Here’s how to get the best ROI on a wellness program
How many hours do your employees work per year? According to the International Labour Organization, Americans work nearly 500 more hours per year than French workers and 260 more hours per year than British workers. Continue reading to learn how employers can get the best ROI on a wellness program.
U.S. employees are working harder than ever and need more support from their employers as a result.
In fact, according to the International Labour Organization, Americans work 137 more hours per year than Japanese workers, 260 more hours per year than British workers, and nearly 500 more hours per year than French workers.
With that growing burden — along with more individuals of all ages recognizing how important their health is — comes an increased need for companies to invest in well-designed health and wellness programs. Rolling out these programs can lead to better employee morale and engagement, a healthier and more inclusive culture and fewer absences due to illness, according to research — all of which are especially important in today’s fast-paced work atmosphere.
In addition, the rise of social media means that businesses are being held accountable by their employees in a way that was not the case for previous generations. According to the British Standards Institution, employees trusting their employers’ commitments is now an increased focus. Health and well-being are becoming a significant part of that workforce trust agenda.
With these points in mind, it’s important to recognize that your organization needs to make and keep commitments to investing in and executing successful health and wellness programs for your workforce. These programs must keep trust momentum going to ensure healthier and happier workers, and it is proven that happier and healthier workers are more productive. This can lead to overall company success.
For example, a recent employee wellness study from the U.S. Chamber of Commerce showed that effective wellness programs have good return on investment of $1.50 to $3.00 per wellness dollar spent over a two to nine year timeframe. Another study from the Australian-based Black Dog Institute concluded that thriving and healthy workforces typically perform more than two times above average, compared with organizations that do not invest at all in their employees’ health and well-being.
BSI recommends a three-pronged approach for successfully investing in your employees’ health and wellness. First, it’s important to define your health and well-being initiative and what it means for your company. While there are many definitions, BSI recommends considering one that recognizes the need to manage workplace occupational health and safety, in addition to the promotion and support of managing healthy behavior, such as stress management, work-life balance and an ever-changing work environment.
Next, employers should define what their health and wellness program for workers should include. In particular, BSI suggests a good model to follow: the U.S. federal government’s recommended approach for workplace health and well-being programs. Created by the Center for Disease Control’s National Institute for Occupational Safety and Health, the program is called Total Worker Health.
TWH is a holistic approach to occupational health and safety and worker well-being. It recognizes that work has an important function in the social determinants for health and is defined as “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.”
However, this program also goes much further than other wellness programs and reflects the nature and challenges of the changing workplace, from new forms of employment to new technologies. It also reflects that non-work-related illness and stress can be adversely impacted by work, can have health and safety implications within the workplace, and the way an organization manages absence and rehabilitation policies can have hugely positive or negative impacts on the individual and the business.
Once you know what health and well-being means to your business and what kind of program your organization wants to execute, it’s time to move forward. For step three, BSI recommends companies review and implement ISO 45001, the new global management system standard on occupational health and safety. This standard has physical, mental and cognitive well-being and health at its core, while continuing to drive high safety standards for companies.
ISO 45001 also recognizes that the most successful and productive organizations take a holistic approach and therefore, good occupational health and safety management can be integrated with employee well-being initiatives. Related to this, holistic employee wellness programs can be used as a recruitment tool. Evidence from WhenIWork.com suggests that employees want their employers to take an active role in their health, so if you can show potential employees that you are invested in their well-being, you will gain an advantage over companies offering only bare-bones benefits.
As a global standard, ISO 45001 also enables a consistent worldwide approach. With its focus on culture and employee participation, it also provides businesses a best practice model for developing an effective health and well-being program. And employee participation will happen. For example, experts from the Johns Hopkins Bloomberg School of Public Health recently analyzed surveys to determine the overall perceptions of wellness programs from employee and employer perspectives. Its data analysis revealed that nearly 60% of employees think employers should attempt to improve the health of their workers.
Overall, seeking accredited certification of the standard not only builds trust within the organization, but also provides external assurance to customers, shareholders and the wider community. Investing in employee health and wellness programs increases healthy behavior and curbs the risk of lifestyle-related disease, leading to happier workers, more productivity and overall company success.
SOURCE: Field, K. (4 June 2019) "Here’s how to get the best ROI on a wellness program: (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/how-to-get-the-best-roi-for-your-wellness-program
Why employers can’t hit snooze on tired employees
Research shows that a lack of sleep can negatively impact performance and mental and physical health. The Centers for Disease Control and Prevention reports that more than a third of American adults are not getting the recommended 7-8 hours of sleep each night. Continue on to learn more.
