Tag: health care

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The Mental Health Parity Challenge

Mental Health Parity

It’s been a decade since the Mental Health Parity and Addiction Equity Act went into effect, with the goal that insurers and health plans offer mental health and substance abuse benefits comparable to coverage of medical and surgical care.

Despite progress made since the law’s passage, some barriers to equality still exist. As vital as behavioral health care is for people with substance abuse and mental health disorders, unlike their physical health needs, employees with employer-sponsored coverage may face challenges in accessing and affording quality mental health care coverage.

The current environment sees employers, employees, the government and individuals spending more money on behavioral health than ever before, but the results just aren’t there, said Henry Harbin, a psychiatrist with over 40 years’ experience in the behavioral health field.

Harbin, whose experience includes senior positions at public and private health organizations, said that while fatality rates for many medical issues are decreasing, fatality rates from suicide and opioid overdoses — two major issues in behavioral health — are increasing. Between 2004 and 2014, the death rate for heart disease decreased by 16 percent and for stroke by 19 percent. In the same span, the death rate climbed by 17 percent for suicide and over 200 percent for opioids, according to the Centers for Disease Control and Prevention.

For employers, genuinely caring about their employees’ mental health issues is a good start, but providing quality coverage is important as well. Behavioral issues among employees are prevalent. According to the National Institute of Mental Health, 1 in 5 adults in the United States have a mental health disorder. Meanwhile, 1 in 22 adults have a serious mental illness like schizophrenia, major depression or bipolar disorder, the study noted. 

Access Issues

There is a national shortage of seasoned behavioral health professionals in the United States, which can “constrain access to essential care and treatment for millions of individuals with mental illness of substance use disorders,” according to the Health Resources and Services Administration report “Behavioral Health Projections, 2016-2030.” The agency, part of the Department of Health and Human Services, focuses on improving access to health care services for individuals who are uninsured, isolated or medically vulnerable. The report stressed the fact that certain areas of the United States have few or no behavioral health providers available.

The shortage of behavioral health care providers impacts a majority of employer-sponsored health plans, according to Mercer’s May 2019 “10-Minute Survey on Behavioral Health” that surveyed 523 employers. Sixty-three percent of respondents reported that they lack adequate access to outpatient behavioral health care in some or all of their locations.

Some 74 percent of employers said they are taking action to improve employee access to quality behavioral care. Most commonly, 49 percent addressed this by enhancing their employee assistance program services or changing their EAP provider. Only 12 percent of these employers conducted a network analysis to identify gaps in behavioral health care.

Early intervention can be vital for behavioral health, especially for patients with a severe disorder, Harbin said.

For a patient with schizophrenia, for example, screening by one’s primary care physician or pediatrician can help identify the problem early on. The patient can then see a specialist sooner and will likely see better outcomes, Harbin said.

Tom Sondergeld, vice president, global HRIS, benefits and mobility at global pharmacy giant Walgreens Boots Alliance, said that one of the biggest priorities in their carrier analysis was to evaluate access. Employees with a behavioral health issue often face long wait times to see a behavioral health specialist such as a psychiatrist. “To me, that’s not parity,” Sondergeld said.

Walgreens has been pushing hard on its insurance carriers in recent years so that employees can find coverage for the care they need in a timely manner, Sondergeld said.

While larger organizations may have more resources to negotiate with insurance carriers, he suggested that small organizations can join coalitions such as the National Business Group on Health, allowing their voice to be heard within that larger pool of companies.

He also said that using data to tell a powerful story is a way smaller organizations can influence their carriers. Employers can get this information through their health plan, which can use its data to analyze utilization and costs across the various benefits to get a better picture of the overall spend and areas to concentrate on to improve spend.

For example, if a third of the workforce needs access to behavioral health care for themselves or their loved ones, but the data show that a majority of people can’t access care in a timely manner, that’s a powerful, data-supported story.

Also read: Managing Mental Health Crises at Work

The human impact of mental health problems is notable, as mental illness impacts how people handle stress, how they relate to others and whether they make healthy choices, according to the Centers for Disease Control and Prevention. Still, HR can use the business case to support the need for better access.

