New direct primary care rules are a tough pill for HSAs
For many Americans, direct primary care has taken control of medical costs, which has cut through many frustrating options and has created a peach of mind when it comes to both health and its costs. Read this blog post to learn more
As an employee benefits attorney and compliance consultant, last summer’s executive order on “improving price and quality transparency in American healthcare to put patients first” piqued my interest. In particular, I honed on in section 6(b), aimed at treating expenses related to direct primary care arrangements as eligible medical expenses.
As someone dealing with a complicated medical history, digging into the order and digesting the resultant proposed IRS rule was more than my job – it was and is part of my life.
Several years ago, I decided to give direct primary care a try. For about $100 a month, I gained direct access to and the undivided attention of a physician who knows me and my unique medical needs. I pay a flat, upfront fee and my doctor coordinates and manages my treatment, which isn’t always smooth sailing for someone dealing with a complex connective tissue disorder. My primary care physician serves as the coach and quarterback of my medical care, directing tests, meds, and visits to various specialists like rheumatologists or neurologists. If I have a common cold or infection, she’s readily available to prescribe treatment and set my mind at ease.
Since arriving on the scene in the 2000s, direct primary care has grown in popularity and availability. In the age of skyrocketing monthly premiums and a multitude of confusing options, more Americans are flocking to direct primary care to supplement their existing coverage. Some employers are even looking at it to drive down costs.
Now, direct primary care only covers, well, primary care, so I’ve paired it with a high-deductible healthcare plan and a health savings account to pay for my many additional medical expenses. I’m not alone: more than 21 million Americans are following the same path.
However, rather than making direct primary care more accessible, the proposed regulations actually make it virtually impossible for all of us with HSAs. Remember, by law, to qualify for an HSA, individuals must be covered by a high deductible health insurance plan. The rationale for this is consumers with more on the line are more responsible in controlling their health care costs and thus rewarded with the tax-advantaged benefits of an HSA.
Here’s the problem: the proposed regulations define direct primary care as a form of insurance – one that is not a high-deductible health plan and would therefore disqualify me from having access to an HSA.
Regulators point out that direct primary care arrangements provide various services like checkups, vaccinations, urgent care, lab tests, and diagnostics before the high deductible has been satisfied. According to the preamble to the proposed regulations, “an individual generally is not eligible to contribute to an HSA if that individual is covered by a direct primary care arrangement.”
Keep in mind, 32 states consider direct primary care a medical service rather than a health plan and exempt it from insurance regulation. Even the Department of Health and Human Services shares that view, noting in a March 12, 2012, final exchange rule that “direct primary care medical homes are not insurance.” In addition, the proposed rule itself includes some contradictory language and implications when it comes to defining direct primary care relating to other factors.
By its very nature, direct primary care is a contract between patient and physician without billing a third party. In cutting out the insurance companies, it seems obvious that direct primary care is not a competing insurance plan, but instead, a valuable service that can accompany existing coverage.
Furthermore, there is no clear justification for painting direct primary care as disqualifying medical insurance for those with HSAs. The IRS has more than enough flexibility and discretion to determine that direct primary care does not count as insurance. Regulators could do so while still treating direct primary care as a tax-deductible medical expense, which seems to be the intention of the proposed rule in the first place.
For millions of Americans, direct primary care has been a godsend in taking control of medical care, cutting through frustrating options, and gaining peace of mind when it comes to both health and healthcare costs. In short, direct primary care is everything primary care should be and was supposed to be. It’s an option that individuals should be permitted to access to complement (not compete with) high deductible health insurance plans and HSAs.
Although the comment period for the proposed regulations is now over, I am hopeful with a few tweaks and small changes they can better align with the stated purpose of the executive order, empowering patients to choose the healthcare that is best for them. If not, the new rules would likely be a hard pill to swallow for the entire direct primary care community.
SOURCE: Berman, J. (26 August 2020) "New direct primary care rules are a tough pill for HSAs" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/new-direct-primary-care-rules-are-a-tough-pill-for-hsas
What employers are missing in their workforce data
If employers don't analyze their data thoroughly, they may be missing valuable information that could save their establishment of many costs. Read this blog post to learn more.
Employers are missing out on valuable healthcare information and cost-saving opportunities if they don’t analyze their data thoroughly, panelists at the annual Disability Management Employer Coalition digital conference said.
According to professionals from an insurance company in Portland, Ore., many employers have access to three types of data: healthcare, absence and productivity. HR departments are typically tasked with collecting and analyzing this data, but rarely do they use all three together. But maximizing these findings can help employers better inform their benefit decisions, the panelists said.
“Most employers want to know how much they’re spending on healthcare, but they can learn so much more than that,” said Case Escher, managing partner of the insurance company in Portland, “Very few [employers] use it to explore how health of the workforce is affecting productivity.”
“By comparing health data and absence, you can see if a health condition is causing an employee to miss more work than usual,” said Brycie Repphun, account executive at the insurance company in Portland. “You can use this information to help better inform that person about the services available to them to help them be successful at work.”
Employers can also use their productivity data to help determine if individual employees, or an entire team, are struggling, Escher said. Since productivity is measured differently at every company, and in various positions, employers have to exercise their own judgement about how to interpret it, he said.
“Obviously, if it’s a sales position, and one of your top performers is out because of medical issues, or another personal reason, the productivity of that team is going to suffer,” Escher said. “And if that person is going to be out for a while, the data will likely show that the rest of the team is getting burned out faster to compensate for being understaffed.”
Since the majority of the nonessential workforce is working from home due to the pandemic, Repphun recommends that employers start looking at their data to see how employees are coping.
“Health conditions can definitely impact work performance, but we’re finding that this is happening because of the current work from home situation,” Repphun said. “People aren’t working in ideal conditions, and many have children learning at home as well.”
Escher said self-funded employers are better positioned to make use of their workforce data because they don’t have to go through multiple third-party providers to access all of it. But other employers can still benefit from the information if they’re willing to put in the time and effort to retrieve the reports. While employers can certainly survey their workforce to gauge how working remotely is affecting their productivity, Escher and Repphun said they can get a clear answer by looking at all three data points.
“There’s an indisputable link between health and productivity,” Escher said. “As an employer, you can take this information and use it to make smart decisions to help your employees continue to be successful.”
