Category: Benefits

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Employers Struggle to Reduce Wasteful Health Care Spending

health care

Employers have found ways to manage health care costs, but need to step up their efforts to tackle a more vexing problem — eliminating wasteful medical care spending.

A recent Journal of the American Medical Association study found that 20 to 25 percent of medical spending is unnecessary.

“As long as we are in a fee-for-service world we will get services whether we need them or not,” said Mike Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions. “We need to shift from paying for volume to paying for value, and employers need to put pressure on providers to get this right. They should be asking for spending reports from vendors, like Blue Cross Blue Shield, and they should be analyzing claims and identifying waste. The problem is not new and neither is value-based medicine, but there are new efforts to address wasteful spending.”

The estimated waste hovers between $760 billion and $935 billion, with administrative costs such as claims processing, billing and transferring medical records making up the largest share at $266 billion annually, according to the JAMA study.

Yet, more than half of employers aren’t actively doing anything about it, according to a 2018 report by the NAHPC. While the first step for employers should be identifying the problem, nearly two-thirds of businesses surveyed don’t collect or analyze data to track waste.

“Employers should be asking for reports from the vendors and analyzing claims data to identify waste,” he said. “Part of the reason why vendors don’t offer this information is because they’re responsible of getting rid of it.”

Employers need to take a more proactive role in tackling wasteful spending, according to Daniel Wolfson, executive vice president and chief operating officer for the American Board of Internal Medicine. He urges them to speak not only to health plans but also to health care providers about what they are doing to minimize the problem. Wolfson leads Choosing Wisely, an ABIM initiative designed to encourage patient-doctor dialogue around the overuse and misuse of medical services. The program, which was launched in 2012, publishes a list of more than 400 recommendations on treatments that patients and physicians should question.

The Washington Health Alliance looked at 48 common medical treatments, tests and procedures and found that an estimated $341 million was spent on unnecessary health care in the course of a year.

“I think employers are absent from the conversation,” he said. “They have not used their leverage to impact this problem. Employers have had a tremendous influence on quality issues but they are not using their leverage, their power, their influence and their thinking when it comes to wasteful health care spending. They should be saying ‘If we’re going to be purchasing health care services from you we want to hold you accountable.’”

Also read: The 4 Myths of Health Care Cost Reduction 

Some employers are using the Choosing Wisely recommendations, which were created by 17 national medical specialty societies. Each list offers information on when tests and procedures, such as imaging for lower back pain or breast cancer treatments, are appropriate.

In Washington state, the Washington Health Alliance looked at 48 common medical treatments, tests and procedures and found that an estimated $341 million was spent on unnecessary health care in the course of a year. Of the 2.9 million services examined, nearly half were found to be unnecessary.

The prescription of opioids for lower back pain was the most wasteful treatment, followed by the use of antibiotics for upper respiratory and ear infections, annual EKGs for low-risk patients and imaging tests for eye disease.

In Missouri, the St. Louis Business Health Coalition partnered with the Midwest Health Initiative in 2016 to identify unnecessary care. It found $303 million in wasteful spending to vision screenings, imaging tests, EKG services and pre-op lab studies in 2016.

In 2017, the coalition examined emergency room use for upper respiratory infections and found that $2 million a year could be saved if patients went to an urgent care clinic instead of a hospital emergency department.

Louise Probst, executive director of the employer coalition, said that benefit plan design can help through increased copays for ED visits.

“We all have a problem with low-value care,” she said. “It’s important to ask employees to think about that as an individual and then as a company. Look at incentives in your plan design, look at contracts, look for partners. Get the best data that you can and keep track of it. Employers, hospitals, physician organizations, labor unions, and other community partners need to come to together with a single focus of improving value in health care.”

 

 

 

 

 

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A Fun Culture Isn’t Enough to Retain and Engage Top Talent

In today’s job market, companies are under pressure to not only attract top talent but retain it as well. The allure of flexible hours, unlimited time off and craft beer on tap may speak to the promise of a fun culture, but don’t hold much weight when an employee considers greener pastures.

Employee benefits programs  are a strong deciding factor when people consider staying with or leaving their company.  A recent study found that 78 percent of employees would be more likely to stay at their current job because of the benefits they receive. With benefits holding a priority position on employees’ pro and con checklists, it’s imperative for employers to offer coverage that is not only valuable but competitive in the marketplace.

Absence and disability programs are two primary areas of employee benefits that are undervalued in the U.S. workforce. Based on a survey of HR decision makers by The Standard, 23 percent of companies embrace a holistic approach to accommodating disabilities. Further, less than 33 percent of companies have embraced the need for family and medical leave that is more comprehensive than current laws permit. Based on these findings, it’s no surprise that only 1 in 4 employees see their employer as a leader in managing absence and disability. This poses an opportunity for companies to prove they are in touch with employee needs and offer benefits that are both valuable and competitive.

