Last week the U.S. Department of Labor announced that it’s launched a new toolkit for employers to help them understand mental health issues and create a supportive work culture.
The EARN Mental Health toolkit — created by the DOL’s Office of Disability Employment Policy and its Employee Assistance and Resource Network on Disability Inclusion, or EARN — includes an educational framework and a list of case studies of successful programs at organizations of various sizes.
Awareness: Build awareness and a supportive culture.
Accommodation: Provide accommodations to employees.
Assistance: Offer employee assistance.
Access: Ensure Access to treatment.
I want to focus on access for now, because no matter how much you try to create a disability-friendly culture, if employees can’t access or afford medication, therapy or whatever medical assistance they need to treat their mental illness on a regular basis, then a huge piece of the treatment puzzle is missing.
APA Publishing, a division of the American Psychiatric Association, recently published an informative article on this issue of access. The article covers a February 2019 panel discussion hosted by the New York Academy of Medicine, the New York County Psychiatric Society, and the New York State Psychiatric Association.
There are a lot of points I find valuable in this panel discussion of several people in the medical community. First, one of the panelists noted how Aetna recently settled a lawsuit in Massachusetts after an investigation found that the insurer violated state law with its “inaccurate and deceptive provider directories and inadequate provider networks.” Basically, this means that patients couldn’t access timely behavioral health care because listed providers weren’t accepting new patients or had retired.
This isn’t necessarily an anomaly, the article noted. For example, it cited a very comprehensive report that’s worth a read for anyone interested in this.
The 2017 research report by Milliman Inc. found that compared to medical/surgical care, people seeking behavioral health care more often have to access an out-of-network provider. While in-network care generally has lower co-pays for patients, when they must seek out-of-network care that means more out-of-pocket costs and more expensive behavioral health care.
Also, the report stated, “Some patients may want to avoid the higher costs and delay seeking needed services from behavioral health care providers, which can lead to less effective care.”
The article also stated the employer’s role in this. An excerpt:
Schwartz said that the business community is a strong ally in improving access to behavioral health care given the high cost of not addressing these issues in productivity loss, lower employee retention, high rates of disability, and higher overall employee costs. “While employers are paying for benefits, they are not getting what they paid for when employees cannot access behavioral health care,” he said. “Businesses are well positioned to ask health plans for data on provider networks and to examine disparities to improve accountability.”
Also noteworthy was a list of actionable items that presenters believe could help improve access to care. For example, a suggestion from the National Alliance and the Center for Workplace Mental Health is that “employers obtain quantitative assessments from third-party administrators on how well their employees are accessing mental health and substance use benefits.”
Again, I don’t want to suggest that environmental factors in the workplace don’t impact people’s general well-being. But offering free yoga classes in your building or teaching employees how to use mindfulness to reduce stress are NOT the medical equivalent of seeing a therapist or accessing an outpatient center.
Self-care is not medical care. If your organization has a deluge of trendy perks to help employees de-stress but doesn’t have a sufficient behavioral health provider network, how much of a difference could that really make?
My favorite television show is airing its final episode in a few weeks.
“Crazy Ex-Girlfriend” follows the life of Rebecca Bunch, a wealthy New York lawyer who has a mental breakdown and, when she runs into her high school boyfriend on the street, decides to follow him to West Covina, California. The show does a lot of things well including dismissing the sexist “crazy ex-girlfriend” stereotype and showing the nuances of how people deal with mental health problems like depression and alcoholism — all while being a musical!
Some of the best songs include a parody of the “La La Land” tune “Another Day of Sun” called “Anti-Depressants Are So Not a Big Deal,” a romantic Fred Astaire-Ginger Rogers-inspired number called “Settle for Me,” and “This Session Is Going to Be Different,” in which a therapist sings about her frustrating patient in a song that sounds very much like Liza Minnelli’s “Maybe This Time” from the movie “Cabaret.”
One of the best parts of this show is how is deals with Rebecca’s eventual diagnosis, borderline personality disorder. I never knew much about BPD, and “Crazy Ex-Girlfriend” has taught me a lot about it. I learned about the many misconceptions about people with personality disorders. Also, I got to see how a person with BPD manages their symptoms and goes through the ups and downs of recovery and treatment.
According to the National Alliance on Mental Illness, it’s estimated that 1.6 percent of adults in the U.S. has BPD, but that number could be as high as 5.9 percent. Experts believe it’s underdiagnosed in men.
As employers increasingly address mental health in the workplace, it’s worth learning about BPD and how it could potentially impact an employee.
BPD is “a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness,” according to the Mayo Clinic.
Online resource Verywell Mind goes through some of the symptoms of BPD at work. One major one is unstable interpersonal relationships. A person with BPD tends to see the world in a very absolute, black-and-white way. A job or a coworker is either completely good or completely bad, with not much room for nuance. They may enter a new job loving and idealizing everything and everyone. The idealization phase eventually disappears, leaving basically the opposite scenario, with the employee seeing nothing positive about anyone, “instead experiencing them as hostile backstabbers.”
BPD also causes people to have intense reactions to rejection or perceived rejection, potentially leaving a person prone to abandonment issues.
The Women’s Centre for Health Matters suggests ways in which managers or coworkers can help an employee struggling with BPD. Stable environments are important for people with BPD, so providing the employee as much consistency is their job as possible is helpful. This excerpt explains more strategies:
It can be a challenge interacting with individuals with BPD so it is essential to set limits clearly and stress proper workplace conduct, remind about completing assigned tasks and take consideration of coworker’s feelings. An explanation of the appropriate time and place for different interactions such as meetings, problems and complaints may be necessary. Also be prepared for protests and the possibility that the employee will be mad with you for unknown reasons. Demonstrate validation of emotions and stay civil. You don’t necessarily want to validate an employee’s perspective, instead validate the feelings attached to this perspective – “I hear you” or “I understand the way you feel.” Do not cross boundaries and try to document everything.
The Women’s Centre also lists 20 potential accommodations for employees with BPD, including:
Encourage attending counseling or psychotherapeutic appointments and allow flexible work scheduling to fit the appointments.
Provide confidential weekly/monthly meetings with the employee to discuss workplace issues and performance.
Allow telephone calls or phone breaks during work hours to therapists and others for needed support.
Offer appropriate praise and reinforcement for positive work interactions.
Consider a program that allows employees to work from home on some days.
I want to stress that I’m not a medical expert, but I did get this information through trustworthy research. Also, there are realistically resources out there for safety-concerned employers who don’t want disruptive employees to cross any lines — for example, this 2010 guide from the Australian Human Rights Commission.
