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.
Employers should consider a more inclusive definition of “caregiver,” argues employee caregiving platform Torchlight, which released its annual report titled “Modern Caregiving Challenges Facing U.S. Employees” in January. While caregiving has traditionally been defined as “care for an aging loved one or child with a diagnosis or disability,” the report says, the “modern caregiver” may or may not fit in that limited box — but they may have similar problems regardless.
Torchlight analyzed its user data to see the top caregiving challenges people face whether caring for a child or an elder. Some of these relate to a specific disability, but others don’t.
For elder care, the most pressing problems include housing (tasks such as helping a loved one move or helping them create safe home environments) and cognitive impairment (managing Alzheimer’s or other causes of dementia). For child care, the most pressing problems are mental health (addressing anxiety or depression in one’s child with a concrete strategy) and executive functioning (teaching children organizational skills and basic skills like managing time and setting goals).
This fine line between a caregiver and someone who simply has family responsibilities outside of work is difficult to define, according to Adam Goldberg, founder and CEO of Torchlight. Still, what makes it necessary is that it provides proactive rather than reactive caregiving support, he added. “So many of the things associated with caregiving can be mitigated or avoided by taking steps upfront, and we feel that’s a really important part of caregiving,” he said.
For example, an employee’s child might be experiencing “homework hell” at school. An employee knows to look out for red flags that might signal a problem like a learning disability, executive dysfunction or emotional issues like budding anxiety — all things that can be chronic, costly disorders. These red flags might not turn out to be a traditional caregiver challenge like a diagnosed disability, but if they do, employees can be proactive.
Adam Goldberg
Many caregivers don’t report their caregiving challenges to their manager or HR until there’s a crisis, Goldberg said. That means that when HR hears about it and they want to help, they’re often struck by the suddenness of it. What may end up happening then is that HR decides to deal with the situation by implementing a point solution, also known as coming up with a solution without considering the underlying issues.
“Leading employers are speaking out and saying the traditional benefits approach [to caregiving] has not worked, so we need to take a fresh look at this,” Goldberg said.
One of PepsiCo’s strategies to address the caregiving population includes something that a company of any size could consider: It looks at the perks it already provides and considers how they could be expanded to help caregivers. For example, the company extended its second-opinion medical service provider perk to extended family members and parents of employees, said PepsiCo Vice President of Global Benefits and Wellness Erik Sossa. It’s a good example of taking advantage of something they were already paying for.
The large organization — with 108,000 U.S. employees — offers other perks that caregivers (as well as other employees) benefit from, like flexible schedules and compressed work weeks, parental leave for mothers and fathers, and onsite day care.
Erik Sossa
“I don’t think an employer is going to distinguish themselves anymore in having a really great pension plan or a really great benefits plan. Those are the prices of admission now. How do you bring value beyond that? That’s going to distinguish some of the leading employers,” Sossa said.
In general, large organizations have more resources and opportunities to offer richer caregiving benefits, like leave time, but small- and medium-sized employers can get creative, said Candice Sherman, CEO of the Northeast Business Group on Health.
Even the smallest employers, she said, can do things like provide a list of nonprofits that offer services caregivers could take advantage of, she said. Also, many communities have community organizations, religiously affiliated or otherwise, that may offer relevant services.
“The more recognition there is about the fact that in any employee workforce, there are caregivers in our midst, I think employers will definitely get more creative and expansive in terms of the kinds of things they think about offering,” Sherman said.
Law firm Balch & Bingham, based in Birmingham, Alabama, is another organization trying to appeal to the broader needs of the modern caregiver. While 20 years ago the term primarily described a woman caring for a child or parent, now it applies to a much bigger demographic, said Director of Human Resources Lisa Arrington. The law firm’s caregiving population includes men caregiving with a partner, grandparents caring for a grandchild and employees in less traditional, blended families.
With caregivers in different circumstances, their first and foremost approach is to listen to employees and ask questions, Arrington said. “What are their needs? We have people in all different seasons of life, and all those needs are completely different from one another. It’s important to find and target things for each of those different groups.”
