May is Mental Health Awareness Month, which is as good a time as any to bring up an issue that has been weighing heavily on my mind — the looming mental health crisis that our employees are facing and will continue to face in a world and workplace changed by coronavirus.
Coronavirus has altered all of our lives, and all employees are dealing with stress, anxiety, and isolation.
Social distance has robbed us of the human contact we need from our family and friends, and work-from-home of the connections with our co-workers.
Some have fallen ill with coronavirus. Most of us know someone who has. And sadly there are those of us who have dealt with the loss, unable to properly grieve because of social distancing rules.
We’ve all missed celebrating milestones such as graduations, birthdays and weddings.
Many of us have dealt with the stress of layoffs, furloughs, lost income or closed businesses, and the stress that flows from figuring out how to pay the bills and feed our families.
Parents are balancing the new job of homeschooling (or at least assistant homeschooling) their kids with the old job of their actual paying job.
We’ve all lived with the everyday stress of just stepping out into the world. The simple task of grocery shopping has transformed into a life-and-death game of six-foot distance, anti-bacterial wipes and face coverings. Even the simplest of daily tasks such as walking the dog has transformed into a game of social distancing chicken — who is going to move off the sidewalk first.
And when society starts to return to some semblance of normal, some of your employees will return to work with mental health issues of varying degrees caused by all of this stress, change and loss. Some will be dealing with the exacerbation of pre-existing mental health issues, and some will have what I am calling coronavirus PTSD.
The easy part is understanding that coronavirus has caused these mental health issues. The harder part is figuring out what we as employers can do and should do to help employees identify and manage these serious issues.
For starters, Ohio has created a free COVID Careline for people to talk to someone about their concerns. It’s available 24/7 at 1-800-720-9616.
Other than letting employees know about this state-provided resource, what else can employers do to help ensure that employees have the support and resources they need now and in the future? I have five suggestions.
1. Check the benefits available to your employees. Do you have an Employee Assistance Plan and are its mental health and counseling services are up to date? Are your health insurance plan’s mental health benefits easy to access and affordable?
2. Revisit paid-time-off policies and consider providing employees the time they need to take care of themselves and their families. And understand that everyone’s situation at home is different. Some only have themselves to worry about, while others have children to tend to during the workday. None of this is ideal, but for some, it’s less ideal than for others, depending on how much non-work responsibilities are on one’s plate.
3. Consider holding town hall or all-employee meetings that focus on mental health awareness. If senior leadership encourages education and communication around mental health issues, your employees will be more likely to access care if and when they need it.
4. Just because many are working remotely does not mean that employees have to be separated. You can use technology to foster togetherness and a sense of community. Virtual get-togethers, mindfulness breaks and online team-building events all help ease the sense of aloneness and isolation that many are feeling.
5. Small gestures of kindness can go a long way. An extra day paid day off, a gift certificate for takeout meals or grocery deliveries, or a surprise delivery of a midday snack can help employees feel appreciated and connected instead of overwhelmed and stressed.
A business is only as strong (or as weak) as its employees. Those that are considerate, flexible and kind will be in the best position to come out of this on the other side with as vibrant a workforce as possible.
I tuned in April 28 to Ohio Gov. DeWine’s briefing to learn why Ohio had changed its stance on face masks and coverings from “mandatory” to “recommended best practice.” His explanation falls way short.
The governor offered two explanations, both based on feedback he received from constituents in the hours after his original pronouncement.
Masks are offensive to some, who don’t like the government telling them what to do.
Masks can be problematic for people with disabilities.
The answer to point No. 2 is as easy as three letters: A-D-A. The ADA allows employers to modify work rules as a reasonable accommodation for an employee’s disability. If a mask or face covering causes an issue for someone with a disability, the solution is to offer that individual an accommodation.
Maybe you segregate the employee so he or she does not come into contact with anyone else. Maybe you permit that employee to work from home. Maybe you grant a leave of absence until the risk abates. The point is that the employer and the employee have options other than the state modifying a rule that puts everyone at a greater risk of infection.
Which brings me to point No. 1. The governor said, “I understand some people may find that offensive, the government telling you what to.” Yet, if I’m choosing between offending some people and safety, I’m choosing safety 10 times out of 10. As I pointed out yesterday, everyone wearing masks or facial coverings reduces the risk of transmissions and infection down to a virtual zero.
Models show that if 80 percent of people wear masks that are 60 percent effective, easily achievable with cloth, we can get to an effective R0 of less than one. That’s enough to halt the spread of the disease.
One of the things we absolutely must do to combat the spread of COVID-19 is to wear masks or other facial coverings when at work or in public. While there are studies that question the ability of masks to protect people from the virus, we are not wearing masks to protect ourselves from catching COVID-19.
We are wearing them to protect others from us spreading COVID-19 to them. Thus, if everyone covers their face in public, we will protect everyone by limiting the spread of this virus. It’s just that simple, not difficult to comprehend, and not an affront to personal liberty.
So here’s my bottom line. Anyone who refuses to wear a mask in public because it’s offensive is selfish, thoughtless and doesn’t give a damn about the well being of their fellow humans, period.
I’ll be continuing to wear my mask when around others in public. I sincerely hope that for the well being of all others, you will too.
Buddy Phillips injured his ribs while playing with his grandchildren.
Over the next two weeks, he called his employer, United Trailers, to report he would miss work. Eventually, however, he stopped making these phone calls. When he failed to show up at work for three straight days without giving notice, United fired him under its attendance and reporting-off policy.
He sued, claiming that United interfered with his rights under the FMLA by failing to advise him of his rights under the statute after it had notice of his serious health condition but before he went AWOL.
In Phillips v. United Trailers, the 7th Circuit Court of Appeals held that in this instance, the employee’s FMLA rights trumped the employer’s attendance and reporting policy.
Even if Phillips failed to comply with the FMLA by failing to report his absences, he did so after United would have violated the FMLA. Phillips stopped calling in to work at least nine business days after he first reported his rib injury to United. Under the regulations, United had five business days after receiving notice of Phillips’s rib injury to determine whether he qualified for FMLA leave.
In other words, an employer cannot rely on its attendance and reporting-off policy to terminate an AWOL employee if the employer is already on notice that an FMLA-qualifying event might be the cause of the employee’s unreported absences.
So what should an employer do in this situation, when an employee might have triggered the FMLA’s protections? The FMLA’s regulations offer some guidance.
If the need for leave is foreseeable to the employee, it’s a much easier issue. The employee must give 30 days notice, which gives the employer and the employee more than enough time to work out their leave and attendance issues.
