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Author: Rita Pyrillis

Posted on May 6, 2014August 1, 2018

Investing in Employees to Invest in Health Care

Executives at New York-based publishing house John Wiley & Sons Inc. tried with little success to get employees enthused about their benefits and health care, from a nurse hotline to a disease management program to an employee assistance program, but nothing seemed to spark interest.

The first year after its debut in the early 1990s, just 52 of Wiley’s 2,500 U.S.-based employees called the 24-hour hotline. Last year, just two employees called, despite the fact that many of the employees suffer from diabetes and other chronic conditions. Not surprisingly, the hotline was dropped. A disease management program came next. Only 12 people responded.

“One year we got it to 18, but 18 out of 2,500 isn’t much,” said Patrick Nevins, Wiley’s director of benefits. “While some of these programs sound good on paper, colleagues didn’t seem to be interested. We also have an EAP, and while people had positive things to say about these programs, not enough were using it.”

Employers like Wiley seem to be on an endless quest to get employees to care more about their benefits and health care, giving rise to a booming multibillion-dollar wellness industry and an array of online tools and gadgets that help workers track steps, choose benefits or pick a doctor. And yet, employee engagement remains a frustrating mystery to many employers. But finding a way to connect with employees is becoming increasingly important as companies usher in an era of health care consumerism.

‘It’s like you’ve been driving an automatic your whole life and now you’ve been given a stick shift.’

— Jim Skinner, president, JMS Benefits Solutions

Passive patients and apathetic employees who for decades chose their benefits on a sort-of autopilot mode now are being asked to start thinking like smart shoppers when it comes to their health care. The philosophy of following doctor’s orders and not knowing the true cost of an emergency room visit is giving way to informed purchases based on factors like price, outcomes and negotiation — much like buying a car. Experts say this is the future of employer-sponsored health care, but just how prepared employees are for this transformation is unclear.

“It’s like you’ve been driving an automatic your whole life and now you’ve been given a stick shift,” said author and consultant Jim Skinner, president of JMS Benefits Solutions in central Texas. Skinner founded the Smart Patient Academy, a division of his consulting firm that specializes in teaching employers and employees how to use consumer-driven health plans — high-deductible plans that were designed to give consumers more control over their health care decisions.

“The holy grail is employee engagement, because without it there’s no management of cost and no responsibility on the part of the consumer,” he said. “Corporations are shifting risk to their employees and giving them little in the way of tools. They might offer a price shopping service but that’s just one part of it.

“As soon as you get into a chronic condition, your focus on money starts decreasing and your focus on outcome starts increasing. And when you get into life and death you don’t give a damn about the money. You’re talking to different consumers with different perspectives, and employers need to know how to communicate with all of them.”

Despite the failed programs, Wiley executives believe they’ve begun to solve the problem in the form of an online tool called WiserHealth, which matches patients with treatments that are most likely to work. Wiley launched the cloud-based platform created by Washington, D.C.-based tech firm WiserTogether Inc. on Jan. 1, and in the first two months more than 450 employees had logged on, Nevins said. WiserHealth allows consumers to research medical conditions, find the treatments and providers with the best outcomes, learn how much it will cost them, and what patients with similar conditions have to say about the treatment, among other information.

“I believe that most of us are on information overload,” Nevins said. “Most of us just Google [conditions], and we’re not so sure about the reliability of the information we get.”

Nevins said that WiserHealth encourages employees to “become active participants in decisions about their medical care,” by understanding all their options.

So Many Choices, So Many Tools

The health care technology market is going gangbusters, and tools to help employees pick their benefits, find treatment options or compare prescriptions are flourishing. Here are a few tools from some of the biggest players:

Alex: Chicago-based Jellyvision, a developer of interactive online programs and games, released “Alex,” a virtual benefits counselor, in 2009. The program helps employees figure out which health plan best suits their needs. Last year the company introduced Alex Does Health Care Reform, which helps employers talk to their workers about how the Affordable Care Act might affect them and helps employees understand the basics of health care reform. It also lets employees know if they qualify for tax subsidies or special programs.

Castlight Health: The company’s database offers pricing information for elective procedures, high-cost diagnostic tests, specialists, hospitals and other types of care. The company recently launched a pharmacy app to help consumers shop for the best prices on medication. Since it was launched in 2008, the cloud-based health care management system has become the leading cost comparison tool with clients like CVS Caremark Corp. and Kraft Foods Group Inc. In March, the San Francisco-based software company made headlines with its nearly $200 million initial public offering, more than doubling its value.

Change Healthcare: Employees can search for a prescription or medical, dental or vision services based on their health plan, network or location. The online system provides cost comparisons and quality ratings and sends users a personalized alert to remind them of preventive screenings, manage their medications or find nearby providers that offer the best value. The Brentwood, Tennessee-based company, which was founded in 2007, recently launched Healthcare University, an online training program for employees to learn about their health benefits through videos, games and quizzes.

Healthcare Blue Book: Launched in 2007, this price transparency tool uses an algorithm to give users not just the range of available prices, but also an estimate of what a “fair price” is for a given procedure or medication, like the Kelley Blue Book for cars. The information is provided both online and through an app. The Nashville-based tech firm offers a free version of its search tool that anyone can use by entering a ZIP code on the company’s website. The premium version is available to consumers only through their employer or health plan.

WiserHealth: Dubbed the “eHarmony” of health care decision-making tools by the company’s founder, this platform helps users find the most appropriate health care for their particular condition based on their cost limitations and personal preferences. It also provides feedback from other people who were faced with similar health issues about how satisfied they were with their treatments. WiserHealth was developed by WiserTogether Inc., a Washington, D.C.-based company founded in 2008.

—Rita Pyrillis

Shub Debgupta, the founder and CEO of WiserTogether Inc., describes WiserHealth as the “eHarmony” of health care decision tools. In fact, it was modeled after the dating service website, which uses an algorithm to determine compatible matches. WiserHealth offers information on the most effective treatments for a particular condition, like carpal tunnel syndrome, and surveys thousands of patients and doctors with the same condition about which treatment they chose, what the side effects were and so on. It is the platform’s ability to collect data from external sources like random surveys of patients and providers that sets WiserHealth apart from other tools that focus on one aspect like price transparency, Debgupta said. WiserHealth also provides cost information and lets users know which treatments are covered by their health plan.