What I can say from my own point of view, based on years of reporting on health and benefits issues, is that you may very well come across an employee with a physical or mental health issue. Just because it takes some accommodations to ensure they can get along in your workplace, that doesn’t mean you should dismiss them as viable candidates.
As one article stated, “While BPD symptoms can make things more complicated, many people with BPD go on to have very successful careers.”
Employers are doing everything they can to curb health care costs.
Sure, and if you believe that you may also believe in unicorns, the Loch Ness monster and Bigfoot roaming the Pacific Northwest.
Cutting health care costs is the elusive white whale for many businesses. Employers indeed may be putting forth a good faith effort to cut their health spend but oftentimes the results just aren’t there. It’s like the arcade game of whack-a-mole — try one new fad and miss, and another pops up followed by the same result.
In the meantime, health care costs have soared. In 1999, the average annual premium (both employer and employee contributions included) was $2,196 for an individual and $5,791 for a family, compared to $6,896 and $19,616, respectively, in 2018, according to the Kaiser Family Foundation 2018 “Employer Health Benefits Survey.”
What are the myths of health care costs?
Among the myriad solutions employers try, there are overriding myths about cutting costs that don’t save money, provide a nonexistent ROI or are just plain ineffective.
We’ve asked several leading health care experts to offer their thoughts on what we’ve determined are four prevailing myths to cutting employer health expenses. There are others, but this is a good start at peeking behind the wizard’s curtain.
MYTH 1: LOWER PRICES! SAVE MONEY!
A big misconception in cutting health care costs is that employer expenditures rely on addressing what costs the most, said Jaja Okigwe, president and CEO of First Choice Health, a Seattle-based national health provider network. In fact, sometimes cost control doesn’t rely on addressing employee benefits at all. There’s a link between health costs and environmental factors like how employees are treated and how they think about their job, he said.
“Those things carry over into the potential for more serious illness. And there aren’t very many companies who have an easy time at getting at that,” Okigwe said.
There are some companies that have acknowledged the direct relationship between environmental factors and health and done something about it. It’s a positive step when employers decide that “we’re going to do things that create an environment that allows our employees to be their healthiest and most productive, and that’s going to spill over into our health care cost,” Okigwe said.
Utilization of Health Care Services
Health Advocate’s Arthur “Abbie” Leibowitz, chief medical officer, founder and president emeritus at the national health advocacy, patient advocacy and assistance company, also believes that companies can’t control costs by controlling price. Rather, health care costs are driven by utilization.
This brings up a different problem for employers: Motivating employees to use the health care system effectively and efficiently.
One thing that employers can do is help employees connect with trusted medical professionals and offer a path for employees to foster a consistent patient-doctor relationship, Leibowitz said.
This does not necessarily mean that employers should encourage employees to see the doctor for a physical every year, he added. In fact, that can be a fallacy because there’s little reason for the average person to see a doctor annually. “The likelihood of discovering a problem you didn’t know about at a visit like that is so low that it makes it almost [impossible],” he said. Instead, employers can promote getting in touch with one’s doctor when the employee actually needs help.
Promoting the idea that it is good for patients to connect with a trusted physician is smart because many plan designs now don’t require a patient to choose a primary care physician, Leibowitz said. When HMOs were more popular, a patient initially needed to select a primary care doctor in order to access the health system, but fewer models require that now.
“So, in that regard, employers can encourage people to select a doctor even though their plan design may not require it,” he said.
“It’s the attitude — people call it a culture of health — that the employer creates within the work environment that is the best trigger to getting people plugged into a physician relationship that will come in to pay dividends if not immediately then down the road,” he added.
Okigwe offered suggestions to establish a culture of health other than promoting the doctor-patient relationship. For one, companies can have regular walking meetings, since research shows 30 to 40 minutes of walking a day changes one’s risk of heart disease over time.
“Yet sometimes employers don’t think that’s really their job,” he said. Rather, their focus is on the bottom line and employee productivity. But small investments in making the workplace healthier to work in can pay off.
Long-Term vs. Short-Term Costs
It’s hard for most employers to think long term with health care costs, Okigwe said. “I do think the vast majority are looking at the annual spend and trying to figure out how to reduce it in one year, and that’s just very difficult.”
But thinking long term is something that could help with health care costs. Employers and employees alike may have to pay short-term expenses in order not to have the shock of major medical expenses in upcoming years. “In general, we tend to think of any spend as being bad,” Okigwe said, but that’s not an accurate way to view health care costs.
It’s almost as if employers believe employees want to spend money on health care, he said, while in some cases what causes costs to skyrocket is that they don’t want to. There needs to be some sort of balance on spending a little bit on the care and activities that deter crises from happening down the line.
Employee cost concerns aren’t necessarily founded in reality in some cases, according to Leslie Michelson, chairman and CEO of Private Health Management and author of “The Patient’s Playbook,” a book about how to become an effective health care consumer.
“People are always concerned that the best care is the most expensive care, and that’s just not true,” he said.“In the rest of our economy there’s a pretty tight coupling between cost and quality. In health care there isn’t.”
About 80 percent of the U.S. population lives within an hour’s drive of at least one large city where there is at least one major medical academic center. Virtually all of these centers are in-network for most carriers. Patients could access specialists on complex conditions here, and care at these facilities is likely to cost less than going to an out-of-network provider.
Michelson’s organization works with patients who have medical problems and identifies for these patients the most advanced doctors with promising and cost-effective interventions.
“If you want to address the cost bar, what you need to do is sweep in a supportive way to help people who are going to become expensive cases, identify the top experts for their care, educate them about the treatment options available, and provide a coordinated, integrated support system to channel them to the best doctors and to ensure they’re getting the care they need,” he said.
The key to controlling health care costs is addressing this small subset of patients with the most expensive cases, he said. Ten percent of patients represent 65 percent of health care costs, and 1 percent represent 25 percent, he said.
“If you aren’t doing something that meaningfully addresses that very small portion of the cases, you’re not going to have a significant impact on the costs,” he said.
Bad Incentives
One health care myth related to costs is that quality and prices aren’t improving because of cheaters in the system, according to Rob Andrews, CEO of the Health Transformation Alliance, a nonprofit group made up of 47 companies whose goal is to fundamentally transform the corporate health care benefits marketplace.
Of course, he said, there are some in the health care system who have committed wrongdoings, but they are rare.
“The problem isn’t that insurance companies are bad, or that drug manufacturers are bad, or that hospital systems are bad or that government regulations are bad. Some of all that is true. But the main problem is that incentives are bad,” Andrews said.