If the need for leave is unforeseeable, however, the employee must provide notice of his intent to take leave to the employer as soon as practical under the circumstances. That notice must “provide sufficient information for an employer to reasonably determine whether the FMLA may apply to the leave request.” Critically, an employee “need not expressly assert rights under the FMLA or even mention the FMLA, but may only state that leave is needed.”
The burden then shifts to the employer. The employer must decide whether to designate the request for leave as FMLA-qualifying. Its decision to designate FMLA leave “must be based only on information received from the employee.” If the employer lacks information about the reason for an employee’s request for leave, the employer should inquire further of the employee to determine whether leave is potentially FMLA-qualifying. The employer should not, however, bury its head in the sand and ignore the employee, because if the leave turns out to be FMLA-covered, the employer will have a big legal problem. Just ask United Trailers.
Importantly, the employer only has five business days to notify the employee whether leave will be designated as FMLA-qualifying, absent extenuating circumstances.
Throughout this back-and-forth time period, the employee must comply with the employer’s “usual and customary notice and procedural requirements for requesting leave.” If the employee does not comply with the employer’s usual leave-request requirements, the employer is within its rights to deny or delay the FMLA leave. If, however, the employee provides notice and complies with the employer’s attendance policy, the employer’s failure to timely determine whether the employee’s leave counts as FMLA-qualifying may constitute an interference with the employee’s FMLA rights.
These are complicated issues that often do not have cut-and-dried answers and can carry seriously expensive consequences for an employer’s missteps. If an employee presents you with an injury- or illness-related absence that may or may not qualify for FMLA protections, your first call should be to your employment lawyer to make sure that you are handling this issue correctly under the FMLA’s maze of rules and regulations.
A judge in the United Kingdom has ruled that “ethical veganism” is a protected class akin to religion and is protected from workplace discrimination. The Washington Post shares the details:
An employment tribunal made that landmark determination in a case involving a man who claimed he was fired from his job at an animal rights organization for revealing to colleagues that their pension funds were invested in companies that experiment on animals. The tribunal has yet to rule on the merits of the case, but it did on Friday take the step of deciding that the man’s ethical veganism constitutes a “philosophical and religious belief” protected by anti-discrimination law.
That’s the United Kingdom. What about the United States? Well, it depends.
There are two leading cases on this issue.
In Chenzira v. Cincinnati Children’s Hosp. Med. Ctr. (S.D. Ohio 2012), the federal court denied the hospital’s motion to dismiss the employee’s religious discrimination claim. The core issue the court decided is whether veganism is a sincerely held religious belief, or merely a moral or secular philosophy or lifestyle (as the hospital argued). In support of her argument, Chenzira—a customer service representative who refused a flu vaccine because it contained animal by-products—cited an essay, The Biblical Basis of Veganism. She also cited bible verse to her employer when she made her request for a religious accommodation. In denying the motion to dismiss, the court stated:
The Court finds that in the context of a motion to dismiss, it merely needs to determine whether Plaintiff has alleged a plausible claim. The Court finds it plausible that Plaintiff could subscribe to veganism with a sincerity equating that of traditional religious views.
Contrarily, in Friedman v. Southern California Permanente Medical Group (Cal. Ct. App. 2002), the state appellate court dismissed the religious discrimination claims of a vegan IT worker who refused a mumps vaccine for similar reasons as Chenzira. He claimed the vaccine “would violate his system of beliefs and would be considered immoral by him,” which resulted in the withdrawal of his employment offer. The court concluded that veganism is not a protected religion:
We do not question plaintiff’s allegation that his beliefs are sincerely held; it is presumed as a matter of law that they are.… There is no allegation or judicially noticeable evidence plaintiffs belief system addresses fundamental or ultimate questions. There is no claim that veganism speaks to: the meaning of human existence; the purpose of life; theories of humankind’s nature or its place in the universe; matters of human life and death; or the exercise of faith. There is no apparent spiritual or otherworldly component to plaintiffs beliefs. Rather, plaintiff alleges a moral and ethical creed limited to the single subject of highly valuing animal life and ordering one’s life based on that perspective. While veganism compels plaintiff to live in accord with strict dictates of behavior, it reflects a moral and secular, rather than religious, philosophy.
In other words, while his beliefs are sincerely held, they are moral beliefs, and therefore secular and not religious.
To answer my question on how U.S. courts would view this issue, it depends on the jurisdiction in which your business is located, and perhaps whether the employee’s beliefs are grounded in spiritualism or personal morals.
These cases also raise a more fundamental question — how far should businesses go to accommodate employees’ requests for special treatment. To me, sometimes, the path of least resistance makes the most sense.
For a hospital, there may not be a path of least resistance when comes to public health issues such as vaccinations. Other businesses, however, have to balance the burden of granting the accommodation versus the risk of a lawsuit (and the costs that go with it). In many cases, the accommodation should win out, because it is easier and less costly than denying the request and eating a lawsuit, even if it’s a defensible lawsuit.
For example, if you face this same vaccination issue at your widget company, is there a harm in letting employees opt out on religious ground, even if it’s a borderline (at best) religion, like veganism. You can defend your decision to deny the request based on the bona fides of the claimed religion. But, where does that get you? Are you on right side of the law? Possibly. Have you irreparably damaged your relationship with your employee, while at the same time demonstrating to your entire workforce that you practice policies of exclusion instead of inclusion? Likely.
In other words, there are more factors to consider other than answering the question, “What does the law say about this?” How you incorporate those other factors into your accommodation decision-making is often more important than simply answering the underlying legal question.
Out of sight and out of mind is far from the truth when it comes to maintaining engagement among a remote workforce.
Today’s business culture is much more open to hiring remote workers as it expands the playing field for hiring new top talent, allows for more flexibility in schedules and in turn creates a better work-life balance for employees. Working remotely has increased by 103 percent since 2005.
Currently, 3.7 million employees work remotely (2.5 percent of the workforce) at least half the time. However, this can make maintaining high employee engagement and retention rates a bit tricky due to the common feeling of isolation among remote workers.
Jason Patel, founder of Transizion, a college and career prep company, said that starting with the onboarding process is key and that it is best to treat onboarding as if they were in-office employees.
“It’s important to set the tone from the start, that remote employees are just as appreciated as office employees. If that tone is set in the culture, it will percolate,” Patel said in an email statement.
Maintaining a productive and successful remote team culture requires a strong communication line. Communication tools such as Slack, Workplace or Zoom make it easier for remote teams to communicate and feel as though they aren’t missing out on important information, meetings or celebrations. They should feel like they are in the office alongside everyone else, voicing their opinions, sharing their ideas and actively contributing to the conversations.
