. Mobility enables this career fluidity by giving people an opportunity to grow in ways that suit their needs. In fact, a recent study found that more than 70 percent of employees saw mobility as a career growth opportunity, even without a raise or promotion.
To close the gender gap. Diversity and inclusion have become chief priorities, especially when it comes to leveling the gender playing field. Despite the push toward gender equality in the C-suite and boardroom, women still have less opportunity in mobility, despite its key role in leadership growth. The bottom line: if you want more women in senior leadership, you must have gender equality in your mobility population. This can also be solved with better communication and promotion of opportunities. By showcasing women in successful expat roles to demonstrate its transformational benefits for personal and professional growth, companies can entice more women to seek out mobility-based career and leadership opportunities. When they see that it works, and that your company will support them every step of the way, it’s easier to see themselves as eligible candidates.
To utilize data to drive efficiency. Traditional recruiting and HR management systems data have become invaluable when it comes to recruiting and talent optimization. But, as mobility begins to play a larger role in shaping a talent management strategy, it needs to be tied into the fold. The holy grail for success: the ability to identify and predict for whom mobility will be successful. By measuring factors such as how long the assignment lasted, what did the individual’s career path look like after, how long did they stay with the company, etc. we can use mobility data to optimize the process, move more people cost-effectively, foster greater success for the individual and ensure the company gets the most bang for its buck.
The potential is there for mobility to influence talent management in the coming years. While many areas of talent management have gone through a digital transformation, including recruiting, performance management, learning management and recognition and rewards, mobility has been somewhat left behind in most organizations. As a result, employees are often faced with highly fragmented experiences, forced to deal with five or six vendor systems and plagued with redundant data entry.
Adopting robust global mobility management solutions will transform the relocation process, giving companies the comprehensive tools they need to operate efficient, successful and growth-oriented programs, while also making relocation an exciting, exhilarating and life-changing experience for employees.
National Basketball Association Commissioner Adam Silver made an important comment this week at the MIT Sloan Sports Analytics Conference in Boston, saying that a lot of players are “unhappy” and acknowledging the very real impact of mental health problems on people, no matter how much fame or money they have.
As a benefits writer who occasionally covers mental health, I think it’s genuinely positive when a powerful figure makes a straightforward, sympathetic comment about mental health issues.
Still, I don’t agree with everything Silver said. According to CBS Sports, Silver said, “We are living in a time of anxiety. I think it’s a direct result of social media. A lot of players are unhappy.”
I contend that this argument is too simplistic. I’ve seen this argument before in research and reading, this concern that technology or social media is making people more depressed or anxious.
I prefer a more nuanced approach. Yes, social media has become increasingly ubiquitous over recent years and so has this trend of people being more open about mental health problems, but this sounds more like correlation than causation. That’s a topic worthy of more research.
Mental illness isn’t as simple as X caused Y. Being too focused on social media and technology’s impacts could blind you from other factors that could influence mental health, like personal or professional problems, going through a traumatic event or something physical like brain chemistry. In the context of the NBA, there are understandably some stressors specific to being a professional athlete.
I also don’t believe that mental illnesses are any more or less common than they have been historically. At least I haven’t seen or heard any convincing evidence of that. We need to acknowledge the very real fact that because of stigma, this wasn’t something that people talked about for a long time.
The lack of public acknowledgement doesn’t mean it did not exist. Whenever someone makes the “technology/social media causes mental problems” argument, I wonder if they’ve ever stopped to consider historical context. I wonder if they truly think depression, anxiety, bipolar disorder, borderline personality disorder and panic attacks just didn’t happen before. That sounds naïve to me.
Regardless of my preference for a more nuanced take on the causes of mental health problems, I love seeing that the league commissioner is talking about it. This also led to me read about the NBA’s mental wellness program and the organization’s decision to hire a director of mental health and wellness.
The details of the mental health program are interesting. This story references the league’s old policies to deal with mental health problems, often by team physicians who had no expertise in mental health.
It talks about the NBA’s decision to create a wellness program and the time and considerations that went into it. Basically, this is a comprehensive case study that also brings up some philosophical questions about wellness programs.
It also brings up a noteworthy point about privacy and transparency. The wellness program is run independently of the teams, league and players’ union. According to the article, Michele Roberts, executive director of the National Basketball Players Association said, “We don’t want players to be discouraged from getting help when they need it because they’re concerned that it will get back to the team, or it may affect their play, or it may affect their next contract.” Yet, the article continues, “even that can be debated when it comes to wellness.”
Data privacy and health privacy are topics I care about, which is why it’s intriguing to find debates like this. This story makes a point that when more people are open and transparent about mental health, there’s less stigma.
Wanting anonymity when you’re seeking mental health treatment helps “contribute to the continued stigma.” Further, one former player expressed concern that when people want anonymity, people like him are then persecuted for being up front.
I get this to a certain degree, and I understand this person’s idealized version of the world where everyone can be open about everything and there’s no judgment or consequences. But mostly I prefer to be realistic.
In any organization’s wellness program, privacy should be a clear choice. Health information is private, and no employee should feel pressured to talk publicly about something they want to keep private. HIPAA exists for a reason. And, yes, HIPAA doesn’t apply to many wellness programs, but that doesn’t mean that organizations should respect employee health privacy any less.
As employers get increasingly involved in employees’ physical, mental and financial health, it’s worth a reminder that many people want privacy, and that a respectful employer doesn’t pry into people’s personal data.
The 7th nominee for the Worst Employer of 2019 is an employer that (allegedly) permitted a nearly year-long campaign to malign and harass an employee living with ADHD and Tourette’s syndrome.
Melinda Crooke worked as a line worker for Herbruck Poultry Ranch, an egg farm in western Michigan. As noted above, she has ADHD, which causes her to be overtly talkative and sometimes confused, and Tourette’s syndrome, which manifests in head twitches, facial tics, uncontrolled arm movements, and occasional swearing. According to the lawsuit the EEOC filed on her behalf, all of her co-workers knew of her disabilities.
Crooke claimed that as soon as her supervisor learned of her disabilities, her harassment at the hands of said supervisor and some co-workers began. They called her “Mindy Tourette’s,” “Gabby,” “Motormouth,”and “Wandering Wanda.” They mocked her Tourette’s syndrome by biting their tongues and making exaggerated hand movements. And, after she complained to HR, the mockery only worsened. For example, her supervisor sped up the production line to make it harder for her to keep up, and followed her into the bathroom during breaks to berate her for wasting time. When she complained again to HR, she claims she was told there was nothing anyone could do.
As a result, she quit her job and went to the EEOC, which has now filed suit on her behalf. According to EEOC Trial Attorney Dale Price, “An employer cannot condone a work environment where an employee with an impairment is ridiculed because of it. It must step in to stop such behavior.”
Otherwise, you not only might get sued, but you just might end up as one of the nominees for the Worst Employer of 2019.
Third, the literature on engagement usually describes three states of engagement: engaged, disengaged, and actively disengaged. This three-part description lacks a positive upper range of active engagement — distinguished by the concept of employee work passion, 
Utilization of Health Care Services 
Employers need to know the right questions to ask wellness vendors and the best way to research their options. Simply asking fellow employers about their programs is one way to conduct research.
Barriers to Health Care Navigation