Poor mental health and stress can impact an employee’s job performance, their relationship with co-workers and their physical capabilities and daily functioning, according to the CDC. Depression interferes with a person’s ability to complete physical job tasks about 20 percent of the time and reduces cognitive performance about 35 percent of the time, the agency notes.

“When [employees] can’t find the care they need, the business suffers because they aren’t engaged,” Sondergeld said.

Network Issues

A host of issues exist even when an employee does access care for behavioral health problems. A majority of people with behavioral conditions are screened and treated through primary care and not a specialist, Harbin said. The quality of this behavioral health care is often low, with many people not necessarily even getting a diagnosis but getting a prescription for a psychiatric drug. Harbin noted that the patient’s response to the drug may not be tracked efficiently, the drug and dosage may remain unchanged, and this may help lead to low efficacy outcomes. 

Employers should urge employees to use specialists if they want improved outcomes, he said.

Patients accessing out-of-network providers is another issue, he added, citing a 2017 Milliman Inc. report, “Addiction and Mental Health vs. Physical Health: Analyzing Disparities in Network Use and Provider Reimbursement Rates.”

Patients seeking behavioral care more often need to use an out-of-network provider than patients seeking medical or surgical care, according to the report, which also found that medical and surgical providers are paid at higher rates than behavioral providers. The lower reimbursement rates are one reason for low network participation rates among behavioral health providers, making it difficult for patients to find more affordable in-network care.

Employers can work with their providers or vendors to understand if there are places where there are more complaints about access issues than others, said Mandie Conforti, a licensed clinical social worker and senior consultant at Willis Towers Watson.

Even though the mental health stigma is lifting, it’s still there, she said. Many employees hesitate to call HR to complain about not being able to find a behavioral health provider.

“We’ve been asking behavioral health centers to do more customized networks, enhancing the network in locations where employers may have a larger base of employees,” she said.

Quality Control Issues

It’s difficult for a patient to find the right provider for their unique situation or one who can get them the best results.

Employers have historically not asked their insurers many questions about behavioral health or the quality of these provider networks, said Sandra Kuhn, Mercer’s national lead for behavioral health consulting. This is an area in which they have potential to be more proactive and really push for more information from their insurers. 

Questions can include: What quality measures do you use to bring carriers in and keep them in-network? Can you share with us at the end of the year a data set to show how many people were in treatment and the average length of time people stay in treatment? Also, did people improve while they were in treatment?

“Tools exist to measure those things, they’re just not being uniformly applied,” Kuhn said.

Also read: Lessons on Addressing Mental Illness in the Workplace

She also suggests that employers look for specific data points as indicators of whether the health plan is adequately addressing behavioral health, starting with data on what the employee population looks like. Then, look at EAP utilization. If utilization is low but a lot of people are using the behavioral health network in the health plan, then perhaps employees aren’t aware of the EAP services. That knowledge could give employers the opportunity to close the gap.

Data can also educate employers on how much out-of-network behavioral health care employees are getting. Maybe employees are having access issues, or maybe they’re unsure of how to go about finding care. They could be relying on friends’ referrals rather than something more evidence-based.

“If [employees] don’t have a clear way to obtain information about the network, the types of providers and what provider is good for what types of challenges, they’re just randomly picking, and that’s problematic,” she said.

She continued that quality metrics are “reasonably established” for certain areas of the behavioral health system. The type of care people may need ranges from outpatient care for mild or moderate cases to more complex and higher levels of care for more severe conditions. This inpatient care is where quality metrics are consistent, but most people come into contact with behavioral health services at the outpatient level, Kuhn said.

There are some insurance carriers and tech solutions like Ginger.io and Lyra Health that are using their own measures, but these aren’t consistent with each other, she said. This can lead to inconsistency and member confusion.

“They don’t know if they’re going to a quality provider or not, and oftentimes they don’t know how to judge if they’re improving,” Kuhn said. That may lead to people thinking that if they go to their friend’s therapist, they’ll get the best care.

“There are all sorts of wives tales that come out of there not being a good way to determine quality,” she added.

Employers can also push vendors on how they assess quality, said Conforti. Many times providers self-report quality to behavioral health centers. Whether they actually have the competencies to do so, they could simply check the boxes that they can work with any disorder.