SOURCE: Webster, K. (31 August 2020) "What employers are missing in their workforce data" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/what-employers-are-missing-in-their-workforce-data
5 ways to prepare for open enrollment during COVID-19
As open enrollment draws near, it's time to critically prepare for it especially during the crazy time that the coronavirus pandemic has brought to many families. Read this blog post to learn more.
The COVID-19 pandemic has focused consumer attention on health care, germs and the impact a single illness can have on their lives, livelihoods and loved ones. With the fall open enrollment season just months away, you have the opportunity to think more critically about the specific plans you choose for yourself and your family, as well as any voluntary benefits that may be available to you, including childcare, elder care and critical illness. In a world where it feels like health is out of the individual’s control, we all want, at the very least, to feel control over our coverage.
As we know all too well, there’s a lot to consider when it comes to choosing and using health care benefits. The most important piece of becoming an informed health care consumer is ensuring you have access to — and understand — the benefits information you need to make smart health care choices. Here are five tips to keep in mind as you prepare for and participate in open enrollment.
1. Prepare for COVID-19 aftermath
As if dealing with the threat of the virus (or actually contracting it) wasn’t enough, consumers must consider the unexpected consequences. Quarantines, stay-at-home orders and business shutdowns have resulted in missed preventive care visits — including annual immunizations. For instance, many children will have missed their preschool vaccinations, which could result in an uptick in measles, mumps and rubella. If school is conducted virtually, the risk of catching one of these highly contagious diseases is somewhat reduced, though consumers should still proceed with caution as states reopen. In fact, with continued waves of COVID-19 expected well into the school season, you and your children may have to wait even longer to get vaccinations due to pent up demand and possible shortages.
Don’t forget that preventive care is covered by most plans at 100% in-network regardless of where that care is received. Schedule your appointments as soon as possible (and permissible in their area), and research other venues for receiving care, such as pharmacies, retail clinics and urgent care facilities. Most are equipped to provide standard vaccinations and/or routine physicals.
Unfortunately, there are also the long-term implications of COVID-19 to consider. Research suggests that there are serious health impacts that emerge in survivors of COVID-19, such as the onset of diabetes and liver, heart and lung problems. And many who were able to ride out the virus at home are finding it’s taking months, not weeks, to fully recover. As a result, you should prepare for the possibility that you, or a loved one, may be ill and possibly out of work for an extended period of time. Be sure to evaluate all of the plans and programs your employer offers to ensure your family has the financial protections you need. For some, a richer health plan with a lower deductible, voluntary plans such as critical illness or hospital indemnity insurance, and buy-up life and disability insurance may be worth investigating for the first time.
2. Re-evaluate postponed elective procedures
Many employees or their family members have postponed or skipped elective procedures — either from fear of exposure to COVID-19 at hospitals and outpatient facilities, or because their hospitals and providers cancelled such procedures to conserve resources to treat COVID-19 patients. As a result, an estimated 28.4 million elective surgeries worldwide could be canceled or postponed in 2020 due to the virus.
As hospitals reopen, it may be difficult to schedule a procedure due to scheduling requirements and pent up demand. A second opinion may be in order if your condition stabilized, improved or worsened during the delay; there may be other treatment options available.
A delay in scheduling also provides an opportunity to “shop around” for a facility that will provide needed care at an appropriate price — especially if you are choosing to go out-of-network or have a plan without a network. Researching cost is the best way to find the most affordable providers and facilities with the best quality, based on your specific needs.
Many medical plans offer second opinion and transparency services, and there are independent organizations who provide “white glove,” personalized support in these areas. Read over your enrollment materials carefully, or check your plan’s summary plan description, to see what your employer offers. If nothing is available, ask your employer to look into it, and don’t hesitate to do some research on your own. Doing so can often result in substantial cost savings, without compromising on quality of care.
3. Confirm your caregivers
Because so few elective procedures were performed during the initial phases of the pandemic, many hospitals sustained huge financial losses. As a result, many small hospitals are closing, and large hospitals are using this opportunity to purchase smaller, independent medical practices that became more financially vulnerable during the pandemic. Further, many physicians have opted to retire or close their practices in light of the drastic reductions to their income during local shutdowns.
Be sure to check up on your preferred health care providers — especially those you might not see regularly — to confirm they are still in business and still in network (if applicable). If you live in a rural area, you may have to travel farther to reach in-network facilities. If you’re currently covered by an HMO or EPO, you may want to evaluate whether that option still makes sense, if your preferred in-network providers are no longer available.
4. Look at ALL the options
Voluntary coverages — such as critical illness, hospital indemnity, buy-up disability, and supplemental life insurance — may help ease your concerns about how you will protect your and your family’s finances if you become ill. Pandemic aside, these benefits can provide a substantial safety net at a relatively low cost. Investigate your employer’s offerings — many employers are offering virtual benefit fairs where vendors can provide more information about these benefits while remaining safe from large social gatherings.
When was the last time you changed your medical plan? If you’ve been keeping the same coverage for years, it might be time to look at what else is available. Your employer may have introduced new plans, or you may find that a different plan makes more sense financially based on how often you need health care. Don’t forget — the cheapest plan isn’t always the one with the lowest premiums.
5. Uncover every resource available
Besides your health coverage (medical, dental and vision), many employers offer other plans and programs to support your health. While you’re already focused on benefits, take the time to learn about what else is available to you. These offerings may range from the previously mentioned advocacy and transparency services and voluntary benefits, to personalized, one-on-one enrollment support, to telemedicine services and an Employee Assistance Program (EAP). Also, many employers made temporary or permanent plan changes to address COVID-19 regulations and concerns. Be sure to familiarize yourself with these changes — and when they might expire.
You may also want to consider setting aside funds in a health savings account or health care flexible spending account (if available). If your employer offers a wellness program, this might be an opportunity to start adopting better health habits to ensure you’re better equipped physically and mentally to deal with whatever lies ahead.
While open enrollment may seem daunting, devoting an hour or two to reviewing your plan options, the programs available to support you and your family physically, mentally and financially, and how to get the most from the coverages you do elect, can go a long way towards providing peace of mind as we face the unknowns of 2021.