Balch & Bingham, which has about 425 employees, promotes getting this type of feedback from employees through ongoing discussions rather than one-time conversations. This could happen in a formal context like a one-on-one meeting between a manager and an employee or an organized discussion among the workforce to tackle a specific topic. It can also happen informally, just by passing someone in the hallway and asking how their day is going.
Some of the ways the law firm uses to appeal to caregivers include flexible work arrangements; EAPs that offer caregivers support resources about budgeting, dealing with stress and navigating blended families; and hosting family-friendly holiday events like a Halloween costume parade.
One major thing employers of any size can do differently is have top level executives be open about their caregiving experiences, Sherman said. Many executives have personal experience with it, and as more of them that share their experiences, that can help unveil some of the stigma that may exist in the organization around caregiving.
For example, employees may worry that if they label themselves as a caregiver and admit they have competing caregiving responsibilities outside of work, they may not get put on a big project they’re interested in or get the promotion they’ve been working toward.
Senior leadership has a promising role in relating their own personal stories to their people, Sherman said. “That goes a long way in creating what we as a business group call a ‘caregiving-friendly working environment.’”
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!
Now is as good a time as any to rethink our workplace health and well-being initiatives. It’s a chance to freshen up stale offerings and engage with employees who might be looking to make health changes of their own.
The winners of the 2018 HERO — Health Enhancement Research Organization — Health and Well-Being Awards have ideas that should help. The HERO Health and Well-Being Awards recognize individuals for leadership, research contributions and other noteworthy accomplishments in the field of workplace health and well-being. In interviews conducted at the 2018 HERO Forum, winners talked about four key elements of successful well-being initiatives.
Employee perspective matters. The innovative well-being initiatives that 2018 Heart of HERO winner Sheri Snow oversees at American Cast Iron Pipe earned that company the C. Everett Koop National Health Award in 2014. One key to those offerings, she said, is the opportunity for employees to shape what is available to them. Whether they gather information through surveys, one-on-one interviews or other methods of exploring employee perspectives, Snow believes it is important for employers to understand what employees want in a well-being initiative.
“Employers can really enhance their programs by listening to employees and involving them in planning, seeing what they want,” Snow said. “Conduct surveys and listen to what employees say they want, not just what you think they need.”
Sheri Snow. Photo credit: HERO.
Bill Whitmer Award winner Shelly Wolff said the gap between employer and employee perspectives on well-being can be instructive. As health and workforce effectiveness leader at Willis Towers Watson, Wolff works with her clients to reduce the existing gap and adjust their well-being offerings accordingly. “Understanding that gap has helped companies dial into the importance of hearing directly from employees,” Wolff said. “That evolution of human-centered design and putting the employee at the center of the effort is having a big influence on what well-being means to employers.”
Support starts at the top. Leadership support plays an important role in the success of well-being initiatives. Research has shown that organizations realize better results on both health improvement and medical costs when leaders recognize healthy behaviors, and when they model work-life balance with their own actions. Healthy HERO Award winner Amanda Potter offers real-world support for that theory. The award, now in its second year, recognizes employees who have used their employer’s well-being offerings to transform their own lives and encourage co-workers to make positive changes. Potter, a social media manager for Midco Communications, changed her nutrition and fitness habits after the birth of her son, leading to improvements in her mental well-being and physical health. She also started a workday walking group that earned early buy-in from the people above her on the pay scale.
Amanda Potter. Photo credit: HERO.
“When I started that walking group, I created an email list that allowed people to opt in if they wanted to participate. I got my boss and my boss’ boss on board immediately,” said Potter. “That made a big difference — to have them be not only supportive, but embracing it.”
Balance is key. One of Jerry Noyce Executive Champion Award winner Beth Bierbower’s biggest accomplishments is the implementation of a digital detox policy that bans work emails from 6:00 p.m. Friday through 6:00 a.m. Monday. That break gives employees a chance to get away from work, connect with their families and get re-energized for their return to the office. That policy might not work for everyone — some businesses or groups may need to be connected 24/7 — but Bierbower is an advocate for thinking broadly about well-being and not just focusing on physical fitness and activities.