Over the past 60 years or so, he said, a system has been built where incentives aren’t aligned with what’s best for people’s health, giving the example of two hypothetical practices. If there are two radiology practices — one that does 1,000 images a week and produces wrong results 5 percent of the time, and the other that does 500 images a week and only gets incorrect results 1 percent of the time — the first practice would make more money under Medicare. That’s because Medicare rewards are based on the number of procedures done, not how well they’re doing.
Not to say that medical practices or insurers are incompetent, he said. This problem exists because the incentives aren’t aligned correctly in the health care system.
“What we aim to do in the HTA is align the $27 billion a year our members spend on health care with value.” Andrews said. “We want to identify and reward the producers who produce the best value.”
“We chase the shiny object — the price — but we need to be focused on the real issue of value,” he added.
MYTH 2: WELLNESS WORKS
Creating a successful wellness program isn’t as simple as offering one and watching the savings roll in, said Gary Kushner, president and CEO of benefits consultancy Kushner & Co.
Workplace wellness programs have gone through numerous iterations in the past severaldecades. While there have been health-related work programs dating back to the 1920s, it wasn’t until the 1980s and ’90s that wellness programs took off on a much larger scale. The first iteration of this more recent workplace wellness boom is what Kushner called “An Apple a Day” wellness. If an employee eats right and exercises, health care costs will drop. This was not successful, Kushner said.
The second iteration took the original idea a step further, with organizations subsidizing health club memberships and contracting with nutritionists to show employees how to prepare healthy meals. This also didn’t work to reduce costs because the types of employees taking advantage of these subsidies were the ones who already worked out regularly and had healthy lifestyles, Kushner said. The habits of employees who didn’t go to the gym remained the same.
The third iteration of wellness features employers who target their own workforce based on the health needs of that specific population. An employer with a large population of employees with type 2 diabetes may track things diabetics should be doing — like A1C testing and eye exams — through their health plan and encourage at-risk employees to get appropriate testing done.
This type of program, which is more altruistic in nature, has slightly better results. Still, “Every CFO I’ve talked to with these employers keeps coming back to wanting to see savings in the health plan. And they’re having trouble quantifying those. They’re not seeing the difference,” Kushner said.
Where Art Thou, ROI?
Investing in employee wellness is a good thing, but it’s not a short-term policy, said David Henka, president and CEO of ActiveRadar, a health care analytics and patient education company based in Gold River, California.
Although there’s value in wellness programs, he said, that value is not a financial return on investment. Wellness companies often cite huge ROIs for their programs. But academic research reveals that wellness programs do little to reduce health care costs.
A University of Illinois at Urbana-Champaign study published in June 2018 found that workplace wellness programs don’t change employee behavior much or save money on health care costs. Similarly, a University of Pittsburgh clinical trial whose results were published in JAMA in 2016 found that the use of monitoring devices and wearables — often a hallmark of corporate weight loss programs — may have no advantage over traditional weight loss strategies.
“As an employer, if you go into the wellness space thinking you’re going to get an ROI, then you’re going to be greatly disappointed,” Henka said. “But if you go into it by saying it’s the right thing to do for my employees because I want them to maintain healthier habits or lifestyles, then I think you’re tracking along the right frame of mind.”
The realistic value of wellness is more cultural, he said. Wellness companies claiming big returns are not accurate, but it is the right thing for employers to do. It lets employees know that the company values them, he said.
Many employers are not holding wellness providers accountable for the results of their programs, said Cheryl Larson, president and CEO of Midwest Business Group on Health. There are reliable wellness programs on the market, but unfortunately the average employer only pays attention to what the vendor tells them, Larson said.
Employers need to know the right questions to ask wellness vendors and the best way to research their options. Simply asking fellow employers about their programs is one way to conduct research.
Another way to improve vendor services is only agreeing to terms that suit both parties, Larson said.
“I would say if you ask [the vendor] for things, and they say, ‘We’re not going to do that’ — and you’re being fair, you’re doing industry standards, yet they still won’t do it — maybe that’s not the right vendor for you,” Larson said.
Henka suggested providing flu shots as a clear way to show ROI since the flu accounts for lost productivity and absenteeism in the workplace. As last year’s flu season showed, it can be deadly. According to the Centers for Disease Control and Prevention, 80,000 Americans died of the flu and its complications in the winter of 2017-18.
Wellness Done Right
First Choice Health’s Jaja Okigwe addressed potential issues with health screenings — a common component of wellness programs.
One staple of preventive care is annual health screenings and checkups. But the younger a person is, the less likely they are to need regular screenings, according to Okigwe. It’s not until they get older that they need annual screenings.
“It’s a big production to take off time from work and do your screenings,” he said, especially if a patient also has to do something additional like fast for a certain amount of time before the screening. “From a person’s [point of view], there’s a barrier to do it, and then in the end you get this set of information that you probably already knew.”
Companies such as Chicago-based Visibly and Tel Aviv-based 6over6 Vision allow people to get an eye exam using the camera in their phone. The process only takes about 15 minutes, and with results that are 95 to 98 percent as effective as the results they’d get at the optometrist’s office, it’s beneficial for employees who simply need a new prescription for glasses, Okigwe said. While a virtual test can’t diagnose glaucoma, it has a clear benefit for a specific need. A patient who doesn’t need a glaucoma test won’t need to take an hour out of their day to see an optometrist.
“I’m at the age where I wear two pairs of glasses. And sometimes when I’m in that in-between zone I get headaches. Updating the prescription becomes very important and allows me to be more productive,” Okigwe said.
MYTH 3: THE CONSUMER RUMOR
Employers often turn to the consumer-directed health care plan — commonly referred to as a high-deductible health plan — in part to make their employees smarter health care shoppers.
These organizations have a lofty goal when they seek to turn employees into sophisticated health care consumers. Although the goal itself is admirable, the reality is that the health care delivery system is too complex and patients don’t touch it with enough frequency, said Brian Marcotte, president and CEO of the National Business Group of Health.
An employer might have a comprehensive program that gives employees treatment options and resources when they face a surgical decision. But that may be a decision a person has to make once a year or lifetime. “It ends up being a resource that’s out of sight, out of mind,” Marcotte said.
The idea that giving employees more resources and price transparency information would make them more sophisticated consumers did not pan out like employers thought it would, he added. Employers started rolling out HDHPs in the early 2000s and ramped up the strategy when the Affordable Care Act was passed with the Cadillac tax provision. Since health care is generally not part of most people’s regular spending routine like grocery shopping, organizations need to find a way to fit it into employees’ everyday lives.