SOURCE: Buckey, K. (17 August 2020) "5 ways to prepare for open enrollment during COVID-19" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/list/5-ways-to-prepare-for-open-enrollment-during-covid-19
3 ways to support workplace well-being during COVID-19
The coronavirus has created many struggles for employees to deal with, and some of the struggles will continue even after measures become lifted. Read this blog post to learn more.
Personal and professional worlds are colliding in ways that have never been seen before, leading employees and employers to navigate new challenges in uncharted waters. As employees continue to struggle with balancing work and personal obligations at home, they are dealing with emotional, physical and financial consequences from the pandemic. Some of these struggles will remain even after social distancing measures are lifted and the economy stabilizes, and they could have a lasting impact on people’s overall wellness.
While many companies are rightfully focused on the bottom line and maintaining business operations throughout the pandemic, it is equally important that they take steps to ensure their employees are supported throughout this tumultuous time. Employee well-being is directly tied to business health, which is why it is so important for organizations to optimize their benefits and deliver the right health and wellness offerings for their workers.
Reassess employee benefit programs
The pandemic is raising awareness that total wellbeing, not just physical health, is a key component to success for businesses and the economy. Employees that are facing at home pressures or feeling financially insecure may be less productive or distracted during the workday, which can impact company success. COVID-19 has hit companies hard. Many are looking for places to trim costs, but benefits and wellbeing programs are not an area they can afford to cut.
Diabetes, depression, mental health and financial stress are on the rise with the majority of employees dealing with unprecedented challenges like childcare, caring for family members who are sick or otherwise impacted by COVID-19 and general anxiety about their future. Cutting benefits programs now may save a few thousand dollars today only to spend tens of thousands of dollars on healthcare costs tomorrow.
Employers who understand the value of employee benefits programs will fare much better than those that guess which programs will be effective. This is an ideal time for businesses to re-assess their current well-being offerings to ensure the programs they are investing in align with the needs of their workforce. It’s also essential that employers make sure employees are aware of the wellness offerings available to them and how to use them. Therefore, it’s important for businesses to increase their communications to employees around wellbeing programs that can help provide physical, mental and emotional support through the pandemic and beyond.
Evaluate current and future employee needs
Not all people are the same, which is why one-size-fits-all programs fail. A successful well-being program should be personalized to best meet employees’ current and future needs. This can be difficult, especially when considering environmental and lifestyle factors, but with the right partner it can be done effectively. Many large employers are working with a partner that leverages social determinants of health data such as household composition, purchasing habits, education and income level and more, to identify individual employee needs.
Employers should also evaluate new types of resources to accommodate the “new normal”. Case in point: we have seen double digit increase in engagement with financial wellbeing and EAP resources. Telehealth and remote condition management programs are on the rise as well as stress management and resilience programs. For example, “Linda” has diabetes, so she needs to know the COVID-19 risks associated with her condition. She may also need extra support to ensure she is keeping up with her healthy eating and exercise regimen during quarantine. Connecting her with a remote diabetes program like Livongo or Virta Health can help Linda feel valued and stay on track. Or, “Tom” has been having severe back pain and his doctor recommends he have surgery to correct a spine-related issue. But not all health systems are offering elective surgeries right now, so he is better off with a telehealth pain management program like Telespine or Hinge Health, Physera and Simple Therapy.
This information allows employers to personalize the health and wellness plans they offer to employees and provide them with the right tools to make their healthcare journeys easier as they navigate this new way of life. Employers will also see the benefits in healthier, happier employers, increased productivity and potentially lower long-term healthcare costs.
Have a solid strategy for returning to work
COVID-19 return to work programs will require an increase in spending for heightened safety measures, such as enhanced cleaning and disinfection practices, employee daily temperature checks (which are now required by some states) and developing and implementing policies and procedures that address preventing, monitoring for and responding to an emergence or resurgence of COVID-19 in the workplace.
As businesses begin reopening workspaces, it is critical for leaders to have a solid employee engagement plan in place to keep workers safe. Be sure to clearly and effectively communicate new safety protocols to employees, so they can feel safe going to work as offices reopen. Invite employees to discuss any concerns they may have in an open forum or via a survey and involve them in problem-solving. Listen to their needs both personally and professionally as our lives will be complicated for months, and possibly years to come. It sounds cliché to say that people are companies most valuable assets. However, it could not be more true right now. It’s time for businesses to make employees’ wellbeing a priority and step up to the challenge of evolving their programming to meet current and future needs. Both the business and its employees will benefit.
SOURCE: Hinkle, C. (19 August 2020) "3 ways to support workplace well-being during COVID-19" (Web Blog Post). Retrieved from employeebenefitadviser.com/opinion/3-ways-to-support-workplace-well-being-during-covid-19
Strategies for making mental healthcare core to your organization
Mental health in the workplace has been a topic of discussion for a continuous-time, but due to the coronavirus and many rules and regulations beginning to rise, there has been a rise in mental health numbers these past few months. Read this blog post to learn more.
American workers’ mental health improved last month after hitting a three-year low, but overall remains poor, as people struggle with the physical, psychological and financial stressors of the pandemic.
According to HR technology company Morneau Shepell’s May Mental Health Index, which surveyed 5,000 U.S. employees, the overall mental health score for May was -6, up slightly from April’s score of -8, the lowest in the last three years. However, with negative scores indicating worse mental health, the results show that American sentiment remains low.
The rise in May is likely due to state decisions to begin a phased reopening of non-essential retail businesses and restaurants, as well as employers allowing workers to return to the physical workplace, says Paula Allen, the senior vice president of research, analytics and innovation at Morneau Shepell.
“People are starting to see the light at the end of the tunnel,” she says. “But this is for sure not going to be linear. The possibility of a second wave of COVID is quite high.”
The coronavirus and its economic impact is not the only uncertainty that employees are facing. Protests demanding racial equality and justice for the victims of police brutality have erupted across the nation in response to the deaths of George Floyd and Breonna Taylor. Thirty-percent of Americans experienced symptoms of anxiety last week, according to data from the CDC.
“It’s kind of like having the Spanish Flu, the Great Depression, and the Civil Rights Movement all at the same time,” Allen says. “It would be unusual if that doesn’t impact people’s mental health and well-being because you really are taking away a sense of predictability, a sense of certainty, a sense of safety, with all of these things happening at the same time.”