“The broader you get, the more you can get your employees engaged,” said Bierbower, president, employer group segment at Humana. “If an employee isn’t interested in physical fitness, maybe they’re interested in volunteering, or in financial well-being. When you create a better balance of well-being offerings, you’re creating more entry points where people can get involved.”
The value of data. Whether it’s the latest fad diet or the hottest tech gadget, people like new things. The same is often true in the area of well-being. It’s easy to chase trends, but Mark Dundon Research Award winners Kerry Evers and Sarah Johnson prefer a more measured approach, and they believe in taking the long view when it comes to well-being and behavior change.
Kerry Evers and Sarah Johnson. Photo credit: HERO.
“It’s important to rely on the evidence base that’s been developed,” said Johnson. “It’s so easy to fall into the exciting trends that are happening and ignore the evidence base, so it’s important for people to remind themselves how important it is for efforts to be rooted in science.”
Evers recommended looking beyond major benchmarks while measuring well-being progress. Doing so moves us away from an all-or-nothing approach where measurable results are key and adds an understanding of how changes take place over time.
“If you look at the entire continuum, you can see groups and programs making progress and making incremental gains along the way,” said Evers. “Understanding those gains is key to keeping morale up and for implementing programs, to see how successful they are.”
Understanding of health and well-being initiatives will continue to evolve because people will continue to change. Millennials have different priorities than baby boomers, so their perspective on well-being will naturally differ from that of their older colleagues. As that evolution continues, it’s important to check in from time to time with the people who are close to the heart of the industry. There’s no better time than now.
A while back a source mentioned to me that many people have a limited view on mental illness. It’s depression; it’s anxiety; or maybe it’s PTSD. But there are many more mental illness conditions to address. Like eating disorders.
Eating disorders account for the highest mortality rates of all mental illnesses, with someone dying every 62 minutes as a direct result of an eating disorder. The National Alliance of Healthcare Purchaser Coalitions hosted a webinar a few weeks ago on the topic — perfect timing to educate employers for Eating Disorders Awareness Month in February.
The alliance referred to eating disorders as a “hidden health crisis” in email communications about the webinar and, I have to say, to me this sounds like an accurate way to describe it. I had no idea that they accounted for so many deaths! I also fell victim to the stereotype that the demographic most likely to develop an eating disorder are young, white, rich girls. Really, it cuts across gender, ethnicity and socioeconomics at pretty much the same rates.
Also, as someone whose been writing about benefits, wellness and health for 2 ½ years, this may have been the first time I’ve seen a pitch or an event about eating disorders. Panelist Craig Kramer, global mental health ambassador at Johnson & Johnson, cited some basic numbers on eating disorders:
30 million Americans suffer from eating disorders, including anorexia, bulimia and binge eating disorder. There are other problems that are still in the process of being officially defined as a disorder. To be clear: An eating disorder is different from dieting or occasionally consuming too much. It’s a clinically diagnosed mental health disorder.
Eating disorders are “the only chronic condition of the young,” with half of sufferers experiencing them by age 14 and 75 percent by age 24. Most people don’t receive treatment, for reasons like stigma and lack of access, and the longer they wait to treat it, the worse it gets. Although people often develop this at a young age, it’s possible for people to still have an eating disorder into old age.
The eating disorder community is underfunded, raising about $10 million per year. Kramer pointed out that an organization dedicated to autism, Autism Speaks, raises $50 million a year.
The National Eating Disorders Association has a toolkit for employers, sharing some warning signs that someone may be suffering and explaining exactly how eating disorders impact the workplace.
There are several reasons why this applies to the employer population. One, this is a major mental health consideration, and many employers are saying they want to address mental health issues. Two, employers are developing an affinity for employee health and wellness programs. As they focus on areas like exercise, diet, weight loss, healthy eating initiatives and body mass index, they should also acknowledge that eating disorders are a big deal. Three, people have eating disorders in the workforce but have never received treatment for it.