“Will it work for me personally? That is the piece that’s missing from the health care system,” Debgupta said. “Trial and error costs the payer and the system a tremendous amount of money.”

For Nevins the hope is that Wiley employees with chronic conditions will use the information to pick the most effective treatments, which in turn will improve health outcomes and lower costs, although he’s quick to point out that cost was not the primary reason for introducing WiserHealth.

“Providing this wasn’t so much about reducing costs,” he said. “I believe that giving people guidance and educating them on their options about the most effective treatments will improve quality of care. And in the long term that will help to moderate increasing costs. We didn’t do this because we thought it would have a measurable ROI.”

But getting employees to take an interest in their health care after a lifetime in a health care system where “doctor knows best” is the prevailing wisdom and few people think about health care costs as long as their insurance copays are low is no small feat, experts say.

Consumer-driven health plans are touted as a way to change that dynamic, and they are becoming increasingly popular. More than half of large employers offer a CDHP, and this year 22 percent will offer them as their sole plan, according to a National Business Group on Health survey. While cheaper than other health plans, CDHPs have higher out-of-pocket costs, which critics say could be problematic for low-income people and those with chronic health conditions who use the health care system frequently. To help offset some of these costs, CDHPs are paired with a tax-exempt reimbursement account — typically a health savings account or a health reimbursement account — to pay for qualified medical expenses.

In a CDHP, enrollees must keep track of funds in their account. If their savings are spent before their annual deductible is met, they must pay the difference out of pocket until they meet the deductible. Once it’s met, the plan works like a traditional preferred provider organization plan with the plan paying the majority of the costs.

 “In 2006 we began working with CDHPs and HSAs and we realized that the consumer had no clue how these plans worked,” Skinner said. “They had no understanding of even their basic PPO plan and we want to transition these people into a more complex environment? These plans mean a huge cost shift to employees, and they’re completely unprepared.”

But proponents see CDHPs as an employer’s most effective tool in driving consumer behavior, according to Travis Klavohn, director of consumer health solutions at BenefitWallet, an online platform for managing HSAs. It was launched last year by copier company Xerox Corp. A 2013 study by Buck Consultants, which is owned by Xerox, showed that 51 percent of employees with HSAs set aside more money for medical costs than before they had the account, 29 percent are having more discussions with their doctors about costs, and 13 percent are actively managing their chronic conditions.

“They shop for the cost of care and talk to providers more,” said Klavohn, who identifies himself as a “consumerism evangelist” on his LinkedIn profile. “Because the HSA is owned by the individual, employees are making a cognitive link between their long-term wealth and short-term medical spending.”

Unlike an HRA, an HSA is controlled by the employee, not the employer, which allows workers to invest unused funds in interest-bearing accounts and also enables them to take their account when they leave the company.

 “It’s about taking control of the situation,” said Scott Matthews, vice president of marketing for Castlight Health, referring to the employee-managed aspect of CDHPs. “It’s nothing people want to do, but if there’s enough money at stake people will want to do it.”

Castlight is just one of several companies, including Change Healthcare and Healthcare Blue Book, offering cost transparency tools to help users shop for health care services. Matthews said they will need that level of awareness to effectively navigate the new consumer world.

“We’ve been lulled to sleep by the fact that we have insurance and low copays,” he said. “We need to wake up out of our insurance-induced sleep and start thinking about how we are spending our money.”

Posted on April 8, 2014September 20, 2018

Ashley Goldsmith: More Doing

Ashley Goldsmith

Rowing through crocodile-infested waters in a flimsy canoe is not everyone’s idea of a dream vacation, but for Ashley Goldsmith it was the trip of a lifetime. She describes her experience on a safari along the Zambezi River in Zimbabwe as “the most exhilarating, frightening and slightly crazy thing” that she has ever done.

It wasn’t a trip for the faint of heart.

“Hippos are very scary,” said Goldsmith, chief human resources officer at HR software vendor Workday Inc. “They’re right there giving you all the signs that they don’t want you there, and then they go underneath the water and you just don’t know where they are. I had more adrenaline in an hour there than in a month in my normal life. It was fantastic. I can’t recommend it enough.”

She applies the same derring-do in her career. The word “crazy” has also been used to describe some of her job moves, according to Goldsmith, who joined the Pleasanton, California-based company last November. Among them was her 2007 decision to quit a key executive position at The Home Depot Inc. for a job as head of HR at a small medical company in Tucson, Arizona. She had started as a temp at the home improvement retailer in 1995 and within 12 years had worked her way up to vice president.

‘I remember going to my boss and saying that I’m going to a 600-person company as head of HR. … He looked at me like I had lost my mind, and he said, “You’re going to a popcorn stand.” ’

— Ashley Goldsmith

“I remember going to my boss and saying that I’m going to a 600-person company as head of HR,” she said. “He looked at me like I had lost my mind, and he said, ‘You’re going to a popcorn stand.’ But it turned out to be a wonderful career move.”

Later she jumped industries again and went to Polycom Inc., a Silicon Valley-based developer of video conferencing systems. She now lives in San Francisco with her husband and their two French bulldogs.

Goldsmith, 41, has surprised many in the course of her career, like her co-workers at a Home Depot store in Georgia where she was assistant manager. At the time, she was part of the company’s new executive leadership program, which rotated high-potential employees through a variety of roles. At age 24 with a college degree but no retail or home improvement experience, she joined the company’s ranks of orange-aproned workers.

“I was in my 20s and I didn’t know anything about home improvement, and yet there I was in a leadership role and you can imagine,” she said. “They looked at me like I was crazy.”

Growing up as the only child of a single mother in Marietta, Georgia, Goldsmith seems to have inherited her work ethic from Mom, who she said “worked incredibly hard to create a positive future for me.”

The Outsider

Goldsmith, at a petite 5-foot 3-inches tall, stood out immediately among the burly tradesmen who made up most of the sales staff. Adding to her outsider status was her psychology degree from Vanderbilt University. Most of the employees had high school diplomas only, she said. Today, Goldsmith also has an MBA from Northwestern University.