The Growth of Virtual Solutions
One way organizations are trying to make health care more a part of employees’ routines is through virtual solutions. While people today can find basically any product or service on demand, what is lacking in health care is the ability to get on-demand service, Marcotte said.
The promise of virtual solutions is that they open up avenues to access, convenience and quicker response times from medical professionals.
Virtual care covers a lot of bases including chronic disease management for conditions like diabetes, lifestyle coaching and virtual second opinion services.
However, virtual care can create complicated issues when a patient has to rely on an outside care team rather than the primary care physician with whom they might already have a strong relationship. “The challenge for all these virtual solutions as well is, ‘How do I integrate them back into care and get it within the delivery system itself?’ ” Marcotte said.
Barriers to Health Care Navigation
One reason for the “rampant confusion on how these plans work” — which unfortunately sometimes leads to employees avoiding care — is that “the industry has never done a good job teaching people how to shop for coverage,” said Kim Buckey, a health compliance expert and vice president of client services with benefits compliance company DirectPath.
A person can’t be a good consumer if they don’t know the prices of services, and there’s no easy-to-read or readily available price list, said Buckey’s colleague, Bridget Lipezker, senior vice president and general manager of advocacy and transparency at DirectPath. She referenced what she called the “myth of transparency.”
“The lack of control the consumer has over what they’re paying for something, or even understanding what they’re paying for and what their level of responsibility is — to me, consumerism becomes a myth because of the that. Because you don’t have choice,” Lipezker said.
Another barrier to employees is time.
Patients can call their doctor and ask for options and prices, Lipezker said, but finding this information is a difficult and time-consuming process, and, as Buckey pointed out, most doctors are only available during business hours, so employees need to find the information they need while at work, adding to their stress and cutting into their productivity.
“Some employers are taking the bull by the horns and are offering advocacy and transparency services to their employees to give them a source of support where they can turn over these issues to someone else to fight on their behalf,” Buckey said.
Socioeconomic Issues With HDHPs
Socioeconomics also is an important factor that employers must consider in health care strategies. One problem that HR has, according to technology-led business process services company Conduent’s Bruce Sherman, is that “we design benefits for people like us,” thus isolating people with different benefits needs and life experiences.
Low-income workers have been especially impacted by employers’ attempt at cost containment through HDHPs. According to the February 2017 Health Affairs article “Health Care Use and Spending Patterns Vary By Wage Level in Employer-Sponsored Plans”— which Sherman co-authored with Teresa B. Gibson, Wendy D. Lynch and Carol Addy — cost shifting in benefits plans has meant a 67 percent increase in deductibles since 2010. That’s six times more than the rise in workers’ wages (10 percent) and inflation (9 percent).
The article explored patterns of health care usage relative to employee wages and found that workers in the lowest wage group ($24,000 or less a year) were the most likely to have (had) an avoidable emergency visit, while the highest earners ($70,001 or more a year) were the least likely.
“It may be helpful to ask employees in different socioeconomic groups what benefits they’d like to have,” said Sherman, a longtime researcher of health issues. “This opens the door for information sharing and doesn’t obligate the employer to provide what employees request.”
While more employers are talking about establishing a “culture of health,” oftentimes they also fail to address social and economic determinants in that culture of health, he said, suggesting that employers review organizational policies and practices and keep that perspective in mind to give themselves a broader understanding of where there’s opportunity to improve workplace health for different groups of people.
Some employers offer hourly employees a half day every year specifically to see their doctor for preventive care services, he said. Other employers offer paid sick leave to all employees, including hourly workers. And other employers have ditched “just-in-time” scheduling practices and opted for fixed work hours for all employees — a perk for hourly employees since variable scheduling limits predictable income for employees living paycheck to paycheck.
Some organizations are utilizing wage-based cost-sharing arrangements to address socioeconomic disparities, according to the National Business Group on Health’s 2019 “Large Employers’ Health Care Strategy and Design Survey.” According to the survey, 34 percent of employers offered a wage-based premium contribution in 2018, with 32 percent of employers planning to do the same in 2019. Similarly, 8 percent of employers offered a wage-based cost-sharing arrangement through deductibles or out of pocket costs in 2018, compared to 7 percent planning to do that in 2019.
MYTH 4: WE’RE DOING ALL WE CAN ALREADY
Many employers are doing a lot to help employees with health care costs. But in actuality they demand more from insurance companies and other providers, said DirectPath’s Bridget Lipezker.
Employers comprise the largest group of payers for health care in the United States. According to 2017 National Health Expenditure data, private health insurance accounted for 34 percent of health spending, beating out Medicare (20 percent), Medicaid (12 percent) and out-of-pocket (10 percent).
Employers have a responsibility to do more and they carry a lot of clout. But there are many barriers hindering that influence, she said. It takes a lot of time, energy and focus, and most organizations don’t have the luxury of hiring a person solely focused on benefits.
A majority of small- and midsized businesses only have one person managing HR, and oftentimes HR isn’t even their primary responsibility, according to HR platform BerniePortal’s 2019 “HR Today and Tomorrow” report.
“I think that employers do try to act in the best interests of their employees, at least in my experience. But they don’t always have the expertise in-house or the dollars to hire consultants to help them figure it out,” Lipezker said.
Disruption Will Cut Costs … Not
Counting on disruption to save on health care spend (think major policy changes like the Affordable Care Act) is a strategy, but it’s a poor one for plan sponsors, said ActiveRadar’s David Henka. Employers need to be proactive.
There’s only so many levers employers can pull to affect cost, Henka said. With trends like the consolidation of health systems and influential health care industries like pharmacy benefit managers clashing with employers, organizations have limited options to influence costs.
The most valuable and accessible lever is at the pharmacy, Henka said. Pharmacy costs and formularies are decided on a national scope, unlike hospital and provider networks, which are often decided on locally or regionally. This adds an additional challenge for an employer with offices or employees in multiple states to trim costs.
The lack of transparency in pharmacy benefits is noteworthy, Henka said, and the reality is that for many drugs, there are alternatives that have the same therapeutic benefit for a fraction of the cost. For example, the brand name drug Lipitor has an average cost $184 while Atorvastatin, the generic version with the same active ingredients, has an average cost of $36, according to Henka.
He suggested reference pricing programs, with which costs go down in the short term and, in the long term, patients became more compliant with drug treatments. Reference-based pricing uses complex algorithms to identify the most expensive drugs used by the employee population, highlights more cost-effective alternatives and then encourages members to switch to the most affordable drug.
While reference pricing is trending in parts of Europe, it’s mostly gaining traction in the U.S. among large employer groups, Henka said. He added that many employers think that by switching to a generic-mandated program, they’re doing enough — but they can do more. They could save money by switching from one generic to a different, more cost-effective one.