Making sure to include remote employees in meetings and scheduling regular check-ins is also vital for creating an inclusive environment and tracking progress, according to Carlos Castelán, managing director of business management consulting firm The Navio Group. If remote employees aren’t provided with clear expectations and direction, it can be easy to feel like they are stranded on an island. Those who work remotely need to feel a sense of purpose in order to stay motivated and passionate about the company’s goals. “One of the hardest parts of staying motivated as a remote worker is fully grasping how your contributions fit into the overall picture and mission,” Castelán said.
Although emails, phone calls, video calls and text messages are convenient, Deb Boelkes, founder of leadership development firm Business World Rising, suggests taking it a step further and planning in-person meetups as a best practice if the budget permits. Whether in the form of large company events or small team-bonding outings, it is essential to build a sense of camaraderie as this can be an obstacle for those who don’t see their co-workers five days a week.
Boelkes also recommends scheduling weekly team calls to update everyone on individual and team progress, asking and offering help, brainstorming approaches and recognizing major accomplishments and successes. “Really knowing each other and meeting face-to-face helps build trust. Try to meet in person at least occasionally,” Boelkes said in an email statement. “Otherwise use video conferencing technology whenever possible. Team members need to know the other members on the team, what they are doing, and how they can help each other.”
Gamification has also become more popular in today’s business culture as it creates a sense of collaboration, cooperation and a competitive edge to everyday work responsibilities. Gamification applies game-playing elements to nongame environments, which can be used as a tactic to encourage engagement in a fun way.
This can be implemented into the recruitment or onboarding and training processes as well to increase retention rates. According to a 2019 TalentLMS study, 61 percent of the 900 employees surveyed said they receive training with gamification. Some 83 percent of those who received gamified training claimed to feel more motivated, and 61 percent of those who did not receive gamified training said they felt bored and unproductive.
“Whatever you do with office employees is what you should be doing for remote employees. If anything, you should be more disciplined and clear when working with remote employees,” Patel said. “There are far too few touch points between you and the remote employee, which means there are plenty of intersections for miscommunication. That’s why agendas, metrics, and goal and mission articulation are so important. Make it seem as if they are in the office with you.”
Writing about workplace health and health care for the past several years has meant reading my fair share of buzzy health trends.
That’s why I’ve enjoyed reading about the worst wellness trends of the 2010s and discussing it with my friends and family. Vice even did a March Madness-style bracket, which I found to be fun.
Not surprisingly, the anti-vax movement took Gold, with the keto diet taking Silver.
I was especially happy that corporate wellness made it to Round 3! It lost to another unfortunate workplace trend, #NoDaysOff. You know, that crazy idea that people who work 90 hours a week and never take a break are superior to other employees, so they brag about it online? Woof.
Still, I’m glad workplace wellness made it as far as it did, because academic studies have shown that they’re not effective at cutting health costs or changing habits. They mostly shift health care costs to employees, hence the “cost-savings.” Here was Vice’s reasoning:
Corporate wellness is the latest iteration of workplace wellness, which has been around since the late 1800s and has always existed to increase worker productivity. The current iteration of corporate wellness is mainly focused on mindfulness, but can also include, uh, taking DNA samples from employees or harassing a double-mastectomy patient into getting a mammogram. Surprisingly, these programs don’t actually contribute to workplace wellness. Go figure!
This wonderful bracket made me think about the worst trends I’ve seen in employer health in the past several years.
Some of these relate to other parties that intersect with employers, and none of this is to throw shade at employers. A lot of good things have gone on this decade, as well! Reminiscing brings up cringe-worthy memories for everyone. For example, 10 years ago I used to crochet my own ill-fitted beanies and wear them out in public because I thought they made me look artsy. It’s not fun to revisit that one.
Here are my list of worst health trends, in no particular order.
1. The “culture of health” trend: Recently U-Haul got mixed reactions online for revealing that “it will no longer hire people who use nicotine in any form in the 21 states where such hiring policies are legal.” I’ve seen positive feedback from health advocates online, but ultimately, this is a scary, slippery slope. Are we headed in the direction of a person’s employability being increasingly more linked to their habits or their health?
Think about how the Affordable Care Act protects people with pre-existing conditions when it comes to accessing health insurance. Individuals with a health condition should have just as much of a chance at getting a job as healthy individuals. Health status shouldn’t be akin to a line on your resume.
2. Health care consumerism: One of my favorite articles in the past several years was a New York Times op-ed arguing that we have to stop referring to people paying for health services as “shoppers.”
I know, I know… This movement of encouraging individuals and employees to be smart health care consumers isn’t going away soon, probably. But I agree with the argument. Encouraging employees to be educated about health care is a good thing, but marketing health care as merely a consumer good rather than a vital service people need to survive seems misleading to me.
We should stick with “patients” instead of “health care consumers” or “shopper.” And, like this op-ed suggested, we can simplify our language and just say that patients “pick” or “choose” a health plan rather than “shop for” it.
3. Pseudoscience/misinformation: A big piece of wellness this month is “The Goop Lab with Gwyneth Paltrow” arriving on Netflix. Historically, Paltrow has received criticism from health advocates and medical professionals for spreading misleading or false health information through Goop, her wellness company. Yet Goop is still a big money-making player in the wellness industry.
Meanwhile, people also get misinformation about diets and workouts from social media wellness influencers, who may not be peddling effective or safe advice.
The bottom line is, take medical advice from professionals, not celebrities or influencers. And this doesn’t just apply to individual people. Health risk assessments, which some employers rely on, sometimes contain misinformation, according to Slate.
4. Overhyped health studies: Health journalism is infamous for the “big scary study.” A news outlet gets its hands on some research and twists a finding into something that will get attention. That’s how you get headlines about how some number of glasses of red wine a day reduces your chances of getting cancer.
According to the “How bad science can lead to bad science journalism — and bad policy” from the Washington Post, this also impacts employers’ decisions. This article gives the example of accountable care organizations, which employers may choose to offer employees. The best available evidence shows ACOs don’t work, the article cited. Still, journalists have sung their praises based on studies with deep design flaws.
I’ve written about this in more detail before, but both individuals and benefits decision makers should approach health journalism skeptically. Don’t be afraid to ask questions about how the research was conducted and what might be the limitations of the study.
Finally, my honorable mention goes to consumer-directed genetic tests — specifically the fact that individual or employer consumers may get marketing talking points rather than well-rounded information when companies try to sell these products to them.
I think about her session every time I read or research something about burnout — which, as most everyone on LinkedIn knows, is an increasingly common subject to come across in the news.
One of her most vital yet obvious points at the 2017 conference was that while the term “occupational burnout” wasn’t coined until the late 1970s, that doesn’t mean it didn’t exist before the ’70s. People just didn’t talk about it.