“Back in those early Home Depot days, if you had a college degree we were told not to ever talk about your education because most of the employees didn’t have it,” she said. “It was really a good thing to work your way up. So the fact that the only way you could get into the leadership program was with a college degree, made people look at you with suspicion.”

So Goldsmith made it her mission to earn the respect of her colleagues, working in every department and volunteering for the overnight shift, which frequently entailed restocking merchandise and rearranging displays — a job that is much harder than it sounds, Goldsmith said.

“You crawl out from the racks looking like you just walked out of a chimney,” she said. “So they’d be walking in in the morning, and I’d be walking out at 6 a.m. dirty and looking like I had worked really hard. By far, that was the biggest credibility-earner.”

By the time she left six months later for her next assignment, she made some good friends and earned a traditional Home Depot farewell.

“One of the things they do whenever someone leaves a Home Depot store, and I hope they still do this, is that everyone in the store signs your orange apron,” she said. “They gave me an apron and it had so many signatures — there were probably 200 people in the store. It was such an overwhelming feeling.”

That kind of initiative was no surprise to Cindy Lubitz, the supervisor who hired Goldsmith while she was a temp. Lubitz was in charge of launching Home Depot’s leadership development program and in need of someone to help her organize printed materials when Goldsmith arrived. When her temp assignment ended, Goldsmith called Lubitz at home and invited her to lunch.

“When she was leaving she said, ‘I’m just out of school and I’d like to talk to you sometime about what you do,” said Lubitz, who now runs her own talent management consulting firm in Atlanta. “A week later she called me at home. I had just had a very busy day at work. She asked me to lunch and I said, ‘Sure, or what if you come back in and help me full-time? That’s how she ended up with her first job.”

She worked with Lubitz for two years as a talent management analyst, and when Home Depot launched a leadership program for high-potential employees, Lubitz nominated Goldsmith.

“Ashley has a really nice balance of qualities,” Lubitz said. “She’s really bright and, relationally, she’s very strong. She’s someone people like working with.”

But one of her biggest career challenges lay ahead in 2005, a year after Goldsmith was promoted from head of HR for HD Supply — a distributor of industrial building supplies formerly owned by Home Depot — to vice president of HR for Home Depot.

Hurricane Katrina had struck the Atlantic Coast and traveled to the northern Gulf Coast, causing death and destruction in New Orleans and Mississippi and other areas. The Southeast had endured several hurricanes the year before, so the company was well-stocked with essential materials like sandbags and plywood, but no one could fully prepare for Katrina, she said.

Home Depot booked hundreds of hotel rooms in the region for volunteers from other stores and for local employees, many of whom manned the stores with skeleton crews until the last possible second, according to Goldsmith. Because banks were shut down and workers were unable to cash their paychecks, the company deployed armored cars to the stores to dole out cash. Meanwhile, back at company headquarters in Atlanta, Goldsmith and other company leaders coordinated workforce and rescue efforts. All told, Home Depot donated millions of dollars to Katrina recovery efforts.

Goldsmith had proven herself in a time of crisis, which is not hard to imagine given her eagerness to consort with crocodiles and other wildlife. It is that cool head that makes her a good leader, according to former colleague Elisa Gilmartin, chief human resources officer at Polycom, where Goldsmith worked before joining Workday.

“Ashley is incredibly consistent under times of stress, and she was consistent in her leadership,” Gilmartin said. “She doesn’t get ruffled. She’s also incredibly smart, agile and a benevolent leader.”

In Stride

Goldsmith describes her leadership style as collaborative and agrees that she usually takes things in stride.

“I don’t tend to fly off the handle,” she said. “It doesn’t mean that I’m not stressed out internally, but there’s no point in letting that emotion run rampant through the organization. I don’t think it helps get you where you need to go.”

It is precisely those qualities that make her an ideal fit for Workday, said Grant Bassett, the company’s vice president of global talent. The developer of cloud-based HR software has been growing rapidly since it was launched in 2005 by David Duffield, the founder of PeopleSoft Inc., which was acquired in 2004 by Oracle Corp. in a hostile takeover. The company has been giving its competitors a run for their money ever since, becoming one of the fastest-growing HR technology vendors in the country. Its most recent quarterly statement reported revenue of nearly $128 million.

‘She’s really bright and, relationally, she’s very strong. She’s someone people like working with.’

—Cindy Lubitz, Home Depot

“We’re proud that we hire people who are great at what they do, but they are also really great people,” Bassett said. “We look for humility and humanity. Culturally, this place is built on bringing your whole self to work.”

“What’s interesting to me about Ashley is that she grew up grounded in HR principles at Home Depot, but she also has a business presence that gives her a seat at that proverbial table. She’s extremely sophisticated about business. She doesn’t see HR as a transaction.”

Goldsmith said that although she “fell into” HR as a Home Depot temporary worker, she developed a fascination with the power of people to help a company succeed.

“HR is such an interesting part of driving the business, and to me it is the most complicated variable,” she said. “Humans are challenging, and I like the complexity of trying to figure out how to harness this incredible asset, all these talented people, and help them not only achieve business goals but help them feel satisfied with their work. It’s an intriguing problem to solve.”

The idea that HR might have to fight for a seat at the executive table seems odd to Goldsmith. She has never thought of HR as anything less than a critical and strategic part of any business.

“What’s more strategic than how you leverage one of the most expensive variable costs in a company — your people?” she said. “I think we have an opportunity now more than ever to be strategic with technology. It allows us to not spend on low-value transactional items and gives us ample opportunity to do strategic work by bringing us more analytics and data.”

It was that passion for the potential of technology to transform HR that drew Goldsmith to Workday, a company that she said has “changed the game for HR.”

She met co-founder and CEO Duffield while she was at Polycom. Workday was seeking new business and had invited Goldsmith and other executives to spend a day at the company. The technology impressed her, but she said that Duffield’s business philosophy inspired her.

“He said, ‘Happy employees mean happy customers,’ ” she said. “I loved that it was the first thing he would say to a customer, that their employees are that important. I thought this was great coming from a CEO and a founder.”

The message resonated for Goldsmith, who still remembers the lessons learned working on the sales floor at Home Depot.

“That’s where I learned about the importance of the customer and the importance of the people that you work with,” she said. “It doesn’t matter if they went to Harvard or never went past eighth grade. If they’re the ones helping the customer, then they’re the ones that matter.”