The coronavirus crisis has brought to light the necessity of promoting better mental health in the workplace. Seventy-eight percent of companies offer an EAP with mental health resources, according to the Society for Human Resource Management. Ninety-three percent of companies have encouraged employees to take advantage of EAP resources like telehealth and virtual mental health programs in response to the pandemic, a recent Business Group on Health survey found. Morneau Shepell recommends that employers make mental health more visible in the organization and continue to provide support for employees.
“It works very well when an organization doesn’t look at mental health as a separate program or a separate project that they have a coordinator working on. It’s really built into their business culture as something that they see as valuable and they look for opportunities in every single way to help their employees,” Allen says.
With organizations feeling the effects of the economic downturn, 34% of companies in North America are considering or have implemented pay cuts, according to research from Korn Ferry.
The Morneau Shepell research shows, however, that this can actually be more detrimental to morale: Employees whose salaries were cut had lower mental health scores on the Mental Health Index than those who lost their jobs.
Those who experience a salary cut are put in “a position of limbo” as opposed to having “a clean break” from an employer, Allen says. While an organization may look at reducing an employee’s salary as a lesser evil when compared to terminating them outright, this can cause more anxiety than actually letting the employee go.
“The main thing is we’ve put people in a position of uncertainty, and that increases anxiety, ” she says. “It’s an important thing for organizations to pay attention to because often they will feel that it is a benevolent thing not to terminate someone but to keep them in a way that they can afford, which is to reduce salary. But the other side of the coin is recognizing that this does have a very real impact on people, and anything that those organizations can do to continue to make those people feel connected, to continue to make them feel valued and recognized, make sure that there’s outreach to them by managers, anything to balance the situation is what we would recommend.”
To improve mental health in the workplace, leaders should talk about the importance of good mental health and make employees aware of support services offered, such as an employee assistance program, Allen says.
“Make mental health a very visible thing in the organization. Communication from senior leadership that speaks about the importance of mental health, that the organization cares about the employees’ mental health, and makes sure that people are aware of services that the organization might sponsor,” she says. “That strong voice is important to build awareness and to reduce stigma.”
Organizations must also train their managers on how to handle mental health issues in the workplace. Sometimes managers will notice a change in an employee’s behavior and be at a loss as to how to deal with it, Allen says.
“They might ignore it, they might let it get worse, they might try to step in and become a counselor when they’re not a counselor,” she says. “But if a manager handles that situation well, often it’s a good trigger point for the employee to get the kind of help that they need.”
SOURCE: Del Rowe, S. (12 June 2020) "Strategies for making mental healthcare core to your organization" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/strategies-for-making-mental-healthcare-core-to-your-organization
How Hospitals Can Meet the Needs of Non-Covid Patients During the Pandemic
As there has been many waves of coronavirus cases for many months, health care has seemed to only point to helping those who have been impacted by the virus. Although there are still many cases that test positive for the virus, there has been a dramatic decline in other non-COVID related health issues. Read this blog post to learn more.
During the initial wave of the Covid-19 pandemic, hospitals worldwide diverted resources from routine inpatient critical care and outpatient clinics to meet the surge in demand. Because of the resulting resource constraints and fear of infection, clinicians and non-Covid patients deferred “non-urgent” visits, evaluations, diagnostics, surgeries and therapeutics. Indeed, early in the pandemic physicians and leading public health officials noted a dramatic decline in non-Covid-related health emergencies, including upwards of a 60% decrease in patients with acute myocardial infarctions and strokes.
Drawing on key principles from operations management and applying a health-systems perspective, we propose four strategies to facilitate care of non-Covid patients even as hospitals are stretched to absorb waves of patients with Covid-19.
1. Innovate outpatient management to reduce demand at downstream bottlenecks.
To reduce future bottlenecks in emergency departments (EDs) and hospitals, outpatient clinicians should expand their proactive management of patients at high risk of needing acute or inpatient services, such as those with poorly managed hypertension or diabetes, and triage patients with acute needs to EDs now in order to reduce more serious complications later. This will help reduce potential future spikes in demand on EDs and inpatient beds from non-Covid patients.
While most clinicians have rapidly adopted some form of telemedicine, they will need to increase their digital engagement with high-risk patients in a more targeted fashion. Clinicians should evaluate their patient panels to identify high-risk individuals and initiate telemedicine visits, rather than relying on patients to initiate contact, similar to the process for proactive disease management used by several community health care organizations.
Although high-risk patients will vary by specialty, targeted populations may include patients recently discharged from the hospital and those at high risk for hospitalization, including those with uncontrolled heart failure or active malignancy. To facilitate remote patient monitoring of high-risk patients, clinicians may opt to send telehealth kits tailored to patients’ medical and technological needs. These kits may include connected health devices such as blood pressure monitors, pulse oximeters, and heart rate monitors, and even mobile technology devices such as tablets or smart phones. To most effectively leverage telemedicine during the pandemic, clinicians must also promote multidisciplinary virtual collaboration across primary care clinicians, specialists, social workers, home health clinicians, administrative support, and patients and their caregivers.
2. Combine essential non-Covid inpatient services across hospitals.
To balance demand across hospitals, public health officials should apply a version of the logistics strategy known as “location pooling,” combining demands from multiple locations. Rather than each hospital in a region redundantly providing the full suite of essential inpatient non-Covid clinical services, each of these services should be concentrated at one location. For example, each region should have a single designated cancer center, transplant center, stroke center, and trauma center. Implementing this strategy is fraught with challenges as hospitals are currently organized independently and compete with one another for patients and revenue. Nevertheless, during the initial Covid-19 wave, several hospitals in Boston collaborated to share data on the availability of hospital beds to efficiently route patients based on their clinical need and the available capacity. And centralization of acute stroke care, in which patients are taken to central specialty hospitals rather than the nearest hospital, demonstrates both the feasibility and potential improved outcomes of utilizing this approach in several countries including the United States, Canada, the Netherlands, Denmark, and Australia.
Crises require all possible realizations of economies of scale. Location pooling mitigates variability in service-specific demand faced by each hospital. As demand falls for specific non-Covid services at an individual hospital (e.g., for acute stroke care), hospital administrators can close those services and repurpose the specialty capacity to care of Covid-19 patients with underlying conditions, as discussed below. If all hospitals implement this strategy, not all non-Covid services will be available at every hospital. However, location pooling draws demand from across hospitals, ensuring that as a given hospital loses some patients it gains others, allowing it to maintain sufficient census to remain fiscally viable.