Not even academia took it seriously in the 1970s. Maslach first published her seminal research on burnout in a non-academic publication, resulting in a large amount of reader feedback from employees who had experienced burnout.
While the conference session focused on burnout among medical professionals, many of Maslach’s findings also apply to a group of employees that receive much less attention than salaried medical staff: hourly shift workers. Just like academia didn’t take burnout seriously decades ago, I wonder if some organizations still have the same attitude toward this hourly, generally less-educated group of employees.
“As technology and automation advance to simplify the lives of skilled laborers, the needs of low-wage hourly workers are forgotten,” wrote WorkJam CEO Steve Kramer in a recent article. He stressed a few reasons why low-wage workers might be experiencing burnout and what their needs are. He also noted that increasing productivity expectations, no predictable hours and chronic understaffing are a few of the major reasons for hourly employee burnout.
Employers are not powerless against this burnout, though, he wrote. He suggested technology as a potential solution for managing burnout.
Some digital tools, for example, allow frontline workers to give feedback and constructive criticism to managers and higher-ups. Other tools allow employees more agency in the scheduling process. Also, digital, personal training exists that can help employees learn new skills.
I would like to argue that managing burnout among hourly workers is not as simple as “run to the shiny new technology.” If a manager gets anonymous feedback that they’ve created a stressful work environment, what if they’re the type of manager that wouldn’t do anything to change?
If employees express that productivity goals are unrealistic for individual employees, what if the company sees that as employee laziness rather than a valid concern? If an employee has issues with whatever digital tool is used by their manager, will company decision makers actually think about replacing it with something less problematic?
As Vox writer Emily Guendelsberger points out in her essay, “I was a fast-food worker. Let me tell you about burnout,” enhanced technology has improved the lives of many skilled, educated workers. Meanwhile, the same advancements allow employers to track worker productivity down to the second — a reality that helps create burnout in hourly workers.
In 2019, after the newspaper she worked at closed, journalist Guendelsberger decided to work three different hourly jobs (in an Amazon warehouse, at a call center, and at a McDonald’s) to see how tech was now being used and to gauge how working in these jobs had changed over the years.
Here’s one of the changes she noticed:
“When I used to do service work, we still mostly used paper time cards; you could make your case to the manager if you were late, or maybe stay a few minutes beyond your shift to make up for it. At many modern service jobs, the digital time-clock system will automatically penalize you for clocking in a minute after the start of your shift or after a break.”
This is just one example, but it shows how the lack of humanity in digital systems could potentially punish someone for being human and making a small mistake occasionally. Could there be any way for digital tools to treat employees like people and give them some leeway? Not leeway to come in 15 minutes late every other day, but to come in five minutes late every once in a while.
While I don’t doubt that technology has the potential to help any type of employee, I’d encourage company decision makers to think critically about the impact of certain technology on low-wage employees. Rather than romanticize the potential of tech, try thinking about it rationally. Ask yourself a few questions: How are my expectations impacting employees’ stress levels? Could this burnout lead to health problems in my employees? Do I expect my hourly workers to work like humans or machines? Are the hourly wages my company offers keeping up with the rising expectations of how much these people must do on a daily basis?
The modern working class of America are fast food, retail, warehousing, delivery and call center workers, as Guendelsberger noted. “These jobs are not just a source of teenage pocket money; they’re something adults are trying to survive on,” she wrote. Burned-out fast food workers might suffer physically by accidentally burning themselves or suffer mental stress from constantly putting up with rude customers.
Just like we should care that white-collar professionals and medical professionals may make mistakes due to burnout, we should care that working class employees go through the same. Burnout isn’t just an affliction of the middle or high-class employee.
Money, power and status do not protect people against mental illness.
Executives are affected by mental illness as often and as severely as other segments of the workforce, said Dr. Samuel Ball, director of psychology and executive programs at Silver Hill Hospital. He specializes in treating executives suffering from mental illness.
Alcoholism is one of the most common afflictions, Ball said, followed by personality disorders and mood disorders such as depression and anxiety. Executives struggling with depression may have difficulties with productivity and have to force themselves to perform their job due to lower energy levels and interpersonal skills, while some people afflicted with alcoholism can drink heavily while often being functional at work.
A group of high achievers may be initially reluctant to admit the problems they’re experiencing, Ball said. They feel a “different kind of shame about the problems they’re struggling with because they’re on a pedestal. So many people rely on them, [and] so many people look up to them at work and in their family.”
They need to feel secure, he added, describing a patient who felt comfortable speaking up because the CEO gave him a clear message that they wanted him back after treatment.
Home Life Versus Work Life
An executive’s spouse and family play a critical role in convincing them to get help.
“In a number of cases, the problem is not as widely known at work as it is at home. And the spouse has gotten to the end of their rope with [their] concerns,” Ball said.
At work, the executive will “put on the best face or a mask of maintaining their competency” because they’re motivated to maintain their career status. But when they get home, it’s different. Their spouse will usually be the one to convince them to get treatment.
If someone has these health issues, it can negatively impact their spouse and children, especially children in their teenage years. According to the Centers for Disease Control and Prevention, growing up in a family with mental health or substance abuse problems is considered an adverse childhood experience — a potentially traumatic event that occurs in childhood and increases people’s risk for health problems as adults.
This group of patients generally have the means to afford outpatient treatment, which is a good first step, Ball said. The patients he sees, though, are often the ones too ill for outpatient treatment. Instead of living at home and regularly seeing a psychiatrist, they need inpatient care. Ball will get a phone call from the spouse, who has done the research to find the ideal place for inpatient care — usually somewhere in a different city that’s nearby enough that family can visit.
How Peers and Employees Can Respond
When an executive’s mental health is severe, employees and peers may notice. But knowing what to do or how to express sympathy or concern is different. For those employees who report to this higher-ranking person, it can be difficult to know what to do, if anything.
An exception might be if an executive has a trusted assistant who has been with them for a long time, Ball said. This type of direct report may have some ability to do something about the situation, especially if they play a “work spouse” role in this person’s life. But a majority of direct reports are not in this situation.
Typically, these high-ranking people won’t go to HR or contact an employee assistance program, Ball said.
“These executives report to the most senior people in the organization. And when they do finally admit to having a problem, if they do admit it, it’s not clear to them where to go in the organization to get support,” he said.
Usually it’s the one or two people above them — usually the CEO or COO — telling them to go on leave to get treatment that finally makes them get help, Ball said.
“They’ll say something like, ‘You’re incredibly valuable to us and we want you back, but you’re not well enough to work now. Take a month, two months, but we want you to get into a treatment program,’” he said.
