Digital health revolution: What we’ve learned so far

Digital health devices provide personalized feedback to users, helping improve their health. Continue reading this blog post to learn more about the evolving digital health revolution.


The promise of the digital health revolution is tantalizing: a multitude of connected devices providing personalized feedback to help people improve their health. Yet, some recent studies have called into question the effectiveness of these resources.

While still evolving, many compelling use-cases are starting to emerge for digital health, including a set of best practices that can help guide the maturation of this emerging field. In the near future, many people may gain access to individual health records, a modern medical record that curates information from multiple sources, including electronic health records, pharmacies and medical claims, to help support physicians in care delivery through data sharing and evidence-based guidelines.

As these advances become a reality, here are several digital health strategies employers, employees and healthcare innovators should consider.

Micro-behavior change.

Part of the power of digital health is the ability to provide people with actionable information about their health status and behavior patterns. As part of that, some of the most successful digital health programs are demonstrating an ability to encourage daily “micro-behavior change” that, over time, may contribute to improved health outcomes and lower costs. For instance, wearable device walking programs can remind people to move consistently throughout the day, while offering objective metrics showcasing actual activity patterns and, ideally, reinforcing positive habits to support sustained change. Technology that encourages seemingly small healthy habits — each day — can eventually translate to meaningful improvements.

Clinical interventions.

Big data is a buzz word often associated with digital health, but the use of analytics and technology is only meaningful as part of a holistic approach to care. Through programs that incorporate clinical intervention and support by care providers, the true value of digital health can be unlocked to help make meaningful differences in people’s well-being. For instance, new programs are featuring connected asthma inhalers that use wirelessly enabled sensors to track adherence rates, including frequency and dosage, and relay that information to healthcare professionals. Armed with this tangible data, care providers can counsel patients more effectively on following recommended treatments. Rather than simply giving consumers the latest technologies and sending them along, these innovations can be most effective when integrated with a holistic care plan.

Real-time information.

One key advantage of digital resources, such as apps or websites, is the ability to provide real-time information, both to consumers and healthcare professionals. This can help improve how physicians treat people, enabling for more customized recommendations based on personal health histories and a patient’s specific health plan. For instance, new apps are enabling physicians to know which medications are covered by a person’s health plan and recommend lower-cost alternatives (if available) before the patient actually leaves the office. The ability to access real-time information — and act on it — can be crucial in the effort to use technology to empower healthcare providers and patients.

Financial incentives.

Nearly everyone wants to be healthy, but sometimes people need a nudge to take that first step toward wellness. To help drive that engagement, the use of financial incentives is becoming more widespread by employers and health plans, with targeted and structured rewards proving most effective. From using mobile apps and comparison shopping for healthcare services to encouraging expectant women to use a website to follow recommended prenatal and post-partum appointments, financial incentives can range from nominal amounts (such as gift cards) to hundreds of dollars per year. Coupling digital health resources with financial rewards can be an important step in getting — and keeping — people engaged.

The digital health market will continue to grow, with some studies estimating that the industry will exceed $379 billion by 2024. To make the most of these resources, healthcare innovators will be well served to take note of these initial concepts.

SOURCE: Madsen, R. (14 March 2019) "Digital health revolution: What we’ve learned so far" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/digital-health-revolution-what-weve-learned-so-far?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001


To check or not to check: Managing blood sugar in diabetic employees

There's been a growing prevalence of Type 2 diabetes in the U.S. over the last 20 years. This chronic condition significantly impacts employees, their family members and even employers clinically and financially. Read this blog post to learn more.


Over the last 20 years, there’s been a growing prevalence in the U.S. of Type 2 diabetes, a chronic condition that significantly impacts employers, their employees and family members clinically, financially and through quality of life. With that comes an increase in the use of insulin for people with Type 2 diabetes to better control blood sugar to reduce long-term complications, which includes eye, kidney and cardiac disease, as well as neuropathic complications.

Most of these patients manage their condition with oral medicines versus insulin, and it’s estimated that 75% of patients with Type 2 diabetes regularly test their blood sugar, even though doing so may not be needed. Blood sugar testing is an important tool in managing diabetes as it can help a patient be more aware of their disease and potentially control it better. But it also can be painful, inconvenient and costly.

Blood sugar testing can be an important tool in managing diabetes, and there are two types of tests. The first is a test conducted at home by the patient that shows the blood sugar at a specific point in time. The second type is called HA1c (a measure of long-term blood sugar control) that shows the average blood sugar over the last two to three months. The value of at-home testing is now thought to be questionable.

In 2012, the Patient-Centered Outcomes Research Institute began a study to evaluate the value of daily blood sugar testing for people with Type 2 diabetes not taking insulin. The endpoint for the study was whether there was a difference in HA1c levels for those who did daily testing and those that did not. The conclusion of the study found that there were no significant differences between those two populations.

In response to these findings, the institute developed an initiative called Rethink the Strip that involves stakeholders including primary care practices, healthcare providers, patients, health plans, coalitions and employers. Given the cost for test strips and monitors for patients with Type 2 diabetes who test their blood sugar daily, it’s important to adopt an evidence-based patient-centered approach around the need for and frequency of self-monitoring of blood glucose.

As employees and employers cope with the costs associated with blood sugar testing, there are several strategies that should be considered to better manage this issue. They include:

1. Support shared decision-making. Like all interventions within healthcare, it’s important to weigh both the benefits and the risks of daily blood sugar testing in a thoughtful manner between the patient and their provider.

2. Managed benefit design. Employers should pay for daily blood sugar test strips in cases where it brings value (e.g., Type 1 and Type 2 patients who are taking insulin as well as patients that are either newly diagnosed or are going through a transition period, for example, post hospitalization or beginning a new medication regimen).

