7 tips for keeping shift workers healthy
Most companies that are open for more than 10 hours a day have some sort of shift work or work pattern. Though shift work can have multiple positives for companies and their workers, it can also have numerous negative impacts on physical and mental health. Read this blog post for seven tips on keeping shift workers healthy.
For companies open for more than 10 hours a day, it’s likely that you have some sort of shift work, or a pattern of work involving rotation through different fixed periods across a working week or month. Employees who work in healthcare, call centers, manufacturing and in a warehouse all regularly work round-the-clock shifts, and these are some of the most common industries utilizing this type of model.
While shift work can have numerous positives for the company and even the workers, it also can have many negative impacts on health — both physical and mental. Beyond the most common health impact — sleep disruption — there are numerous other ways shift work can negatively impact a worker’s health including: mood disorders, gastrointestinal disorders, injuries and accidents, metabolic disorders, cancer, cardiovascular disorders, interference on family live and limited social life.
Shift workers also experience high levels of annual leave requests and short-term disability claims.
For employers in one of these industries, or any industry with non-regular shift hours, there are a few best practices that will help improve worker productivity and minimize leave.
Provide schedules that are as predictable at possible. Allowing an employee to settle into a regular schedule will allow them to establish a routine both at work and at home. Interference with home and social life can be a key trigger for a variety of negative health habits.
Limit the number of nights worked consecutively. Just like a traditional Monday-Friday, 9-5 worker, those working night hours need a weekend of their own, too. While this may not always be Saturday-Sunday, allowing them a couple of consecutive days off will give them time to disconnect and recharge.
Designate areas and times for employees to rest in the workplace. Whether a nurse in a busy ER department or a warehouse worker stocking shelves, everyone needs a break during their workday. Work with the shift manager to map out regular breaks and a calm and quiet place for employees to take a break.
Provide health and wellness programs that are accessible at night and on weekends. Since most HR professionals work office day jobs, they often forget about accessibility of services to employees working different hours. Assure your EAP provider is accessible 24/7 and if you have on-campus programs, be sure to offer them at different times for your shift workers. A factory employee working third shift should have the same level of access as a first-shift office worker.
Give employees more control over their schedules with shift-based hiring. This is an approach of hiring people for individual shifts rather than hiring employees, then scheduling them into shifts. Employees come to companies with a range of responsibilities outside of the workplace. Allowing them to match with the shift that best works with their personal lives will result in greater productivity and fewer health impacts.
For those returning to work following a leave, keep the schedule as close to their normal schedule as possible. While it’s not always possible to perfectly align with their previous schedule, you’ll want to get those returning from a leave back into the routine of their previous shift work. While on leave, many will have transitioned into a different sleep routine, so getting them back to the previous patterns will help with the transition back to work.
Provide resources on good sleep health. For shift workers, a healthy sleep routine can be challenging. However, there are simple and well-proven approaches to establishing sleep patterns regardless of the time of day. Be sure to regularly promote resources in the workplace and through regular communications. The American Academy of Sleep Medicine is a good place to start.
SOURCE: Willett, S. (26 April 2019) "7 tips for keeping shift workers healthy" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/tips-for-keeping-hourly-employees-healthy?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001
7 ways employers can support employee caregivers
Seventy-three percent of employees in the United States act as caregivers for a child, parent or friend, according to research from Harvard Business School. Continue reading for seven ways employers can support employee caregivers.
The number of caregiving adults in the U.S. has reached a tipping point.
As the baby boomer generation gets older, an increasing number of people in the workforce are taking on the role of unpaid caregiver for a family member or friend. Many also are in the midst of raising their own children, which means they’re pulled in many different directions, trying to keep up with work commitments and family responsibilities. In fact, according to researchers at Harvard Business School, 73% of employees in the U.S. are caring for a child, parent or friend.
What do all these statistics point to? They mean that employers have an opportunity to play a role in helping employees balance these often competing priorities.