“There has to be a better way at assessing and making sure that providers are doing good, sound, evidence-based care,” she said.

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EEOC Settlement Teaches Lesson on Extended Leaves of Absence as ADA Accommodation

Jon Hyman The Practical Employer

An employee tells you that he was recently diagnosed with prostate cancer and needs a few weeks off for treatment, surgery and recovery.

Assume either you’re not an FMLA-covered employer or that the employee is not FMLA eligible.

Do you …

(a) Fire him.

(b) Deny the request and force him to quit to have the surgery.
(c) Grant the request, but ask the employee to provide medical information supporting the disability, the need for time off, and an expected return-to-work date.

I hope you picked “c.”

An Atlanta distributor of industrial supplies chose “a,” and it cost them $75,000 to settle an EEOC lawsuit. From the EEOC’s news release:

“Medical leave is a widely recognized accommodation, and in Mr. Smith’s case, could easily have been granted, preventing the firing of a valuable employee. However, instead of accommodating him, Vallen fired him less than 24 hours before his surgery,” said Antonette Sewell, regional attorney for the EEOC’s Atlanta District Office. …

Darrell Graham, district director of the Atlanta office, said, … “An employee should not be forced to risk termination for seeking leave to treat a medical condition, which can be a perfectly reasonable accommodation under federal law.”

Takeaways?

1. Unpaid time off can, and often does, qualify as a reasonable accommodation under the ADA, whether or not the FMLA applies. Moreover, if you fail to consider it as a reasonable accommodation, you’ve likely violated the statute.

2. Firing someone who asks for a few weeks off for cancer surgery is awful. It’s even more awful if you wait until the day before the surgery to do the firing.

3. Given the egregiousness of the violation, $75,000 seems light (although I don’t know all of the particulars of this employee’s damages).

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Which Mental Health Service Does the FMLA Not Cover?

Jon Hyman The Practical Employer

Recently I discussed our national mental health crisis, and the important role employers play in removing barriers to employees receiving the help they need.

Then, I came across this post on LinkedIn, discussing a massive barrier that the FMLA institutionally imposes.

An individual suffering with a mental health issue has various treatment and therapy options available to them. For medication, one can see a psychiatrist, a primary care physician or a nurse practitioner. For assessment and therapy, one can see a psychologist, a clinical social worker or a licensed professional counselor.

Amazingly, however, the FMLA does not recognize one of these licensed mental health professionals as a “health care provider.”

I won’t leave you in suspense. The answer is licensed professional counselors (unless an employer’s group health plan covers licensed professional counselors). The FMLA’s regulations specifically itemize all of the other categories of mental health professionals as “health care providers,” and specifically omits licensed professional counselors from its list. This omission is important, because an employee’s mental condition cannot qualify for FMLA leave as a “serious health condition” if, for outpatient treatment, the employee is not under “continuing treatment by a health care provider.”

As a matter of policy, however, the FMLA absolutely should cover licensed professional counselors as health care providers. According to a recent study by the National Council for Behavioral Health, the leading cause of our country’s mental health crisis is a lack of access to mental health services. We should not be erecting any barriers to mental health services, let alone one ingrained in the federal law that protects employees’ jobs when they take time off for health reasons, including their mental health. By refusing to recognize licensed professional counselors as FMLA-covered health care providers, the FMLA is deterring employees from seeking critical mental health treatment, or at least forcing them to choose between treatment and their jobs if a licensed professional counselor is the only available help. Many who can’t afford to live without their jobs will choose their paycheck over their health, exacerbating their mental health issues.

Gene Scalia has been nominated to replace Alex Acosta as Secretary of Labor. I implore him to close this dangerous loophole by amending the FMLA’s regulations to make it clear and explicit that licensed professional counselors qualify as health care providers in all cases, and not just those in which an employer has made the choice that its group health plan covers their services.