3. Involve vendors. To ensure alignment in all messaging to plan members, ask health systems and/or health plans and third-party vendors to align their communication, measurement and provider feedback strategies on when it’s appropriate for daily blood sugar testing.

These strategies can help employees with diabetes understand how their daily activities (nutrition, exercise and stress) and medications impact their condition. This benefits the employee in reaching treatment goals and feeling their best, while also helping employers and employees reduce the need for unnecessary and costly test strips.

SOURCE: Berger, J. (14 March 2019) "To check or not to check: Managing blood sugar in diabetic employees" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/managing-blood-sugar-in-diabetic-employees?brief=00000152-146e-d1cc-a5fa-7cff8fee0000


Do paycheck advance apps improve financial health?

Do you allow your employees access to draw money from their paycheck before payday? Many apps now let workers have early access to their money. Read this blog post to find out more about paycheck advance apps and how these may improve financial health.


Fintechs that let workers draw money from their paycheck before payday through an app are having a moment.

Such apps, including Even.com, PayActiv, EarnIn, DailyPay and FlexWage, are designed for consumers who live paycheck to paycheck — roughly 78% of the U.S. workforce according to one study.

More than 300,000 Walmart employees, for example, use this feature, called Instapay, provided by Even and PayActiv. PayActiv, which is available to 2 million people, announced a deal with Visa on Thursday that will let people put their pay advances on a feeless prepaid Visa card.

Earnin, which lets consumers retrieve up to $100 a day from upcoming paychecks, received $125 million in Series C funding from DST Global, Andreessen Horowitz, Spark Capital, Matrix Partners, March Capital Partners, Coatue Management and Ribbit Capital in December. The Earnin app has been downloaded more than a million times.

In theory, such apps are useful to those who run into timing problems due to large bills, like mortgage and rent, which come due a few days before their paycheck clears. Getting a payday advance from an employer through an app can be less expensive and less problematic than taking out a payday loan or paying overdraft fees.

But do these programs lead to financial health? Or are they a temporary Band-Aid or worse, something on which cash-strapped people can become overdependent?

Volatile incomes, gig economy jobs

One thing is clear — many working poor are living paycheck to paycheck. Pay levels have not kept up with the cost of living, even adjusted for government subsidy programs, said Todd Baker, senior fellow at the Richman Center for Business, Law and Public Policy at Columbia University.

“That’s particularly evident when you think of things like home prices and rental costs. A large portion of the population is living on the edge financially,” he said. “You see it in folks making $40,000 a year, teachers and others who are living in a world where they can’t handle any significant bump in their financial life."

A bump might be an unexpected expense like medical treatment or a change in income level, for instance by companies shifting to a bonus program. And about 75 million Americans work hourly, with unstable pay.

“Over the last several decades, we’ve changed the equation for many workers,” said John Thompson, chief program officer at the Center for Financial Services Innovation. “It’s harder to have predictable scheduling or even income flow from your job or jobs. But we haven’t changed the way we pay, nor have we changed the way bills are paid. Those are still due every month on a certain date. This income volatility problem that many people experience hasn’t been offset by giving the employee control of when they do have access to these funds.”

Where on-demand pay comes in

Safwan Shah, PayActiv's CEO, says he has been working on the problems for consumers like this for 11 years. The way he sees it, there are three possible ways to help: by paying these workers more, by changing their taxes, or by changing the timing of when they’re paid.

The first two seem out of reach. “I can’t give more money to people; that’s not what a Fintech guy does,” Shah said. “I can’t invent money. And I can’t change the tax laws.”

But he felt he could change the timing of pay.

“I can go to employers and say, your employees are living paycheck to paycheck,” Shah said. “They’re bringing that stress to work every day. And you are suffering too, because they are distracted — a Mercer study shows employers lose 15 hours a month in work from these distracted employees.”

Shah persuades employers to let their employees access a portion of the wages they have already earned. His early wins were at companies whose employees frequently request paycheck advances, which generates a lot of paperwork. Employees can access no more than 50% of what they have already earned — a worker who has earned $300 so far in a month could at most get $150.

Employees pay $5 for each two-week period in which they use PayActiv. (About 25% of the time, the employer pays this fee, Shah said.)

PayActiv also gives users unlimited free bill pay and use of a Visa prepaid card. In July, PayActiv became part of the ADP marketplace, so companies that use ADP can use its service.

PayActiv's largest employer is Walmart, which started offering it via the Even app in December 2017. In October, Walmart began allowing employees to pick up cash through the app in Walmart stores, so users who were unbanked could avoid ATM fees.

Shah said the service helps employers reduce employee turnover, improve retention and recruit employees who prefer real-time pay. He also has a guilt pitch.

“I was first in the market to this, in 2013,” Shah said. “People looked at me and said, ‘What? I’m not going to pay my employees in advance. Let them go to a payday lender.’ Then I’d show them pictures of their offices surrounded by payday loan shops. I’d say, ‘They’re here because of you.’ ”

Does early access to wages lead to financial health?

When Todd Baker was a Harvard University fellow last year, he studied the financial impact of PayActiv’s earned wage access program. He compared PayActiv’s $5 fee to payday loans and bank overdraft fees.

Baker found that a $200 salary advance from PayActiv is 16.7% of the cost of a payday loan. Payday lenders typically charge $15 per $100 borrowed, so $30 for a two-week, $200 loan. If the borrower can’t pay back the amount borrowed in two weeks, the loan gets rolled over at the original amount plus the 15% interest, so the loan amount gets compounded over time.

With PayActiv, "there is always a full repayment and then a delay before there is enough income in the employee’s payroll account for another advance," Baker said. "It never rolls over.”

