Not surprisingly the future of the United States heath care system is already a huge topic of debate for next year’s presidential election.
Many of the 2020 Democratic nominees for president are supporting a single-payer or Medicare for All solution.
Since the United States has never had this type of health care, it’s helpful to sort out the myths from the facts, which is exactly what one woman did at an employer-centric health care conference recently.
One of the first ideas Berger brought up is key. Every country in the world, including the United States, is having the same health care problems no matter what the financial model is being used, she said. These problems include rising costs and access issues. The only way the U.S. is different, she added, is that we’re the only country that has made health care “political warfare.” Also, in most other countries people don’t go bankrupt or homeless because of health care costs.
Meanwhile, Berger also debunked several myths about other countries’ single-payer systems. One key myth is that “health care is socialized medicine.” While some socialist countries do use a single-payer system, many non-Socialist countries do, too. Pulling the socialist card to dismiss the single-payer discussion is “a bullet people use to not discuss change,” Berger said.
Berger listed other misconceptions about single-payer health care:
Single-payer financial models are all the same. (None are the same.)
“Single-payer” applies to both the finance and delivery of health care. (Only four countries have fully integrated models.)
Single-payer means no cost to the consumer. (This is very rarely true. There are out-of-pocket costs in almost all countries that use single-payer.)
Single-payer means no focus on preventative care. (This is not true, Berger noted, giving the examples of Cuba, Costa Rica, Israel, Saudi Arabia and Australia.)
Single-payer dictates how doctors treat patients. (It doesn’t.)
Single-payer models destroy innovation. (Berger noted many examples of how this is not true. To name a few: The Netherlands, which has one of the most unique memory-care systems in the world; South Africa, with its automated pharmacy teller machine.)
“We don’t have to be somebody else, but we have to learn from somebody else,” Berger said.
One other idea that Berger mentioned was the need to know the definitions of key phrases if you’re going to have a conversation about the different health care proposals. For example, the difference between Medicare and the Medicare For All bills. While Medicare doesn’t cover vision or dental, the predominant Medicare for All Act in Congress covers a broader range of services, she said. While the word “Medicare” is used in this context, by definition Medicare for All does not mean the exact quality and coverage of Medicare expanded to each U.S. citizen.
It’s also necessary to understand the definition of universal health coverage, which the United States does not have even with the Affordable Care Act. The World Health Organization defines universal health coverage as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship.” It continues, “People need to be protected from being pushed into poverty because of the cost of health care”— a milestone the U.S. has yet to reach.
None of this is to say health care should be one way over another. But if we’re debating on what health care system works best for the country, then relying on facts rather than myths for information is a good start.
It’s possible to admit that the current employer-based health care system is not doing well in certain regards. Almost 24 million Americans enrolled in employer health plans must spend a large share of their income on health care. High-deductible health plans have the power to impact low-wage workers in much more detrimental ways than they impact high-wage workers. Contributing to HSAs like some employers promote just isn’t possible for many low-income employees; in fact, Bruce Sherman, medical director at the National Alliance of Healthcare Purchaser Coalitions noted at this same MBGH conference that only 1 percent of low-income employees contribute to HSAs.
Whatever the solution is to problems within employer-sponsored plans currently are, it’s not something that has been solved yet. There are going to be plenty of suggestions from the candidates.
As the 2020 election nears, we’re likely to hear a lot of hyped and a lot of misleading “facts” about certain health system proposals, and I’d encourage you to look at the facts instead of falling too deeply into the “political warfare” of U.S. health care.
It’s the human resources dilemma: how to balance what’s best for the business with what’s best for employees.
The place where you feel it the most? Medical benefit costs. With health care costs increasing nationally, HR is stuck in the middle trying to decide between savings for the company and easing the cost burden on employees.
Finding new strategies to lower costs is a constant challenge — one that doesn’t always prove fruitful. Employers that tried 14 or more tactics to curb rising health benefit costs, such as having healthy food choices available or offering onsite fitness facilities, only realized .4 percent savings, according to a recent Mercer survey. That’s a lot of work for little payoff.