In particular, companies should consider accommodations for employee mental health conditions if they want to retain talent and increase job satisfaction. The rate of millennials experiencing a mental health condition continues to rise and conversations about employee burnout, anxiety and depression are becoming more prevalent. According to Pew Research Center, millennials make up the largest sector of the U.S. workforce with Gen Z following close behind. The impact of mental health in the workplace will only continue to grow as baby boomers and Gen X retire and exit the workforce. Millennials are more open about mental health conditions than any previous generation and expect their employers to both support them and provide realistic accommodations.

Companies are struggling with this shift. The Standard’s research found that 71 percent are not confident in managing employee mental health conditions. Moreover, 63 percent of organizations do not feel prepared to accommodate absence or disability related to behavioral health conditions. It’s time for companies to rethink their approach to employee mental health if they want to be viewed as positive places to work.

Organizations that are committed to improving their approach to behavioral health can incorporate a variety of tactics. First, company leaders can offer explicit support to employees experiencing mental health or substance abuse issues. Public communications, such as email campaigns and company-wide meetings, should aim to address and reduce the stigma around behavioral health conditions in the workplace. A strong wellness campaign backed by manager training on issues such as depression, anxiety and addiction can further bolster a strong behavioral health strategy.

In addition to a company culture that supports and responds to mental health and substance abuse needs, employers can search for a behavioral health benefits program that attracts and retains valuable talent. Organizations should consider implementing a formal wellness program that factors in “mental health days,” flexible work schedules, subsidized employee subscriptions for mental health, parental leave and other key benefits. While accommodating these needs is not always easy territory to navigate, employers who provide workers with the tools they need to address mental health and substance abuse will enjoy the benefits of employees who are far better equipped to meaningfully contribute to the company mission.

Offering absence and disability programs that accommodate behavioral health conditions while destigmatizing workplace discussions around mental health are key to the development and execution of a successful program. Behavioral health assessments can create open discussions about mental health in the workplace, but findings show that only 10 percent of companies are offering them. These assessments can help employees understand if they are likely to suffer from a mental health condition.

The U.S. workforce is undergoing a generational shift, and employers are trying to retain employees in a job market where many new opportunities abound. Companies that come out on top will do so by expanding and improving their employee benefits programs. At the end of the day, people stick with companies that value and support them through life’s ups and downs.

 

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Please Tell Me Why Worksite Wellness Programs Are a Waste of Time and Money

My father passed away in October 1986 from a heart attack at age 49.

That was his last in a series of major and minor cardiac events. I was 21 years old when he died. At the time I perceived my father to be old (as do most children).

Now, at age 53, it’s an odd perspective to look back at his passing and reflect on where he was in his stage of life and career and consider his outlook on the future.

Gary Cassidy

My family has a history of heart disease and my father was no exception. As an engineer for General Electric, he worked long, hard hours and traveled frequently.

Physical activity, nutrition and doctor’s visits were not high on his priority list. I call this attitude the “I feel fine so I must be fine” mentality.

He enjoyed eating the crispy skin off the Thanksgiving turkey, fat from a well-cooked steak and ladles of cream sauces — all the good-tasting stuff that was loaded with calories, fat, cholesterol and sodium.

When my father had his first heart attack, the doctors found he had extremely high blood pressure and major blockages in all four of his arteries. By that time, too much damage had been done to his heart and there was nothing they could do for him. Still, my father started eating better, took up golf, spent less time at work and focused on reducing his stress.

It’s important to remember that during my father’s lifetime, 1937 to 1986, company wellness programs did not exist. He grew up with exercise guru “The Jack LaLanne Show,” hula hoops, calisthenics, the sauna suit, vibrating belts and other early fitness trends and fad diets. Most centered on the external appearance of fitness but lacked a focus on inner fitness, the biometric and lifestyle measurements that truly determine if one is healthy.

You would think I learned something from his experience, but you’d be wrong. When I was young I felt indestructible.

I had a high metabolism and didn’t gain weight no matter what or how much I ate. The good news: I was physically active in soccer, aerobics, long-distance running, weight lifting, competitive Taekwondo and many other activities.

The bad news: my diet was significantly less than stellar. It wasn’t unusual for me to have fast food for breakfast, lunch, dinner and a late-night snack all in the same day. I inherited my father’s “I feel fine so I must be fine” mentality.

In 1993, after eight years in the Air Force, I returned to civilian life to work at a large insurance carrier, where I learned about health care claims, annual employee benefit renewals and risk management, which drive and control an employer’s health insurance costs. I began to understand that the overall health of a workforce can affect an employer’s health care costs.

I learned about the decisions that organizations must make about health insurance cost sharing, like imposing premium increases, and that employee benefits are a large part of the workforce’s total compensation. I observed how employees who do not take responsibility for their personal health can cause others who do to pay more for their own health care benefits, something that always struck me as unfair.