The types of U.S. organizations mostly adopting these programs are union trust funds and private employers, he said.
The second largest health care purchaser in the country, CalPERS, is also a proponent of reference pricing, he added. Second only to Medicaid, CalPERS purchases health care benefits for employees in the state of California that work for school districts and other public agencies and covers about 1.2 million lives. They have “already implemented reference pricing for a number of medical procedures and are in serious discussion of implementing it for their pharmacy program as well,” Henka said.
Enter the Chief Medical Officer
A conversation that is gaining traction among employers is working to get more control of health care costs in unique ways, said of First Choice Health’s Jaja Okigwe.
Cable and internet provider Comcast was among the first companies to hire a chief medical officer. In 2005, it hired Tanya Benenson to have an expert solely focused on health care outcomes. Similarly, Google hired David Feinberg, former CEO of Geisinger Health, in November 2018 to lead its health strategy, and banking giant Morgan Stanley hired David Stark as its first chief medical officer in October 2018.
“The novelty of Comcast’s situation was that they were taking charge of crafting the whole benefit program and experience for their employees,” Okigwe said. “This is typically done by carriers and benefit consultants.”
The role of the chief medical officer varies by industry, said DirectPath’s Kim Buckey. In a hospital, that role likely will oversee clinical outcomes, while at an insurance company the position is responsible for decisions on what should be covered, or to help develop health and wellness programs. For organizations like Comcast, a CMO will identify opportunities for savings, oversee the organization’s health vendors to control costs, lead negotiations with providers and analyze claims data.
Large employers can afford to have someone in this position, Buckey said, but most are “a ways away” from the chief medical officer being a common corporate title.
National Basketball Association Commissioner Adam Silver made an important comment this week at the MIT Sloan Sports Analytics Conference in Boston, saying that a lot of players are “unhappy” and acknowledging the very real impact of mental health problems on people, no matter how much fame or money they have.
As a benefits writer who occasionally covers mental health, I think it’s genuinely positive when a powerful figure makes a straightforward, sympathetic comment about mental health issues.
Still, I don’t agree with everything Silver said. According to CBS Sports, Silver said, “We are living in a time of anxiety. I think it’s a direct result of social media. A lot of players are unhappy.”
I contend that this argument is too simplistic. I’ve seen this argument before in research and reading, this concern that technology or social media is making people more depressed or anxious.
I prefer a more nuanced approach. Yes, social media has become increasingly ubiquitous over recent years and so has this trend of people being more open about mental health problems, but this sounds more like correlation than causation. That’s a topic worthy of more research.
Mental illness isn’t as simple as X caused Y. Being too focused on social media and technology’s impacts could blind you from other factors that could influence mental health, like personal or professional problems, going through a traumatic event or something physical like brain chemistry. In the context of the NBA, there are understandably some stressors specific to being a professional athlete.
I also don’t believe that mental illnesses are any more or less common than they have been historically. At least I haven’t seen or heard any convincing evidence of that. We need to acknowledge the very real fact that because of stigma, this wasn’t something that people talked about for a long time.
The lack of public acknowledgement doesn’t mean it did not exist. Whenever someone makes the “technology/social media causes mental problems” argument, I wonder if they’ve ever stopped to consider historical context. I wonder if they truly think depression, anxiety, bipolar disorder, borderline personality disorder and panic attacks just didn’t happen before. That sounds naïve to me.
Regardless of my preference for a more nuanced take on the causes of mental health problems, I love seeing that the league commissioner is talking about it. This also led to me read about the NBA’s mental wellness program and the organization’s decision to hire a director of mental health and wellness.
The details of the mental health program are interesting. This story references the league’s old policies to deal with mental health problems, often by team physicians who had no expertise in mental health.
It talks about the NBA’s decision to create a wellness program and the time and considerations that went into it. Basically, this is a comprehensive case study that also brings up some philosophical questions about wellness programs.
It also brings up a noteworthy point about privacy and transparency. The wellness program is run independently of the teams, league and players’ union. According to the article, Michele Roberts, executive director of the National Basketball Players Association said, “We don’t want players to be discouraged from getting help when they need it because they’re concerned that it will get back to the team, or it may affect their play, or it may affect their next contract.” Yet, the article continues, “even that can be debated when it comes to wellness.”
Data privacy and health privacy are topics I care about, which is why it’s intriguing to find debates like this. This story makes a point that when more people are open and transparent about mental health, there’s less stigma.
Wanting anonymity when you’re seeking mental health treatment helps “contribute to the continued stigma.” Further, one former player expressed concern that when people want anonymity, people like him are then persecuted for being up front.
I get this to a certain degree, and I understand this person’s idealized version of the world where everyone can be open about everything and there’s no judgment or consequences. But mostly I prefer to be realistic.
In any organization’s wellness program, privacy should be a clear choice. Health information is private, and no employee should feel pressured to talk publicly about something they want to keep private. HIPAA exists for a reason. And, yes, HIPAA doesn’t apply to many wellness programs, but that doesn’t mean that organizations should respect employee health privacy any less.
As employers get increasingly involved in employees’ physical, mental and financial health, it’s worth a reminder that many people want privacy, and that a respectful employer doesn’t pry into people’s personal data.
When you write about topics as broad as benefits and wellness, it’s easy to have too many ideas and want to write about a million things at once.
But that’s impossible. So these are some topics in the health and benefits space that have intrigued me these past few weeks. They relate to employee wellbeing based on compensation; the employer mandate; days off; and a wellness conference.
What’s been on your mind recently? Any trends, debates or legislation that you find especially fascinating? Let me know!
Unpaid Internships and the Government Shutdown
I had many reactions to the government shutdown, which doubtless made a lot of employees’ lives difficult, having to work in some cases while not getting paid while benefits were compromised and many people had to deal with things like not being able to afford basic necessities like food and rent. I recognize that the struggle this put on federal workers was very rough.
It made me think of unpaid internships. These interns must go through these exact same struggles (unless they’re wealthy, or their family is) of needing to work their asses off while not getting paid. A lot of students can’t take internships that would be good experience and look good on their resume because they need to make money and pay basic expenses. Proponents of the unpaid internship argue that they are a valuable learning experience or that students can get class credit.
But in my opinion as a millennial in the beginning of my career, most of us in college needed to take out loans to afford an education. Couple that with unpaid internships and entry-level jobs that for many fields pay minimally. The financial burden put on young people through education costs and unpaid work can be significant.