Baker also calculated that the PayActiv fee was only 14.3%, or one-seventh, of the typical $35 overdraft fee banks charge.

So for people who are struggling to manage the costs of short-term timing problems and unexpected expenses, Fintech tools like PayActiv’s are a lot cheaper than alternatives, Baker said.

“Does it create extra income? No. What it does is help you with timing issues,” he said.

Aaron Klein, a fellow at the Brookings Institution, said workers should have access to money they’ve already earned, whether that’s through real-time payments or through apps that provide pay advances.

“I also am on board with the idea that by saving your $35 overdraft and saving your payday loan rate, you’ll be better off,” Klein said.

But he’s not willing to say these tools solve the problems of low-income people.

“If the core problem is I used to make $35,000 a year, now I make $30,000, and because of that shock I’m going to end up accruing $600 of payday loan and overdraft fees, eliminating that $600 makes you a lot better off,” Klein said. “But it doesn’t negate the overall income shock.”

Thompson at CFSI says it’s too soon to tell whether earned wage access brings about financial well-being.

“We’re just beginning to explore the potential for these tools,” he said. “Right now they feel very promising. They could give people the ability to act quickly in an emergency and have access to and use funds in lieu of a payday loan or some other high-cost credit or consequence they would rather avoid, like an overdraft fee.”

What could go wrong

Thompson also sees a potential downside to giving employees payday advances.

“The every-other-week paycheck is one of the few normal structures we have for people around planning, budgeting and managing their money,” he said.

Without that structure, which is a form of savings, “we’re going to have to work hard to make sure we don’t just turn people loose on their own with even less structure or guidance or advice on their financial life.”

Another common concern about payday advance tools is that if you give people access to their money ahead of time, they’ll just spend it, and then when their paycheck arrives, they will come up short.

But Klein, for one, doesn’t see this as an issue.

“I trust people more to manage their money,” he said. “The people who work paycheck to paycheck spend more time budgeting and planning than the wealthy, because it’s a necessity.”

A related fear is that people could become addicted to payday advance tools, and dig themselves into a deeper hole.

Jon Schlossberg, CEO of Even.com, somewhat surprisingly acknowledges this could happen.

“Getting access to your pay on demand is a tool you can use the right way or the wrong way,” he said. “If you offer only on-demand pay, that could cause the problem to get worse, because getting access to that money all the time triggers dopamine; it makes you want to do it more and more. If you are struggling with a very low margin and you’re constantly up against it, getting more money all the time accelerates that problem."

Quantitative and qualitative analyses have borne this out, he said.

Even has granted users $700 million worth of Instapays; they typically use Instapay 1.4 times a month. Schlossberg doesn't see high use of the feature as success.

“You shouldn’t need to be using Instapay,” he said. “You should be becoming financially stable so you don’t have to.”

Baker said addiction to payday advances isn't a danger because they don't roll over the way payday loans do. With a salary advance, “It’s conceivable you could get $200 behind permanently, but it’s not a growing obligation and it’s not damaging,” he said.

Shah at PayActiv said users tend to withdraw less than they're allowed to — about 75%.

“When it comes to usage of their own salary, instead of asking for more, people behaviorally ask for less,” he said.

They see PayActiv more as a headache reliever like Tylenol, rather than an addictive candy or drug, Shah said.

Pay advances are just one of many tools that can help the working poor. They also need help understanding their finances and saving for goals like an emergency fund and retirement.

“This conversation about on-demand pay is a double-edged sword because people are paying attention to it now, which is good, but they’re viewing it as this magic tool to solve all problems,” Schlossberg said. “It isn’t that. It is a piece of the puzzle that solves a liquidity problem. But it is by no means going to help people turn their financial lives around.”

SOURCE: Crosman, P. (14 March 2019) "Do paycheck advance apps improve financial health?" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/do-paycheck-advance-apps-improve-financial-health?brief=00000152-146e-d1cc-a5fa-7cff8fee0000

Editor at Large Penny Crosman welcomes feedback at penny.crosman@sourcemedia.com.


4 questions to ask before adding biometric screenings

According to the Kaiser Family Foundation (KFF), fifty-two percent of large firms that provide employee health benefits offer workers the opportunity to complete a biometric screening. Continue reading this blog post to learn more.


A growing number of employers are adopting workplace wellness programs to improve employee health and subsequently lower their health insurance spend. As they do, benefit managers are tasked with vetting options that will deliver meaningful health and financial results for their companies.

This vetting process typically involves answering questions that range from which types of participation incentives their organization should offer to what type of wellness programs will yield the greatest health-improvement outcomes.

But there’s a problem: Very few benefits managers ask for details about wellness biometric testing, even though most programs are, at least in theory, designed around the information that screening provides. Biometric screening typically involves one or more laboratory tests as well as physical readings, such as blood pressure and body weight, to identify markers of health risks if not an actual disease.

According to the Kaiser Family Foundation, 52% of large firms that provide employee health benefits offer workers the opportunity to complete a biometric screening.

Just as workplace wellness programs are not all the same, biometric screening can vary. Failure to question the specific details of a proposed biometric screening program can lead to suboptimal results.

Before moving forward with biometric screenings as part of a workplace wellness program, benefit managers should pause to ask themselves certain questions. Doing so will enhance the likelihood of favorable outcomes — both for employee wellness and the financial bottom line.

1. Why should we screen?

It sounds simple, but setting clear goals for biometric screening is a step too many benefits managers overlook. This may be because they do not know how to anticipate the kind of actions that will be available to them and their employees given the results.

Based on my experience, the most compelling reason to provide biometric screening as part of a wellness program is to help individuals identify risks for several chronic conditions that, if caught early, may be prevented. With insights from a biometric screening, an individual may be better able to take steps to reduce health risks. Common goals may be to reduce body weight, exercise more or visit a physician for treatment.