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Employee Suicide Is the Next Big Workplace Safety Crisis

Jon Hyman The Practical Employer

A recent headline at businessinsurance.com caught my eye:

Suicide seen as “next frontier” in workplace safety risks. It’s a pretty dramatic headline, but when you drill down into the statistics, it has a lot of weight.
  • Suicide is the 10th leading cause of death in the U.S.
  • Between the ages of 10 and 34, however, suicide is the second leading cause of death, and the fourth leading cause of death between the ages of 35 and 54.
  • In 2017, 47,173 Americans died from suicide (more than double the number of homicide victims), and another 1.4 million attempted suicide.
  • Between 2000 and 2016, the U.S. suicide rate among adults ages 16 to 64 rose 34 percent, from 12.9 deaths for every 100,000 people to 17.3 per 100,000.
  • In 2016, the U.S. Bureau of Labor Statistics hit a record in its 25-year tally of workplace suicides at 291, with the number gradually climbing over the prior decade.
  • The highest suicide rate among men was for workers in construction and mining jobs, with 53.2 deaths per 100,000 in 2015, up from 43.6 in 2012.
  • The highest suicide rate among women was for workers in arts, design, entertainment, sports and media, with 15.6 deaths per 100,000 in 2015, up from 11.7 in 2012.
The numbers are stark and scary and show a nation in the midst of a mental health crisis. What can employers do to recognize and mitigate this risk, and provide a safe workplace for employees in crisis?
For starters, educate yourself. There are a lot of free resources available online.

Next, employers need to increase awareness and reduce the stigma that surround mental health issues. Stigma and silence are the two biggest reasons why those that need help don’t receive it. What can employers do to recognize and help an at-risk employee?

1. Be aware of individual risk factors for suicide. You cannot always prevent suicide, but you can understand some of the risk factors so that can recognize when an employee might be in crisis and in need of help.

  • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders.
  • Alcohol and other substance use disorders.
  • Hopelessness.
  • Impulsive and/or aggressive tendencies.
  • History of trauma or abuse.
  • Major physical illnesses.
  • Previous suicide attempt(s).
  • Family history of suicide.
  • Job or financial loss.
  • Loss of relationship(s).
  • Easy access to lethal means.
  • Local clusters of suicide.
  • Lack of social support and sense of isolation.
  • Being victimized by discrimination, harassment, or bullying.
  • Stigma associated with asking for help.
  • Lack of healthcare, especially mental health and substance abuse treatment.
  • Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma.
  • Exposure to others who have died by suicide (in real life or via the media and Internet).

2. Provide mental-health awareness training to managers and supervisors. They spend the most time observing their employees, and are often in the best position to observe behavioral changes and risk factors, and hear from co-workers that someone might be in danger. Some of the warning signs for everyone to look for include:

  • Talking about wanting to die or to kill themselves.
  • Looking for a way to kill themselves, like searching online or buying a gun.
  • Talking about feeling hopeless or having no reason to live.
  • Talking about feeling trapped or in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious or agitated; behaving recklessly.
  • Sleeping too little or too much.
  • Withdrawing or isolating themselves.
  • Showing rage or talking about seeking revenge.
  • Extreme mood swings.

3. Consider implementing a comprehensive psychological health and safety management program to help improve overall workplace culture and resolve issues more effectively. This program would include eliminating stigma related to mental health issues; developing an inclusive working environment for all; and ensuring that you have a confidential Employee and Family Assistance Program (EAP) that offers support and counseling services and that your employees are aware of it.

4. Educate all employees and support those are struggling. This effort includes mental-health awareness and suicide prevention education to employees; reducing stigmas relating to protected classes, mental illness, substance use disorder, and suicide; expanding awareness of mental illness and addiction; encouraging help-seeking for those at-risk; creating a caring and supporting work environment, including the promotion of listening and interpersonal skills to help all employees.

If you or someone you know is having suicidal thoughts or exhibiting suicidal behavior, help is just a phone call away via the National Suicide Prevention Hotline, 800-273-8255. One phone call can save a life.
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Why Are Employers Testing Job Applicants for Prescription Medications?

Jon Hyman The Practical Employer

During a pre-employment medical examination and drug screen, an applicant tests positive for Alprazolam, the generic form of Xanax (a medication commonly prescribed for anxiety), a fact she had already disclosed during the examination.