At age 35, I finally visited my doctor for an annual physical, and the results were not good. My total cholesterol was over 300, my HDL was low and my LDL and triglycerides were high. I was also diagnosed with hypothyroidism.

While this was an “aha!” moment, I should have seen it coming. I knew that I had a family history of high cholesterol and most men on my father’s side of the family died young from cardiac-related causes. But “I felt fine so I must be fine.”

My doctor prescribed cholesterol and thyroid medication. I began to focus on nutrition and continued to be physically active. After one year, my numbers started to improve, but even now I still have work to do. Progress, not perfection.

While conditions like these may take years to produce symptoms and can initially go unnoticed, they are still incrementally causing damage to one’s health and well-being. This is why it’s so important to focus on preventive measures to manage a disease before it has the chance to cause a major medical event.

After my father had his first heart attack, he was released from the hospital and sent home. He walked slowly so as not to raise his heart rate. One day I watched him spend 20 minutes walking up 15 steps in our house. When we lose our health it’s the simple things we take for granted that are impacted the most.

Seeing first-hand the impact of how an undiagnosed heart condition affected my father’s health helps me stayed focus on wellness. In every wellness program participant, I see someone whose life can be positively impacted.

I often reflect on what would have happened if my father’s company had a wellness program. Knowing him, he would have been one of those people who wouldn’t want to participate. Because he was too busy. Because he didn’t have the time. Because it didn’t make sense; he “felt fine.” Because he had too many other things to do. Because it was his choice how he managed his health, not the company’s.

While all of this may be true, I think that if he had participated in a wellness program, gotten his blood work done and learned about his high blood pressure and high cholesterol before he had a heart attack, he would still be here today.

So I ask you, what’s the downside of participating in a wellness program?

Gary Cassidy is the director of employee education, communication and wellness for Camden, New Jersey-based insurance broker Corporate Synergies.

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Monitoring Emotions at Work

With emotional well-being in the workplace, “prevention is better than intervention,” said one author and entrepreneur.

Steve Curtis

Marc Brackett, founder and director of the Yale Center for Emotional Intelligence, argues in his new book “Permission to Feel” that the workplace tends to deny healing.

“You check your feelings at the door because you’re there to do business,” he said. “What people have to realize is emotions don’t get checked at the door. They are at the seat of every table. They’re on the phone with every client and are influencing all aspects of performance.”

Emerging technologies are helping employees assess the impact of their emotional state on work performance.

One platform in the development stage, Evolve Biologix, uses the heart’s electrical signals through an ECG measurement tool wrapped around the chest to correlate with a range of emotions to develop emotional awareness and learn techniques to manage it individually and in relationship to others.

People already are using devices connected to the body such as a watch, but having something connected closer to their heart is new, said Evolve Biologix CEO Steve Curtis.

Evolve Biologix differs from other platforms in that while others are self-reporting, its focus is on gathering real-time electrical signals from each heartbeat.

“An ECG wave has different peaks with electrical signals firing through our brain,” said Curtis, whose company is in a corporate environment beta stage as Curtis seeks partners to collaborate on the notion that it can serve as a health benefit. “We’re utilizing data science and machine algorithms to understand the specific signatures of these body systems to draw out emotions, build a group performance dashboard and optimize algorithms that drive content interventions and suggestions at an organizational level.”

Marc Brackett

An Evolve Power Index score, which is displayed on a phone, represents the user’s emotional level. The higher the score, the more the end user is believed to be in alignment with their emotional state, which can range from shame and guilt to peace and enlightenment.

Regarding privacy concerns, Curtis said results aren’t connected to individuals but provide a picture of group dynamics down to work groups of three.

“[HR] departments are continually challenged with how to keep innovation alive in their organization, increase the change readiness, manage empathy in environments where people are becoming progressively more technical in nature and how to get people to care about each other and function as a cohesive team,” he said. “It’s imperative to be able to view these kinds of metrics.”

Brackett foresees a time when employee benefits will include more emotional wellness technologies.

“There’s a benefit-cost analysis to taking seriously people’s development of skills, teaching emotional self-awareness and emotion regulation as opposed to treating it once you have a full-blown anxiety disorder or depression,” he said.

 

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Federal Employee Labor Union Files Grievance Against VA’s Smoking Ban

The Department of Veterans Affairs’ new smoking ban took effect on Oct. 1, prohibiting all patients and non-staff from smoking on VA hospital premises. In January the ban will extend to employees.

The smoke-free policy was created to initiate a healthier environment and improve care for veterans, but the American Federation of Government Employees argues that the ban violates the labor union’s contract.

A 2008 contract that is still in effect states that all VA facilities will provide employees with “reasonably accessible designated smoking areas.” However, the ban does not allow any smoking while on VA property, including parking areas.

Because of the conflicting policies, the AFGE filed a national grievance, which the VA’s Office of Labor Management Relations denied. The 670,000-member labor union has invoked arbitration and is waiting to schedule a hearing once the arbitrator is selected.