Barry Rose, superintendent of Cumberland School District in Wisconsin, cycled through numerous health plans in the last six years, none of which struck the right balance between saving the district money and satisfying employees. “I couldn’t keep taking money out of the budget to spend on health insurance. Our district needs that $2 million for a new high school and teacher salaries.”
One hidden culprit behind the health benefits struggle? High-deductible health plans. Today’s average deductible is $3,000. Yet, many Americans don’t have $400 in savings to cover medical costs.
Deductibles often are preventing people from seeking the care they need. Due to cost, 44 percent of Americans say they avoided the doctor last year when they were sick or injured. In addition to lower company morale, care avoidance is costing businesses a lot of money. Illness-related productivity losses cost employers $530 billion on top of the $880 billion they spent on health benefits in 2018.
When J&E Manufacturing Co., a custom metal manufacturing company in the Midwest, learned from their existing health insurance provider their premiums were set to balloon over 30 percent in 2019 along with a deductible of $6,500, Ha Nguyen, corporate human resources manager, took a hard look at alternatives for their 200 employees.
“I couldn’t stand before our employees and tell them that,” said Nguyen, “It would upset most people, and we would risk some of them deciding to explore the marketplace to find a different job. Manufacturing is in a talent shortage right now, so we can’t afford to lose employees.”
With unemployment at an all-time low, it’s a candidate’s market; they have negotiating leverage and little tolerance for inferior benefits. Recruiters are struggling to offer attractive new incentives — commuter reimbursement, stock options, and personal trainers. Between the 14 tactics to lower costs and the myriad efforts to attract and retain talent, human resource professionals are juggling a lot.
HR managers need solutions that lower everyone’s health care costs and also promote compelling talent acquisition and retention. How can they do that? By giving employees what they want:
Clarity on what care is covered.
Clarity on the exact cost for that care.
Employees want access to both those things before they obtain care, not weeks after. When employees have access to these things in their health insurance plan, it can drive down costs for the employer.
Both J&E and Cumberland found such a solution in on-demand health insurance, a new model of health insurance that gives employees more control. Instead of a deductible and unpredictable costs, they have simple copays, easy coverage verification, and price certainty before they step foot into a doctor’s office.
“Our employees became better consumers because they see exactly what they’re paying for care,” Rose said. Seventy percent of members on the plan spent less than $500 in total copays — that’s one-sixth the cost of the average deductible.
And they have a compelling new advantage to attract talent.
“Top tier labor is hard to find. When people look at our benefits package and compare it to others, they see our plan is superior,” said Nguyen. “In the past, I just glossed over the health insurance plan during interviews. Now, it’s one of the first things I mention.”
Take some time to evaluate your current health insurance offering. Are you feeling like you are trapped between your employees and your C-suite? You don’t have to be. It’s time to make health care easy and affordable, and it’s time to empower your employees to make informed care choices.
Tinsley was so stressed that even something as simple as her co-workers at Caterpillar Financial Services bouncing stress balls off the ground would trigger her post-traumatic stress disorder.
Tinsley, who worked as a business system analyst for Caterpillar Financial, believed that the stress of her job was causing her to suffer adverse health issues. She emailed her supervisor, Paul Kaikaris, asking to be removed from a particular project, claiming that her “many [work] responsibilities … [were] causing [her] to be stressed beyond what [she was] physically able to handle,” which “negatively impact[ed her] work, sleep, and overall health.”
Kaikaris met with Tinsley and said he would see what he could do to take work off her plate. Six days later, however, Tinsey submitted a doctor’s note requesting four days off for a “confidential medical condition.” Upon her return, Kaikaris, good to his word, met with her and reassigned some of her projects.
Her job performance, however, continued to suffer. Kaikaris informed Tinsley that she was not following the prescribed methodology for completing her work, the quality of her work was subpar, and she had been leaving work early without prior approval. A poor formal mid-year review and a performance improvement plan followed.