It’s a lesson that she’s unlikely to forget. She has her signed orange apron to remind her, which hangs in a frame over her desk.

Posted on April 1, 2014June 20, 2018

Another ACA Delay for Employers

Many employers applauded the Obama administration’s decision to again delay the “employer mandate,” but none louder than those in retail, hospitality and restaurants with fluctuating workforces, according to health care reform experts.

Determining who meets the Affordable Care Act’s definition of a full-time employee has been a sticking point for employers with workers who have changing hours or work seasonally. The law defines a full-time employee as someone who works at least 30 hours per week.

The latest delay, which was announced Feb. 10 by the Internal Revenue Service and U.S. Treasury Department, gives employers more time to plan. Companies will have until Jan. 1, 2016, to determine if they must provide health insurance coverage.

'We won’t have to worry about the government breathing down our backs for another year.'

—Steve Wojcik, National Business Group on Health

“Those with workers whose hours fluctuate or are not offering benefits that meet the ACA’s requirements will need to make decisions about health care benefits and staffing,” said Steve Wojcik, vice president of public policy for the National Business Group on Health, a coalition of large employers based in Washington, D.C.

This is the latest revision to the ACA and affects companies with 50 to 99 employees. Employers with more than 100 employees will be allowed to comply in stages, offering coverage to 70 percent of full-time workers in 2015 and 95 percent in 2016 and beyond, or they will be subject to tax penalties. Also, seasonal workers who are not employed for more than six months will not be considered full time, and employers will not be required to provide health care benefits to them, according to the revised rules.

Employers who are getting questions from employees asking how the changes will affect them in 2015 should send a “reassuring message” telling them that nothing will change, Wojcik said.

“We won’t have to worry about the government breathing down our backs for another year,” he said. “Even if it doesn’t change what we’re offering, at least we have another year to deal with the issue of whether or not we will be audited.”

Posted on March 10, 2014June 29, 2023

Take Care to Communicate Health Care Costs

health care costs; HSA retirement

In the early 2000s, the average worker paid about $2,000 for his or her share of health care benefits and out-of-pocket expenses.Today, those same employees are paying nearly $5,000 for the same coverage.

Try explaining that kind of spike in costs to employees when the topic of employer-sponsored health care coverage comes up.

“Employee contribution rates have accelerated dramatically in the past 10 years, and one reason is advances in technology,” said Tim Nimmer, chief health care actuary for consultancy Aon Hewitt.

According to a 2013 Aon Hewitt analysis, employee contributions and out-of-pocket costs climbed from $2,011 in 2004 to a projected $4,969 in 2014. But getting employees to understand and appreciate how much their employer contributes to their health care plan can still be a challenge.

“You hear a retiree say, ‘I remember when my health care spend was $1 a month.’ ” Nimmer said. “We take for granted the types of technology we have today. We always want the best and we want it now. We don’t want care that’s outdated by 10 or 20 years. Employers have paid that cost.”

In 2011, 44 percent of workers surveyed said their benefits were 'definitely worth it,' given the out-of-pocket costs. Last year that figure dipped to 32 percent, according to a Mercer survey.

According to the 2013 Mercer Workplace Survey, the perceived value of benefits is eroding among workers who complain about out-of-pocket health care expenses. In 2011, 44 percent of workers surveyed said their benefits were “definitely worth it,” given the out-of-pocket costs. Last year that figure dipped to 32 percent, according to the Mercer survey. And nearly three-fourths of employees surveyed feel that their employers should offer better benefits.

The most prevalent way to shift costs is through plan design changes like increasing deductibles, copayments or coinsurance, Nimmer said.

“These are the most easily communicated to employees,” he said. “If you change a deductible from $500 to $700, employees know what that means and we know that there’s an immediate impact on health care costs.” Other cost-saving strategies that don’t involve benefit plan changes include steering employees to the most cost-effective providers and using wellness incentives to encourage better lifestyle choices, he said. “Employers have a lot of different levers that they can pull.”

While employees need information to help them understand why and how their out-of-pocket expenses are increasing, Joann Hall Swenson, a communications consultant at Aon Hewitt, said that too much information can be a bad thing.

“We often find that clients, especially HR leaders and in the C-suite, want to give employees the whole rationale behind these changes. We say that’s well and good but employees want personal information about their health plan,” she said. “They want to know, ‘When I go into the doctor, what’s it going to cost me? Keep your rationale and all the details for the C-suite. People get lost and really annoyed. For employees, think about how communicating clearly and personally is important.”

In fact, more employees are asking for personal guidance in choosing their benefits than ever before, she said. 

When health care was very inexpensive for employees, “you didn’t need that much information, but because of the complexity of health care today and the rising costs and all the different tools and options that they have, it’s confusing,” Swenson said.

According to David Slavney, a communications consultant with Mercer, the key message to employees needs to be, “We are all in this boat together.”

“Costs are going up for employers, too,” he said. “Certainly, employers are talking about how those costs are divided between employer and employee, but it’s a very tough conversation to have.”

Posted on December 11, 2013August 1, 2018

Mary Barra, General Motors’ Next CEO, Breaks Ground for Women and HR

Mary Barra, seen here in January 2012, will become the next CEO of General Motors in January 2014. Photo by John F. Martin for General Motors.

It wasn’t only women who cheered when General Motors Co. appointed Mary Barra as CEO on Dec. 10, making her the first female CEO in the male-dominated U.S. auto industry. Human resources professionals also had reason to celebrate — she is one of the few HR professionals to reach the pinnacle of the corporate ladder.

“It’s also an important signal to HR professionals that if you’re interested in a career path that extends beyond HR you need to have experience in multiple facets of the business,” said author and consultant Sue Meisinger, who is the former president and CEO of the Society for Human Resource Management. “For many HR pros, their capstone is to be the head of HR. This shifts the sights of many in human resources.”

Barra, 51, executive vice president of global product development, began her career as an intern at GM 33 years ago. From there she moved to the manufacturing floor as a manager and worked her way through several key positions, including vice president of global human resources from 2009 to 2011.

Her promotion to head of HR was also seen as groundbreaking. Barra had no human resources experience. She has a degree in electrical engineering and an MBA from Stanford University.