“Although we believe that the agency violated the law and our contract by implementing the directive for AFGE’s bargaining unit employees, we encourage employees to comply with the directive to avoid the threat of discipline while we continue to challenge the policy,” said Alma Lee, AFGE National Veterans Affairs Council president, in a statement.

In addition to the contractual dispute between the union and the VA, the ban has received pushback from veteran’s and their families who don’t think the policy is necessary.

Alma Lee, AFGE National Veterans Affairs Council president.

Al Lewis, author of “Cracking Health Costs,” said that the ban is only a good idea in theory and questions whether it is a wise decision for the overall productivity of the organization. “Instead of creating a culture of health, you are creating a culture of deceit,” Lewis said.

The idea of taking away all designated smoking areas from veterans using VA facilities is also seen as cruel and unfair. Based on the affiliation between tobacco products and the military, it is common for veterans to rely on smoking as a source of comfort.

Pat Englewood, an organizational psychologist and counselor said that the use of tobacco products can be part of good and bad memories of the military service that a veteran may choose to not let go of, or can’t let go of.

A Centers for Disease Control and Prevention study released in 2018 found that about 30 percent of veterans use tobacco products, which is a much higher rate than most of the non-veteran population. The prior culture of tobacco use in the military is considered a significant influence on this issue.

Englewood said that part of the upset toward the smoking ban may be derived from the veteran’s addiction to these products.

“The craving has become a necessary habit in their daily routine,” said Englewood, who is also a Vietnam era and Gulf War veteran. “If there is any threat that this craving will not be satisfied, then the big guns come out and they blame others through their defensive comments and behaviors.”

Although taking away the designated smoking areas will make it difficult to take smoke breaks, Englewood saw the new policy as a responsible step toward better protecting the health of the VA’s patients and staff.

“It is not an overstepping of power to look out for the health and well-being of all service members and hospital staff,” she said. “No one is taking anyone’s control of their lives away.”

Gary Kunich, a spokesman for the Milwaukee VA Medical Center, also supports the ban as he considers it to be a positive and healthy change toward maintaining a healthy work environment.

“We’ve actually gotten a lot of positive comments from people who are happy that we’re doing this, that there’s not a cloud of smoke outside or that there aren’t cigarette butts on the ground,” Kunich said.

Since the Milwaukee VA Medical Center has undergone this change, Kunich says that the ban has “changed things for the better.” According to Kunich, a majority of the employees and veterans at the Milwaukee facility don’t smoke and have wanted a healthier environment to provide and receive better care.

In the 10 years that Kunich has worked at this facility, he recalls town hall meetings where some of the veterans would ask why they still allowed smoking on the property. “It just seemed to be a logical step forward and the right thing to do for all of our employees and all of our veterans,” he said.

For veterans who are struggling to quit smoking or using other tobacco and nicotine products, Kunich encourages them to take this as an opportunity to find healthier habits by taking advantage of the programs that the VA offers.

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Eggnog With a Splash of Paid Time Off

holiday vacation, paid time off

Providing employees extended time off at the end of the year is one way to add a bit of holiday cheer.

Office closures during the holidays — typically the days between or immediately around Christmas and New Year’s Day — can enhance employee productivity, according to a November 2018 survey of 2,000 full-time employees conducted by Chicago-based consulting firm West Monroe Partners. The study explored employee productivity during the holiday season and gauged how additional days off during the holidays affected that productivity. It found the “employees at offices that close additional days during the holidays are significantly more likely to report higher productivity during the time that they’re actually in the office” — 42 percent compared to 17 percent in offices that don’t shut down outside of federal holidays.

The study suggested that employers close the office on days beyond federal holidays, when feasible.

Some employers look at this potential benefit and can’t see past the missed productivity of those three or four days between Christmas and New Year’s, said Michael Hughes, a managing director with West Monroe and lead of the firm’s Operations Excellence practice. But they’re not considering the return on investment.

Also read: Experts Advise Revising Ailing Time-Off Policies

“In a tight job market, the ROI from deciding to close the office becomes very real,” he said. “We’ve tried this at our own company and [we] see the benefits of it year after year in terms of retention and productivity.”

According to the International Foundation of Employee Benefit Plans’ 2018 “Employee Benefits Survey,” 12 percent of organizations offer the full week between Christmas Day and New Year’s Eve as a paid holiday, compared to 9 percent of organizations in 2016.

If a company can withstand the hiatus from the client delivery and service perspective, it should strongly consider doing so.

Michael Hughes

Especially at a time with a tight labor market, employers are looking for new, innovative ways to attract talent and increase morale, said Julie Stich, vice president of content at the foundation. An extended vacation during the holiday season is one way to vie for candidates’ attention.