In response, Tinsley claimed that Kaikaris rated her poorly and assigned the PIP in retaliation for her complaints that he had enabled a “hostile work environment” by permitting co-workers to bounce stress balls off the ground. Thereafter, Tinsley began submitting doctors’ notes ad seriatum requesting more time off for “mental and emotional duress brought on by an over-excessive workload, unrealistic deadlines, a hostile work environment and a manager’s reckless indifference to [her] mental and emotional well-being.” Those notes culminated in the company granting a five-week FMLA leave of absence.
At the end of Tinsley’s FMLA leave, her doctor cleared her to return to work “at full capacity.” However, because of her “post-traumatic stress disorder,” her doctor recommended that Caterpillar Financial return her “in a different work environment and specifically under a different manager.” The company refused the transfer or managerial change, but did permit her to take an additional eight weeks of medical leave (totaling 18 for the year).
At the end of that leave, and with Tinsley still insisting on a new manager, Caterpillar Financial decided that it had enough. It told her that it could not accommodate her “confidential” medical condition and that it did not believe that her request for a transfer to a different supervisor was a reasonable accommodation.
Tinsley has asserted that her impairment (PTSD) impacted only the major life activity of working.… Thus, we must now examine whether Tinsley’s PTSD sufficiently limited her ability to perform a class of jobs or a broad range of jobs. The evidence demonstrates that it did not.… [T]he record is replete with undisputed evidence showing that Tinsley’s issues stemmed directly from Kaikaris’ management style as opposed to the responsibilities of a broad range of jobs. The clearest example of this is when Tinsley told Human Resources that she would be able to continue in the same position so long as she was under the direction of a different supervisor because her disability was triggered by “the way [Kaikaris] managed … with all the balls bouncing.” … Tinsley’s diagnosis does not limit her ability to work a broad class of jobs; rather, it relates solely to her ability to work under a specific manager. Accordingly, she is not “disabled” pursuant to the ADA and was thus not entitled to a reasonable accommodation of additional time off or a transfer.
The ADA covers working as a major life activity. However, for an employee to be “substantially limited” in that major life activity, it is not enough to be unable to perform the specific job. The employee must be “significantly restricted in the ability to perform either a class of jobs or a broad range of jobs in various classes as compared to the average person having comparable training, skills, and abilities.”
This court reached the absolute correct result. It wasn’t that Tinsley couldn’t work as a business system analyst but that she just could not work under Kaikaris. Her own doctor said as much when he released her to return to work “at full capacity.”
If faced with a disabled employee claiming a substantial limitation in their ability to work, examine the request carefully. The ADA’s coverage of disabilities is broad. However, it is often difficult for an employee to establish “working” as a substantially limited major life activity. And, unless the employee cannot work in a class or broad range of jobs, the ADA does not cover them and you don’t have to offer to accommodate.
I recently received a pitch about how Amazon’s Alexa now has a “HIPAA-compliant upgrade” through which people can book appointments, ask health care questions and check on the status of prescription deliveries. The immediate reaction of my editor and me was, “How can this possibly be HIPAA-compliant?”
I bring this up because I’ve also recently read a Washington Post article about a pregnancy tracking app that claims to be HIPAA-compliant. And there was a lot to unpack here. From a patient advocacy perspective, a lot of scary things to unpack.
Before I get into that, a quick anecdote from my high school years. My dad gave me some job advice I’ve never forgotten. Watch out for yourself and if you want to quit, don’t feel guilty about leaving a company you don’t want to be working at anymore. If the tables were turned and the company had to sack a bunch of people, it’d feel no guilt about letting you go. It would make a non-emotional business decision. Employers mostly watch out for themselves, and employees should too. Loyalty can only go so far.
I know that many employers tout a “culture of health” nowadays and make broad claims about how much they care about the health of their employees. As a benefits and health writer, I don’t buy that. Not for nefarious reasons, but because I know that at the end of the day, it’s all about the business. That’s their No. 1 priority. Just like my career should be my No. 1 priority. To believe otherwise is naïve.
I’d argue that this self-interest extends to health plans. As this Washington Post article stated, “The real benefit of self-tracking is always the company. People are being asked to do this at a time when they’re incredibly vulnerable and may not have any sense where that data is being passed.”