The doctor performing the medical exam and reviewing the drug screen concludes that the applicant is medically acceptable for work as an intake specialist at an inpatient mental health facility. The employer, however, has other ideas. It withdraws the job offer without providing the applicant any opportunity to discuss the results.

The applicant sues, claiming disability discrimination.

Who wins?

(a) The employer, because the ADA permits pre-employment medical examinations and drug screening, and further because there exists a nexus between the applicant ’s underlying mental impairment (anxiety) and her fitness to work at a mental health facility.

(b) The employer, because the ADA only protects physical and mental impairments, not drugs used to treat them.

(c) The applicant, because the employer conducted an illegal medical examination.

(d) The applicant, because the only logical explanation for rescinding a job offer after an applicant tests positive for a prescription drug commonly used to treat anxiety is that the employer regarded the applicant as disabled.

While we may eventually find out the official answer to this puzzle (the EEOC recently filed suit alleging an ADA violation arising from these facts), if you answered (d), grab yourself a Kewpie Doll.

Still, the answer might not nearly be this cut-and-dry. The ADA is remarkably silent on the issue of testing for legally prescribed medications.

generic drugsThankfully, courts have stepped in to fill in the ADA’s omission. For example, Bates v. Dura Automotive Sys. (6th Cir. 8/26/14) [pdf].

1. Does the ADA permit an employer to test for prescription medications?

Whether the ADA permits an employer to test employees for prescription medications will hinge on whether the test is a “medical examination.” If the test is a “medical examination,” then the ADA only permits it during employment if the test is “job-related and consistent with business necessity.” According to the Court, whether the prescription-drug screen is a “medical examination” will hinge on whether the test “is designed to reveal an impairment or physical or mental health,” which examines both the employer’s reasons in using the test and the test’s typical uses and purposes.

2. Does the ADA permit an employer to require employees, after a positive test, to disclose medications to a third-party administrator?

The court concluded that there exists a huge difference between a general requirement that employees disclose a list of all prescription medications taken (possibly illegal), versus a policy that only requires the disclosure of job-restricted medications after a positive test.

How can an employer make sense of this discussion? These are difficult issues that balance an employer’s right to maintain a safe workplace against an employee’s right to medical privacy. What is an employer to do?

    1. Limit testing for the use of prescription drugs to safety-sensitive positions, and then only for those medications that could pose a safety risk.
    2. Do not ask employees to disclose the underlying medical condition for which they are taking the medication.
    3. Be consistent in your treatment of employees who test positive.
    4. Only disclose the results to those who need to know.

In conclusion, I want to focus for a moment on point No. 1 — limit testing for the use of prescription (any?) drugs to safety-sensitive positions and then only for those medications that could pose a safety risk.

Unless one is applying for a job that poses a safety risk, why are we drug testing at all? If you don’t want those who use illegal drugs to work for you, I get that.

That’s your right and your decision. But prescription drugs?

What are you hoping to learn from those tests? Unless you have a legitimate reason to hunt for medications that could impair an employee’s ability to safely perform their job, the risks of the test severely outweigh any benefits to gain.

You’ll learn a heap of protected medical information (or make assumptions based on the physical or mental impairments the drugs are used to treat). Either way, you are opening yourself up to a difficult disability-discrimination lawsuit if you rescind a job offer, as Rogers Behavioral Health in the lawsuit the EEOC recently filed.

Is this risk worth the minimal benefit?

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The Employer’s Voice in the Future of American Health Care

shrm health care

I went to the Society for Human Resource Management’s annual conference in Las Vegas this past week with one very specific goal: Get a feel for what HR professionals are excited and worried about in the benefits space, especially regarding health care and the 2020 election.

Tracy Watts, senior partner at Mercer, began here health care presentation with her “favorite quote from the president”: “Nobody knew health care could be so complicated.”

shrm health care

This obviously got a lot of laughs from the audience of HR professionals.

Watts’ main message to employers in the course of her session was that employers, who insure 54 percent of the American population, have a vital role in helping to shape the future of the country’s health care. She cited that employers collectively spend about $668 billion annually on health benefits to cover employees and their dependents. “[Employers] have a bigger stake in this than anybody,” she said.