Michael Hughes, West Monroe Partners
Michael Hughes, West Monroe Partners

This makes sense in some industries more than others. The top three industries that offer holiday time off perks include education, technology and manufacturing. Conversely there are many industries in which virtually no companies offered such perks, including banking, finance, food service and health care, Stich said.

The top three industries provide examples for the type of environment that can more naturally offer this perk, Stich said. People in education may already have that downtime over winter break. Tech companies tend to be innovative in the benefits they offer. And manufacturers sometimes need to shutter their shops and turn off the machines for a week for maintenance. Offering that week between or around Christmas and New Year’s Day could fit in with a business need as well as give many employees the perk of a longer break, she added.

Hughes said that if a company can withstand the hiatus from the client delivery and service perspective, it should strongly consider this time off.

At West Monroe Partners, the finance and accounting teams are often working at the office or at home during this time of the year to meet end-of-year deadlines. The same goes for IT, as clients’ expectations of getting the necessary tech guidance does not stop just because it’s the holiday season.

One year a client experienced a ransomware attack the week between Christmas and New Year’s, Hughes said, and employees on the cybersecurity team stepped up, working on Christmas Eve and the days following Christmas. Instead of time off, these employees were recognized and rewarded in other ways for going above and beyond in their jobs.

“Folks in these positions understand this is a busy time based on their role in the company,” Hughes said. “As long as you provide them with a similar benefit — paid time off during another non-busy time in the year — or rotate who’s ‘on call’ from year to year, they are less affected by the decision.”

“If it’s not possible for your business to close for additional days during the season, then it’s even more important to offer workers alternative ways of disconnecting and recharging, such as greater scheduling flexibility,” he added.

Customer relations are something else to keep in mind. Organizations need to let their clients or customers know in advance that they will not be providing services over a certain period of time. They can’t just rely on an update on their website to get the message across, Stich said.

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Personalization Versus Ease of Use

I recently had coffee with a benefits leader who is implementing a new technology platform for her organization’s employees and spouses. Her scenario is much like that of many of our clients: She works for a big organization with employees all over the United States and in many locations around the world. The company’s benefits and HR programs are complex — and getting more so as it seeks to meet the needs of different employee segments and an increasingly diverse population. Data is used for everything in the organization, and HR is catching up to the rest of the enterprise.

Their goal is to provide a better experience for employees, driven by data. Her team is looking at consolidating all benefits information from existing channels (including the intranet, external sites, vendor sites, email newsletters and more) into a personalized portal.

But she has a lingering concern: As we look to offer employees a highly personalized experience, do we unintentionally make it harder to access benefits information?

This is a critical question. Ease of access and ease of use need to be the highest priority if we are going to get the right people to use their benefits at the right time. It’s also an often-overlooked question when pursuing personalization. And it becomes even more important to consider when you’re using personalization and engagement to drive health strategy. Personalization is among large employers’ top health care initiatives for 2020, according to the National Business Group on Health’s latest survey. Some 26 percent of respondents said they plan to “implement an engagement platform that aggregates point solutions and pushes personalized communications to employees.”

That initiative follows employers’ top three strategies, which are largely focused on changing the health care experience: implementing virtual care solutions, a more focused strategy on high-cost claims, and expanding centers of excellence to include additional conditions.

So, why are personalized tools getting so much attention? Personalized portals and apps are good at doing several important things. They can serve up data-driven content, send just-in-time notifications, and help identify missed opportunities in a very relevant way. They can also deliver recommendations, which helps create the “Amazon” experience so many plan sponsors are looking for.

Amid all this incredible promise, it’s important to remember that these tools can deliver customized content only if and when people use them. By their nature, personalized tools have more access barriers, because all that personal information needs to be protected. It is easy to underestimate the amount of effort it takes to get people to engage frequently with even the most cutting-edge and appealing platforms.  You must have a compelling reason to check anything out. You must have an even better reason to go back.

If you’re asking someone to download an app, authenticate with personal information, keep that app up to date, allow notifications, and go back to it frequently, is that actually easy? Each one of those action steps is a specific user behavior that has to be promoted and encouraged.

Think about when you log in to a website and have forgotten your password. Are you always motivated to track it down? Or do you file that for “do later” and move on to something else? We all have a lot of to-do’s and a lot of distractions — especially on our phones.

When you’re considering a personalized app or platform, you need to take into account the ease of access and the amount of resources you’ll need to drive ongoing use.

Of course, we have clever ways to encourage engagement. And this is where we can really use HR’s unique advantages.

First, we can make something so enticing that you can’t resist going there often. The best example of this that I’ve seen recently is a large retailer that puts their employee discount in their benefits engagement app. The only way they can use their discount is to have the app on their phones. You can bet all their employees are using that app.

You can also make the app so critical to an individual’s day-to-day job that using the platform becomes a de facto job requirement. Some large companies have built their HR apps to include core functions like scheduling and time tracking. If you have to use the app every day you work, it’s an ideal channel for serving up key benefits and HR reminders.