Centrally coordinated regional organization, similar to mass casualty planning, is critical to ensure that each essential service remains fully operational for routine emergencies, while adapting to dynamic changes in the region’s hospital capacity. The number of hospitals to include in location pooling should be determined by weighing the tradeoff of efficiency gains from pooling across more locations versus inefficiencies from increased travel time incurred by patients and emergency medical services.
3. Group hospitalized Covid-19 patients by their underlying clinical conditions.
At the same time that hospitals should be location-pooling specialty services for non-Covid patients, to the extent possible they should place their Covid-19 patients who have serious underlying health issues (e.g., cardiac conditions) with other Covid-19 patients with the same condition. In each of these “cohorted wards,” redeployed clinical staff from the relevant specialty service, such as cardiology, can provide essential specialty care alongside clinicians addressing patients’ Covid-specific care needs.
While such cohorting limits efficiency gains from pooling all Covid-19 patients in one ward, it maintains specialty care for patients who still need it while reducing the additional inpatient capacity strain resulting from patients being dispersed across the hospital. Indeed, prior research demonstrates that displacing patients from cohorted specialty units is associated with prolonged hospital length of stay and more frequent readmissions.
4. Discharge patients into post-acute care based on Covid-19 status.
Nursing home, rehabilitation hospital, and long-term acute care facility leadership should collaborate to establish separate regional, specialized, post-acute care facilities for Covid-19 and non-Covid patients. Sending patients to specialized post-acute care facilities based on their Covid-19 status will facilitate discharge planning, improving patient flow out of the hospital for Covid-19 and non-Covid patients alike. This will relieve strain at ED and hospital bottlenecks while maintaining care quality. Furthermore, having dedicated post-acute care facilities for Covid-19 patients will preserve post-acute care capacity for those recovering from non-Covid illnesses, while lowering their risk of becoming infected.
Challenges to this model include ensuring timely access to Covid-19 testing and rapid test results to guide appropriate patient routing. To prevent discharge delays due to testing constraints, hospitals need to implement rapid tests more widely, and post-acute care facilities should designate quarantine areas for patients to receive care while awaiting results.
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These strategies will undoubtedly be challenging to implement. But now is the time to rethink health care delivery and adopt operations management strategies with demonstrated success that are most promising. This will allow us to be better prepared for future waves of the Covid-19 pandemic.
SOURCE; Song, H.; Ezaz, G.; Greysen, S. Ryan.; Halpern, S.; Kohn, R. (14 July 2020) "How Hospitals Can Meet the Needs of Non-Covid Patients During the Pandemic" (Web Blog Post). Retrieved from https://hbr.org/2020/07/how-hospitals-can-meet-the-needs-of-non-covid-patients-during-the-pandemic
Navigating the New Normal in International Business Travel
The coronavirus pandemic has placed many restrictions on travel for both leisure and business. As parts begin to open up and lift certain regulations, organizations are now looking at travel for the business, and if those are possibilities once again. Read this blog post to learn more.
What can your company expect in terms of your employees' ability to travel internationally as parts of the world begin to come out of months of lockdown?
And what will the ongoing restrictions and changes in everyday life mean for your company's ability to transfer or hire new foreign national talent in key areas? Only time will tell exactly what will happen, but we are beginning to see patterns and hints of what is to come.
Some countries that have managed to flatten the curve of COVID-19 infections are gradually easing restrictions on freedom of movement and commerce. This is typically being undertaken cautiously and in a multistep fashion. Other countries have been slower to ease travel restrictions. A broad travel ban remains in place in China, and countries in Latin America continue to extend travel limitations with a wary eye on the outbreak in Brazil.
International travel restrictions on freedom of movement are being eased, albeit more slowly than domestic restrictions. We expect that the easing of international travel restrictions will be incremental in nature as the easing of domestic restrictions has been. We also expect that quarantine requirements for arriving travelers are likely to be put into place in many locations, significantly hampering international business travel.
Arriving travelers are also likely to be questioned more closely than in the past regarding their recent travels, health, reasons for visiting and plans for satisfying quarantine requirements. Although the primary purpose of the vetting may be to limit the spread of COVID-19, an unintended consequence may be that the purpose of the visit and whether the traveler has the correct documentation is scrutinized more closely than in the past. If the traveler is attempting to enter to engage in productive or remunerated work—which often includes consulting, commissioning, installing, troubleshooting and, in some countries, even training or audit activities—without the proper work visa, they are likely to be identified and denied entry.
Governmental migration authorities around the world are beginning to either ramp back up where they were operating at limited capacity or to reopen where they were shut down completely. But although many facilities are ramping up and/or reopening, significant backlogs of applications exist. Many government offices and consulates are encouraging or requiring contactless submissions via post or even e-mail.
The New Normal: A Long-Term Perspective
Looking ahead, it is somewhat challenging to predict what will happen in the global immigration space given that we do not yet know how long the pandemic will drag on. The longer it continues, the more different our new global immigration normal is likely to be. What is already clear is that even if a vaccine or effective remedy for COVID-19 is developed, things are unlikely to go back to "normal" as we knew it before the pandemic. So, what will the new normal look like for your company?
Rise in Remote Work—Decrease in Global Mobility
Many companies have discovered the ability to conduct business remotely, including across borders. What used to require an international business trip (with the corresponding time, costs and visas) now takes place via conference call. Where you used to relocate key staff across borders to facilitate teams working together in person, you likely have now discovered that with everyone working remotely, it may not matter whether your newest team member is physically sitting in Canada, China or France.
New Challenges for Essential Travel
Despite the rise in remote work, technology can't replace all short- or long-term global movement of employees. Some work—installing or commissioning equipment, quality control on a production line, testing of systems and more—simply cannot be done via conference call. If your company has employees who must travel for business purposes, those employees will likely continue to encounter quarantine requirements until the pandemic has been resolved. This means your employees traveling for work will need to provide evidence that they will quarantine for 14 days following arrival, before attending their meetings and/or work duties.
