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Tag: health care

Posted on December 10, 2018June 29, 2023

Daily Wellness and Motivation Tips

In my experience, self-improvement is a day-to-day task. It’s a culmination of hard work that over time is accomplished by small but constant steps.

With the new year comes a good number of people whose New Year’s resolution is to get healthy. Given that people spend a good amount of time at the workplace, I’ve spoken with workplace wellness experts and others about well-being tips employees should keep in mind on a day-to-day basis in 2019. Some of them have also explained the employer’s role is in accomplishing these basic tasks.

Keep track of your achievements: Sometimes we can get caught up in the fast pace at work, getting bogged down by problems and difficulties and failing to appreciate our successes along the way, said Rick Hughes, head of service at the University of Aberdeen’s Counseling Service and a co-author of the book “The Wellbeing Workout,” along with Andrew Kinder and Cary L. Cooper. This can lead to anxiety, tension and stress.

“Toward the end of each work day, list three ‘achievements’ of the day in your diary,” Hughes suggested, adding that they don’t need to be major accomplishments. They can be as simple as “I had a good meeting with my colleague” or “I got appreciation from a customer.”

“At the end of the week you’ll have 15 achievements,” he said. “Sit back, applaud yourself and look forward to building on this further the following week.”

Work on your composure: This is a way to keep your sense of well-being strong on a daily basis, said Joyce Young, managing director for the High Health Network.

“Believe it or not, being composed is a skill,” Young said. “When you’re composed you have more control, more optimism, you make better decisions, and those decisions you make, because they’re better, help you stay in balance.”

She suggested three ways in which people can hone this skill.

  1. Connect with something personally meaningful. “If you stop every so often and say, what is meaningful to me? It resets the idea that I’m not just wandering here. There are things in my life that matter to me, and you basically are connecting with them. If we don’t connect and reflect, then these important points in our lives get away from us,” Young said. She added that if someone spends a couple minutes reflecting on what’s personally meaningful to them, the example might not be something positive. It could be something that’s causing negative thoughts or emotions. That’s still valuable, though, since it gives people a sense of centering and takes them away from the trivial things that can take up one’s day-to-day life.
  2. Nap. Studies have shown that even a three-minute nap can be refreshing, Joyce said. Personally, she enjoys taking 20-minute naps many days. Short naps can help someone feel more refreshed and composed.
  3. Connect with nature. This can help with something called “attention fatigue,” Joyce said. One’s sense of attention gets tired, much like a muscle, and experiencing nature can help restore that attention, for example by looking out the window at the office at the park across the street or keeping plants at the desk.

HR has a role in this, too. First, if decision makers in the HR community actually engage in the practices, they get the benefit of the practices, Young said. Also, if they engage in practices like this then it’s easier and more apparent to them what specific things they could do to help support their employees in similar endeavors.

Get fresh air: Expanding on Young’s “connect with nature” idea further, Tracy Hultgren, the creator of the blog Trail Tracing, advocates that people take a little time out of their day to get fresh air and take a walk. Hultgren spoke with Workforce earlier this year, and his ideas are worth revisiting.

For one, his notion to walk outside every day is simple and applicable to most geographies, from the middle of a city to a suburb close to local parks. Walking is a simple form of exercise that most people can do, Hultgren said. While many people have an “all-or-nothing” approach to working out — an attitude like, “If I’m not going to run a marathon, I’m not going to run at all” — allowing oneself a short, stress-free daily workout like walking lets them have a little time every day to take care of themselves in a low-key and not stressful way.

An employer’s role in this is simple. Basically, they just have to be open to allowing employees a short amount of time each day to leave their desk.

Scrap the resolutions: This one is coming from me. A while ago, a friend suggested that having a “goal” for the year was better than having the traditional resolution. So instead of telling yourself to go to yoga once a week, make a theme like “tranquility.”

It’s something more flexible, realistic and creative, because instead of doing one specific task every so often, you have a general vibe you’re striving for, and a lot of different activities fit in it. You might to yoga to calm down and feel more at peace, but you could also go on a long walk, spend a little time pampering yourself, or cook yourself a dinner that makes your apartment smell good.

This is also something realistic to fit in your everyday life, I believe.

Any other wellness tips you find valuable in your workplace? Comment below or reach out to me on Twitter @Andie_Burjek. I’ll add them to this list post-publication.