There is tremendous promise with personalization. But that promise can only be fulfilled if people have a good experience with personalized tools and use them frequently. It is our job to use all the tools we have to make that desirable — and most importantly, easy.

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Health Care Surveys Show Employers What to Expect in 2020

association health plans

Recent surveys show that employers are increasingly addressing outside financial and environmental factors in their benefits offerings.

While the Kaiser Family Foundation’s annual survey gives insight into cost trends in employer-sponsored health care, the National Business Group on Health’s new study focuses on what large employers are doing to address these trends.

One noteworthy trend is rethinking impact of cost-shifting and consumer-driven health plans, also referred to as high-deductible health plans.

Employers are bringing back choice, according to the National Business Group on Health’s “2020 Large Employers’ Health Care Strategy and Plan Design Survey,” which was conducted in May and June 2019 among 147 large employers. Collectively, respondents represent a wide range of industry sectors and offer coverage to more than 15.6 million employees and their dependents.

According to the NBGH survey, 11 percent of employers offering an optional HDHP for 2020 previously offered HDHP-only. Employers cited several reasons for this shift, including the desire to be more sensitive to employees with chronic health care conditions and their health care expenses.

The Kaiser Family Foundation also stressed the adverse impact of HDHPs on many employees in its 2019 “Employer Health Benefits” report released in September. Forty percent of non-elderly adults who have employer-based coverage said that either they or a dependent have had difficulties affording health care.

Further, people with HDHPs were worse off. Among all employees surveyed with chronic conditions, 60 percent said they felt confident enough to afford the cost of the major illness. This percentage halved for chronically ill employees with HDHPs. Only 1 in 3 said they feel confident affording this major medical cost.

Taking employees’ health into account goes beyond health insurance. The NBGH survey found that 60 percent of employers are considering strategies to address food quality/access in the next few years.

“One of the primary things that employers can do is offer nutritious food in on-site cafes and vending machines — and importantly — reduce the cost of these items to make them more desirable than less nutritious ones,” said Steve Wojcik, vice president, public policy at NBGH.

Other ways to address employees’ food quality and access challenges include partnering with local grocery stores to offer employees discounts on healthy foods and offering healthy, prepared take-home meals for purchase, he added.

Macro trends that impact people’s physical or financial health go beyond food deserts. The NBGH report also cited other notable macro trends like stagnant wages, poor public transportation systems and high housing prices.

Bringing an end to the most pressing social and environmental challenges will likely require action and partnership from both public and private sectors, Wojcik said. Companies are increasingly understanding that business performance, employee well-being and community health are intrinsically linked.

“Large employers are uniquely positioned to use their voice to draw attention to issues, advocate for public solutions (potentially in partnership with other employers or nonprofit organizations) or invest corporate social responsibility funds into initiatives that will positively impact their employees, customers and the communities where they work,” he said.

Also read: 4 Myths of Health Care Cost Reduction

Wojcik also suggested that if employers claim a position on some external issue, their internal benefits should be aligned with that. If a company has a corporate social responsibility program or external initiative on affordable housing, for example, it should also make sure that it supports financial well-being program such as employer-sponsored housing programs or homebuyer workshops.

The Kaiser report also stressed the need to keep employees’ financial situations in mind,  comparing the needs of low-wage versus high-wage employees.

“When people talk about the 153 million people with employer-based coverage, they often gloss over the very real cost differences for different groups of workers across the marketplace,” according to the report, which compared companies that have a large share of low-wage workers with companies that have a small share of low-wage workers.

Covered employees in organizations with large shares of lower­ wage workers on average face higher deductibles for single coverage and must contribute a greater share of the premium for family coverage than workers in firms with a smaller share of lower­ wage workers, the study found.

Being eligible for employer-sponsored coverage also is impacted by wages. In companies where at least 35 percent of employees earn $25,000 a year, 66 percent of employees are eligible for the coverage compared to 81 percent of employees in companies with a smaller share of low-wage workers.

The national debate around expanding Medicare was also a major theme in these reports. Most employers have major concerns about Medicare for All, NBGH noted. Fifty-seven percent of those surveyed believe that Medicare for All would increase the country’s health care costs, 69 percent believe it would decrease health care innovation and 56 percent believe it would decrease quality.

While the Kaiser report did not go into attitudes people have about Medicare, it did explore attitudes people have toward employer-sponsored plans. The debates over Medicare and the future of U.S. health care have raised concerns about the performance of employer-based coverage, the report noted. Many employees with chronic conditions, especially people with HDHPs, have issues affording health care, and low-wage workers may very well face higher premiums for health care than employees who earn more.

“Regardless of its outcome, the national debate around expanding Medicare or creating public program options provides an opportunity to step back and evaluate how well employer-based coverage is doing in achieving national goals relating to costs and affordability,” the report stated.