Biometric screening often can reveal disease risks an individual may not otherwise know. A study published in the peer-reviewed journal PLoS ONE, for instance, found that one in three first-time participants in a company-sponsored, lab-based wellness program by Quest Diagnostics were not aware they were at risk for a serious medical condition, such as diabetes or heart disease, according to biometric screening results. Many of these individuals were in a health plan, suggesting that healthcare access alone does not guarantee preventive care to identify risk for common chronic health conditions.

Biometric screening also can help an employer identify programs to target at-risk employee segments based on the type of risk with appropriate interventions. Reliable insight into disease risks for a workforce population may also aid the prediction of future healthcare costs.

2. What should we screen for?

Ideally, biometric screening should provide enough information into disease risks for both individuals and the employer in order to take meaningful actions. Here, many employers miss the mark by implementing bare bones biometric screening options. The result is potentially misleading results — and missed opportunities to identify individuals at risk.

Take diabetes screening, for instance. A non-fasting fingerstick glucose screening really doesn’t tell us anything considering the variety of food individuals might have eaten, and how that may have affected their measurement.

A fasting fingerstick glucose test may help identify diabetes risk in some individuals and be less costly to perform than a hemoglobin A1c test, which involves a venipuncture blood draw. However, a study from Quest Diagnostics found that some individuals in a workforce population with normal fasting glucose results were still at higher risk for diabetes, and a glycated hemoglobin (HbA1c) test identified them.

In a similar manner, many employers overlook screening for chronic kidney disease, one of the major causes of kidney transplantation. Eighty-nine percent of participants identified as at risk for chronic kidney disease did not know it, according to the aforementioned PLoS ONE study. The estimated glomerular filtration rate (eGFR) lab test can help identify this condition very cost-effectively, but it’s often absent in biometric screening programs. Other conditions that laboratory tests can help identify include metabolic disorders, thyroid disease, and colorectal cancer, among others.

3. How often should we screen?

Annual biometric screening reinforces the importance of management places on employee wellness. It can also help identify health risks in individuals who are new to the organization. An annual program also provides a regular cadence of engagement that is not too onerous on employees while minimizing the confusion that can occur when screening happens less frequently.

Annual screening has an added benefit of allowing the employee to track her progress over time. Quest provides graphic charts that show changes in an individual’s numbers year over year. This is a powerful motivator for those who have adopted healthful behaviors to stay the course. And longitudinal changes also can reveal patterns, like modest annual weight gain, that the individual may otherwise dismiss until they see the cumulative effect.

4. How can we connect employees to care and intervention?

Screening is just one facet of a successful wellness program. Some individuals who identify health risks may proactively modify their behavior or consult a physician. But not all will. Employers can improve the odds of at-risk employees accessing the care they need following biometric screening.

Most employees in biometric programs receive a personalized report of their screening results. Additionally, many participants can consult over the phone with a third-party administered physician.

At Quest, for instance, we offer programs that help at-risk employees access behavioral change programs. If an individual’s screening results suggest evidence of prediabetes, that employee may participate free of charge in a 16-week, CDC-based diabetes prevention program that includes coaching and lifestyle modification. An individual with a problematic cholesterol result may be able to access a similar program for heart disease prevention.

Biometric screenings can be a powerful facet of an employee wellness program. Understanding the reasons to screen, which methods to use and how often to use them, and the paths to connect employees to care are key. Benefit managers who do this well will be rewarded with a wellness program that results in healthier employees and lower healthcare costs over time.

SOURCE: Goldberg, S. (21 February 2019) "4 questions to ask before adding biometric screenings" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/4-questions-to-ask-before-adding-biometric-screenings


How employers can take advantage of the best-kept wellness secret

How can you take advantage of insurance companies’ best-kept secret? Some insurance carries pay wellness dollars to companies who implement wellness programs. Read on to learn more.


Did you know some insurance carriers pay companies to implement wellness programs? It’s called wellness dollars, and it is insurance companies’ best-kept secret.

Wellness dollars are a percentage of a company’s premiums that can be used to cover wellness-related purchases. The healthier employees are, the fewer dollars insurance carriers need to pay out for a policy. Many insurers have incentives like wellness dollars for employers to improve the well-being of their workers.

The benefits of adding a wellness program are plenty. These programs typically generate a positive return on investment for companies. Research done by three Harvard professors found that overall medical costs decline $3.27 for every dollar spent on wellness programs. Costs from absenteeism fall about $2.73 for each dollar. Well-designed programs can improve employees’ overall wellbeing and life satisfaction, according to a report from the U.S. Chamber of Commerce.

It’s a new year, and group health insurance plans are starting fresh. Here’s how employers can take advantage of wellness dollars.

Get in touch with your carrier. The first step is to get in touch with your insurance carrier to find out if your self-insured or fully-insured plan covers participatory or health-contingent programs. If you don’t have wellness dollars, it’s still early in the year, and it’s worth negotiating to see if you can include them in your company’s current package.

You will work with your insurance carrier to determine how your wellness dollars can be spent, based on an agreed-upon contract. The amount of wellness dollars that you receive depends on the number of employees and profitability.

Every company is different, so the range of services varies and could include wellness programs, gym memberships, nutrition programs, massages and more. Sometimes incentives for wellness activities can be used; sometimes it can’t. Ask your carrier for a complete list of covered expenses. This will help you as you shop around to find the right offerings. Save receipts and records for reimbursements.

Determine the best use. There are a few ways to determine what offerings you should use for your company. Before making any decisions, ask your employees and the leadership team what type of program they would be most likely to engage in. Gallup named the five elements that affect business outcomes: purpose, social, community, physical and financial. Look for a comprehensive program that includes these five elements, instead of coordinating with multiple vendors. If only a portion of your expenses will be reimbursed, it’s still worth getting a wellness program. They have cost-savings on an individual and team level.