Still, HR has power here. Lower-level employees may bring their concerns to HR, and an HR representative can speak directly with the CEO or COO, who typically are not surprised by the information, Ball said. From there, the CEO or COO can lead the intervention with the sick executive, and the HR person can stay in the meeting as an observer, especially if there’s been any sort of wrongdoing or complaints about the executive’s behavior.
It’s especially helpful if their boss can show sympathy in this discussion, Ball said.
“When this has gone well, their boss is either someone who has struggled with depression or alcohol, or it’s in their family. And they’ll have that discussion with their affected employee and say something like, ‘I know what this is like, and you’ve got to take care of this,’” he said.
Fighting Stigma
A prime reason executives fear coming forward with mental health issues is the fear that their progress at the company will effectively stall and that people will wonder when their next relapse will be.
“Even if they don’t lose their job, the reputational fallout of people knowing they’ve gone off to rehab is significant,” he said.
Some workplace experts encourage leaders to be open about their mental health struggles in order to decrease stigma for employees. However, since even these leaders experience stigma, talking openly about mental health at work is a hard but courageous thing to do, according to Ball.
Still, he said that it does have a positive effect on the workplace when leaders are honest and open about their struggles. He mentioned a patient who, upon preparing to leave soon, plans to go back to work and share broadly with the workforce that he’s been on leave treating his depression. This executive said he wanted people to take better care of themselves and recognize the signs that he did not.
“I think it’s courageous when people do that,” Ball said. “It’s helpful to employees when they send that message.”
The phrase “drugs in the workplace” understandably elicits an alarmed reaction from employers. But the truth is the amount of substances that are considered drugs are many and varied, and many are commonplace for an employee’s daily routine.
Substance use abounds in the workplace — and that’s just legal substances. Employees roll into work and can’t get anything done without their daily dose of caffeine. Colleagues meet in the break room with cases of beer to partake in the regular happy hour. Someone anxious about an upcoming deadline picks up a CBD-infused coffee at breakfast or a CBD-infused burger for lunch. And don’t forget about that roll of antacids or bottle of ibuprofen in the desk drawer or an energy drink in the fridge for a mid-afternoon pick-me-up.
In short, regulating substance use among employees is not simple and straightforward. Drugs like caffeine and alcohol are legal, but employers may get into trouble if an employee’s alcohol consumption leads them to cause problems during the employee get-together.
Cannabis is still illegal federally in the United States as more states legalize it for medical and recreational purposes, causing confusion for employers who can’t keep compliance straight among the constant changes. And, a recent surge of “smart drugs” — substances taken to improve creativity, attention, executive function and working memory — poses major ethical questions about whether it’s OK to take a mental steroid to be productive at work.
PRODUCTIVITY
Much has been made about college students taking medication to stay productive and awake, but that habit doesn’t end at graduation.
People use cognitive enhancing drugs — also referred to as “smart drugs” — to improve their creativity, attention, executive function and memory. Much like athletes may use performance-enhancing drugs to improve speed and endurance, employees may use smart drugs to be productive at work.
“Some people start using them in college and then they’re carrying that habit with them into the workforce. And things don’t get easier when you go from college to the workforce,” said Nick Heudecker, vice president of research-data & analytics at Gartner.
The use of smart drugs isn’t limited to an industry or economic status, Heudecker said. Even though Silicon Valley workers taking microdoses of lysergic acid diethylamide — more commonly known as the hallucinogenic LSD — to stay focused has received media attention, knowledge workers aren’t the only ones taking part. “Every workforce population is engaging in cognitive enhancement in some way,” Heudecker said.
ADHD drug Adderall is by far the most common smart drug, he said, followed by Ritalin, or methylphenidate. Modafinil, a narcolepsy drug, is another common cognitive enhancer. Energy drinks and caffeine — common parts of many people’s daily routines — are also considered smart drugs, according to Heudecker. And the over-the-counter dietary supplements called nootropics claim to improve people’s cognitive abilities, as well. Nootropics alone, according to Grand View Research, Inc., is a $2.17 billion market as of 2018 and expected to be a $4.94 billion market by 2025. Meanwhile, microdosing LSD means that the user takes about 1/10th of a dose as a way to “break down cognitive barriers and help them be more creative,” Heudecker said, adding there is no research on how microdosing LSD impacts users’ health.
The nickname “smart drug” is a misnomer. “These drugs don’t make you smarter. They allow you to better use the facilities you already have,” Heudecker said. They do so by helping people stay more focused or awake. Users may have that “feeling of being in the zone” for longer.
The use of these substances “is becoming more prevalent, not less,” he said, adding that too few employers are thinking practically about how they will address smart drug use in their workforce.
Why People Take Them: In 2018, The European Agency for Safety and Health at Work, or EU-OSHA, released the report “Managing Performance Enhancing Drugs in the Workplace: An Occupational Safety and Health Perspective” to explore the trend of smart drug use among workers.
Employees take them for “increased monitoring of employee health, stress levels, alertness and fitness,” especially when these measures are used to judge an employees’ ability to do their jobs. “It is possible to anticipate that employees under this level of scrutiny may turn to various pharmacological means to allow some control over biometric readings,” the report noted.
Workers in low-paid jobs that are not protected under standard labor laws may feel increased pressure to hit certain productivity levels, especially since they are increasingly being monitored by their employers. Not wanting to lose a job they rely on, they may turn to smart drugs. “Electronic means of monitoring employees are likely to be accompanied by an increase in the stresses on workers,” the article noted.
Employers in general don’t seem aware that this trend is happening, Heudecker said. “It’s not like someone goes out for lunch, has a few martinis, and their speech is slurred. It looks like, ‘I’ve got a really productive worker.’ You’re not going to ask questions because it’s a positive outcome,” he said.
While employers may appreciate that their employees are being more productive, if employees must turn to drugs to reach those performance goals, then the employer should consider how the company culture or policy drove them there, Heudecker said.
“There’s a lot of demand to always be on, so you need to give your employees permission to be off,” he said. His 2017 Gartner report “Cognitive Enhancement Drugs Are Changing Your Business” also explored the main reasons that push employees to take these substances. Basically, employees either view smart drugs as an opportunity to push the boundaries of what they can accomplish in the workplace or feel coerced into taking them to maintain performance and keep up with their workload.
If employees feel forced, that has the potential to get employers in trouble. “This may expose organizations to legal risk if CED users obtain drugs illegally because they felt forced by colleagues or management,” the report noted.
Employer Response: Brian McPherson, labor and employment attorney at Florida-based law firm Gunster, has never had an employer raise the issue of smart drugs.
Medical cannabis is legal in Florida and that’s received all the attention, he said. “[Employers don’t have] the time or capacity to focus on the other issue that is brewing somewhat underneath.”