It’s time for a wake-up call. We’ve all heard the familiar phrases — sleep when you’re dead or burn the midnight oil from high-powered CEOs and celebrities touting how they sacrificed sleep to advance their careers.
But research shows that lack of sleep may have the opposite effect. Rather than helping people get ahead at work, losing out on sleep can negatively impact performance and, more importantly, mental and physical health.
It’s time for employers to recognize the role sleep plays in employee well-being and take steps to foster a workplace culture that reinforces and encourages healthy behaviors.
More than a third of American adults are not getting the recommended 7-8 hours of sleep, according to the Centers for Disease Control and Prevention. A lack of sleep can lead to:
- Increased absenteeism and illness. The U.S. loses an equivalent of around 1.2 million working days due to insufficient sleep, and research has found that sleeping fewer than five hours consistently is associated with staying home sick for 4.6 to 8.9 more days.
- Lost productivity. Losing even just a bit of sleep can affect productivity. A recent study found that participants who lost just 16 minutes of sleep on a nightly basis reported having more distracting thoughts at work.
- Consequences for physical and mental wellbeing. Lack of sleep has major consequences on long-term health, including increased rates of chronic diseases and conditions, such as diabetes, heart disease and hypertension.
Lack of sleep affects workers regardless of occupation. For employees who work shifts (often overnight), such as in call centers, manufacturing, hospitals and oil and gas, losing sleep can become a safety risk. In fact, findings have shown that shift work sleep disorder impacts approximately 10% of the night and rotating shift work population.
So how can we promote a healthy sleep culture? There are a number of tools and programs that employers can use to show they value and encourage healthy sleep habits, educate employees about how sleep can improve their work performance and support them in sticking to sleep goals. Organizations like the National Sleep Foundation offer employers resources to learn more about the benefits of sleep tracking to monitor sleep stages and tips to improve sleep for everyday health.
Employers can provide employees with tip sheets, send emails or hang posters around the office to encourage healthy sleep habits and explain how critical sleep is for their wellbeing. Tips employers can share include shutting down electronics 30 minutes before bedtime, keeping smartphones and laptops away from bed to create a sleep zone and using a guided breathing exercise or meditation apps to help the body wind down. It’s also important for managers to lead by example and encourage healthy sleep habits, including avoiding sending emails too late in the evening and being conscious of employees working in other time zones.
Wearables can also help people track their activity, sleep and overall health goals. Before the launch of wearable devices, many types of health data, including quantity and quality of sleep, were only accessible to study participants via sleep labs – which are both costly and time consuming. With today’s technology, employees can better understand their sleep patterns and use that data to find a sleep plan that works for them.
Sleep tracking can also be useful to help employees correlate data and insights based on their schedules, activity levels and what they’ve had to eat or drink. For instance, someone who tracks their sleep may find that getting exercise after work helps them get a better night of rest. Having a different sleep pattern on work days versus days off can cause social jetlag — a feeling almost like changing time zones that can take a significant toll on sleep cycle and overall health. That’s why it’s important to keep a consistent sleep schedule throughout the week and the weekend.
Here’s the bottom line: insufficient sleep contributes to poor productivity, worse health outcomes, absenteeism at work and can create safety risks. Today, more and more employers are working to combat the idea of sacrificing sleep in corporate culture and are recognizing that it is an asset to the workplace, not an enemy.
SOURCE: McDonough, A. (28 May 2019) "Why employers can’t hit snooze on tired employees" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/sleep-deprivation-impacting-company-bottom-line
Getting employees up to speed with health literacy
Do your employees know how much sugar is in a granola bar or how much radiation is in a CT scan? If not, it's most likely because no one is teaching them. Continue reading to learn more on getting your employees up to speed with health literacy.
Your employees probably don’t know how much sugar is in a granola bar or how much radiation is in a CT scan. They may not even know how to reach your employee assistance program.
That’s because no one is teaching them. Which is what happens when wellness program education ends at eat more fruits and vegetables and avoid added sugar.
Sometimes the advice is even wrong. For example, below is a clipping from a popular health risk assessment. Focus on the lower right quadrant.
It isn’t entirely true that low-fat and nonfat dairy is healthier. In fact, full fat dairy does have health benefits, for example some studies suggest it could help protect against diabetes. By comparison, low-fat or nonfat yogurt could be a significant source of sugar.