Wellness programs are all about building culture, and with unemployment at a record low, it’s a sticking point to keep employees invested in your company. A few examples of wellness offerings include fitness classes, preventive screenings, on-site yoga, financial wellness workshops, healthy living educational workshops, and health tracking apps.

Once you’ve implemented wellness offerings in your workplace, keep track of your company’s progress. Create a wellness task force, a healthy workplace social group, or conduct monthly survey check-ins to make sure employees are staying engaged. Some wellness programs utilize technology to track participation, integrate with wearables, and report other analytics. Ask your insurance carrier if wellness dollars have flexibility in adding or changing the services throughout the year, based on engagement.

SOURCE: Cohn, J. (14 February 2019) "How employers can take advantage of the best-kept wellness secret" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/how-employers-can-take-advantage-of-the-best-kept-wellness-secret


Employee wellness programs and compliance: What to know right now

How do you decipher any given wellness program's compliance under the law? Under the Health Insurance Portability & Accountability Act (HIPAA) current guidance, employers need to assess whether the plan is “purely participatory” or “health-contingent.” Read this blog post to learn more about wellness program regulations.


Defining “wellness” for any one person is no simple task, and neither is deciphering a given wellness program’s compliance under the law.

In 2016, when the Equal Employment Opportunity Commission (EEOC) released its final regulations defining a “voluntary” program under the Americans with Disabilities Act (ADA), the entire landscape — at least what can be seen on a hazy day — appeared defined. But thanks to AARP’s successful challenge to these regulations and the EEOC’s recent acknowledgment of the demise of its incentive limitations, employers find themselves back in the “Wild West” of sorts for wellness compliance.

That being said, the uncertainty is not new for employers with wellness programs, and there is now more guidance than before, so let’s take a moment to take in the current view.

The current guidance under the Health Insurance Portability & Accountability Act (HIPAA) remains unchanged, so any wellness program integrated with a health plan or otherwise constituting a health plan itself, employers need to assess whether the plan is “purely participatory” or “health-contingent.” The health-contingent plans (which condition the award of incentives on accomplishing a health goal) will require additional compliance considerations, including—but not limited to—incentive limitations, reasonable alternative standards (RAS), and notice requirements.

The RAS should be of particular importance because they can be missed most out of the compliance parameters. Often there is an “accidental” program such as a tobacco surcharge, and the employer does not even realize the wellness rules are implicated, or the employer’s RAS is another health-contingent parameter that actually necessitates another RAS.

The Department of Labor is actively enforcing compliance in this area, so employers will want to take care.

Additionally, the EEOC’s ADA (and Genetic Information Nondiscrimination Act) regulations are still largely in force. This seems to be a common misconception—ranging from a celebration of no rules to a lament for the end of incentivized wellness programs that include disability-related questionnaires (like an average health risk assessment) or medical examinations (including biometric screenings).

The truth is somewhere in the middle.

The ADA’s own RAS and notice concepts still apply, along with confidentiality requirements. All that has changed is that the EEOC has declined (again) to tell us at what point an incentive turns a program compulsory. So employers sponsoring wellness programs subject to the ADA have three choices, based on risk tolerance (In truth, there are four options, but charging above the ADA’s previous incentive limitations would be excessively risky):

  • Run incentives for ADA plans up to the 30 percent cap that existed before. This is the riskiest approach. To take this route, an employer must rely upon HIPAA’s similar (though not exactly the same) incentive limitations as indicative of non-compulsory levels. The fact that Judge Bates did not accept this argument in the AARP case advises against this approach, but this case does not have global application. If this path is chosen, it will be imperative to document analysis as to why this incentive preserves voluntariness for your participants.
  • Keep the incentives below the previous 30 percent cap but incentivize the program. This approach does have risk because no one knows at what point an incentive takes choice away from participants. However, the incentive is a useful tool to motivate and reward health-conscientious behavior. The wellness incentive limitations stood at 20 percent under the HIPAA regulations for quite some time without much concern, so this could be a relatively safe target. But the most important thing is to carefully assess the overall structure of the program(s) offered, consider the culture and demographics of the employees who may participate, and balance the desire to motivate against the particular tensions of the program to decide on a reasonable incentive. Make sure to document this analysis and reconsider it every time a program changes.
  • Not incentivize the program at all. This is the most conservative approach from a compliance perspective but ultimately not required. Before the EEOC’s 2016 regulations, employers were incentivizing programs subject to the ADA, and nothing about the AARP case or the EEOC’s response to it prohibits incentives.

There’s no doubt the wellness compliance landscape has changed a little over this last year, but this is also just the tip of the iceberg. With enforcement heating up, it is imperative for employers to carefully consider compliance, document the reasonableness of incentive choices and lean on trusted counsel when necessary to avoid potentially costly and time-consuming issues.

SOURCE: Davenport, B. (13 February 2019) "Employee wellness programs and compliance: What to know right now" (Web Blog Post). Retrieved from https://www.benefitspro.com/2019/02/13/employee-wellness-programs-and-compliance-what-to-know-right-now/


Treat Your Weekend Like A Vacation

How did you feel at work this past Monday? According to research, your answer may reveal a lot about your approach to the weekend. Read this blog post to learn more.


Take a moment to recall how you felt at work on a recent Monday. Were you happy and satisfied? Or stressed and worried?

Your answer may reveal a lot about the way you approached the prior weekend. According to our research in progress, making one small mindset change — treating your weekend like a vacation — can increase your happiness. And unlike taking a more traditional vacation, this emotional boost doesn’t have to be expensive or time-consuming.