Studies support the increased use of Adderall, Ritalin and other drugs for performance, he said. Still, most employers try to stay away from getting involved in the prescription drugs employees are taking, and they assume they are complying with their physicians’ directions.
“We know it’s happening on a grand scale, at least more than it has in the past, but employers aren’t really talking about or dealing with it,” McPherson said.
Heudecker suggested policies companies can adopt to directly address smart drugs. A chief human resources officer can work with other leaders to draft a policy around cognitive enhancer use in the workforce. They also can support “non-pharmaceutical cognitive enhancement” — practices that naturally help people be more productive by “improving work-life balance, adjusting work schedules, promoting physical activity and educating employees on healthy nutrition and sleep practices,” Heudecker said.
An employer’s response also has to respect the fact that many smart drugs are prescription drugs that people need. “You don’t want to alienate people who need something for their ADHD,” Heudecker said.
THE LEGAL LANDSCAPE
The substance that employers mostly ask about is cannabis, said McPherson. Since medical cannabis is legal in the Florida, McPherson has fielded many questions about its use.
All indications point to cannabis laws continuing to progress in more states, he said. Once states approve it for medicinal purposes, the “floodgate starts to open” and there is a “general march toward recreational use.” Currently, 33 states, the District of Columbia and Puerto Rico have passed laws broadly legalizing marijuana in some form. As of Jan. 1, 2020, 11 states — Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont and Washington — and the District of Columbia have adopted laws legalizing marijuana for recreational use.
“As long as marijuana remains illegal under federal law, employers are getting a comfort level that they can still enforce the drug-free workplace tests for marijuana,” he said. “If it ever becomes legal under federal law, that will really change the landscape, and it will become a much more complex situation.”
Drug use among many U.S. sectors is growing, according to the Quest Diagnostics 2019 “Drug Testing Index.” The data involved in this analysis come from pre-employment testing for safety-sensitive positions or drug-free workplaces, said Barry Sample, senior director of science and technology at Quest Diagnostics, which has been annually analyzing workplace drug testing data since 1988.
Cannabis is the most commonly detected drug in the workplace, according to the “Drug Testing Index.” Positive tests have increased in most sectors. Meanwhile, positive test rates have declined for cocaine, heroin and opiates.
Interestingly, the inclusion of cannabis in testing panels may vary by state, the index showed. In almost all states, 95 percent of organizations still test for it when they have the option. Colorado and Washington, the states where recreational use has been legal for the longest time, saw a 4 percent decrease in organizations testing for cannabis between 2015 and 2018.
There may be differences by industry, Sample added. “Where there are generally less skilled workers, employers are having difficulties finding employees that will pass all the background screening, including drug testing,” he said. “They may be making a risk-based judgment on their part that ‘We’re going to take the chance and ignore the use of marijuana, because we really need people on board.’ ”
Meanwhile, two organizations have announced more nuanced drug tests for cannabis that may hit the market in 2020, according to Business Insurance. A research team at the Swanson School of Engineering at the University of Pittsburgh has developed a breathalyzer prototype, and Oakland, California-based Hounds Labs Inc. plans on bringing a breathalyzer to market in 2020.
Such tools could help detect marijuana use, which can stay in a person’s system up to 30 days after consumption, McPherson said. “The employers I’ve talked to about these tests are excited and hopeful about them,” he said.
Dan Harrah, senior associate at Mercer and a consultant specializing in behavioral health and health care operations, is skeptical about these tests. “The science of impairment is not settled yet. There’s a lot of subjectivity,” he said.
There will need to be a way to review these tests and see how effective they actually are, he added.
Psychedelic Legislation: While laws regarding cannabis use is moving rapidly, legislation on psychedelics is slower, said McPherson. Two cities — Oakland and Denver — have decriminalized psychedelics such as magic mushrooms, and the Chicago City Council in October 2019 approved a resolution that experts say could pave the way to decriminalizing them. The resolution uses the term “entheogenic substances,” defined as any range of natural plants or fungi “that can inspire personal and spiritual well-being,” as well as other psychological and physical benefits.
“The most alert employers are watching what’s going on with the psychedelics and they are concerned,” McPherson said.
Regardless of the substance, he advises employers to stay informed.
ADDICTION
A person with an addiction is hyper-focused on obtaining their drug of choice and getting that high, which can affect their hygiene, sleep, basic social behaviors and work performance, said Andrea Elkon, clinical psychologist and director of behavioral health for Alliance Spine and Pain Centers. This hyper-focus applies to substances such as nicotine, alcohol or opioids as well as behaviors like gambling or shopping.
An employee struggling with a serious substance addiction is fairly obvious to spot, Elkon said. They may consistently come in late, leave early or not show up to work at all, take extended lunch breaks or exhibit erratic behavior such as falling asleep at their desk or acting more emotional than usual.
In such cases, managers need to be assertive, Elkon said. It may be an uncomfortable subject, but not enough people know how to handle it, she said. Managers should learn how to take action — sooner rather than later — while still showing concern toward the addicted employee.
When an employee does not yet have a serious addiction but is on the path toward one, managers can still notice behavior patterns like absenteeism that may point to a substance problem. “That is a way to address the early signs, to focus specifically on the behaviors that are disruptive to the workplace,” Elkon said.
Employer Communication: Many employers have benefits programs in place to address addiction but not an environment that allows for open conversations about substance use, Harrah said.
“When it comes to behavioral health, everybody is able to talk about [how they] didn’t sleep well last night, and there’s no stigma around that. But nobody says, ‘I’m really thinking about cutting down on my drinking.’ There’s more stigma around that statement.” he said.
More employers have been taking on behavioral stigma, but there’s still work to be done. And the lack of communication around substance use benefits can lead employees down the wrong road, Harrah said. For example, if someone with an addiction realizes they need help, oftentimes the first thing they do is Google treatments. While the employer plan may include in-network carriers with good programs for addiction, a simple internet search can lead to low quality, out-of-network care, he said.
“One of the things that I caution my clients on is you can have these supportive conversations, but you better understand what programs are in place. Because once you start having those conversations, your employees start to come to you, whether for themselves or a family member,” Harrah said.
Substance abuse and mental health benefits also belong in open enrollment conversations, said Morgan Young, vice president of client services, employee benefits at insurance brokerage Holmes Murphy. Young didn’t mention mental health and substance abuse benefits in a recent open enrollment meeting, and an employee later asked if the company covered mental health benefits. Young was reminded of how important it is to share that message to employees.
Substance abuse benefits should go beyond the employee assistance program, she added. Employers consistently see low utilization of EAPs and try to convince employees to use them more, but they’re not going to be the only solution, she said.