She also listed the health-related issues that different governing bodies can address and the ones that they’ve already begun to address. For example, the Trump administration has the ability to address HSA guidance, mental health parity, drug prices, HRA guidance and ACA Section 1557 nondiscrimination, and it’s currently addressing the latter three. Meanwhile, Congress has the ability to address the Affordable Care Act employer mandate, HSA reforms, drug prices, the ACA Cadillac tax and out-of-network “surprise” medial bills, and it’s currently addressing the latter three.

My question for employers: What power do you have to impact the health care environment? How are you currently utilizing that power? Where is there still room for improvement?

This session also gave me the opportunity to overhear gossip from the audience about the latest developments in the benefits space. For example, a major piece of health care-related breaking news had just happened in the past 24 hours: President Donald Trump announced his “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.”.

Meanwhile, more major changes were happening on the state level. California had just voted to reintroduce the individual mandate for health insurance. Also, a few women around me were expressing frustration about how difficult it is to keep up with what’s happening on the state level in the paid sick leave and paid family leave areas. They expressed exhaustion at dealing with “the nuance of state laws.”

Overall, the 2019 conference meant many HR folk were feeling confused and overwhelmed by the massive regulatory changes happening (or likely to happen) in the benefits space.

Also watch: Tracy Watts on the Executive Order and its Implications for Employers:

More 2019 SHRM Conference Coverage:

Brené Brown at SHRM Conference: ‘Leaders Are Never Quiet About Hard Things’

Exclusive Video Interviews from the 2019 SHRM Conference

The State of #SHRM19 Speech: Wait Until Monday

Day 2 at #SHRM19: It’s All About the Underutilized Talent Pool

SHRM Releases Annual Benefits Survey

Gary Kusher on Workplace Health Care Issues and the 2020 Election

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Experts Advise Revising Ailing Time-Off Policies

Presenteeism

Presenteeism is heralded as a big problem in business as it’s something that can decrease an individual’s productivity or affect that of their co-workers as well.paid time off

Presenteeism, which is chiefly defined as employees who are not functioning at maximum capability due to illness, injury or another condition, could be helped if employees took time off when sick or vacation days to unwind. But the issue is not that simple. Reasons for presenteeism depend on many factors, whether it’s an individual’s attitude toward work, an employer’s workplace culture or the overall economic environment.

Employees taking time off bottomed out during the Great Recession. Over the past decade, the numbers haven’t recovered, said Steve Koepp, former Time Inc. editor and founder of From Day One, a Brooklyn-based conference series focused on creating a more collaborative, empathetic and productive workplace.

The United States is the only country without mandated vacation or sick leave. If the nation doesn’t set the tone that time off is important, it doesn’t trickle down to companies, Koepp said.

There are some things companies can do to address presenteeism, based on the reasons why employees are not taking time off.

Company Culture

Employees may face barriers to taking time off if the company has overt or subtle ways to vacation-shame employees, Koepp said. If a manager responds to a request for time off with a negative response like, “But this is the worst time,” that may have a  “chilling effect” on future requests, he said. In unhealthy workplace environments, an employee may return from a vacation only to hear from their manager that something stressful would not have happened if the employee had been at work.

“Companies should lay out some structure, and not just about the number of weeks but about how managers should handle the request, the return and everything about it,” Koepp said.

Leadership expert and coach Jack Skeen shared other ways to address presenteeism. Managers can help create an environment where people feel comfortable taking time off, perhaps by taking time off and talking to employees about how they used it.

Skeen had further suggestions for employees anxious that their career, salary or reputation could be tarnished by using paid time off. The crux of the matter is that you can’t convince people of anything if there’s not trust in the employee-management relationship, he said. That trust is key to delivering PTO-friendly messages successfully.

Skeen suggests that employers clearly and repeatedly tell employees that PTO is encouraged, supported and respected. Employers can share stories about employees who both used PTO and were promoted.

For formal vacation and sick-day policies, Skeen said that they must be fair to everyone in the company, from the frontline workers to the executives at the top. Also, employers should make sure that the policy is clear, specific and not open to excessive interpretation.