One of the interesting ideas that came from this webinar was the causation of eating disorders. Alliance President and CEO Mike Thompson brought up an organization that deals with childhood obesity. Through this organization, Thompson learned how sensitive one must be when they talk about weight with children. It’s possible to push a child in the direction of developing an eating disorder if you don’t communicate with them the right way.
The National Eating Disorders Association was one of the organizations that, three years ago, opposed the EEOC’s “voluntary wellness rules” that allowed for incentives up to 30 percent. According to the association:
“There’s an increasing trend of tying these [wellness] programs to health insurance benefits, with penalties that can mean that the employee ends up paying more money for their health insurance. Additionally, these programs aren’t necessarily just harmless ways to encourage people to be healthier, they could also include office-wide, Biggest Loser-style group weight loss programs that can be triggering for people who struggle with disordered eating.”
The bottom line for employers: Don’t underestimate the impact of an eating disorder, even in a workforce full of adults. Think about eating disorders when you’re crafting messages for weight-loss programs.
When you’re thinking of your population, ask yourself, “How easy it is for them to find an in-network specialist provider who has adequate training, specifically treating this [eating disorder]?” said panelist Jenna Tregarthen, founder and CEO of Recovery Record.
And, as panelist Kristina Saffran, co-founder and CEO of Project Heal, said: “People are not quite sure where [eating disorders] belong. Although there’s a medical and a behavioral component, it is a mental health condition when it comes down to it. So, it should be a part of your behavioral health strategy.”
Other wellness topics on my mind …
Money and motivation: There’s an idea floating around that more money doesn’t motivate people; rather, other rewards like trips or non-cash prizes do. Every time I read or hear that, I have one major reaction, even though I don’t doubt there’s some truth in this. It makes perfect sense in certain contexts. Still, I hope companies don’t use this as an excuse not to give employees standard-of-living raises or to raise minimum wage. Financial wellness is more than just giving employees access to financial advisers or tips on how to save money. It’s also acknowledging that as the cost of living rises, appropriate compensation will help them with basic financial needs.
Hate crimes: Ever since the alleged hate crime against “Empire” actor Jussie Smollett, I’ve been seeing a lot online about the broader topic. For example, the number of hate crimes in Washington, D.C., have nearly doubled since 2016, with crimes based on sexual orientation accounting for half the city’s total hate crimes in 2018, according to the Washington Post. This is a major public policy and public health issue, but the workplace should take notice, too. I plead with employers — no matter what religion or morality your organization associates with — to think seriously about how your employees’ behavior and workplace policies impact LGBTQ people, especially now. Are you taking incidences of harassment or discrimination against this community seriously?
As columnist and employment law blogger Jon Hyman has written in several posts in Workforce’s blog The Practical Employer, there is no good reason for employers to be anti-LGBTQ rights. Hyman wrote:
“When LGBTQ discrimination becomes universally illegal in the United States (and it will), and history looks back on this era during which this brand of discrimination was questionably legal, on what side of history do you want to be as an employer? The side that condoned (or, worse yet, participated in) this discrimination, or the side that took a stand against it?”
Good news from our columnist!:Jennifer Benz, the Benefits Beat columnist for Workforce magazine, had a major announcement recently. Benz Communications has joined forces with consulting firm The Segal Group. Benz is now the SVP communications leader at Segal Benz. Congratulations, Jennifer!
February 5 was the 26th anniversary of the Family and Medical Leave Act being signed into law.
During last night’s State of the Union Address, President Trump called for Congress to make paid family leave a federal law.
I am also proud to be the first president to include in my budget a plan for nationwide paid family leave — so that every new parent has the chance to bond with their newborn child.
The devil is very much in the details. We have zero idea what this law would look like.
Who will pay for the leave — employers, directly via payroll, or employees, indirectly via a tax the funds a government benefit pool?
How much paid leave will the law provide — 6 weeks, 12 weeks, more, less?