In the past, citizens of privileged countries, such as the U.S., have often enjoyed a low level of scrutiny at ports of entry and have been able to avoid issues when traveling for work purposes without a visa. In fact, before the pandemic, your company's employees may have been previously accustomed to traveling to certain countries with just their passport and no visa. Under the new normal, we anticipate that all international travelers will be subjected to increased scrutiny on entry through the destination country's customs and immigration process. This means your employees are more likely to need to secure a visa in advance of any foreign travel. For this reason, it will be important for you to verify immigration requirements with the most recent information well in advance of your employee's planned travel date. After all, the last thing you want is for your employee to experience the unpleasant surprise of being denied entry or prevented from boarding a flight.
New Challenges for Long-Term Relocation and Local Hires
While it is true for some industries that it does not matter whether a new hire is sitting in Canada, China or France, for others, it absolutely matters. It is probably impossible for a manager to supervise a manufacturing facility via Zoom. Unfortunately, it is likely that companies seeking to transfer or hire foreign nationals will face increased hurdles, even beyond the immediate travel-related hurdles posed by COVID-19 travel restrictions. As unemployment numbers have soared, we have already seen a significant political backlash against immigrants in the U.S. Even putting aside any politically or economically motivated reduction of work visa numbers, the labor market reality of having millions of citizens out of work will make it extremely difficult to pursue work visas that require labor market testing. This would include Labour Market Impact Assessment work permits in Canada, Tier 2 General work visas in the U.K., and Subclass 482 work visas in Australia, among others.
Mitigating Negative Impacts: Preparation and Strategy
It is hard to imagine how any company, let alone a company with global operations and travel needs, could avoid the negative impact of the pandemic. Here are a few ways your company can mitigate (rather than eliminate) the negative impacts:
- Raise awareness. Your company and your employees are likely to face many obstacles that you are not accustomed to, whether it is a requirement that employees add 14 days to a business trip to accommodate a mandatory quarantine period, the need to obtain visas in advance of travel where they previously could travel without one, or delaying many months before starting a new position while waiting for a work visa approval. It is crucial that all key stakeholders within your company are made aware that immigration is not business as usual. Stakeholders include not only HR and legal personnel but also company managers and recruiters. To the extent that employees can book international travel without managerial approval, it may be prudent to disseminate policies and information to all employees regardless of level. Requirements for travel, transfer and new hires alike must be checked before business commitments and plans are made or contracts with clients are signed. We recommend providing both written and video training to ensure that managers and other employees outside of legal and HR who may not be familiar with immigration concepts have both an opportunity to ask questions and reference materials to refer to in the future.
- Conduct quarterly planning. In countries where international transfers or hiring of foreign nationals is not prevented by political and labor market challenges, it will be important for your company to plan well in advance for any transfer or new hire. It is likely that the process of obtaining the necessary work visa and/or permit will be slower for some time given the COVID-19-related backlogs. Even where the immigration process itself is not slower than usual, it may take significantly more time to procure the corporate and personal documents (such as birth certificates, marriage certificates and university diplomas) that often must be included in visa applications. It is also possible that there will be more requirements that must be satisfied to obtain the visa, such as medical exams and negative COVID-19 tests. Given this, we strongly recommend that your company plan as far in advance as possible. Although it is not always possible to anticipate all business needs, it is a best practice to work to identify upcoming assignments or new hires on a quarterly basis. We have seen that having a policy and schedule in place with the relevant managers and recruiters can go a long way to reducing last-minute immigration surprises. As part of this plan, before committing to a client contract or signing an employment contract, companies should confirm with their immigration counsel or another trusted source that the employee is able to qualify for the necessary visa and the timeline involved.
- Implement a global mobility management system. While we have always recommended that companies with global mobility needs have an organized way to track and manage the global movement of their employees, the pandemic has greatly increased the need for such a system. Many companies were caught off guard by the fast-moving pandemic and did not know where their employees were in the world, when their visas were expiring or how they were going to get them home again. Having a centralized system will certainly not solve all your problems, but it will at least equip your company with the information and tools needed to make informed decisions. A "system" does not necessarily mean the very latest and most expensive software for managing global mobility, but rather, some sort of functional, organized method by which to vet and track travel, international transfers and new foreign national hires, along with a clear company global mobility policy.
SOURCE: Lustgarten, A. (08 July 2020) "Navigating the New Normal in International Business Travel" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/talent-acquisition/pages/navigating-new-normal-international-business-travel.aspx
A new tool for employee temperature checks ensures safety and security of workers
As employers begin to move employees back into the workplace, they have to be mindful of new legal guidance that has come from the CDC and HIPAA. In regards to new legal guidelines set into place, employers and management teams will now have to check employee temperatures. Read this blog post to learn more.
Temperature checks will be mandated at workplaces once employees return to the office, due to legal guidance from the Centers for Disease Control and Prevention, but privacy concerns could heat up among workers concerned for their security.
“It’s now permissible to take employee temperatures, but if employers store it and keep track of it, there’s no exemption from HIPAA and identity laws,” says Dan Clarke, president of IntraEdge — an Arizona-based tech company.
IntraEdge developed a kiosk that privately takes employees’ temperatures, and only shares the results with the employee, keeping any health information concealed from HR. Instead, managers are simply notified if the kiosk gave their employee permission to enter the office, or not, which completely eliminates the potential for HIPAA violations, Clarke says. The kiosk, called Janus, can also prevent sick employees from entering the office if their temperature is too high.
Clarke spoke in a recent interview about how Janus can help employers protect their workforce, while adhering to privacy laws.
How does Janus help prevent the spread of COVID-19?
If we want to limit exposure to COVID-19, we can’t assign someone in the office to take everyone’s temperature; it’s not efficient and it puts more people at risk. Employers need a digital solution, one that puts them in compliance with HIPAA and privacy laws.
Janus uses an accurate thermal camera to take the temperature of the user. Before using it, employees would need to sign up online and provide information to confirm their identity. After that’s done, they’d go to the kiosk and present their identification through their phone. The kiosk will ask them a few questions about how they’re feeling and the camera will take their temperature. The normal temperature range for each employee is personalized based on the individual’s age and medical history. Many people don’t realize our normal temperature increases as we age. If an employee reads at an unhealthy temperature, they’re not allowed inside the office.