Tom Parry, president for the Integrated Benefits Institute, a nonprofit focused on research and benchmarking the link between health and productivity, agreed that trust between the employer and employee is paramount.

“Employees have to trust their employer. If they don’t trust their employer, if they have that culture that lacks trust, then you’ve got a problem [bigger than presenteeism],” he said.

Also read: Eggnog With a Splash of Paid Time Off

Given the vast number of reasons employees don’t take time off, Parry said it’s important to survey employees anonymously to determine what’s standing in the way.

Reasons to Support Time Off

The institute seeks to quantify the impact of presenteeism, Parry said. Absenteeism is visible but presenteeism often isn’t, he stressed. While managers can clearly see if an employee is not at work and estimate some business impact, it’s harder to quantify presenteeism.

IBI has done four studies with CFOs in recent years, Parry said. Conceptually, they understand the link between presenteeism and business impact. Practically, though, they won’t take action unless there’s data. 

The most important takeaway for employers is to consider the forces outside of their company, Parry said. “What happens a lot of time is we take employers out of that economic and business circumstance that they’re in,” he said.

When an employer is thinking about its individual business, long-term thinking is key alongside short-term opportunities.

“You have to be willing to bite the bullet and maybe not take advantage of every business opportunity if it’s going to have a long-term effect on your workforce,” Parry said.

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How Employers Can Utilize Well-Being in the New Social Contract With Employees

Few people realize that the notion of a workplace social contract came about accidentally nearly 80 years ago as the result of an executive order on wage controls issued by President Franklin D. Roosevelt.

Cutting-edge companies at the time then began offering health insurance to employees as a recruitment incentive. And, in the early 1950s, the Internal Revenue Service deemed that insurance and similar benefits wouldn’t be counted as taxable income. Viola! The workplace social contract was born.

Over the last half-century, social contracts between employers and employees have evolved to the point where modern social mores drive a very different conversation today. The old agreement that employees would work for a company in exchange for wages, health insurance and little else sufficed as an agreeable social contract for both parties for decades. Today, however, 56 million millennials and an upcoming 61 million Gen Z workers are reshaping the contract terms.

Also read: The New Employer-Employee Social Contract

And, because younger employees comprise approximately 70 percent of today’s workforce, employers who listen and respond to their demands will be in a better position to compete for and retain top talent than those who ignore their concerns.

One employee benefit that can address these concerns is the often-debated employer-sponsored well-being program.

Many C-suite executives have a hard time seeing a return on investment for their well-being efforts. After all, under terms of social contracts from days gone by, well-being programs were designed to keep employees off the health care merry-go-round, thereby containing the employer’s health care costs. Employees participated in health screenings because employers mandated it, and no one found it to be fun or engaging. What’s more, this approach hasn’t shown improvements in overall employee health.

Today, fortunately, the new social contract between employees and employers presents a tremendous opportunity to leverage well-being as a strategic business tool to not only realize cost containment but to increase productivity and enhance recruitment and retention of top talent.

With these new conditions in mind, employers can utilize well-being benefits as part of a new social contract to address employee demands by doing the following.

Keeping an Integrated Mindset

Well-being initiatives are connected to health insurance and, therefore, overseen by the benefits or human resources department. However, companies won’t get full value of a well-being program if it is viewed solely as a benefit or cost rather than an engagement, culture and productivity driver. Well-being activities should be incorporated more broadly into:

  • The entire organization by including safety, recruitment, onboarding and training departments.
  • The entire work day, rather than expecting people to engage on their own time. Incorporate huddle stretches, encourage your supervisors to set an example by walking around to check in with their direct reports, bring in healthy snacks or ditch the junk food vending machine altogether.
  • Employee-based challenges beyond physical activity. For example, try challenging employees to keep gratitude journals, track their sleep to identify potential sleep issues, even to drink more water. Most employers don’t realize that most of us are dehydrated to some extent and that lack of hydration can play a role in impaired cognitive ability.
  • A single place where employees can access and interact with all of their benefits. The mind-boggling speed of technology growth in the consumer market mandates that companies evolve just as quickly to provide employees with personalized, consumer-based experiences.