“You’re seeing people with HR experience going into executive jobs and people without HR experience going into HR jobs, and I think that’s really interesting,” said Theresa Welbourne, a professor at the Center for Effective Organizations at the University of Southern California.

It also signifies that the male-dominated industries are disappearing, Meisinger said.  

“Much of the attention that she’s received circles around the fact that the car industry is seen as a male domain,” she said. “This signals that there aren’t many companies anymore that are either male or female. That’s why Marissa Mayer and Meg Whitman got so much attention when they became CEOs. There aren’t too many women leaders in the tech industry.”

Barra is viewed as a leader in the company’s turnaround since emerging from a Chapter 11 bankruptcy in 2010. She replaces CEO Dan Akerson who will retire in January 2014.

“This is a woman who is clearly qualified for the job,” Meisinger said. “It’s great succession planning on the part of GM.”

Rita Pyrillis is a Workforce senior editor. Comment below or email editors@workforce.com. Follow Pyrillis on Twitter at @RitaPyrillis.

Posted on October 14, 2013August 3, 2018

Tips for Negotiating a PBM Contract

Understanding pharmacy benefit manager contracts can be a challenge. Here are some tips to help employers cut through PBM terminology and mechanics.

·       Define brand and generic drugs — Require the PBM to classify brand and generic drugs based on a national pharmaceutical market research service, such as First DataBank and ask for specific coding requirements.

·       Defining ‘claims’ — Propose language that specifies that claims will not include duplicate, reversed, or rejected claims to ensure that the PBM reimburses when money is due and will not overcharge on processing fees.

·       Understanding prices — Require the PBM to explain pricing methodologies for all of its covered drugs.

·       Conflicts of interest — Ask the PBM to disclose financial arrangements with drug manufacturers, like rebates, and with pharmacies and other interests.

·       Receiving rebates — Ask the PBM to identify and pass along all sources of rebates.

·       Audits — Establish a method to review the PBM’s performance.

·       Short contracts — Review or renegotiate your PBM contract every two years.

·       Classifying specialty drugs — Obtain a list of the PBM’s specialty drugs and request approval rights before changes are made to the list.

·       Mail order and specialty drugs — Many PBMs operate their own mail-order pharmacy. Ask that the price you pay for a mail-order or specialty drug is the same as what the PBM pays. If the PBM refuses, ask to see the price difference between your costs and the reimbursement received by the mail order pharmacy.  If that fails, negotiate for lower administrative fees.

·       Fee breakdown — Ask for an explanation of the PBM’s administrative fees. Some charge a flat fee for all services and others charge individual fees.

·       Copays — Copays should not be higher than the cost charged by the pharmacy.

·       Plan updates — Ask your PBM to update the plan on a quarterly basis as new drugs enter the marketplace.

Source: Contracting Negotiating Tool: Information on Contracts With Pharmacy Benefit Managers, Pharmacists United for Truth and Transparency and Georgetown University’s Harrison Institute for Public Law, 2012

Rita Pyrillis is Workforce’s senior editor. Comment below or email editors@workforce.com. Follow Pyrillis on Twitter at @RitaPyrillis.
Posted on August 14, 2013June 20, 2018

Medical Mythbusters Crack Back on Health Care Costs

If you think that wellness programs are an effective way to manage health care costs and improve the overall health of your employees, think again. The same goes for accountable care organizations, on-site health clinics, using claims data to predict future health problems, pharmacy benefit managers and a variety of other fashionable trends springing up in the post-health care reform world.
 
In the recent book, “Cracking Health Costs: How to Cut Your Company’s Costs and Provide Employees Better Care,” co-authors Tom Emerick and Al Lewis skewer sacred cows and debunk prevailing wisdom in short order. The gist of the book is summed up with this pithy advice: “Keep vendors away from your checkbook, keep consultants away from your conference room and keep providers away from your workforce.”
 
Emerick, chief strategy officer at Chicago-based Laurus Strategies, is the former vice president, global benefit design for retail giant Wal-Mart. He spoke with Workforce recently about the problem with the latest approaches to managing health care costs and quality.
 
How will the Affordable Care Act impact the way employers manage health care costs, and how effective are wellness programs to that end?
Under ACA, employers won’t have control of health care costs. I’m troubled that as more evidence piles up that the wellness approach isn’t working, more companies are doubling down on it. Employers will have to conform to a government-issued plan design. 
 
The time that employers will realize that wellness programs aren’t effective is when they are being mandated to provide it. You will have to report if it’s improving the health of the population you are targeting, which creates another level of bureaucracy. I imagine that a sanction for not meeting certain health goals won’t be far behind.
 
On the positive side, it will force employers to see if they are having an impact.
 
What is the problem with wellness programs?
The three factors that impact an employee’s health are age — no wellness program can change that — genetics, which you also can’t change, and how well you like your job. In Europe, study after study shows that the single risk of mortal hazard for working-age people is whether they have a job they can tolerate. If you’re in a job that you hate it causes metabolic syndrome, or high blood pressure, it causes alcoholism, it causes obesity. 
 
If you want to offer a wellness program to show employees that you care and it’s not intrusive, go ahead. But please don’t do it and think you’re going to save money.
 
If wellness programs are so ineffective, why have so many employers embraced them? 
Wellness sounds like a great solution. It also sounds noble. Who doesn’t want to think that they can improve the health of their workforce? Also, HR departments are under a lot of pressure to control costs, and this is a relatively easy way to show that you are trying to do that. Wellness vendors send reports on how they are saving you money. They will say things like, “You’ve decreased the risk of heart attack by 150 percent.” But if you decrease the risk of heart attacks 150 percent, that means someone will have to rise from the grave. If you do the math you will see that you’re getting impossible numbers. But offering a wellness program is more attractive than raising deductibles and changing plan design.
 
More and more companies seem to be offering incentives to get employees to adopt healthier lifestyles, yet your book urges employers to spend their money creating a culture of wellness instead. Can you explain?
 