All I’m saying is, at least pay your interns minimum wage. It’s the least you can do. People should get compensated for the work they perform.
Some Employer Mandate News
I came across a couple of BenefitsPRO articles recently that highlight two opposing ideas of the same debate. In late 2018 the U.S. Department of Labor, Department of Health and Human Services and Treasury Department proposed a rule that employers could circumvent employer-mandate penalties by setting up a health reimbursement account that employees could use to purchase health care in the individual market.
The 2018 tax reform legislation struck down the individual mandate. But the employer mandate, an Affordable Care Act provision that states employers must provide affordable health insurance to employees or else face a fine, is still in place.
On the pro side: Large employees would realistically continue to offer group health plans to attract and keep talent. Meanwhile, it could potentially help smaller employers in the 50- to 100-employee range. Also, to avoid penalties, employers would have to make an HRA contribution such that “any remaining premiums the employee would have to pay wouldn’t exceed a percentage of his or her income to be considered affordable under the employer mandate.”
On the opposing side: Employers and employees may not fully understand the differences between employer-sponsored health care and the individual health insurance marketplace, and the limitations that exist between them. Also, the new rules could potentially incentivize employers to switch sicker, more expensive enrollees to the individual market.
“If employers could move sicker patients toward individual and short-term plans — some of which have more restricted coverage — the employer could save money. In addition, short-term plans often are more restrictive about pre-existing conditions,” the article states.
If these rules are finalized, they wouldn’t take effect until Jan. 1, 2020 at the earliest, according to BenefitsPRO.
What do you think?
Should the Super Bowl Be a National Holiday?
I want to give a shout out to a Twitter user and lawyer @SonyaOldsSom who responded to a Workforce tweet with something obvious but important. Also, it speaks to an even broader idea than what she was specifically talking about.
We posted a podcast in February 2018 in which hosts Rick Bell and Frank Kalman briefly discussed if the Monday after the Super Bowl should be a national holiday. That idea, simply, came from organizations’ frustrations that people often aren’t as productive as usual that day.
Amen! Sure, National Super Bowl Monday is a cute idea to debate, but employers (and whoever decides what national holidays are) should consider the thing that’s been right under their noses for a long time. In general, for any organization, it can be easy to get swept up in trendy sounding ideas — whether that’s open office spaces, yoga classes or some other buzzword — but what’s more valuable to people are these straight-up practical ideas, like having voting day as an official holiday.
I spoke to a man who expressed to me one of his greatest frustrations in the workplace wellness space: when companies go gaga over wellness programs without addressing cultural concerns like an abusive or toxic work environment. I agree!
One of my unlikely tablemates was Bruce Sherman, medical director for the National Alliance of Healthcare Purchaser Coalitions. I’ve coincidentally already interviewed him for a story coming up in our March issue! At this conference, he gave a talk about addressing employees with multiple chronic conditions [note: “multimorbidity” is the coexistence of multiple chronic conditions] in your wellness programs. One of his ideas: disease management programs that specifically address one chronic condition oftentimes do not sufficiently help employees with multimorbidity!
Sherman also mentioned that while people in the health care industry tend to have a narrow, clinical mindset with patient health, patients have many more focuses and stresses in their life. Personal health is just one of them — and, according to one survey, it’s not even the highest priority. Ranking factors that stress people out, “personal health” is No. 8, below other factors like finances, family health and work schedule. Personal health is not something that exists in a vacuum for employees!
One perk of working in a city as big as Chicago is the conferences, big and small, that provide learning opportunities, ideas, and free coffee and bagels in the morning — especially the everything bagels.
The Midwest Business Group on Health held an employer-only forum on wellness, well-being, and engagement Jan. 23, giving me the chance to hear what employers had to say, chat with my table mates informally about workplace health, and listen to several experts speak on different health-related topics.
Many more ideas came up in the seven-hour forum, but here are the major takeaways that any employer should be aware of:
The Workplace Wellness Debate: Ryan Picarella, president of the Wellness Council of America, spoke about rethinking the approach to workplace wellness and building inspired organizations. Even though health care costs are going up and even though organizations are spending more money on health and wellness than before, population health is declining. Something needs to change in wellness strategy.
One topic he brought up was the debate over the value of workplace wellness. He thinks it’s fun to debate, and I agree! The reputation of workplace wellness goes up and down through phases, from something that’s celebrated to something that gets analyzed in “Workplace Wellness Programs are a Sham” articles. Where does the truth lie?
I happen to land on the more skeptical side of this (as I do with many topics), unlike Picarella who is more optimistic. That aside, one point he brought up is hard to argue: No matter what side of this debate you’re on, what we can agree about is that having happy, healthy employees is important, and something needs to be done to improve employee health.
He gave a lot of behavioral-science-based ideas for improving wellness programs, like by thinking about what motivates people, how environmental factors impact employees, and where employees’ sense of purpose lies. Workplace wellness programs need a foundation that addresses people’s basic needs like food and shelter. A program that addresses something like the importance of nutrition or going to the gym without acknowledging that some people won’t be able to focus on that if their priority is keeping the lights on or putting food on the table? That won’t do.
Another idea he shared is simple, but I find it to be strong. It’s one of those statements that’s obviously true, but I can see organizations and people not following it in practice in more areas of business than just wellness. More wellness activities and programs aren’t always better, he said. Rather than think about adding another thing, and another thing, and another, think strategically about the value add.
Persuasion Vs. Manipulation: Part of this event was a roundtable discussion about the role of trust in wellness. When someone communicates to you, the message may sound like persuasion or as manipulation, depending on how you feel about that person. Even a neutral message can read as manipulation if you do not trust the party providing the information.
Everyone in the room had discussions with their tables and then with the whole room about how to build trust in the workplace.
I love this discussion because there are so many deterrents to trust now, like with data privacy. Bring in wellness programs to that topic, and you get health data privacy, which is something people can be understandably sensitive about.
Without going into too much detail, the audience response here was interesting. One person spoke about employees worried about where their biometric data was going. The organization responded to this concern by making it crystal clear to employees what the company could see, what they couldn’t see, how the data was protected, and what they’d need to talk to the vendor about for answers.
Another audience gem: One person suggested including compassion in your messaging, and making sure your vendors do, too. At the organization, some employees had complaints about how rude a vendor was in answering questions and addressing concerns. The organization responded by reaching out to the vendor with this issue and suggesting that the call center employees go through compassion training.
In conclusion, be direct, transparent, and comprehensive.
Also, my initial big-picture reaction to this issue of trust: Isn’t a certain amount of skepticism healthy? Why should any employee blindly trust their employer? How much trust is realistic for employers to expect?