How does this help employers stay compliant with HIPAA and other privacy laws?
Employers don’t have access to their worker’s medical history, or the temperatures read by Janus. The kiosk doesn’t display an employee’s temperature on screen. Instead, the employee will receive a text message telling them their temperature and whether they’re allowed inside the office. Printouts are also available for employees who don’t have smartphones.
Is HR or a manager notified when employees aren’t allowed in the office?
Janus doesn’t share with HR what employees’ temperatures were, only if they were given a “yes” or “no” to enter the office. They can receive a text message whenever an employee is given a “no.” This helps employers stay compliant with HIPAA and privacy laws because they never see the full results, and they’re not stored. But it also helps them keep track of their workforce.
It can also be programmed to notify a security officer that someone didn’t pass the temperature check to ensure compliance. We can also program the kiosk to distribute security badges only to employees who pass the temperature check.
Before coronavirus, employees sometimes came to work sick out of fear their colleagues/managers would question their dedication to their job. Do you think this product will help change that after the crisis is over?
I think the crisis is changing the perception of remote work enough that people will be comfortable saying they’re going to work from home when they don’t feel well. Janus can definitely help enforce it, if the employer chooses, but we wanted to ensure it was useful for employers after the crisis is over. It can also be used to clock employees in and out for work and as office security.
SOURCE: Webster, K. (08 June 2020) "A new tool for employee temperature checks ensures safety and security of workers" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/a-new-tool-for-employee-temperature-checks-ensures-safety-and-security-of-workers
U.S. Health Care Is in Flux. Here’s What Employers Should Do.
The coronavirus pandemic has brought uncertainty in many areas of day-to-day lives and is now bringing uncertainty into health care. Read this blog post to learn more.
Emergencies naturally draw our attention — and our resources — to the present. The U.S. response to Covid-19 is no exception. Yet the problems exposed by the pandemic point to the urgent need to prepare now for the next waves of this crisis, including new clusters of infection and new crises of debt and scarcity. They also highlight the opportunity to develop a more resilient health system for the future. Employers can and should play a central role in this effort.
For employers, this period of exceptional economic strain has exacerbated the longstanding challenges of managing the health care costs of their employees. The future course of the disease and economy may be uncertain. But businesses that are rigorous in the way they purchase health care benefits, leverage digital health technologies, and partner with hospitals and physicians will be able to better manage an expected roller coaster in health care costs and premiums.
Dealing with Covid-19 itself is expensive: Covered California estimated that the costs to test, treat, and care for Covid-19 patients this year will be between $34 billion and $251 billion; America’s Health Insurance Plans predicts the cost will total $56 billion to $556 billion over a two-year period. Yet the total costs of U.S. health care this year will likely drop due to the postponement or cancellation of regular clinical services and elective procedures due to the virus. According to one estimate, Americans may spend anywhere from $75 billion to $575 billion less than expected on health care this year. Another actuarial firm projects that self-insured employers may see a 4% reduction in their employees’ health costs this year.
Nonetheless, health insurance premiums for employers are expected to rise in 2021. An analysis by Covered California projected that nationally, premiums will increase between 4% and 40% — and possibly more. Recent filings with the District of Columbia’s Department of Insurance, Securities and Banking related to the individual market and small groups for 2021 show that Aetna filed for an average increase of 7.4% for health maintenance organization (HMO) plans and 38% for preferred provider organization (PPO) plans, while UnitedHealth proposed an average increase of 17.4% for its two HMOs and 11.4% for its PPO plans.
What explains this projection of higher premiums in 2021? Will second and third waves of Covid-19 lead to more expensive intensive-care unit and hospital stays? Will patients flood clinics for the hip replacements, cataract operations, and other “non-urgent” services they delayed during the lockdown? Will hospitals try to charge commercial insurers more to compensate for their losses in 2020?
The answer to all these questions is a definite “maybe.” Ironically, the fundamental reason rates are expected to rise is the cost of uncertainty itself. And the situation may only get murkier if the pandemic resurges.
Even if premiums stay as they are, employers may still be unable to afford them amid plummeting revenues. Before Covid-19, premiums for employer-sponsored plans had been consistently outpacing inflation. In 2019, the Kaiser Family Foundation reported that the average annual premium for employer-sponsored health insurance was a whopping $20,576 for a family of four (and $7,188 for an individual) — a 54% increase over the previous 10 years. That dwarfs the average inflation-adjusted increase of 4% in wages in the same 10-year period from 2009 to 2019.
Given these rising costs, employers should look beyond 2021. They should not seek a short-term fix by raising copayments, deductibles, and other out-of-pocket costs for next year. While this strategy may initially reduce spending on health care, studies show that it will disincentivize employees to seek preventative treatment. In fact, families with higher deductibles are less likely to take their children to see the doctor, even when the visit is free. Over time, this leads to worse health outcomes for employees and their families, which also means much higher costs.
Here are three strategies that can help employers weather the inevitable ups and downs of 2021 and beyond and improve employee health:
1. Manage health care benefits like all other purchases.
Business leaders, especially the CEO, need to make it a priority to understand the health care benefits business. Employee health benefits consume more than $15 million annually per 1,000 employees, and employers should treat costs with the same rigor and expertise that they assess other major expenses. Whether it’s through their broker, insurance company, or consultants, businesses should examine these costs closely and understand where they are deviating from benchmarks and why. A car manufacturer should not overpay for care anymore than it overpays for steel.
For example, when employees experience a common ailment like uncomplicated back pain, do their doctors tend to order MRI and back surgery, driving up costs unnecessarily in an overeager fee-for-service model of treatment? Or do they follow more cost-efficient, preventative guidelines that lead with rest and physical therapy?
By challenging providers with these types of questions, large employers such as Walmart and Boeing have redesigned their employee benefits plans to encourage employees to seek second opinions and have even gone so far as to allow them to expense travel to medical centers that offer better care at lower costs. Employers may also find that forming alliances or joining cooperatives can expand the scale of their data, help them identify and exploit opportunities for improving the quality and cost of treating specific conditions, and enhance their purchasing power for health care.