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Managing Mental Health Crises at Work

employers mental health; Millennials and mental health

Talking about suicide does not need to be taboo.employers mental health; Millennials and mental health

Mental Health America’s 2019 “The State of Mental Health” report has some concerning statistics. While adult prevalence of mental illness has been relatively constant, suicidal ideation, or suicidal thoughts, has increased from 3.77 percent in 2012 to 4.19 percent in 2017.

“That’s over 10.3 million adults in the U.S. with serious thoughts of suicide,” the report noted. Meanwhile, more than 10 million adults in the U.S. have an unmet need for mental health treatment.

Companies should understand how suicide could impact not only a person’s family and loved ones, but also their co-workers, clients and everyone around them, said Ali Payne, practice leader for organizational wellbeing at insurance brokerage Holmes Murphy.

“I think the way we make sure people feel connected is having a strategic relationship with leaders and having leaders be open about how it impacts them or how they do business,” Payne said. She suggested creating a work environment where open conversations are encouraged.

Leaders should educate themselves of the available resources and prepare themselves if a mental health crisis happens, she said.

Suicide is a significant public health issue both in the United States and worldwide. Between 1999 and 2016, suicide rates have increased in every state in the U.S., according to the Centers for Disease Control and Prevention. Further, the World Health Organization estimates that one person dies of suicide every 40 seconds worldwide.

“Our Global Suicide Crisis,” a 2019 report from Prudential, notes that while it’s understood that depression and anxiety can be precursors to suicide, there isn’t yet enough known about the many reasons behind suicide to prevent it. Still, addressing depression and anxiety can help.

One way to address mental health in the workplace is by adopting best practices such as telehealth for behavioral health and on-site mental health clinicians, the report notes. It also stressed that when an employee takes time off to deal with a mental health episode, managers should remain in contact with them. “This may not only help an employee through depression — it can also reduce their fear of returning to work,” the report noted.

Workplace benefits and policies like this are valuable, Payne said, but employers and managers can also learn about accessible community-based resources that address mental health. These resources include mental health services provided by and crisis hotlines, government organizations, state-based organizations and local hospitals and health providers.

“A lot of employers don’t always know what those resources are, and they sometimes take them for granted until they’re impacted by [a mental health crisis],” Payne said. “Then they might take the initiative to figure out what those resources are. But I always say, let’s be as proactive as we can and really try to get a handle on what [these resources] are even outside of what we’re buying today.”

Co-workers can also benefit from guidance in learning how to address what they think may be a mental health crisis in a colleague. It may not be a comfortable situation, Payne said, but part of the training she does for clients is based around understanding how to help struggling colleagues.

Productivity Expectations

One work reality that may impact an employee’s mental health is rising productivity expectations, Payne said. “Right now we’re all asking our people to do more with less,” she added, saying that employees are more often wearing many hats and pitching in wherever the company needs them. “We need to make sure we’re thinking about how workload impacts people.”

Even though employers understandably want employees to be their most productive selves, that’s difficult for an employee when they are having mental health problems. It’s an added stress as well if they still feel workplace pressure to be at maximum productivity even when they’re not feeling good, Payne said.

“If they’re feeling like this, they’re definitely not going to bring their whole self to work. They’ll leave a majority of what they need and what they want somewhere else,” she said.

She also suggests that team leaders learn to help people recognize when they’re not feeling 100 percent and when they need to take a break.

Personalizing Programs

“We can’t just say that mental health affects everyone the same way,” Payne said. Financial stress may negatively impact one person’s mental health while career stress may cause a similar reaction in someone else. There isn’t one simple solution to address this workplace issue.

“There’s no silver bullet to anything, and that’s what everyone wants,” she said. “Everyone wants this silver bullet that’s going to solve all the problems in mental health, like stress management.”

While stress management programs have some value, stress impacts everyone differently. People can improve their resiliency, but even so they may not be as resilient of a person as someone else, Payne said. Some people are just more resilient than others. Simply investing in programs meant to increase employees’ resiliency is not enough to address stress and mental health, she said.

Payne encourages her clients to consider all the resources they have at their disposal that can be impactful to different people with different needs who are struggling.

“It doesn’t mean that they’re struggling all the way to suicide,” Payne said. “It might just mean they’re struggling in general. How do we make it OK to not be OK?”

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Employers: Here’s How to Avoid Getting Bitten by COBRA

COBRA benefits provide continued group health plan coverage after certain qualifying events, like termination of employment, and are a health care safety net for employees until benefits from a new job kick in.

But for employers, staying compliant with COBRA regulations can be difficult. Sure, COBRA — the Consolidated Omnibus Budget Reconciliation Act health insurance program that allows an eligible employee and their dependents the continued benefits of health insurance coverage — is for employees who no longer work at your company.

Since you might think of them as long gone, complying with COBRA might not be a priority. However, any employee who leaves on bad terms may be more likely to file a lawsuit against an organization if it mishandles COBRA. In fact, employers have recently seen an increase in the number of COBRA lawsuits filed against them for leaving out required information.