My colleagues Colin West, Sanford DeVoe, and I came to these conclusions over the course of several studies. First, we looked at the effects of actual vacations on hundreds of thousands of Americans by analyzing the subscription-only 2014–2016 data from the Gallup U.S. Daily Poll. We found that individuals who prioritize vacation are significantly happier: They exhibit more positive emotion, less negative emotion, and are more satisfied in life.

The problem is that Americans are really bad at taking vacations. Compared to workers in the European UnionAmericans spend more hours in the office each week and take less time off. Part of the reason is that the U.S. is the only industrialized nation without legally mandated vacation — one out of four employed Americans receive no paid vacation days at all. But Americans don’t even use the few vacation days they are allotted: More than 50% of Americans leave their paid vacation days unused each year.

This got us thinking. While most working Americans take little time off for vacation, the majority get (and take) two days off from work every week: the weekend. We wanted to see if there’s a way to help people leverage the time they already take off from work to enjoy the potential happiness they would get from a vacation.

To do this, we ran an experiment among more than 400 working Americans over the span of a regular weekend in May 2017. The intervention was simple: On the Friday leading into the weekend, we randomly instructed half of the participants to treat the weekend like a vacation. The other half, serving as a control condition, were instructed to treat the weekend like a regular weekend. That was it. How they interpreted the instructions was entirely up to them. Everyone was left to do whatever they wanted during those next two days.

When participants were back at work on Monday, we followed up with a survey measuring their current happiness (that is, their positive emotion, negative emotion, and satisfaction). The results showed that those who had treated their weekend like a vacation were significantly happier than those who had treated it like a regular weekend. This effect held when we controlled for the amount of money they reported to have spent. Thus, without taking any extra time off from work and without needing to spend any additional money, the simple nudge to treat their time off like a vacation increased their happiness when they were back at work on Monday.

These results seemed too good to be true, so we ran the study again with more than 500 different people on another regular weekend in January 2018. This time, we also measured how happy people were during the weekend, how they spent their time, and the extent to which they were mentally present. The experimental treatment was exactly the same: At random, half were instructed to treat their weekend like a vacation, and the other half were instructed to treat it like a regular weekend. Yet again, the vacationers were statistically happier at work on Monday. They were happier throughout the weekend as well.

How did treating the weekend like a vacation boost happiness? Yes, the “vacationers” behaved somewhat differently: doing less housework and work for their jobs, staying in bed a little longer with their partner, and eating a bit more. These differences in activities, however, weren’t responsible for their increased happiness. Instead, treating the time like a vacation seems to have shifted people’s mindset. Specifically, the vacationers were more mindful of and attentive to the present moment throughout their weekend’s activities.

For example, two women — one in the control group and one instructed to treat her weekend like a vacation — reported making breakfast on Saturday morning. The first woman reported doing so with enjoyment: “Made biscuits and gravy for breakfast. It’s my favorite!” The second woman took her enjoyment one step further: “I woke everyone up with pancakes this morning. It’s something I like to do when we are on vacation. I found myself enjoying the morning more than usual, maybe it’s because I focused on staying in the moment.” The difference between the women’s experience is subtle, but crucial. Even though their activities and behaviors were largely the same, it was the second woman’s attention to the present moment — her mindset — that produced the subsequent effect on happiness during the rest of the weekend and the following Monday.

Why does this mindset shift have such a powerful effect? Research shows that slowing down and paying more attention to your surroundings, the activity at hand, and the people who are involved allows you to enjoy the activity more. Without ruminating on the past or getting distracted by anxieties or fantasies about the future, increasing your attention to the present moment makes you more sensitive to the pleasures that are already in the environment. It helps you savor experiences and life a bit more.

Even if you can’t take the entire weekend “off” because of a looming work deadline or household obligations, it is still possible to gain the benefits of a vacation mindset. You can carve out a piece of the weekend (or perhaps even the workweek) to fully enjoy and be in the present, as you would on vacation. Or you can apply a vacation mindset to whatever task is at hand. Slow down, notice, and make it more fun; turn on some upbeat music in the car while running errands, or make yourself a margarita for folding laundry.

One word of caution: Given that the vacation mindset and resulting happiness stems from mentally breaking from routine and the day-to-day grind, this intervention cannot itself become a routine. Treating every single weekend or evening off from work like a vacation might cause a reduction in its cognitive and emotional impact. We recommend saving the mental vacations for when you really need the break.

When used judiciously, however, this simple reframing allows you to enjoy some of the happiness from a vacation without taking additional time off. Our experiments suggest that your mindset is more important than the activities you take part in, or the amount of money you spend, when you’re not at work. So between weekend errands, soccer practices, and birthday parties, try to notice and appreciate the time you do have. Treating this time like a vacation can provide a needed break from the typical grind, allowing you to appropriately savor moments spent at the soccer field or gathered around the dinner table with family and friends. And when you do head back to work, you’re more likely to feel refreshed and ready to tackle your week.

SOURCE: Mogilner Holmes, C. (31 January 2019) "Treat Your Weekend Like A Vacation" (Web Blog Post). Retrieved from https://hbr.org/2019/01/treat-your-weekend-like-a-vacation


With the Advent of Remote Work, Is the ‘Sick Day’ Becoming Passé?

With many employees working remotely full time, is the practice of employee sick days becoming out of date? Read this blog post from SHRM to learn more.


Your advertising manager works from home full time. She has a nasty cold. But hey—she only needs to walk a few steps from her bedroom to her desk, can nap when she needs to and won't infect her colleagues. So she doesn't really need to take a sick day, right?

Well, she probably should, but as remote work continues to rise, workplace experts find that those who do their jobs from home are inclined to stay on the clock while soldiering through colds, the flu and other maladies—in part because they don't want to appear to be taking advantage of their work-from-home benefit.