What family issues will be entitled to paid leave — just childbirth, the same scope as the FMLA, or will be it broaden protections to other parental issues such as school-related events?
Which employers will it cover — those with 50 more more employees, 25 or more, or even smaller?
Before we heap too much praise on this effort, we need to know details. Still, the United States remains the only industrialized nation that does not guarantee working mothers paid time off after childbirth, and we lag behind most of the rest of world on other paid family leave.
Frankly, it’s embarrassing, and it’s high time we joined the rest of world on what appears for everyone else to be a non-controversial issue. Anything that moves this debate forward is an effort worth applauding.
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?
Company leadership, including the C-suite and HR managers, may first think of the bottom line when it comes to health insurance and employee benefits. But they could be missing the bigger picture.
The broader view includes the value of investment in benefits and people, and the impact on metrics such as workforce attraction, employee retention, productivity and company culture. High-value options and technologies are increasingly defining and shaping holistic employee benefit programs.
Central to these all-encompassing programs are intelligently constructed plans that consider and connect all aspects of care, including both mind and body, and that are reinforced by big data, artificial intelligence and sophisticated metrics.
In today’s health care environment, holistic programs are especially vital. Behaviorally linked health issues and conditions affect almost 1 in 3 adults 18 years of age or older, but the costs are underreported in claims. Some of that cost revolves around the opioid dependency and the addiction crisis, which has cost the U.S. economy $1 trillion since 2001. Other contributors include smoking-related illnesses and complications, which still levy a toll of up to $300 billion each year, and obesity-related diseases that continue to have a tremendous economic impact.
Research has shown that people who are healthy, both mentally and physically, are more productive. For those struggling with health issues, the right support structures can make all the difference, both in quality of life and in long-term health and wellness outcomes. As an employer, an approach to health care benefits that aligns with company goals and fits the company’s culture can help keep costs in check, reduce turnover and sick leave, and even make your company more attractive to potential teammates.
For example, at Brown & Brown, we have designed a framework called the Intelligent Health Plan that encompasses an array of customizable data-driven strategies. These include plan design, clinical programs and solutions (e.g. telemedicine), and well-being and network strategies (e.g. weight reduction programs and onsite clinics, respectively).
Navigation, advocacy and education can be wrapped around these strategies to create a plan that is integrated, coordinated, and ensures members get the right care at the right time by the right provider in the right setting. A digital hub at the center can help to pull the pieces of the strategy together and enable targeted communications. Key to all of this and any employer’s strategy is the development of relevant metrics and monitoring of outcomes.
This approach to employee benefits emphasizes risk reduction and health management. Depending on the workforce and the prevalent conditions and issues found, this could mean investing in drug rehabilitation, smoking cessation, stress reduction, healthy eating, exercise and “let’s move” programs. There are also many options to leverage technology, on both the employee and delivery side, for earlier intervention.
Technology can play a significant role in an intelligent health plan, both in delivery of new services and in increased employee engagement in risk-reduction and health management programs. Research shows that while people will often pay little attention to generic messaging, buy-in is much greater when a message is customized to their individual circumstances.
Messages can be customized through wearable technology, digital platforms and coaching and clinical programs. Components of these programs may be personalized through advances in artificial intelligence and algorithmic learning. Through more sophisticated analysis of past claims and other health data, the methods and options that offer assistance when the time is right are expanding.
This can lead to both lower health care costs and better outcomes. For example, if research indicates noninvasive methods to treat lower back pain produce results as good as surgery, an employee scheduling an MRI might receive messaging about that research and assistance in obtaining appropriate care.
Prevention as part of risk reduction cannot be overstated, but there must be a deliberate approach. Immunizations, such as flu vaccinations, are crucial, but prevention also includes promoting health screening for conditions such as cancers and catching complications early if chronic diseases do arise.
While these elements may seem focused on individuals, they have a wider impact. People with similar health behaviors, such as exercising, tend to cluster together. Therefore, when one person makes healthy changes there is a trickle-down effect with friends and family that eventually impacts a community.