“We need to understand that while an EAP may be a good tool for some, it’s not going to dissolve all the needs we have. We need to come up with different tools, resources and policies and make them available to employees,” she said.
Elkon suggested resources that could help employees or dependents with addictions. One of the first steps is sending them for a substance abuse risk evaluation, she said. These evaluations can tell employers about the employee’s risk of substance abuse problems and treatment options.
If an employee does have a problem, employers can respond by showing concern and having treatment resources available, Elkon said. The employee could use a leave of absence to get the necessary treatment, with the assurance that they won’t lose their job while they’re getting treatment.
“If someone is showing any signs of addiction, it’s important to show concern but be firm with that person sooner rather than later because it could spiral and affect other co-workers.” she said.
Pharmacy benefit managers can help to reduce unnecessary opioid prescribing by improving coordination of care among physicians, pharmacists and patients to identify when the potential benefits of these medications outweigh the risks.
More than 10 million people in the United States misused a prescription opioid in 2018, and the opioid epidemic cost the country $179 billion including mortality, health care expenses, lost productivity, criminal justice expenses and assistance. The National Safety Council notes that the annual direct health care costs of individuals who misuse opioids are 8.7 times higher than those who do not.
The opioid epidemic offers an example of a preventable, complex public health and safety issue that has arisen due to a perfect storm of causative factors. Consequently, it requires multiple stakeholders to develop and deliver an effective solution to help lower costs and improve patient health outcomes. These stakeholders include health care providers, pharmacies, drug manufacturers and even employers.
However, the pharmacy benefit manager is one player in the opioid crisis that fills a critical role by employing clinical programs to ensure safe and appropriate utilization of medications. The PBM is a third-party administrator of prescription drug programs and primarily responsible for contracting with pharmacies for network services, negotiating discounts and rebates with drug manufacturers, developing and maintaining the plan’s list of covered drugs (a formulary), and processing and paying prescription drug claims.
PBMs have become an increasingly important part of health benefits since they first entered the market in the 1970s. Today, three pharmacy benefit managers control more than 80 percent of the American market. All are part of massive health care conglomerates that have interests in other aspects of the benefits food chain — from retail pharmacies to medical insurance.
This can create conflicts of interest, as these mega-corporations stand to profit from every stop on a patient’s journey. These conflicts of interest can in turn leave employers and patients vulnerable to increasing health care costs and crises such as the opioid epidemic.
The American public, from the employee to the executive suite and human resources professionals, as well as those who make decisions about employee-sponsored health care, seeks change in today’s profit-driven benefits industry. Here are just a few of the reasons why:
• In 2017, the average annual cost for prescription drugs used to treat chronic conditions reached $20,000, and drug prices increased at twice the rate of inflation.
• American families spent 67 percent more on health care in 2018 compared to 2008.
• Employer contributions toward health care costs rose 51 percent in the same period.
• More than 66 percent of bankruptcies are due to medical expenses or time out of work as a result of illness.
Mergers and acquisitions may answer the health care industry’s need to create new sources of revenue, but they can leave patients and plan sponsors behind. In a sector dominated by an outsized few, consumers all begin to look the same.
To compound the issue, PBM operations are often seen as veiled enterprises. Complex contracts and opaque business practices conceal the flow of dollars, making it difficult for plan sponsors, HR professionals and members to see what they’re paying for. It may seem impossible to demand meaningful change from such a sizable arm of the health care industry, but it doesn’t have to be.
Human resource professionals occupy a unique position in the U.S. workforce. As part of the decision-making process when it comes to employee benefits, HR leaders can demand change from the industry by learning how to spot PBMs that put member and plan sponsor interests first and move away from PBMs that don’t.
This requires understanding today’s health care landscape and how PBMs should be transforming to work for employers, not just for themselves. Here are four key indicators that demonstrate a PBM has broken from the status quo to operate in the best interests of its clients and their members:
• Pay-for-performance business model.
• Comprehensive clinical programs.
• Complete care coordination.
• Transparent contracting.
Pay for Performance
Most PBMs today operate on a fee-for-service model in which they are paid each time they perform a given function, such as a prior authorization review. While this type of business model is common, it fails to tie the PBM’s financial success to how well the company performs for consumers.
No matter how well or poorly the PBM helps the plan sponsor manage prescription spend, the PBM is paid the same. In some cases, it may even be paid more if the plan’s prescription spending grows based on profit incentives tied to per-claim fees and hidden revenue streams.
That’s why a pay-for-performance business model has so much potential in the PBM industry. Pay for performance is a relatively new model, so far only explored by a few PBMs despite its power to help tie the companies’ interests more closely to those of members and plan sponsors.
The pay-for-performance model helps to support transparent PBM operations by holding PBMs responsible for the quality of the work they do and putting dollars at risk if a plan sponsor’s prescription spending rises above a guaranteed maximum. This puts skin in the game and places people, not profits, first.
Under this type of pay-for-performance structure, the PBM is held accountable. Its success is tied directly to quality of service and whether it reduces overall drug spending through proactive clinical programs that help reduce inappropriate utilization. The plan sponsor is rewarded by performance guarantees tied directly to the PBM’s clinical programs and how well they improve health outcomes and lower costs over time.
This new approach helps encourage a straightforward pricing structure that does not benefit from unnecessary prescribing practices. It eliminates conflicts of interest and places plan sponsors and their members first.
Comprehensive Clinical Programs
Clinical programs can be easily overlooked when it comes to their importance not only in safeguarding patient health, but also in the amount patients and plan sponsors pay for health care each year. While many see programs such as step therapy and clinical reviews for prior authorization as sources of member disruption — and they can be if handled poorly — it’s important to recognize that these programs can positively impact plan sponsors and members alike.
An estimated 40 percent of opioid overdose deaths in 2016 involved a prescription opioid, highlighting the dangers that clinical programs have the chance to prevent. From 2011 to 2016, prescriptions were written for dozens of opioid tablets following surgeries, even when procedures would cause relatively little pain.
This prescribing pattern has tremendous impact, as the probability of long-term opioid use and abuse increases sharply in the early days of therapy, particularly after five days. To prevent addiction and abuse, it is vitally important to ensure patients take prescription opioids no longer than is medically necessary.
PBMs can help to reduce unnecessary opioid prescribing by improving coordination of care among physicians, pharmacists and patients to identify when the potential benefits of these medications outweigh the risks. Comprehensive clinical programs offer a strategic way to ensure medical necessity while protecting patients.
Data from the Centers for Disease Control and Prevention show that the rate of opioid addiction is relatively low if only one day of opioid therapy is prescribed initially, with just 6 percent of patients on opioids one year later. The likelihood of addiction increases sharply with eight or more days of prescription opioid therapy (13.5 percent of patients on opioids one year later). This data demonstrate just one way that clinical programs, such as starter dose and quantity limits, can help protect patients.