How can employers benefit from self-tracking? Through digital health apps that employees sign up for, employers could access aggregate data of employee health; the data is “de-identified,” which means it’s stripped of information like name, social security number and email addresses that could be used to identify the patient. Employers who don’t pry into these anonymous identities can still use this data to understand the overall health of its organization and identify issues that afflict many employees, which could help inform and shape its health strategy.
As for sneakier employers, the article notes that it’s “relatively easy” for companies to identify patients (in this case, women using the pregnancy app) “based on information relayed in confidence, particularly in workplaces where few women are pregnant at a time.” Someone could, for example, cross-reference the app’s data with other data. This potentially could impact people’s health care costs or coverage.
An excerpt:
The apps, [health and privacy experts] say, are designed largely not to benefit the women but their employers and insurers, who gain a sweeping new benchmark on which to assess their workers as they consider the next steps for their family and careers. … Experts worry that companies could use the data to bump up the cost or scale back the coverage of health care benefits, or that women’s intimate information could be exposed in data breaches or security risks.
This is why I’m skeptical about digital health apps. I’ve heard arguments on both sides, but if it’s possible for someone’s private medical information to be used against them, how is that OK? Why aren’t there more protections for patients? And how could current patient protection rules be up to date with the digital age?
To quote an informative article from The Verge: “In 1996, the year Congress passed its landmark health privacy law [HIPAA], there was no Apple Watch, no Fitbit, no Facebook support groups or patients tweeting about their medical care. … [It] is still a key piece of legislation protecting our medical privacy, despite being woefully inadequate for dealing with the heath-related data we constantly generate outside the health care system.”
The Post article brought up something else noteworthy: the app’s 6,000 word “terms of use” agreement that women must consent to. A lot of us in the health space have probably heard the statistic of how few people know how to define basic health care terms like “deductible” and “premium,” suggesting low health literacy rates among people. So how is a person supposed to understand the legal and health care jargon in a 6,000-word “terms of use” agreement? Is that realistic? Do people really know what could happen with that data?
Further, according to the article, while a spokeswoman said the company doesn’t sell aggregate data for advertising purposes, the “terms of agreement” tell a different story. The company has a “royalty-free, perpetual, and irrevocable license, throughout the universe” to “utilize and exploit” de-identified personal information for scientific research and “external and internal marketing purposes.”
Digital health companies are a relatively new thing. And in any communications they make — whether it’s a press release, an executive’s quote in the media or the employee they pick to make a statement to the press — they’re marketing themselves. Of course the focus will be on the positive.
That’s why it’s healthy to be critical of these new institutions that have the potential to greatly impact people’s lives, health and security. If nobody pushes forward to seek change that could protect people’s health privacy, then the future health care environment is not going to be a safe place for patients. Patient advocacy groups should have a greater say in how these digital health companies operate. Insurance companies and employers can easily benefit from the wide array of data in these apps, but what about patients?
Candice Sherman
One final thought comes from an interview I had about six months ago with Candice Sherman, the CEO of the Northeast Business Group on Health. The NEBGH released a fascinating guide about genomic medicine and employers that came from a roundtable including many key stakeholders, including employers, clinical experts, benefits consultants and genomic vendors. The missing stakeholder was a patient.
I asked Sherman about that, and she explained how health privacy concerns would stop patients from participating in a discussion like this. I do understand this, logically — and I am by no means trying to criticize Sherman or the NEBGH roundtable, since I love that they met up to have a discussion on a health-related topic that’s only going to become more prominent.
That said, I think it would be valuable for businesses or business groups to find a way to include the patient stakeholder in conversations like this. Maybe through an advocacy group or an expert who can make sure to represent the patients’ interests without experiencing the same privacy concerns. There are options.
This is a lot of information, but this topic is important now and it’s not going anywhere anytime soon. In summation, de-identified, aggregate data doesn’t always stay anonymous; just because a digital solution is HIPAA-compliant doesn’t mean it’s necessarily harmless to a patient; and patients deserve to have their voice represented in health care conversations.