Posted on November 15, 2018June 29, 2023

Do You Know? Pre-employment Medical Exams

Jon Hyman The Practical Employer

A mayor in Ohio has gotten himself in some hot water for his selective use of pre-employment medical examinations for hirees.

How selective? According to WKYC, one woman claims that the mayor required her and other women, but not men, to be examined by his personal doctor. For his part, the mayor denies the allegations as an act of a “fertile imagination” and claims that he sends all city workers, male and female, to the same doctor for pre-employment exams.

Why would her allegations rise to the level of unlawful activity?

Aside from the obvious sex discrimination (an employer cannot apply one set of policies to male employees a different set to female employees), it also violates the ADA’s requirements for pre-employment medical examinations.

The ADA applies a traffic-light approach to employer-mandated medical exams.

    • Red light (prior to an offer of employment): the ADA prohibits all disability-related inquiries and medical examinations, even those that are job related.
    • Yellow light (after employment begins): an employer only may make disability-related inquiries and require medical examinations that are job-related and consistent with business necessity.
    • Green Light (after an applicant is given a conditional job offer, but before s/he starts work): an employer may make any disability-related inquiries and conduct medical examinations, regardless of whether they are related to the job, as long as it does so for all entering employees in the same job category.

Because these exams fall in the “Green Light” category, the city is in the clear, right? Wrong. Pre-employment medical exams are permitted as long as the employer does so for all entering employees in the same job category. This employee alleges the females were singled out. Thus, unless she worked with all women in her job category (another legal red flag), the city violated the ADA by sending some, but not all, employees for pre-employment medical exams.

Also, pay attention to state laws when conducting medical exams. For example, Ohio prohibits an employer from shifting the cost of any pre-employment medical exam to an employee: “No employer shall require any prospective employee or applicant for employment to pay the cost of a medical examination required by the employer as a condition of employment.”

As for this mayor, these allegations are just the tip of his legal iceberg. It’s also alleged that he uses the n-word to refer to African American residents, and sexually harasses female employees by talking about his private parts and how pistachios contribute to his sexual prowess. Sounds like a great place to work.

Posted on September 6, 2018June 29, 2023

Behaviors, Not People, Are Cost Drivers

cost drivers
Everyone has a health-related vice. It’s more respectful to refer to them as a person and not by their unhealthy habits.

The language you use is important. People are people. Call them what they are.

I say this because of a common phrase I’ve come across occasionally in my health care research. I attended a webinar in which the speaker consistently referred to people as “cost-drivers.” Obese employees were referred to as “cost-drivers;” so were employees with diabetes. What does someone who is obese cost you compared to someone who is not obese, the moderator posed. This is a major pet peeve of mine in health care reporting — both the language used and the idea that a person’s health status could potentially influence a candidate’s perceived hireability for a company.

We’re all in the HR space here. I wouldn’t be surprised if you, too, have come across handfuls of headlines and articles about “putting the ‘human’ back in human resources.” I’d like to argue that when we’re talking about health care and health problems that need medical attention, let’s be careful to keep the “human” in mind, too.

There’s a person behind that health care cost, and you don’t know how much physical, mental or financial stress that health problem is putting on them. Stop acting like people’s health problems are more inconveniences for you than inconveniences for them.

Most people have some sort of cost-driving behavior, whether that’s smoking, not eating healthy enough, not sleeping enough or drinking too much coffee. Even people who work out, do yoga, practice mindfulness and eat healthy participate in some behavior that one might consider unhealthy. Most everyone has a health-related vice.

People should take responsibility for their own health, but adopting the perfect heath behaviors in every aspect of our lives is impossible. Every person, regardless of their health status, drives health care costs.

Yes, of course organizations have the responsibility to try to stay financially healthy, and a continuing, rising cost in many companies are health care expenses. It’s not surprising that businesses want to focus on decreasing health care costs, and it’s not negative that they want to do so.

Referring to employees as rusting machines that require constant maintenance rather than humans whose health problems are realistically more complex than a simple fix rubs me the wrong way. Ultimately, it’s an objectifying way to describe people. It comes across as a way to disregard the human behind the heath behavior.

Also read: Some Constructive Criticism on Workplace Wellness

Not long ago, a pre-existing condition was a valid reason for insurance companies to deny people coverage. And, with the future of health care legislation in the U.S. so uncertain, who knows what the future of this practice will be? Might employers possibly take a similar route and choose the healthiest candidates first, regardless of if they’re the best person for the job, to avoid those pesky, sick “cost drivers”?