Outside of litigious former employees, COBRA is generally confusing to comply with and can carry heavy penalties for employers. These can add up — courts can assess up to a $110 per day penalty for each deficient COBRA notice per person.

Here are some commonly overlooked details.

Not understanding if your organization is subject to COBRA; not understanding eligibility. First, it’s important to understand which employers have to offer COBRA. The federal law says that employers with at least 20 employees in the prior calendar year must offer COBRA coverage starting the day employer-sponsored group health plan coverage ends. COBRA coverage can last up to 18 months under typical circumstances, or 36 months if certain events occur, e.g., the employee becomes entitled to Medicare, gets divorced or dies.

But it’s not enough just to follow the federal law. Employers often overlook that states can also mandate that group health plans offer continuation coverage much like COBRA — called “mini-COBRA” laws — that typically affect smaller employers and provide greater benefits to employees than the federal COBRA law. For example, the New York “mini-COBRA” law mandates 36 months of continued coverage for employers with fewer than 20 employees. In New Jersey, with some exceptions, the state’s mini-COBRA law applies to employers that employ between 2 and 50 eligible employees, and provides employees with:

  • 18 months if an employee is terminated or their hours are reduced
  • 29 months if an employee becomes disabled
  • 36 months for the dependent spouse or child of an employee who dies; goes through a divorce, legal separation, dissolution of a civil union or domestic partnership or otherwise loses dependent status.

Many other states have continuing coverage laws in place as well. And as if understanding the state and federal laws that apply to your employees isn’t enough (and, it can be especially difficult if your employees live in multiple states) — there are also time-sensitive deadlines you must meet in order to stay in compliance with COBRA laws.

Not Complying with Notice Guidelines

One issue that’s landed some employers in hot water is failing to send notifications, or not including the right information in these notifications. Let’s start with the basics—employers that sponsor group health plans must send an “initial notice” or “general rights notice” to covered employees and their covered spouses within 90 days of the date that coverage under the plan starts or, if later, the date that is 90 days after the date when the plan first becomes subject to COBRA.

In addition, and with some exceptions, once an employee separates from the company, the plan administrator (or employer, if the employer and plan administrator are the same entity) must send a COBRA “election notice” within 14 days of receiving notice of a qualifying event, such as being terminated from employment or leaving the company. This notice describes the employee’s rights to elect COBRA.

For both types of COBRA notices, the penalty for not doing this (i.e., in addition to the potential litigation costs) is up to $110 per day.

The Department of Labor outlines exactly what should be included in these notices and even supplies templates called “model notices” to help employers comply with these guidelines.

Not Understanding What’s Covered

COBRA allows employees to pay for the same group health plan coverage they enjoyed during employment — but at their own expense. Unless the employer agrees to pay for all or a part of the COBRA premium, employees are responsible for the full premium amount (plus a 2 percent administration fee). Under COBRA, the term “group health plan” coverage is defined broadly, and includes medical coverage and, depending on plan design, could also include prescription, vision and dental coverage. Life insurance, long-term care insurance and other similar types of insurance aren’t considered “medical coverage” and aren’t included in COBRA.

Health reimbursement accounts, or HRAs, qualify as group health plans, so employees must still offer reimbursement for their expenses under COBRA. Health FSAs are generally included within the definition of “group health plan” and are subject to COBRA, unless the account is “overspent” as of the date of the qualifying event. In such cases, an employer’s COBRA obligations are more limited.

COBRA, Severances and Mergers

One frequently asked question is how COBRA works with severance packages. It’s not uncommon for employers to pay employees’ COBRA health insurance premiums on a pretax basis for a few months as part of a severance package. But if the employee is considered “highly compensated” by the IRS, and the employer’s health insurance plan is self-insured, the employee may be subject to paying tax on COBRA coverage as required under certain nondiscrimination rules under Section 105(h) of the Internal Revenue Code, which generally require that a self-insured employer can’t discriminate in favor of highly compensated employees. Employers can avoid this issue by paying the employee for their COBRA premium on an after-tax basis.

Another point of confusion is how COBRA is administered during a company merger or acquisition.

There are a number of issues to consider, including what type of acquisition, sale or merger a business goes through, and the employee’s status as a result of that event. These factors determine which entity in the M&A deal pays for COBRA, and which employees are eligible unless the parties to the deal have memorialized these terms in their relevant asset purchase or stock purchase agreement.

How to Stay Compliant

Managing COBRA properly can be onerous. Often employers fall into one of three categories when it comes to administering COBRA benefits:

  • Managing it in-house.
  • Relying on a broker.
  • Relying on a COBRA specialist.

Whether your organization takes on administering COBRA in house or relies on your insurance broker or other COBRA specialist, the potential liability for getting COBRA wrong is significant.

Harrison Newman is vice president and benefits consultant for Corporate Synergies.