One size does not fit all when developing health benefit programs. Each company and its employees will have different needs. However, expanding holistic options means programs can be tailored, considering both costs and the value they can return.
Be prepared about how to spot signs of behavioral health problems and the appropriate ways you can respond.
An estimated 23.2 percent of Americans aged 18 and older experienced symptoms of a diagnosable mental health or substance use condition in 2016. At the same time, fewer than half of those diagnosed with a behavioral health condition received treatment. When left unaddressed, these conditions may contribute to various workplace challenges, including loss of productivity, low morale and turnover.
Although behavioral health conditions are prevalent, there remains a lack of understanding in the workplace on how to properly support them. Given that employees spend a great deal of time at work, this presents you with the opportunity to better assist those with a behavioral health condition to foster trust and aid in recovery.
Understanding the typical progression of a mental health or substance use condition and its corresponding symptoms can help you better identify employees in need and connect them to available resources. While these conditions often begin with a relatively mild impairment that has a minimal impact on the employee’s performance, symptoms can progress and ultimately hinder their work.
Be prepared by knowing how to spot the signs and the appropriate ways you can respond. The following five stages explain the cycle of behavioral health conditions that an employee may progress through and tangible ways you can help:
Risks emerge
A challenging aspect of behavioral health conditions is that they often begin without being noticed. In fact, a manager may confuse the symptoms of a health condition with poor performance. While conditions may be hard to identify at this stage, it’s important for employers to create a safe climate and culture for employees to speak out and seek help.
All managers should be trained on how to document performance on a regular basis, noting any observed performance changes. Managers should also be familiar with resources the organization has available to support employees, such as management coaching and employee assistance programs.
Symptoms escalate to impact performance
In the second stage, an employee’s symptoms may increase to a moderate level and are more likely to noticeably impact work performance. An employee may be absent more frequently or request an accommodation under the Americans with Disabilities Act to help them cope with the situation.
Referrals to an EAP are more common at this point, and the employee may be more likely to seek treatment on their own. Absence management approaches may also help employees address issues and stay at work in this stage. That’s why stay-at-work disability management strategies, such as referrals to workplace resources and accommodations, are best initiated at this point.
An increase in severity
In this stage, the employee experiences severe symptoms that could directly impact their work performance and abilities. Performance problems and employee absences may escalate to the point where they require a disability leave. In many cases, the need for accommodations to support recovery becomes more visible to employers.
For those who are able to stay at work, it’s important to work with the employee to develop accommodations tailored to their specific limitations or restrictions. Proactively implementing accommodations may help keep an employee engaged in their work, successful in their role and supported by their peers. For employees who require a leave, being supportive of the employee’s FMLA application also is important.
At this point of an employee’s condition, they may continue to experience severe or chronic symptoms and apply for long-term disability benefits. The employee may also start seeing themselves as “disabled,” struggling to find a sense of purpose or meaning in life.
During this stage, goal-directed case management and return-to-work strategies are generally initiated or continued. But the impact is generally lower than during the previous stages. With earlier interventions, there’s a better chance that the employee will return to work.
Recovery occurs
The last stage is where employees begin to see their condition improve — either through treatment or as part of the natural course of the condition. But with the proper employer response and intervention, recovery can occur at any stage in an employee’s journey.
Recovery before severe or chronic symptoms develop often depends on an employee connecting with timely and effective care and support. Effective support can empower the employee and rebuild confidence.
Given that mental health and substance use conditions are common in the Unites States, it’s important to address this issue through effective services and support for your employees. Research shows that only 50 percent of employees return to work after having been out of work for six months. When you’re prepared, you can intervene earlier and increase the chances that the employee will return to work.
Being prepared for a behavioral health condition means supporting employees in their time of need. Without the proper strategies, resources and assistance, an employee’s work performance may suffer. By offering your employees various programs and benefits, you can help ensure a timely and safe recovery and return to work.
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
A while back a source mentioned to me that many people have a limited view on mental illness. It’s depression; it’s anxiety; or maybe it’s PTSD. But there are many more mental illness conditions to address. Like eating disorders.