That situation isn’t entirely ridiculous. For example, a few stories this past year have focused on the “potential nuances of a culture of health.” CNBC posted a story this past March about a health startup criticized online for being “cultish” and “fit supremacist.”

Corporate Wellness Magazine has published a feature about how companywide health goals and human needs can clash when things like weight-loss competitions and employees with eating disorders combine. Employees of a water company in Sweden risk lower wages if they don’t participate in a mandatory workout every week.

There has to be a way to mix financial responsibility and human understanding — at least if you truly do want to “put the ‘human’ back in human resources.”

My take on this: when you refer to a “cost driver,” make sure it’s a something and not a someone. And don’t let their status as a “cost driver” impact the value you place on them as an employee or as human beings.

Andie Burjek is a Workforce associate editor. Comment below or email editors@workforce.com.

Posted on August 29, 2018June 29, 2023

ComPsych Survey Emphasizes In-Person Counseling Over Mental Health Apps

There’s an app for that — that meaning almost everything. I covered mental health apps for Workforce a couple years ago, exploring how technology solutions can benefit employees with mental health issues, which is why I was intrigued to find a ComPsych survey in my inbox the other morning. The findings? If employers want to help depressed workers, apps may not be the answer.mental health apps

Workforce covered technology in our latest HR tech-themed issue, including a few stories on the negative and positive impacts of technology. While this information was also valuable, I found the survey by ComPsych, a Chicago-based employee assistance program provider, to be especially noteworthy because of the specific population it addressed: depressed workers. We can argue pointedly on both sides about how technology has both positive and negative effects on people’s lives and well-being. But when we’re talking about mentally ill people getting help, I think it’s better to be a bit more careful.

Also read: Is Technology the Answer to Your Employees’ Mental Health Problems?

I can’t speak for this hypothesis, but I can share some of the findings from the ComPsych research. The EAP, considering the loneliness epidemic and the need for more face-to-face interaction, advocates for in-person counseling. The role of apps in getting mental help? “Using them as means to draw people in to receive more in-depth help.”

Also read: Loneliness Creeps into Workplace Wellness World

“There’s a human function and a human interaction component — you can call it empathy, you can call it connectedness, you can all it a lot of things — that you miss regardless of what you employ in the technological realm that an in-person experience with another human being provides for a person seeking care,” said Richard Chaifetz, founder, chairman and CEO of ComPsych.

He added that any way we can improve, increase and expand people’s ability to access care is positive and that technology has a lot of value in mental health. Take, for example, a different technology in health care: telemedicine. This solves some issues related to access and availability of care, but for serious illnesses or comprehensive medical problems, in-person care is preferable. The same could be said about mental health.

Take this instance. Years ago, people would took paper surveys about their mental well-being. Am I depressed? Am I stressed?

“Those moved to internet-based questions, and now they’ve moved to online cognitive help for people to walk through different scenarios in their lives and provide resources and counseling online,” Chaifetz said. “It’s a way to stimulate thought, [and] it’s a way to bring people under the tent to explore issues related to mental health or mental well-being.”

He also added that at ComPsych, when people are online, they constantly are reminded that in-person care in available. Here’s the number you call, here’s how you get something scheduled, here’s what you need to know. It’s a way to make sure people know their options.

Most employers understand that technology is not the answer to everything in medical care, and more employees than in the past are open to getting care for mental health needs, thanks to the stigma disappearing over time, Chaifetz said.

Still, I find this important to bring up because understanding something and taking action are two different things. For example, quality and access in mental health care are still current issues, even if people understand the importance. Chaifetz mentioned that most large and medium sized companies have mental health services beyond basic counseling mandated in their health plans, but that leaves me curious about the state of health plans for small employers, where many employees work and get health insurance.

Looking at this from a broader perspective, this pitch reminded me of something that it couldn’t hurt to remind employers. Wanting to help your overall workforce with their general mental health and wanting to help your mentally ill employees with specific mental health issues are two different beasts.

Both are important, and both require different considerations. It’s the difference between someone needing to take a mental health day to sleep in and do something relaxing and someone needing to take a mental health day to see a counselor for an emergency session. Or the difference between someone wanting to use HSA dollars to help pay for an exercise class and someone wanting to use HSA dollars for medication.

The amount of mental-health pitches I get a day is great and I believe a good sign that employers genuinely want to know what they can do so as not to negatively impact their employees’ mental health.