Starter dose programs limit the initial supply of a drug to help determine its appropriateness for the patient. In the case of opioids, my company, BeneCard PBF, found that a program limiting the initial supply to three days helped curb the number of prescription opioid claims by 67 percent as part of a comprehensive, clinically driven approach preventing opioid addiction. The starter dose program helps avoid members having excess opioids on hand when therapy is needed for just a few days. This approach also reduces the risk of opioid fraud, waste and abuse.
Quantity limits, which control how much of a medication can be dispensed at a time based on medical best practices, can provide similar protection. This helps to prevent unused medication from building up in the home, where it presents a danger not only to the patient, but to others who may be accidentally exposed to the drug (such as children and pets) or who may be at risk of using the medication without a prescription and a physician’s oversight.
Carefully designed and managed clinical programs have the power to save lives and to protect members and their employers from fraud, waste and abuse of prescription medications. There is an urgent need to do so that extends beyond controlled substance abuse. The United States spends about $21 billion on medication errors and $935 billion in overall health care waste each year. However, many PBMs rely primarily on retrospective reviews of prescription drug utilization to identify problems. This approach may represent a conflict of interest, as many PBMs charge a per-claim fee, meaning they get paid every time a prescription is filled.
Instead, look for a PBM that offers comprehensive clinical programs designed to be proactive, not reactive. These programs should include a retrospective review, but they should also work to identify potential concerns before a medication is dispensed and prevent potentially dangerous or wasteful prescription utilization instead of addressing it after the fact.
Complete Care Coordination
Since today’s health care system is so complex, a clinically driven PBM model is important in protecting patient and plan sponsor interests and helping to control prescription spending.
Unfortunately, many PBMs rely primarily on rebates and negotiated discounts to control prescription spending. While these negotiations are necessary in today’s marketplace, they focus on only one part of the equation.
As in any other industry, obtaining strong discounts is simply not enough. PBMs must also be smart about where and how money is spent. That’s why a clinical focus is key. Rebates and discounts do little good if the number of prescription claims continues to rise because patient welfare has become secondary to numbers on a spreadsheet.
But how do you put people first in this challenging environment? Select a PBM that empowers its pharmacists to coordinate care between the various members of a patient’s health care team. This team can include primary care physicians, specialists, retail pharmacists and others.
Often, these individuals are spread across multiple practices, and communication between them can be difficult. However, the PBM’s pharmacists have a unique perspective, with insight into the prescriptions written and filled by multiple providers. This puts them in an ideal position to facilitate more effective communications between all parties involved in a patient’s care.
PBMs should understand a patient’s condition, symptoms, medical history and any other medications they use to help ensure each prescription dispensed is medically appropriate. They must know each drug’s manufacturer recommendations and FDA guidelines to understand if it offers the most effective course of treatment for that particular individual. PBMs also must take into account industry best practices, which constantly evolve as new medications and new clinical data become available.
All of this helps to support better health outcomes by reducing the risk of side effects and adverse drug reactions, improving treatment efficacy and supporting a better quality of life. This, in turn, can reduce the need for repeat visits to the doctor and lower the risk of hospitalization. It can also lower the risk of patients taking a medication that offers little or no benefit. All of this helps to lower overall health care costs, improve member satisfaction and support a stronger workforce.
Health care must be a coordinated team effort to achieve positive results for both the patients and the PBM.
Transparent Contracting
The ongoing conversation regarding PBMs and their role in controlling costs often focuses on transparency, and it must continue to do so. In many cases, PBMs practice selective transparency, allowing consumers to see only what’s favorable to the PBM and its revenue streams.
Complicated contracts help to conceal revenue streams in an industry where conflicts of interest have become increasingly common. This creates an environment in which human resource professionals and their companies are not fully informed regarding how their money is being spent and where PBMs may be profiting at consumers’ expense.
Convoluted business practices and hidden revenue streams make accurate PBM comparisons virtually impossible. This means that there is a greater chance companies and their employees could be spending more to get less from their PBM.
The traditional PBM business model masks several revenue streams, including rebates and spread pricing, which pharmacy benefit managers enjoy at the expense of plan sponsors and members. To avoid these and other conflicts, it is vital to select a PBM that offers clear contract terms.
Clinically driven pharmacy benefit management works, and because it works so well, there’s no need for complicated contracts that conceal exactly what the plan sponsor and their members are paying for. Another method of avoiding hidden revenue streams and conflicts of interest is to work with an independent or privately owned PBM not beholden to shareholders and not driven by the needs of larger health care ventures. This allows the PBM to focus closely on providing superior service with less emphasis on profit margins. Typically, working with these PBMs means carving out the pharmacy benefit from the medical benefit, which offers further advantages and transparency.
There are several small to midsize privately held PBMs that are advancing clinical care, transparency and innovation — outperforming the industry giants for customer satisfaction in numerous categories. The PBMI “PBM Customer Satisfaction Report” is an annual survey of pharmacy benefit managers’ customers to show client satisfaction in multiple categories such as delivery of promised savings; meets financial guarantees; effective tools to manage prescription costs; no conflicts of interest issues; and other important factors.
Let the Past Inform Our Future
To effectively manage a benefits program and protect its members as well as its financial viability, it is essential to understand the issues inherent in the pharmacy benefit management system, as well as the steps necessary to create meaningful and lasting change. This entails exploring smarter, more strategic PBM clinical programs designed to promote clinical efficacy and reduce wasteful and inappropriate prescription utilization. It also involves resisting the traditional per-claim fee structure, which can be prone to fraud, waste, and abuse.
Addressing the underlying issues in the PBM industry requires persistence and tenacity. Armed with proper knowledge, employers can begin asking their PBM the tough questions and start demanding more for their plan and for their members.
Making sure to include remote employees in meetings and scheduling regular check-ins is also vital for creating an inclusive environment and tracking progress, according to Carlos Castelán, managing director of business management consulting firm The Navio Group. If remote employees aren’t provided with clear expectations and direction, it can be easy to feel like they are stranded on an island. Those who work remotely need to feel a sense of purpose in order to stay motivated and passionate about the company’s goals. “One of the hardest parts of staying motivated as a remote worker is fully grasping how your contributions fit into the overall picture and mission,” Castelán said.
Workers in low-paid jobs that are not protected under standard labor laws may feel increased pressure to hit certain productivity levels, especially since they are increasingly being monitored by their employers. Not wanting to lose a job they rely on, they may turn to smart drugs. “Electronic means of monitoring employees are likely to be accompanied by an increase in the stresses on workers,” the article noted.