Incentives have a long history of inducing things like smoker’s amnesia. There were a huge number of these incentive programs around smoking that started back in the latter 1970s and early ’80s and a lot of companies canned them. People wouldn’t tell the truth. Joe would come in and say he saw Bob in the break room smoking and Bob is getting the $50 incentive anyway. What are you going to do, fire him? That’s why a lot of programs from that time got canceled. It’s troubling because those kinds of programs have come back with a vengeance. Companies have lost tribal knowledge of what happened the first time they tried incentives.
 
What does work is doing things like putting healthy food choices on the company menu and creating an environment of wellness by building walking trails. Another way to show that you care about your employees is making sure the restrooms are spic and span. You’re better off reallocating those incentive dollars toward creating a wellness culture.
 
The concept of using claims data to predict which employees are likely to face medical problems has gained a lot of traction, yet you call it health care’s biggest fraud after wellness programs. Why doesn’t it work?
There are people who have strokes and heart attacks all the time with no history of it, but it was genetic. You can’t capture that in claims data. What you have in claims data is a whole lot of medical bills and not much else. If you’re trying to take what people say in their health risk assessments and dovetail it in, oftentimes you’re not asking the right questions. I don’t want to participate in a health questionnaire that asks, “Did your mother, father, brother, uncle have a heart attack?” That’s a bit intrusive in my opinion. When employers ask those kinds of intrusive questions they may or may not get a truthful answer.
 
You write that most employers will never know how much value, if any, pharmacy benefit managers provide because PBM contracts are impossible to understand. So how can employers cut through the smoke and mirrors?
 
It wasn’t designed this way by accident. I’ll tell you what’s wrong with PBMs. I worked with a company that had a brand-name drug on their preferred list. It was there because it came with a $4 rebate. The employer got $2 and the PBM got $2. But there were drugs with no rebate available that cost less than one-fifth of what that drug costs and they weren’t on the preferred list. That $2 rebate ended up costing the employer about $80 on each prescription. Also, the literature said that the rebated drug was not as effective as the cheaper drug. Employers need to question the PBMs about what they’re doing and why they’re doing it that way. The reason that some drugs get higher rebates is because they are not as effective and they need to offer a rebate to get employers to buy them. 
 
I ask benefits managers why they don’t address these issues more aggressively and they say that they’re too busy managing the medical plan and no one is complaining about the pharmacy plan. The reason no one is complaining is because things run pretty smoothly with a PBM and they let a huge number of drugs into the formulary.
 
Employers can save a lot of money by being more restrictive about the drugs they allow on that preferred list, but HR people see that as disruptive and as something that could generate complaints.
 
Popular wisdom says that the best way for employers to control health care spending is to focus on the 10 percent of the people who account for 80 percent of their health care dollars, but you debunk this theory. What does work?
The 10/80 fallacy is that the 10 percent of people with chronic conditions spend 80 percent of plan dollars. That is a huge fallacy. What's true is that 6 percent of the people, who I call outliers, in the middle of an acute health care episode, e.g., cancer, heart or valve surgery, spine surgery, etc., spend 80 percent of plan dollars. Most of what they have is not preventable and many have chronic but coincidental conditions. An example is someone with liver cancer who also has asthma. Many consultants are simply misreading data by looking at averages and not distributions, or erroneously falling into a post-hoc fallacy. It's that simple.  
 
Companies like Wal-Mart, Lowe’s and Pepsi are using the clinics and hospitals that are the most effective in treating these outliers. There are extreme differences in how hospitals manage these illnesses. About 10 to 20 percent of that population is misdiagnosed. That kind of thing is epidemic today. You need to spend the money to get them the correct diagnosis.
 
Rita Pyrillis is Workforce’s senior editor. Comment below or email editors@workforce.com. Follow Pyrillis on Twitter at @RitaPyrillis.
Posted on August 11, 2013June 29, 2023

2013 Game Changer: Monica Sauls

As human resources and talent manager at pharmacy retail giant Walgreen Co., Monica Sauls has helped hundreds of employees manage and grow their careers.

Her specialty is change management, guiding employees through changing job roles and other career transitions. Sauls, 35, who is based in St. Louis, manages HR operations for 8,000 employees at 300 store locations for the retailer. She oversees a team of nine HR practitioners specializing in training development, staffing, succession planning and workforce planning.

“Leading cutting-edge human resources and talent programs that promote an environment where all employees can discover peace, happiness and excitement in their work is the most rewarding aspect of my career,” Sauls says in an email.

And she has shared her knowledge beyond Walgreen, discussing careers on a local television show that also streams on YouTube.

Rita Pyrillis is Workforce’s senior editor. Comment below or email editors@workforce.com. Follow Pyrillis on Twitter at @RitaPyrillis.

Posted on June 3, 2013August 6, 2018

SHRM: Design for the Future

In 2008 the Society for Human Resource Management was in the midst of a makeover. Its well-respected president and CEO was retiring after six years, and the organization was attempting to shed its administrative image and rebrand itself as a global HR thought leader. At that time, Workforce took an in-depth look at the initial stage of the transformation in an article titled “SHRM at a Crossroads.”

During the past half-decade, SHRM emerged from the depths of the nation’s worst recession since the Depression with a growing membership, flush coffers, an increased focus on pushing its political agenda and a heightened global presence.

And according to current SHRM President and CEO Hank Jackson, the organization has done so by remaining steadfast to its mission. “Our society has grown to become the largest human resources organization in the world because it has never lost its focus on the original principles: Serve the members. Give them what they need to assist employers and employees alike. Advance the profession by protecting and promoting its professionalism,” he wrote in the April issue of HR Magazine, the association’s publication. A spokeswoman said that Jackson was not available to comment for this article.

While most SHRM members are content with the direction that the association is heading, the chorus of critics who say that SHRM has lost its way seems to be getting louder.

In a recent Workforce survey on HR associations, a number of participants said that SHRM is focusing too much on profits and increasing membership and not enough on the needs of its existing members. Others still criticize past actions by SHRM’s board of directors, such as its 2005 decision to pay board members and allow them to travel business class. Others say that SHRM has shifted its focus from helping employers and employees to representing the interests of employers only. And others took SHRM to task for not doing a better job in elevating the status of the profession.

Just over half of the respondents—51 percent—indicated that they are satisfied with the direction that SHRM is leading the HR profession, while 40 percent said they are unsure and 9 percent indicated dissatisfaction. Of SHRM members, two-thirds were satisfied.