A piece of career advice that has stuck with me over the years is that even though loyalty and working hard are important, you need to look out for yourself. Don’t blindly believe that your employer always has your best interests in mind. If you feel guilty about quitting when you need to move on with your career, remember that at the end of the day if an employer comes across financial trouble, they may very likely lay you off. It’s just business as usual. Both sides can respect each other but acknowledge the reality that their employment contract is business, not personal.
The idea I’m trying to get across here — as somebody who sees that direct correlation between trust and loyalty — is that employers should want and expect employees to ask questions, be curious and even be skeptical when it comes to workplace matters that concern them. It gives both sides a chance to build a professional level of trust.
What do you think? What wellness-based conversations do you think more employers should be having with one another?
This past year we’ve reported on many aspects surrounding employee benefits, from the shifting retirement landscape to workplace stress and beyond. As we approach 2019, several employee-benefits experts shared with Workforce what trends they’re expecting next year.
Encouraging employees to map out their individual work-life balance strategy:
Employees should make a point to consciously create a harmonious balance between their work and non-work lives, according to Rick Hughes, head of service at the University of Aberdeen’s Counselling Service and a co-author of the book “The Wellbeing Workout,” along with Andrew Kinder and Cary L. Cooper. Their work life can have a positive influence on their non-work life and vice versa.
“For example, a walk or fresh-air break at lunchtime can boost energy and generate a feel-good factor to aid afternoon productivity,” he said. “Or managing problems before leaving work may help to prevent thinking about the issues at home. It’s about getting things into perspective.”
Becoming more holistic in your wellness approach:
One trend that is emerging now is the need to incorporate all dimensions of health into well-being programs, according to Joyce Young, managing director for the High Health Network. Research has found that to achieve the highest level of total well-being, one must focus on physical, mental and emotional wellness as well and one’s purpose in life.
In practice, this means that just focusing on an illness isn’t enough. For example, depression screening has value is some ways, but, ultimately, it’s just a disease search, Young said. It’s not a holistic approach.
“We need to provide the techniques and methods for the everyday person who’s not seeking treatment to be able to build their capacity and strength in the mental, emotional and purpose in life directions,” Young said.
Cecile Alper-Leroux, vice president of human capital management innovation at Ultimate Software, agreed that this is a major trend for HR leaders to be aware of and gave some practical suggestions on how to pursue it.
Employers should design work with overall employee well-being in mind, she said. They can also offer transformative technologies to help monitor and interact with employees to support and reinforce positive behavior.
Creating a workplace where people feel like their total well-being is supported is no easy task, she said. But it will “increasingly set apart the workplaces where employees will want to stay and be their most productive selves, and those that will struggle to retain the best talent.”
Reconsidering your conceptual understanding of health:
According to early trends in a survey she’s involved with, Joyce Young said, 90 percent of people find that the messaging of health frames it as a problem, not a resource. That is, when people see health-related communications, most of it is about getting treatment for an existing problem rather than general self-care.
“It’s not a surprise, but if the mindset is that way, then we don’t have as much motivation to cultivate [health as a] resource because we’re thinking more, we need to get this treatment or solve this problem,” she said.
Alternatively, if people thought of health as a resource, they could benefit in several ways. One, the health care system will deliver more for them. Also, the risks of the kinds of health problems by which people are preoccupied will decrease.
“We must bring our conceptual understanding into the 21st century,” Young said. “If we think differently, that will help us act differently as well.”
Considering onsite health care:
This year saw a few Silicon Valley powerhouses like Apple and Tesla develop their own worksite health centers, and these weren’t the only organizations bringing health care onsite, said Michael Huang, national medical director of Marathon Health. In 2018, one third of organizations with 5,000 or more employees provided a general medical clinic at or near the worksite, up from 24 percent in 2012, according to Mercer’s “2018 Worksite Medical Clinics Survey.”
The onsite health care model has proven results, with employers who measured their ROI last year reporting “returns of 1.5 times or higher,” Huang said. He expects momentum to continue in this area in 2019, with companies of all industries and sizes working with providers to create customized plans and programs that fit their budgets and the unique needs of their employee populations.
“By inserting the health system into the existing workplace, physicians are better able to forge lasting relationships with patients through face-to-face, personalized interactions,” he said. “This individualized care encourages regular visits to the health center, allowing employers to better track health trends, and improvement on those trends, by an employee population.”
Mental health is one area in which onsite care can be particularly beneficial, he said, as employers can utilize onsite care to give employees direct access to resources like counseling and therapy from licensed counselors, addressing barriers to mental health care like long waits for appointments and poor quality of care.
In addition to streamlining access to quality behavioral health care, “bringing these resources onsite signals that employees’ needs are understood and supported, reducing the mental health stigma in the workplace,” Huang said.
Providing cancer support services as an employee benefit:
The number of cancer patients and survivors will reach almost 18 million in the next decade, according to the CDC. And according to a recent survey that nonprofit Cancer and Careers commissioned The Harris Poll to conduct, 79 percent of the respondents said that patients/survivors that receive support from their employer are more likely to thrive in the workplace.
The poll — which surveyed 882 cancer patients/survivors who were either employed or unemployed but looking for work — also found that 53 percent of respondents feel that resources or support programs are needed to address cancer survivors’ workplace concerns, and 64 percent believe that working through their cancer treatment helped them cope.
Penn Mutual Life Insurance is one example of an organization seeking to expand its cancer care services. It began offering services this October through Cancer Guardian’s Comprehensive Cancer Support Program, which includes advanced DNA testing, dedicated cancer support specialists and digital medical records management.
Penn Mutual President and Chief Operating Officer David O’Malley said that a year before the launch of this program, the company began talks with Wamberg Genomic Advisors to learn about the changing genomics landscape and from there spent the next year deciding how to best leverage the cancer benefit.
What the company ended up deciding was offering the benefit to its 1,000-plus associates as a supplemental, employer-paid benefit, available to associates regardless of if they’re on Penn Mutual’s health plan. Also, the company does not track utilization. “Privacy is important to us,” O’Malley said, adding that the company didn’t want employees to feel as if their medical privacy was being infringed.
“We saw this as the opportunity to have a leading benefit,” he said. While benefits surveys have data on cancer insurance at organizations — the Society for Human Resource Management, for example, found that 33 percent of organizations offered cancer insurance in 2018, up from 28 percent in 2017 — the percentage of organizations offering comprehensive cancer support benefits is not as readily available.
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.”
“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.
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.
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.
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.
With millions of American workers eating lunch at their desks, in a car or not taking a lunch break at all, one startup is going all in to make lunchtime more engaging for its staff.