In other benefits-related news this week:

  • Can This New Employee Benefit Help You Hack Death?: A blockchain startup has adopted a stem cell storage benefit, saying that these young, healthy cells can potentially be used in the future for “health maintenance.” However, experts in stem cell research say there’s not yet any scientific evidence that stem cells could be used to reverse illnesses (be in heart-related illnesses, brain-related illnesses or blood cancer) when people age. Is this benefit promising more than it can deliver? (Bloomberg)
  • IRS Clears Way for Student Loan Benefit Tied to 401(k): This company has introduced a new benefit in which debt-straddled employee with student loan benefits can begin to save for retirement by paying off student loans. When they make a loan payment, their company puts money in their 401(k). My benefits sources say this is not yet a trend, for a variety of reasons, but it’s definitely something to have your eye on moving forward. (Employee Benefit News)
Posted on August 24, 2018June 29, 2023

Workplace Wellness Programs: Different Research, Different Results

Andie Burjek, Working Well blog

Since I started researching and writing about workplace wellness for Workforce two years ago, there’s been one story that’s consistently creeps up every so often.

I’ve always seen it as one of the many tension points in workplace wellness: return on investment. Do wellness programs work from a financial perspective? Do they actually save plan members and organizations health care dollars?

[Other points of tension I’ve noticed: 1. financial incentives — are they coercive or not? Do they work or not? 2. Responsibility — is employee health and how employees eat, exercise, etc., outside of work an employer’s responsibility? Is that overstepping a line or a legitimate business decision? What areas of debate do you think are most noteworthy or intriguing tension points in workplace wellness?]

There are studies that claim wellness programs have clear financial benefits, and others that find the opposite. I’ve noticed the types of organizations that publish positive results are wellness companies themselves or the organizations that utilize wellness programs. The types of organizations that have published the more constructively critical results have been third party researchers like universities.

That’s why it was interesting to come across this New York Times story, “Workplace Wellness Programs Don’t Work Well. Why Some Studies Show Otherwise.” This story may be a bit dull for people not interested in the details of workplace wellness programs or the nuts and bolts of how different research studies are structured, but I found it enlightening.

The article compared two types of research studies: observational analyses vs. randomized controlled trial. Many of the analyses of wellness programs that show positive results are observational, it stated, and although there are some benefits to observational research, the randomized controlled trial is the “gold standard of medical research.”

You can check out this article’s deeper information on these two methods and what makes them different. I’ll focus on the implications of the methods on workplace wellness studies. An excerpt from the article:

“… Almost all of those analyses are observational, though. They look at programs in a company and compare people who participate with those who don’t. When those who participate do better, we tend to think that wellness programs are associated with better outcomes. Some of us start to believe they’re causing better outcomes.”

“The most common concern with such studies is that those who participate are different from those who don’t in ways unrelated to the program itself. Maybe those people participating were already healthier. Maybe they were richer, or didn’t drink too much, or were younger. All of these things could bias the study in some way.”

“The best of these observational studies try to control for these variables. Even so, we can never be sure that there aren’t unmeasured factors, known as confounders, that are changing the results.”

In June, a group of researchers published the results from the Illinois Workplace Wellness Study. They conducted a randomized control trial and analyzed the data as if it were an observational trial. Here are some of the results:

  • People who participated in the wellness program went to the gym almost twice as often as those who did not participate, according to the observational analyses. The randomized control trial found that participants and nonparticipants went to the gym roughly the same amount of times a year.
  • Participants spent $525 and $273 monthly on health care and hospital related costs, respectively, compared to nonparticipants who spent $657 and $387, according to the observational analyses. the randomized controlled trial found that wellness programs had little effect on spending.

I’d strongly recommend this to any benefits or wellness professional interested in the ROI of workplace wellness.

One more thought. A while ago I began hearing from some people or reading that wellness programs aren’t a health-care cost saver, really, but a retention and attraction tool for employees. If that’s true, maybe results like those seen in this Illinois Workplace Wellness Study are irrelevant and employers will continue to offer wellness programs no matter what the cost savings (or lack thereof) are. We’ll have to see what the future of workplace wellness has in store!

Andie Burjek is a Workforce associate editor. Comment below or email editors@workforce.com.