Comments like these were typical: “They seem more focused on increasing membership than on improving the profession. The meetings of local chapters seem to be focused on the interests of entry-level HR people and networking rather than on real professional development through in-depth discussion of the issues” and “SHRM has become too big and too commercial.”

Still others praised many of SHRM’s efforts, including education, lobbying and some of the things critics have pointed out, like representing the needs of small employers and entry-level professionals. “Need to make sure that we remain focused on what’s fair for the employer and employee, omitting any political-party agendas,” one respondent writes. “So far, I believe SHRM has been able to do that. Also, the recognition and respect HR professionals now receive, I believe, has been partially achieved by SHRM’s efforts.”

The majority of respondents—67 percent—said they are satisfied with the organization overall, and many praised SHRM’s efforts in education, lobbying and meeting the needs of small employers and entry-level professionals.

Criticism of an organization as large as SHRM—it has 265,000 members worldwide—is probably inevitable. But many SHRM critics are respected longtime members who have been deeply involved in its activities, like Barbara Hobbs, an HR director in Tallahassee, Florida. She has been an active SHRM member for 30 years and is a past president of SHRM’s Jacksonville, Florida, chapter. She says that she is disappointed with some of the association’s actions.

“They’ve forgotten about the small employer and are geared more toward the global economy,” Hobbs says. “And I don’t think they should be spending the kind of money that they do in travel for board members. Somehow SHRM has gone astray. As my grandmother used to say, ‘They’ve become too big for their britches.’ “

Some argue that the entire HR profession is at a crossroads as it struggles to establish itself as a strategic business partner and shed its image as a bureaucratic policy pusher. John Boudreau, research director at the Center for Effective Organizations at the University of Southern California, says that SHRM reflects that transformation.

“There’s been lots of questioning of what the profession needs to be,” he says. “Every professional HR association has done work on that. There has been an upwelling of this discussion in the past two to three years. Our evidence suggests that there’s been progress, but whether or not it’s been quick enough for the aspirations of the profession and to meet the needs of its constituents is an open question.”

The role that HR plays has come under greater scrutiny in part because the recession and its impact on the workforce have led corporate leaders to “look at what this profession can deliver” in terms of strategic thinking and leadership, Boudreau says.

Steve Miranda, who was SHRM’s chief human resources officer from 2005 to 2011, says that during his tenure the association began rebranding itself to reflect changes in the business landscape. Its programs were becoming more sophisticated and more global in perspective, he says.

“There were incredible pressures being placed on HR professionals at the time,” says Miranda, who is now managing director at the Cornell University Center for Advanced Human Resource Studies. “Our courses and conference programming had to rise to the next level. We had to up our game. HR was split into two camps: the administrative and the business strategy. HR was undergoing a change, and SHRM’s offerings had to reflect that.”

According to Bob Carr, SHRM’s senior vice president of membership, marketing and external affairs, SHRM has continued to evolve.

This year the association launched five strategic initiatives designed to increase membership, particularly among senior-level executives, and promote professionalism through professional standards and competencies, Carr says.

Last fall SHRM launched the CHRO Initiative, which aims to attract more senior-level members by establishing networking groups, or “hubs,” in cities around the world. Chief human resource officer hubs are underway in 15 cities, including Atlanta and New York in the United States, and Manila in the Philippines, according to a SHRM overview of the project. SHRM also plans to beef up membership in California, which has a large number of SHRM chapters and affiliates and a unique set of employment laws, Carr says.

Other initiatives include promoting SHRM’s nine HR competencies, or professional standards, which include relationship management, ethics and leadership, among others. Last year SHRM introduced performance management standards to give employers a uniform way to assess and evaluate employee job performance. The standard was approved last year by the American National Standards Institute, a nonprofit organization that oversees the development of professional standards for a variety of companies and institutions.

Attracting more senior-level professionals, however, has been an elusive goal for SHRM.

“The CHRO issue is a conversation that they’ve had since day one and will continue to have ongoing,” says China Gorman, who was SHRM’s chief operating officer from 2007 to 2010. “The strategies to engage more HR leaders in the organization will ebb and flow. Having CHRO support is important because many of their employees are members. Is SHRM ever going to be successful at programming for the Fortune 500 CHROs? I don’t know. But as long as SHRM continues to provide the best services for those entry- and midlevel and senior professionals, it will have the support of CHROs.”

John Haggerty, a senior lecturer at the Cornell’s ILR School, says that SHRM serves “a very important purpose” in exposing entry- and midlevel professionals and those at small companies to industry leaders and knowledge.

“I’ve always thought of SHRM as fulfilling a need in the industry to provide those without solid academic credentials the opportunity to learn a trade,” Haggerty says. “A lot of SHRM’s membership is made up of all sorts of professionals who are not Fortune 50 HR people, and the whole thing about a seat at the table is being played out more often in large companies. That’s where the more strategic HR work gets created. SHRM exposes people in smaller organizations to those best practices.”

While there is little doubt that SHRM is a powerful force in the HR industry, its efforts to be a thought leader have not always been successful.

Last year its proposal to standardize a set of HR metrics, such as employee satisfaction and money spent on training, was torpedoed by an association of CHROs. The HR Policy Association, or HRPA, a Washington, D.C.-based lobbying organization representing 335 of the nation’s largest corporations, strongly opposed the measure, which called for the data to be shared with the public. The HRPA argued that it would overburden employers and expose proprietary information to competitors. SHRM withdrew the proposal late last year.

Some say that SHRM’s effort to be all things to all people has compromised its cache. Anyone who coughs up its $180 annual membership fee can join, whereas organizations like HRPA and the Chartered Institute of Personnel and Development in the United Kingdom are much more selective. HRPA’s annual CHRO Summit is by invitation only, and the CIPD only admits those who pass rigorous testing.

“If you want respect as a profession, you need to limit the numbers of the people you let in,” says Bridie Fanning, a Milwaukee-based consultant who is a member of both SHRM and the CIPD. “Look at law and medicine. You have kids coming out of law school, and there are no jobs. It’s great for the law schools but not for the profession. And then you look at the medical profession, and we don’t have enough doctors. A business strategy is that you say yes to some customers and no to others. SHRM doesn’t know who it’s saying yes or no to.”