Looking at Your Entire Work Environment

Your employees today expect that every touchpoint of their experience at work be influenced by terms of the new social contract. Are the restrooms well maintained? Do you provide sedentary employees with sit/stand desks and stationary bikes for lunch-hour workouts? Does the cafeteria offer healthy food options?

If you aren’t attending to basics such as these, you’ll send mixed messages around how you’re prioritizing your employees’ health and well-being, which can create confusion and cause employees to question the authenticity of your commitment.

A growing component of the new social contract comes from workers who want to work on their own terms — remotely, from home or while traveling. In fact, a 2019 survey of 1,000 hiring managers revealed that up to 73 percent of all departments expect to have remote workers within the next decade. Smart managers will remember to include these workers in well-being efforts to ensure they’re also happy and productive, even though they might not experience the physical work environment on a regular basis.

Getting Your Leaders Engaged

Employees in the 21st century expect their bosses to walk their talk. If your company’s executives verbally extol the virtues of the corporate well-being program, then they also need to actively participate if they’re to meet terms under the new social contract. Do they run in the company 5K? Do they avoid eating lunch at their desks, opting instead for the cafeteria or break room? Do they participate in annual biometric screenings? Are they transparent about their own challenges and efforts?

When your C-suite executives and department heads participate, they organically connect with employees on a human level and will contribute immensely to the success of your initiatives.

Contracts, by their very nature, are designed to protect the best interests of both parties. Today’s new social contract between employees and employers is forcing companies to expand their definition of employee benefits, stretch old-school operating procedures to manage talent and look beyond traditional HR channels to deliver a more fulfilling employee experience. Employers who are up to the challenge can expect that their employees will take more responsibility on their side of the contract to participate in activities that lead to long-term well-being habits, resulting in a rested, alert and productive workforce.

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Proposed Law Wants to Convert ‘Anti-Vaxer’ Into a Protected Class

Jon Hyman The Practical Employer

With a couple of important exceptions, an employer can require that employees be up to date on their vaccinations.

The exceptions?

1. An employee with an ADA disability that prevents him or her from receiving a vaccine may be entitled to an exemption from a mandatory vaccination requirement as a reasonable accommodation.

     2. An employee with a sincerely held religious belief, practice, or observance that prevents him or her from receiving a vaccine may also be entitled to an exemption from a mandatory vaccination requirement as a reasonable accommodation.
A recently proposed Ohio looks to significantly expand these exceptions by elevating “unvaccinated” to the equivalent of a class protected from discrimination.

The misleadingly named Medical Consumer Protection Act would prohibit an Ohio employer from discharging without just cause, refusing to hire, or otherwise discriminating against any person on the basis that the person has not been or will not be vaccinated because of a medical contraindication or for reasons of conscience, including religious beliefs. It would also create a private cause of action allowing an employee to file suit over violations and seek compensatory and punitive damages.

I had a roommate in college who was fond of telling me that my opinion was wrong. I would tell him, “My opinion is my opinion. It might be misinformed. You might disagree with it. But it can’t be wrong.” It’s Hyman’s Law of Opinions. Today, I decree the following amendment to Hyman’s Law:

* … except in the case of vaccinations. If you oppose vaccinating yourself or your children, your opinion is wrong, period (unless you have a bona fide medical condition or religious belief that prevents you from receiving said vaccinations). Otherwise there’s no reason not to vaccinate. If you don’t care about your own health, care about the health of all of those around you, and the public health risks and costs you are helping create.

And if you happen to be an anti-vaxer and take issue with Hyman’s First Law of Opinions (as amended), you’ve brought the measles back from extinction. Case closed.

So I give a big thumbs down to the Medical Consumer Protection Act. It’s both unnecessary (by protecting from employment discrimination those whom the law already protects) and wildly over broad (by also protecting those who are unvaccinated “for reasons of conscience”).

Thankfully, this poorly conceived piece of legislative policy will never become an actual law.

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Some 2020 Election Views: Jan Berger on Single-Payer Health Care

health care

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.

Jan Berger, president and CEO of international health care consultancy Health Intelligence Partners, gave a presentation on single-payer health care at the Midwest Business Group on Health annual conference in May.

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.)

health care costs“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.