I understand the power of data for organizations to understand big picture trends, but if this data could easily be used against an employee, it’s not worth it.
Health data privacy is important. I’m curious what discussions we all must have and how laws should be rethought to represent patients — your employees.
Last week the U.S. Department of Labor announced that it’s launched a new toolkit for employers to help them understand mental health issues and create a supportive work culture.
The EARN Mental Health toolkit — created by the DOL’s Office of Disability Employment Policy and its Employee Assistance and Resource Network on Disability Inclusion, or EARN — includes an educational framework and a list of case studies of successful programs at organizations of various sizes.
Awareness: Build awareness and a supportive culture.
Accommodation: Provide accommodations to employees.
Assistance: Offer employee assistance.
Access: Ensure Access to treatment.
I want to focus on access for now, because no matter how much you try to create a disability-friendly culture, if employees can’t access or afford medication, therapy or whatever medical assistance they need to treat their mental illness on a regular basis, then a huge piece of the treatment puzzle is missing.
APA Publishing, a division of the American Psychiatric Association, recently published an informative article on this issue of access. The article covers a February 2019 panel discussion hosted by the New York Academy of Medicine, the New York County Psychiatric Society, and the New York State Psychiatric Association.
There are a lot of points I find valuable in this panel discussion of several people in the medical community. First, one of the panelists noted how Aetna recently settled a lawsuit in Massachusetts after an investigation found that the insurer violated state law with its “inaccurate and deceptive provider directories and inadequate provider networks.” Basically, this means that patients couldn’t access timely behavioral health care because listed providers weren’t accepting new patients or had retired.
This isn’t necessarily an anomaly, the article noted. For example, it cited a very comprehensive report that’s worth a read for anyone interested in this.
The 2017 research report by Milliman Inc. found that compared to medical/surgical care, people seeking behavioral health care more often have to access an out-of-network provider. While in-network care generally has lower co-pays for patients, when they must seek out-of-network care that means more out-of-pocket costs and more expensive behavioral health care.
Also, the report stated, “Some patients may want to avoid the higher costs and delay seeking needed services from behavioral health care providers, which can lead to less effective care.”
The article also stated the employer’s role in this. An excerpt:
Schwartz said that the business community is a strong ally in improving access to behavioral health care given the high cost of not addressing these issues in productivity loss, lower employee retention, high rates of disability, and higher overall employee costs. “While employers are paying for benefits, they are not getting what they paid for when employees cannot access behavioral health care,” he said. “Businesses are well positioned to ask health plans for data on provider networks and to examine disparities to improve accountability.”
Also noteworthy was a list of actionable items that presenters believe could help improve access to care. For example, a suggestion from the National Alliance and the Center for Workplace Mental Health is that “employers obtain quantitative assessments from third-party administrators on how well their employees are accessing mental health and substance use benefits.”
Again, I don’t want to suggest that environmental factors in the workplace don’t impact people’s general well-being. But offering free yoga classes in your building or teaching employees how to use mindfulness to reduce stress are NOT the medical equivalent of seeing a therapist or accessing an outpatient center.
Self-care is not medical care. If your organization has a deluge of trendy perks to help employees de-stress but doesn’t have a sufficient behavioral health provider network, how much of a difference could that really make?
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.
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.”
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.
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.
When you write about topics as broad as benefits and wellness, it’s easy to have too many ideas and want to write about a million things at once.
But that’s impossible. So these are some topics in the health and benefits space that have intrigued me these past few weeks. They relate to employee wellbeing based on compensation; the employer mandate; days off; and a wellness conference.
What’s been on your mind recently? Any trends, debates or legislation that you find especially fascinating? Let me know!
Unpaid Internships and the Government Shutdown
I had many reactions to the government shutdown, which doubtless made a lot of employees’ lives difficult, having to work in some cases while not getting paid while benefits were compromised and many people had to deal with things like not being able to afford basic necessities like food and rent. I recognize that the struggle this put on federal workers was very rough.