2. Leverage technology.
The Covid-19 pandemic will open unprecedented opportunities for employers to leverage technology that helps employees seek, manage, and receive health care over the internet. During the emergency, public and private insurers lifted provider restrictions on telehealth, and the increasing willingness of both clinicians and patients to use digital technologies is changing the landscape of health care, especially for those who have chronic conditions that require ongoing monitoring. Given that Medicare is likely to sustain these changes, employers should work with their private insurance partners to ensure continued coverage of telehealth for their employees.
Virtual chronic care solutions are also gaining traction. Take people with type 2 diabetes, who now comprise about 10% of all Americans and whose care costs more than $325 million per year. Technologies like a Bluetooth-enabled continuous glucose monitor (CGM) obviate the need for daily finger pricks and glucometer checks for monitoring blood sugars. (Verily, the company I work for, is developing a next-generation CGM with Dexcom.) This technology, when paired with a smartphone app that records meals (a quick photo of the food is sufficient), exercise, and medications, can help individuals understand the impact of their actions on their health. Onduo, a digital health company managed by Verily, combines this technology with telehealth and chat features to connect employees to health coaches and physicians. It offers a virtual diabetes clinic on demand.
Amid a burgeoning marketplace of digital health offerings and innovations, employers should shop and negotiate for health care solutions with the same rigor they shop for their business needs. They should challenge vendors to demonstrate the cost-effectiveness of their programs to produce better health and improve productivity, presenteeism, and quality of life for their employees. They should even consider demanding money-back guarantees like some health systems now provide.
3. Partner with hospitals and physicians.
As health systems struggle with their own financial crises, this is a good time for employers to partner more closely with hospitals and doctors. If the CEOs of businesses have much to learn about health care, perhaps health care has much to learn from these CEOs. Whether it’s lessons in improving operations from a manufacturing plant or ways to deliver better customer service from a retail perspective, employers can offer their own industry-specific expertise to help hospitals and medical facilities practice safer, more efficient, patient-friendly, and cost-effective care. For example, Intel shared its expertise in supply chain and “lean” management to improve clinical care in metropolitan Portland, Oregon. Most hospitals and health systems have a community advisory or governance board. By serving on these committees, employers can begin to understand — and perhaps even improve — the care their employees and their families receive.
Employers’ actions must be decisive precisely because the future is so uncertain. By partnering with the health systems that provide care for their employees, establishing clear expectations for high quality and low-cost care, and leveraging telehealth and virtual care solutions to achieve these goals, businesses can help their employees better weather the ups and downs of Covid-19. In doing so, employers can build a more robust and affordable model for the good of their businesses, the economy, and the health of millions of Americans.
SOURCE: Lee, V. (15 June 2020) "U.S. Health Care Is in Flux. Here’s What Employers Should Do." (Web Blog Post). Retrieved from https://hbr.org/2020/06/u-s-health-care-is-in-flux-heres-what-employers-should-do
Meal program provides healthy lunches to remote workers
The coronavirus pandemic has placed many disruptions in the day-to-day lives of employees, which has caused both mental and physical challenges. Research has shown that more people are now snacking or eating more now, due to the quarantine brought upon many. Read this blog post to learn more.
Disruptions from the coronavirus have infiltrated the daily lives of employees, causing challenges to both our mental and physical well-being. Focusing on proper nutrition is on the back burner for many.
Twenty-seven percent of people reported snacking more during coronavirus, and 15% said they are eating more often than usual, according to a study by the International Food Information Council. Forty-two percent have been relying more on pre-packaged foods than in the previous month, despite believing they are a less healthy option.
“The quality of fuel we put in our body ultimately controls the output,” says Michael Wystrach, CEO of Freshly, a meal subscription service. “So how well our brain functions, how our emotions and hormones are released, how productive we are, it really does start with diet.”
The coronavirus has exacerbated the challenge of accessing healthy food for many across the United States. While there has been a skyrocketing demand for groceries and grocery delivery services during the pandemic, 37 million Americans are considered “food insecure,” meaning they lack access to affordable and nutritious food options.
To address those concerns, Freshly created a new meal service called Freshly for Business to provide healthy and affordable meals for employees working remotely. The program allows employers to offer free or subsidized meal plans consisting of up to 12 meals per week. Employers including PwC and KPMG, among others, are partnering with Freshly, which costs an average of $8 per meal per employee.
“We used our platform to solve the needs of customers who are saying, we have a lot of employees working at home who are working hard but are strained and have a lot of challenges on their plates,” Wystrach says. “Employers wanted to provide them a benefit of healthy food by signing up a few dozen to thousands of employees very quickly.”
Lack of proper nutrition can have devastating and expensive consequences: In the U.S., 40% of adults are obese, and 90% of overweight individuals have prediabetes or Type 2 diabetes, a condition often caused by poor diet. According to the American Diabetes Association, the cost of medical expenditures and lost productivity due to diagnosed diabetes was $327.2 billion in 2017, the most recent data available.
“Type 2 diabetes is the fastest growing disease in America, and it’s principally caused by poor diet. It takes a huge toll on employers and employees,” Wystrach says. “One of the challenges now is the traditional lunch hour is gone and convenience is the pinnacle. But we make poor decisions when we rely on convenience with our food.”
Providing food in the workplace is a much desired benefit, with 73% of employees saying they want healthy cafeteria and snack options at work, according to a survey by Quantum Workplace and Limeade. However, just 32% provided free snacks and food, and only 17% had an onsite cafeteria available for workers, according to the Society for Human Resource Management.
As employers begin considering their return-to-work strategies and how they will make their offices safe and their benefits supportive of the health and well-being of their employees, providing meal options should be a major consideration, Wystrach says.
“Especially as we think about social distancing, the less you’re sending your employees out, the safer everyone is,” he says. “Employers will also be thinking about healthcare costs post-COVID. How do they keep overall healthcare costs down? It’s really in everyone’s benefit to provide benefits that promote health and wellness.”
Meal offerings and proper nutrition are a win-win for employers and their workers, Wystrach says.
“Health and happiness ultimately creates a more productive employee,” he says. “When you’re trying to find a win-win for everyone, it drives productivity, it creates happy employees, and it reduces cost over time. There will continue to be a focus on benefits that provide that.”
SOURCE: Place, A. (12 May 2020) "Meal program provides healthy lunches to remote workers" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/meal-program-provides-healthy-lunches-to-remote-workers