This is why employee health literacy is so important. With easy access to mis-information, employees need to learn to sift through the noise to determine what is actually good for them.
Plus, there is plenty to learn. Spanning from everyday health, employee medical education and health benefits literacy. I’ve outlined just a few of the ways to employers can better educate their population.
Everyday health education
Sugar is one place where health education could be more impactful — but it should go beyond just telling workers to avoid added sugars. Education starts at work. Chances are your break room is stocked with granola bars, maybe Clif Bars. The first ingredient in a Clif Bar is organic brown rice syrup. That may sound healthy, but it’s really just sugar. In fact, there are almost 60 different sugars disguised with fancy names like turbinado or malted barley extract.
Another example is sleep. We all want employees to get enough of it, but do they know how? They may not know little bits of information that could help them get more shuteye, like there is a night shift setting on their iPhone or that energy-efficient light bulbs contribute to insomnia.
But teaching everyday health is just the beginning of health literacy. The real impact comes with employee medical education.
Employee medical education
U.S. consumers are voracious purchasers of healthcare services and yet our outcomes remain poor. Americans have about 240 CT scans per 1,000 people. To put that in perspective, only about 1 in 1,000 covered people in your employee population was hospitalized for diabetes last year. So 240 times more employees are getting scans than uncontrolled diabetes.
CT scans have risks. They have about 500 times the radiation of an x-ray and are especially concerning for children because their cells are dividing more rapidly than adults and are more sensitive to radiation exposure. The dye used intravenously also carries a risk.
But many employees don’t know about these risks. So it may be important to educate your workforce about these common medical procedures and how to decide whether or not it is right for them.
Health benefit education
Here’s a wild guess: your employees don’t appreciate the health benefits you provide for them. If so, you’ve got company. Most large organizations face the same issue.
Consider the employee assistance program. Do workers know you offer one? Do they know it’s confidential? They know their emails aren’t confidential, so don’t assume they know this. Do they know the URL, username and password? How many free sessions do they get?
Repeat a similar set of questions for all your benefits. You can’t expect that some memos and a website will implant your benefits firmly in their mind.
SOURCE: Lewis, A. (25 April 2019) "Getting employees up to speed with health literacy" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/educating-employees-through-health-literacy
Workplace Wellness Programs Barely Move The Needle, Study Finds
A recent study from JAMA found that workplace wellness programs do not cut costs for employers, reduce absenteeism or improve workers' health. Read this blog post to learn more about this recent study.
Workplace wellness programs have become an $8 billion industry in the U.S. But a study published Tuesday in JAMA found they don’t cut costs for employers, reduce absenteeism or improve workers’ health.
Most large employers offer some type of wellness program — with growth fueled by incentives in the federal Affordable Care Act.
A host of studies over the years have provided conflicting results about how well they work, with some showing savings and health improvements while others say the efforts fall short.
Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not.
Now researchers from the University of Chicago and Harvard may have overcome these obstacles with one of the first large-scale studies that is peer-reviewed and employs a more sophisticated trial design.
They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.
The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.
After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.
But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.
“The optimistic interpretation is there is no way we can get improvements in health or more efficient spending if we don’t’ first have changes in health behavior,” said one study author, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)
“But if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause,” Baicker said.
The study comes amid widespread interest in wellness programs.
The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)
Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.
A few employers tie financial incentives to workers actually lowering risk factors, such as high blood pressure or cholesterol — or making concerted efforts to participate in programs that might help them do so over time.
The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.
In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.
Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.
Wellness program vendors said details matter when considering whether efforts will be successful.
Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.
Amounts of “of less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.
An accompanying editorial in JAMA noted that “traditional, broad-based programs like the one analyzed by Song and Baicker may lack the necessary intensity, duration, and focus on particular employee segments to generate significant effects over a short time horizon.”
In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.
It could be, the study acknowledges, that 18 months isn’t enough time to track such savings. So, Baicker and Song also plan to publish three-year results once they are finalized.
Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.
In one interesting point, that study found that wellness-program participants were likely already healthier and more motivated, “thus a primary benefit of these programs to employers may be their potential to attract and retain healthy workers with low medical spending.”
Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.
Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.
“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”
SOURCE: Appleby, J. (16 April 2019) "Workplace Wellness Programs Barely Move The Needle, Study Finds" (Web Blog Post). Retrieved from https://khn.org/news/workplace-wellness-programs-barely-move-the-needle-study-finds/
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/