It made me think of unpaid internships. These interns must go through these exact same struggles (unless they’re wealthy, or their family is) of needing to work their asses off while not getting paid. A lot of students can’t take internships that would be good experience and look good on their resume because they need to make money and pay basic expenses. Proponents of the unpaid internship argue that they are a valuable learning experience or that students can get class credit.
But in my opinion as a millennial in the beginning of my career, most of us in college needed to take out loans to afford an education. Couple that with unpaid internships and entry-level jobs that for many fields pay minimally. The financial burden put on young people through education costs and unpaid work can be significant.
All I’m saying is, at least pay your interns minimum wage. It’s the least you can do. People should get compensated for the work they perform.
Some Employer Mandate News
I came across a couple of BenefitsPRO articles recently that highlight two opposing ideas of the same debate. In late 2018 the U.S. Department of Labor, Department of Health and Human Services and Treasury Department proposed a rule that employers could circumvent employer-mandate penalties by setting up a health reimbursement account that employees could use to purchase health care in the individual market.
The 2018 tax reform legislation struck down the individual mandate. But the employer mandate, an Affordable Care Act provision that states employers must provide affordable health insurance to employees or else face a fine, is still in place.
On the pro side: Large employees would realistically continue to offer group health plans to attract and keep talent. Meanwhile, it could potentially help smaller employers in the 50- to 100-employee range. Also, to avoid penalties, employers would have to make an HRA contribution such that “any remaining premiums the employee would have to pay wouldn’t exceed a percentage of his or her income to be considered affordable under the employer mandate.”
On the opposing side: Employers and employees may not fully understand the differences between employer-sponsored health care and the individual health insurance marketplace, and the limitations that exist between them. Also, the new rules could potentially incentivize employers to switch sicker, more expensive enrollees to the individual market.
“If employers could move sicker patients toward individual and short-term plans — some of which have more restricted coverage — the employer could save money. In addition, short-term plans often are more restrictive about pre-existing conditions,” the article states.
If these rules are finalized, they wouldn’t take effect until Jan. 1, 2020 at the earliest, according to BenefitsPRO.
What do you think?
Should the Super Bowl Be a National Holiday?
I want to give a shout out to a Twitter user and lawyer @SonyaOldsSom who responded to a Workforce tweet with something obvious but important. Also, it speaks to an even broader idea than what she was specifically talking about.
We posted a podcast in February 2018 in which hosts Rick Bell and Frank Kalman briefly discussed if the Monday after the Super Bowl should be a national holiday. That idea, simply, came from organizations’ frustrations that people often aren’t as productive as usual that day.
Amen! Sure, National Super Bowl Monday is a cute idea to debate, but employers (and whoever decides what national holidays are) should consider the thing that’s been right under their noses for a long time. In general, for any organization, it can be easy to get swept up in trendy sounding ideas — whether that’s open office spaces, yoga classes or some other buzzword — but what’s more valuable to people are these straight-up practical ideas, like having voting day as an official holiday.
I spoke to a man who expressed to me one of his greatest frustrations in the workplace wellness space: when companies go gaga over wellness programs without addressing cultural concerns like an abusive or toxic work environment. I agree!
One of my unlikely tablemates was Bruce Sherman, medical director for the National Alliance of Healthcare Purchaser Coalitions. I’ve coincidentally already interviewed him for a story coming up in our March issue! At this conference, he gave a talk about addressing employees with multiple chronic conditions [note: “multimorbidity” is the coexistence of multiple chronic conditions] in your wellness programs. One of his ideas: disease management programs that specifically address one chronic condition oftentimes do not sufficiently help employees with multimorbidity!
Sherman also mentioned that while people in the health care industry tend to have a narrow, clinical mindset with patient health, patients have many more focuses and stresses in their life. Personal health is just one of them — and, according to one survey, it’s not even the highest priority. Ranking factors that stress people out, “personal health” is No. 8, below other factors like finances, family health and work schedule. Personal health is not something that exists in a vacuum for employees!
“We don’t have to be somebody else, but we have to learn from somebody else,” Berger said.
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