Carr concedes that SHRM’s membership strategy is to be inclusive, not exclusive, but he sees that as a strength.

“The strategy behind it was that we didn’t want to disenfranchise people,” he says. “When we were founded, HR was a growing field, and we wanted to make sure we were as inclusive as possible. We wanted access for everyone. Then you reach a point where you want to be seen as the best in your profession, and that’s where certification comes in.”

Carr points out that only those who pass the HR Certification Institute exam can become a credentialed HR professional. The institute offers three main credentials—the Professional in Human Resources, Senior Professional in Human Resources and Global Professional in Human Resources. SHRM sells test preparation kits, but HRCI administers the exams.

While 127,439 practitioners have an HRCI certificate, according to the institute, just how much weight those certifications carry is unclear. In the U.S. some companies, like Netflix Inc., don’t ask for the credentials when hiring, while in the United Kingdom, “You rarely see an HR job that doesn’t require CIPD certification,” says Fanning, who wrote her master’s thesis on HR professionalization in the U.K. and the U.S.

CIPD certification is not required by all U.K. employers, but “they do have a high degree of currency in the employment market, with many employers considering the credentials to be desirable,” says Katy Askew, a CIPD spokeswoman. She says that a CIPD chartered membership, which is awarded to practitioners who pass a rigorous exam and have three to five years of HR experience, is equivalent to a master’s degree in the United States.

While the CIPD is the only HR association in the U.K., there are several in the U.S. in addition to SHRM and the HRPA. Among them are International Association for Human Resource Information Management, which has 1,700 members and National Human Resources Association, which has 1,200 active members.

And there are divisions within SHRM itself.

In 2010, a group of former SHRM leaders who were concerned about decisions made by the association’s board of directors formed a splinter group called the SHRM Members for Transparency. It is a small but powerful group made up of past presidents, former board members and HR leaders like Gerry Crispin, Jac Fitz-enz, Mike Losey and others.

Among their grievances was the board’s 2005 decision to pay its members and allow reimbursement for business-class travel for board members. Other key issues included the large number of board members without HR credentials and the association’s inability to hire a president and CEO in a timely fashion after the departure in 2010 of Lon O’Neil, who took over after Sue Meisinger retired in 2008. The job went unfilled for nearly a year before SHRM hired Jackson as then-interim president and CEO. His lack of HR credentials was also a point of contention for the transparency group.

The group even ran its own candidate in the fall 2012 board elections, but she lost.

Many SHRM members dismiss the criticism as sour grapes.

“I know that there are people out there who like to take potshots out there, but I think very highly of the organization,” says Dave Ryan, HR director for Mel-o-cream Donuts International Inc. in Springfield, Illinois, and a SHRM member since 2001. “Do they make missteps? Of course they do. But they’ve done a lot of good things for this profession. Folks were jacked up last year at the leadership conference about board members traveling to India or South America first class, but that just seemed like sour grapes to me.”

SHRM officials, including Carr, are undeterred by the criticism. “Aren’t those the sort of the inherent tensions in a democracy?” he says. “We are open and inclusive so we will have people with a wide range of views. What we should be or shouldn’t be, what we should do and shouldn’t do who we should be, all that resides with our board of directors.”

As we noted in our survey, about two-thirds of SHRM’s members are satisfied with how it’s leading the profession. Eventually, however, leaders will have to answer the questions of who, or what, SHRM should be if they want to move beyond the crossroads.

“The issue of SHRM’s relevancy is not much of an issue if its membership is growing,” says Miranda, SHRM’s former CHRO. “The real task for SHRM is figuring out what it doesn’t want to be. No organization can be good at everything.”

Rita Pyrillis is Workforce’s senior editor. Comment below or email editors@workforce.com. Follow Pyrillis on Twitter at @RitaPyrillis.

Posted on May 9, 2013August 3, 2018

Happy Talk? Keep Talkin’ but Start Doin’

Ed Frauenheim is on assignment.

A recent New York Times article on corporate culture seems to have hit a nerve with some HR pros.

The May 7 piece by entrepreneur Cliff Oxford titled “Where the Happy Talk About Corporate Culture Is Wrong” asserts that there are two types of happiness in a work culture: “HR Happy” and “High Performance Happy.” The former is a place with superficially nice bosses feigning interest in their workers and the latter is a workplace where employees are treated like grownups and take their lumps like Gen. Patton’s men, no crybabies or slackers allowed.

I’d like to give HR a graceful exit here because I don’t believe that the responsibility for creating a happy or a dysfunctional culture rests with HR. Company dismissed.

Workplace culture is shaped by the folks in charge. They determine whether the workplace has “a second-rate corporate culture where people resign themselves to the fact that they will get more if they accept being treated like children,” or a place that allows them to make decisions and trusts them “to handle their vacation schedule, their paid time off, and the tools they need to get the job done,” as Oxford writes.

If leaders rule by fear they get bullies and brown-nosers. If they rule by micromanaging, they create disengaged employees. The core of a high-performance culture is respect, Oxford argues. And the absence of it is certainly the mark of a dysfunctional one.

 “High Performance Happy means you give employees tremendous responsibility, and they are happy to show that they are the best,” Oxford writes. “You don’t have to con them into doing things with a flavor-of-the-month methodology that suggests they will perform if you make them happy first. HR Happy says, I want you to think that I like you. High Performance Happy says, I believe in you.”

Leaders who truly respect their workers and their talents get people who take work calls at 4 a.m. or finish projects after the kids go to bed. Nothing kills that kind of passion faster than measuring performance by tallying the hours an employee spends in the office rather than the quality and timeliness of their work. Or by the number of times a customer service agent says a customer’s name rather than by the quality of their service.  Those kinds of measures don’t say, “I believe in you.” They scream, “I don’t trust you.”

When trust is at the core of any employer-employee relationship, great things can be accomplished. Motivation comes from an inner drive to do your best and work toward a common purpose, whether it’s helping a customer solve a problem or tackling a global issue. Birthday cupcakes or a shout out in the company newsletter can’t inspire that, but an employer who trusts and values you can.

Rita Pyrillis is Workforce’s senior writer. Comment below or email editors@workforce.com. Follow Pyrillis on Twitter at @RitaPyrillis.

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