Nikki Sucevic, head of recruiting and training at online children’s clothier Mac & Mia, said the company provides lunch for four randomly chosen employees from different departments. There’s just one request of the staffers selected to go to lunch together: Do not talk about work at all; instead get to know each other.
“When you start to create bonds beyond work, you feel more empathy for your co-workers, and want to work harder for them,” Sucevic said.
Sucevic said her office hasn’t collected formal feedback on the program, which was implemented this fall. Anecdotally she noticed a more positive atmosphere in her workplace of 30 employees. Sucevic thinks lunching with colleagues can work for other companies as well.
“A lot of times, companies have happy hours or one-day events, and this is a quick Band-Aid,” Sucevic said. “Instead of doing one big thing now and then, we want to create a culture of this and start to make little adjustments every day. [Our] lunch lottery plan is one of our cultural shift plans to build relationships, empathy and cross-functional respect.”
According to a May 2018 survey conducted by workplace hygiene brand Tork, employees can have multiple reasons for not taking their lunch break. Nearly 20 percent of North American workers worry their bosses won’t think they are hardworking if they take regular lunch breaks, while 13 percent worry their co-workers will judge them. Some 38 percent of employees in the study also said they don’t feel encouraged to take a lunch break.
Making a lunch program with co-workers or even just eating with someone voluntarily can go a long way, said Laura Hamill, chief people officer at employee engagement company Limeade.
The Bellevue, Washington-based company, aside from sharing a similar program with Mac & Mia, has another program where they have new hires start their first day at lunch time and have a meal with their new co-workers. Hamill said this program has received exceptional feedback.
“I had someone who just started on my team and she wrote an email to me sometime this week and she said she felt like a welcomed part of the team and felt like she had another family now,” Hamill said.
Limeade’s marketing team wrote an article last year about the benefits that come from having lunch with co-workers. Those benefits include boosting productivity, building better relationships, making leaders more accessible and improving well-being.
“It’s about being a human being, not talking about work and learning what your co-workers are up to and what their lives are outside of work,” Hamill said. “It has to do with the idea of relationships. The more I think we get to know each other as human beings, we begin to trust each other more and understand the perspective people are bringing to work.”
David Chasanov is a Workforce editorial associate. Comment below or email editors@workforce.com.
Aron Ain, the CEO of workforce management software company Kronos Inc., released his debut book, “WorkInspired: How to Build an Organization Where Everyone Loves to Work,” in October.
Ain discusses how prioritizing employees is beneficial for an entire company. Workforce Editorial Associate David Chasanov spoke with Ain and found out what workplace elements are most important to him as a leader.
Workforce: Where does building a workplace culture begin? Is it at the top, or is it employee-centric?
Aron Ain: At the top. If the CEO and leadership don’t believe, encourage or support [workplace culture], it’s not effective. [At Kronos], if people know it’s important to me, people take it seriously. There’s safety in making sure employees are looked after and encouraged to have the right balance in their life. There’s safety in giving active feedback about how we can do better. I can’t imagine you would have great engagement in your company if people at the top don’t believe in that deeply.
WF:The old saying about employee turnover is that “employees don’t leave companies, they leave managers,” do you believe that to be true and how do you prevent that from happening at Kronos?
Ain: Absolutely true. People join companies because of the company. They leave because of who they work for. At Kronos we’re deeply focused on making sure all managers know their impact. Twice a year, our managers are rated by people on their team and how effective they are. It’s a manager effectiveness index (MEI). MEI holds managers accountable and improves their leadership, so we don’t have situations where great people leave because they’re not happy about who they work for.
WF: What’s your philosophy on performance reviews and how do they play into employee engagement?
Ain: I deeply believe in it. At Kronos, managers with the highest effectiveness index scores have the lowest turnover and highest engagement and [vice versa]. We make sure we do what’s necessary to create an environment where people are engaged. We try to hire above-average people. We want people who will make a difference. If you hire great people you need an environment where people are engaged, or else they will leave because they are great people.
WF: Is employee engagement all about the money?
Ain: Absolutely not. What’s most important to us is that the workplace should be a place where people have a great career opportunity, where they feel they have a great manager who respects them and helps them grow. It’s a place where they have confidence in the future, where they’re learning and growing, they enjoy their co-workers, people are making a difference with customers. If a place is a fun place to work but they’re working for a miserable manager, they’re out of here.
WF: What’s the difference between an established company and a startup?
Ain: An established company has various processes and functions in place to do a lot of the work. At a startup … you’re learning as you go. You don’t have time and resources to have a dedicated HR group, a group focused on legal aspects, financial services or marketing. You don’t have resources for training programs or creating a good environment. Not that you can’t, but it’s difficult.
WF: Are you a rah-rah leader or lead-by-example type of leader?
Ain: Both. I’m very communicative. I do video blogs all the time with employees, I talk to people all the time, I make sure when I’m walking through the halls or on the elevator that I don’t have my nose in my cellphone and I have my head up and I’m saying hello and talking to people. I visit Kronos offices around the world, and the first thing I do is go and say hello to everyone in the office. In India, where there’s about 1,000 people, it takes me a whole morning to go shake hands and say hello.
WF: What’s your favorite element to implement in making the workplace culture a fun community?
Ain: Having a great place where great people can come to work and enjoy what they’re doing. A place where they can also have balance in their lives. I love when I tell people that if the most important thing in their life is working for Kronos, they have their priorities mixed up. People get uncomfortable at first when they hear that, but then they end up believing in it because I keep repeating it to them.
WF: Kronos is located in the Boston area. Talk about major sports franchises in Boston and how they’ve built a culture in their organizations. What can people learn from them in terms of building a successful franchise?
Ain: I’m not super familiar with the inner workings of Boston franchises. But look at what the Patriots have done. From everything I can tell from a distance, they appear to have a focus on the end game. I appreciate most how they deal with difficult decisions actively. If they need to make personnel decisions, they do it. They don’t sit on things. I think we’re similar in that way.
WF:What is a common misconception in the business world right now?
Ain: The whole thing about what makes a company successful or what impact people have on making a company successful. People think having the magic product will make all the difference. The problem is you can’t deliver great products without great people. People say what comes first, the chicken or the egg, and in my world, what comes first is great people. It’s crystal clear. Once you have great people, you must work hard to do all the components to motivate people to want to stay.
Utilization of Health Care Services 
Employers need to know the right questions to ask wellness vendors and the best way to research their options. Simply asking fellow employers about their programs is one way to conduct research.
Barriers to Health Care Navigation
WF: Is employee engagement all about the money?