"Remote workers find it hard to integrate work with the rest of their life because it is so easy to overwork and even plow through your work while you are sick," said Jeanne Meister, founding partner of Future Workplace, a New York City-based HR executive network and research firm. "If you are only traveling from your bedroom to your home office, remote workers may rationalize, 'What harm can be done if I work while I am sick? At least I'm not contagious.' "

In addition, the advent of remote working has introduced another trend: managers suggesting that onsite employees work from home when they're sick.

"It's no secret that many [workplaces] have cultures that encourage the 'always-on' mentality," said Erica Denner, head of people and culture at YouEarnedIt/HighGround, an Austin, Texas-based company that focuses on employee recognition, rewards and performance management. "In my experience, I've found that because of this, employees at these organizations can find it difficult to ask for time off when they're sick and are often encouraged to work from home instead."

Circumstances Matter

Thanks to technology that facilitates remote work, there are instances when working during what otherwise would have been a sick day may actually be a win for the employee and employer.

"There are all kinds of reasons to take sick days," said Ellen Galinsky, president of the Families and Work Institute and a senior research advisor for the Society for Human Resource Management. "If employees have a condition that affects their ability to be mobile, like a broken bone or torn tendon, they might have to take a sick day if they work in a traditional workplace because travel to work would be difficult, but they could easily work at home. I can think of other such illnesses, such as having something contagious and not wanting to infect others but feeling good enough to work or being postoperative and being able to work in short spurts. Working at home could be ideal for that."

Consider U.S. Supreme Court Justice Ruth Bader Ginsburg, who recovered from cancer surgery at home but nonetheless heard arguments in a case before the court. A court spokesperson said Ginsburg would participate "on the basis of briefs, filings and transcripts," CNBC reported.

But if working while ill prevents an employee from fully resting and recuperating, this will likely hinder performance—and even future productivity and morale.

"If an employee is really sick, he or she might power through and get a few things done but might not do them well," Galinsky said.

Working through your cold, sore throat or flu not only can lead to a decline in physical well-being but "also can present mental health challenges," Meister said.

Contractors, or so-called gig workers, in particular, may be wary of taking sick time. Lacking job security, they may fear that doing so would make them appear dispensable to their employers.

What Employers Can Do

To discourage employees from avoiding sick days because they're working remotely:

Communicate to employees that you expect them to take time off when they're sick. Or, encourage them to be open about how much work, if any, they feel they can accomplish. "If you can't produce high-quality work, even from the comfort of your own home, when you're under the weather, relay that message to your manager," Denner said. "If they value your contributions and are a good supervisor, they will understand and step in to help until you're feeling better."

At YouEarnedIt/HighGround, workers are asked to make it clear when they are out sick and unavailable. This includes setting up not only the typical out-of-office notification by e-mail but also notifications across productivity platforms the company uses, such as Slack. "It's remarkable how effective turning on the 'out sick' emoji in Slack is in terms of alerting colleagues you need time to recover," Denner said. "When employees are out on a longer-term medical leave, we actually remove their technology access so they can't check e-mails or Slack. This way, the employee doesn't feel guilty or obligated to respond to messages."

Talk about the importance of taking sick days for one's physical and mental well-being. Bring up the topic during all-hands meetings with onsite as well as remote workers. In benefits materials and handouts, address the importance of taking sick days.

Ensure that managers and executives take sick days themselves. When a boss shows up at a meeting sniffling and coughing, she sends the clear message that work is too important to be interrupted by illness. And that only leaves her subordinates feeling guilty if they take sick days.

"We've found that [modeling sick-day behavior] actually goes a long way in not just encouraging our employees to do the same, but also in further solidifying a culture of trust and respect," Denner said.

Encourage remote workers to take time for themselves even when they're healthy—such as taking a midday break—and reinforce how this is important for their well-being and productivity.

SOURCE: Wilkie, D. (6 February 2019) "With the Advent of Remote Work, Is the ‘Sick Day’ Becoming Passé?" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/employee-relations/pages/remote-workers-and-sick-days-.aspx


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Why chiropractic services could be the next big thing in wellness

Could chiropractic services be the next big thing in wellness? The American College of Physicians' care guidelines recommends the conservative, non-pharmacologic treatment chiropractors provide. Read on to learn more.


The next popular wellness perk could be offering chiropractic services at on-site medical centers.

On-site or near-site clinics typically offer services to employees including first aid, occupational health, condition management, wellness and ancillary services — and increasingly chiropractic care.

Employees, healthcare administrators and physicians are recognizing the health and employee satisfaction benefits of integrating chiropractic care into multidisciplinary settings, research suggests. Care guidelines from the American College of Physicians recommend the conservative, non-pharmacologic treatment chiropractors provide. Employers are finding that adding chiropractic care to their worksite health center teams reduces direct costs of care, decreases opioid prescriptions for neuro-musculoskeletal episodes and improves health outcomes.

Healthcare costs for employers are expected to reach $15,000 per employee in 2019, according to the National Business Group on Health. The direct and indirect costs associated with low back pain are estimated between $85 billion and $238 billion, and expenditures for back pain are rising more quickly than overall health expenditures. To help stem that growth, as many as 65% of large companies are expected to offer on-site or near-site care by 2020, NBGH reports.

Employer focus on improving workers’ health and wellness has gained momentum in recent years, as evidenced by last year’s announcement from Amazon, Berkshire Hathaway and JPMorgan Chase that they would form an independent healthcare company for their U.S. employees. Another example is employers with self-funded health plans contracting with narrow, high-quality provider networks and even negotiating directly with local hospitals on their prices.