Posted on October 9, 2006May 3, 2019

Some Employers Look to Break the PBM Habit

Earlier this year, the University of Michigan terminated its relationship with Caremark Rx after the university decided it could save more money by dumping the pharmacy benefit manager and managing its own prescription drug spending.

The university expects to save $2.5 million by handling the estimated $60 million it will spend this year on prescription drugs. Most of the savings come from eliminating fees from the university’s former pharmacy benefit manager and using the claims data of the 80,000 people it provides insurance for—data the PBMs do not share with their clients—to help school officials negotiate better drug prices.

By managing its pharmacy benefit plan, the university is considered the first employer in the country to wean itself off pharmacy benefit managers, the middlemen of the prescription drug world. Critics have argued for several years that PBMs do not deliver the kind of savings large employers could reap if they aggressively managed their own pharmaceutical spending.

Though it may seem like a function beyond the expertise of most benefits administrators, some consultants contend that cutting out the middleman is possible for anyone looking to contribute to a company’s bottom line by reducing one of the fastest-growing costs in health care spending: prescription drugs.

“Why rely on a middleman?” says Chiara Bell, president of Clarus Inc., a health benefits consultancy in West Palm Beach, Florida. Clarus is among the handful of consultancies working with companies to help cut out pharmacy benefit managers. “At the end of the day, employers can build their own in-house piece.”

The University of Michigan, for one, will see its drug costs increase 6.5 percent this year, says Keith Bruhnsen, who manages the school’s prescription drug plan. When compared with the 13.8 percent increase expected nationally, according to an annual survey published by the Segal Co., the school’s cost containment efforts seem to pay off.

The three-year transition from PBM dependency to “insourcing” Michigan’s own drug benefits required Bruhnsen to hire a data analyst, a pharmacist and other support staff. Bruhnsen mined his newfound data to learn which drugs the school’s insured population consumed most. Armed with detailed information about its drug spending habits, the pharmacist built the drug formulary and set up co-pays that would encourage the use of certain drugs. Finally, Bruhnsen, who was already on staff, was able to play the role of PBM and negotiate the prices the school was willing to pay for chain pharmacies to dispense the drugs.

“If (employers) are not managing their claims and looking at their data, they are not going to be managing their drug trend and therefore their overall costs,” Bruhnsen says. “Are employers willing to take on the challenge?”

The Pharmaceutical Care Management Association, the industry group representing the estimated 50 PBMs nationwide, says the marketplace has determined that PBMs save money for employers by offering a service outside the core expertise of most.

 


“The reason everybody uses a
PBM, though no one is required to,
is because of the savings. If
employers can do it and find new way to build a better mousetrap, more power to them.”
–Mark Merritt, president, Pharmaceutical Care Management Assn.


 

“The reason everybody uses a PBM, though no one is required to, is because of the savings,” says association president Mark Merritt. “If employers can do it and find a new way to build a better mousetrap, more power to them.”

Bruhnsen says companies with 5,000 or more employees should be managing their own pharmaceutical spending.

Smaller companies and unions can still do so, Bell says, by forming coalitions—which requires cooperation and data sharing.

Bell argues that when a company owns its claims data, it can negotiate prices with manufacturers just as easily as a small or startup PBM.

“The real power lies in who owns the data,” Bell says.

Coalitions, however, do not always succeed. In 2004, the HR Policy Association made a big splash by announcing it was going to eliminate PBMs. By the end of the year the association realized the effort was “unfeasible,” says spokeswoman Marisa Milton. Part of the problem was that while employers pooled their purchasing power, each insisted on administering its own program. As a result, each manufacturer had to deal separately with each employer.

Similarly, Health Insurance Plan of New York tried to manage its pharmacy benefit plan several years ago, but ran into static from manufacturers and chain pharmacies. Manufacturers preferred to deal with pharmacy benefit managers because PBMs, which represent millions of consumers, purchase more drugs, says Edward Kaplan, a health care consultant at the Segal Co.

For companies and coalitions looking to cut out PBMs, the market may be more accommodating now than it has been in recent years. Today, PBMs have also become mail-order pharmacies, which is beginning to change the dynamic of the industry. Mail order is a growing business that competes directly with chain pharmacies like CVS and Walgreens. Employers that eliminate PBMs and negotiate directly with chain pharmacies will likely find a willing partner, Kaplan says.

“It just depends on how aggressive you want to be,” Bruhnsen says. “For us, we went full-tilt.”

Workforce Management, September 25, 2006, p. 34 — Subscribe Now!

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