Clinics offer similar cost control and oversight benefits. More importantly, they offer faster and easier access to care that keeps employees healthy, motivated and engaged — and out of the emergency room or hospital. As such, 54% of large employers currently offer on-site or near-site clinics, while another survey showed that 94% of employers reported their clinics improved employee health and 95% said they contributed to increased employee productivity.

Each clinic’s services, cost-sharing, use privileges and staffing can be customized to meet the needs of a specific organization and employer benefit plans. These decisions should be reflective of the objectives of the sponsoring employer and the healthcare needs of the population.

While most healthcare clinics are located on-site or close to the workplace, a growing number are near-site or shared clinic locations, serving populations from multiple locations of the same employer or various employers. Additionally, more care is being delivered virtually. The objective is to provide easy access and immediate attention for employees, at little or no cost, for a host of services and products that an employee would normally have to leave the work site to obtain.

According to a recent survey by the National Association of Worksite Health Centers, the majority of employers reported their workers had expressed interest in chiropractic services at their clinics. The nationwide cost for treatment and management of low back pain and arthritis has reached $200 billion annually. Another study attributes two-thirds of these costs to lost wages and reduced productivity.

The fact that chiropractors deliver drug-free therapies should be particularly meaningful to employers in light of the country’s opioid abuse epidemic. The good news is a recent study published in “The Journal of Alternative and Complementary Medicine” concludes that for adults receiving treatment for low back pain, the likelihood of filling a prescription for an opioid was 55% lower for those receiving chiropractic care than for adults not receiving chiropractic care.

In particular, chiropractors follow evidence-based and value-based guidelines to promote safety and effectiveness. Findings like these and many others show that by adding chiropractic care, employers will strengthen the opportunity for cost savings, improved outcomes, greater worker productivity and stronger employee retention.

SOURCE: Lord, D. (25 January 2019) "Why chiropractic services could be the next big thing in wellness" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/why-chiropractic-services-could-be-the-next-big-thing-in-wellness?brief=00000152-14a7-d1cc-a5fa-7cffccf00000


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Analytics are key to wellness success. Here’s why

How can benefits managers utilize analytics to maximize their companies’ investments? Continue reading to learn how analytics can help employers optimize their health, wellness and other benefits programs.


What do benefits managers have in common with Walmart? Both have the power to leverage data to create a sustainable competitive advantage.

Like other leading retailers, Walmart mines vast quantities of data and applies predictive analytics to fuel solutions that improve store checkout processes, maximize inventory turnover and optimize product placement. Data analytics also helps the company identify shoppers’ preferences and personalize their shopping experiences. New parents, as identified by prior purchases, might receive digital coupons for infant products, for instance.

Walmart’s data intelligence gives the international retailer the ability to act upon insights quickly. One Halloween, for example, a novelty cookie generated high sales across the United States, but no sales at all in two U.S. stores. The company’s data analytics swiftly ascertained that the cookies were never put on the shelves at those stores. The problem was resolved immediately through high-visibility product placement.

Employee benefits managers have similar opportunities to maximize their companies’ investments. The effective use of disparate data can help employers optimize their health, wellness and other benefits programs, and pinpoint the true value of their total rewards.

A data-driven approach to benefits analytics

Three out of five U.S. employers use health screenings and risk assessments to help employees detect conditions earlier, when treatment might be more effective and costs lower. However, the majority of employers do not measure the impact of these programs.

Those that do assess a program’s impact typically compare the dollars spent on it with the medical claims saved. Forward-thinking benefits managers, however, are examining the total value of investment (VOI) instead. This innovative approach analyzes not only the effect of a wellness initiative on medical costs but also its influence on productivity, absenteeism, disability costs and other factors.

By aggregating and analyzing different types of data — such as claims and non-claims data — benefits managers can determine crucial correlations between preventive screenings, health outcomes and healthcare costs. Thus, they can develop more targeted benefits packages that reduce costs while improving overall employee health and productivity.

Case Study: Implementation of predictive analytics in preventative screenings

One recent initiative undertaken by a state employee health plan demonstrates the power of data analytics to reveal the VOI of preventive cancer screenings.

The state provides medical benefits to around 205,000 employees and dependents. The agency that administers the benefits program wanted to know whether preventive cancer screenings improved health outcomes, and whether the program was cost effective. Analyzing screening and claims data showed that 6% to 8% of those who underwent screenings for breast, colorectal or cervical cancer received a diagnosis of cancer or a related condition. The follow-up and all-important question was: did those members experience different outcomes than members whose cancers were not detected through screenings?

The results indicated a high VOI for members’ preventive cancer screenings:

  • The majority of new cases of breast, colorectal and cervical cancer were detected through preventive screenings.
  • Among members who received preventive screenings, 5% to 11% underwent treatments because of screening results — and not just for cancer. Treatments included removal of benign tumors or polyps.
  • Those diagnosed with breast, colorectal or cervical cancer through the screenings experienced less invasive treatments and had fewer complications than those diagnosed through other means.
  • New cases of breast and cervical cancer diagnosed through the preventive screenings had lower costs, on average, than cases detected through other means.

Positive action through data

This cancer screening example illustrates how data analysis can empower benefits managers to improve employees’ health outcomes while reducing costs. Analytics can help employers invest in more effective care management resources, as well as design benefits packages that provide positive VOI in wellness, screening and preventive care.

With the cost of health benefits continuing to rise, it’s critical to leverage data to determine the total value of wellness investments. Just as retailers use data analytics to improve the retail experience and increase profits, benefits managers should use data analytics to guide the design and evaluation of benefits and other rewards.

SOURCE: Kramer, M. (21 January 2019) "Analytics are key to wellness success. Here’s why" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/analytics-are-key-to-wellness-success-heres-why