The Harvard study highlights the impact of employee caregiving responsibilities on the workplace. While only 24% of employers surveyed believed employee caregiving influenced their employees’ performance at work, 80% of the employees who were surveyed admitted that caregiving had an effect on their productivity at work and interfered with their ability to do their best work.
The survey also found that caregiving can affect employee retention, with 32% of the employees surveyed saying they had left a job because of their caregiving responsibilities. In addition, employees who are caregivers are more likely to miss work, arrive late or leave early, which affects not only productivity, but also the employees’ ability to progress in their careers.
Employers can take a proactive role in supporting employees who are caregivers. That support, in turn, can have a positive effect on productivity, morale and employee retention. Here are seven strategies employers should consider.
Create an organization-wide understanding of the challenges caregivers face.
Employees who aren’t sure that their managers and leaders would understand the juggling they’re doing and the stresses they face are more likely to not only have problems at work, but — because they face high stress levels trying to get everything done at home and work — they also are at higher risk for a number of health problems such as depression and heart disease. By creating a culture that allows employees to openly express their challenges and ask for support, employers can not only keep employees healthy and productive, they also can reduce secondary costs associated with decreased productivity and chronic health problems.
Know what challenges employees face.
Regular employee surveys can help employers assess employees’ needs in terms of caregiving and tailor the benefits the organization offers to help meet those needs.
Communicate the benefits that are available.
In many cases, employers already offer programs and benefits that can help employees who are caregivers such as an employee assistance program and referral services for finding caregivers who can help when the employee isn’t able to. However, many employees aren’t aware these programs are available, so it’s important to continuously share information about them in company newsletters, emails and at meetings.
Consider flex time and remote work options.
Depending on the employees’ work responsibilities, employers can offer flexible work arrangements that allow employees to work different hours or to telecommute for a certain number of days per week.
Change the approach to paid time off.
Rather than dividing paid time off into vacation days, sick days and personal days, consider grouping all time off into one category. That allows employees to take time off for caregiving as needed. A growing number of companies, including Adobe, Deloitte, Bristol-Meyers Squibb and Coca-Cola, are also offering paid family leave benefits so that employees can take time off to provide care.
Connect employees with resources.
Beyond an EAP and referral services, employers can offer programs that connect caregivers with resources for both their caregiving role and for the self-care they need to remain healthy and able to handle both job and caregiving roles better. Those resources can include:
Beyond an EAP and referral services, employers can offer programs that connect caregivers with resources for both their caregiving role and for the self-care they need to remain healthy and able to handle both job and caregiving roles better. Those resources can include:
- Advisory services that help employees connect with healthcare providers for their parents, children and themselves
- Nurse managers, case managers and geriatric care managers who can help employees who are managing the care of a family member who’s living with a serious health condition or disability
- Advocates who can help employees who are dealing with complex insurance claims for the person they care for, planning for long-term care, or managing the legal and financial complexities that can arise when a parent or spouse dies
Internal caregiver resources groups that bring together employees who are dealing with the issues surrounding caregiving so that they can share ideas and experiences
Measure how well your support is working.
The first step to supporting caregivers in the workforce is to implement policies, programs and benefits that offer them the tools they need to balance work and caregiving. An equally important second step is to regularly review what is offered, how much the offerings are used, and by which employees. Ask employees for feedback on how effectively what the organization provides is in helping them with issues they face as working caregivers and solicit ideas for new approaches and tools they’d like to have.
SOURCE: Varn, M. (25 March 2019) "7 ways employers can support employee caregivers" (Web Blog Post). Retrieved from https://www.benefitnews.com/list/7-ways-employers-can-support-employee-caregivers
What HR pros should know about clinical guidelines
Sets of science-based recommendations, also known as clinical guidelines, are designed to optimize patient care in areas such as screening and testing, diagnosis and treatment. Read this blog post for what HR professionals should know about these guidelines.
Your employees and their family members frequently face tough questions about their healthcare: How do I know when it’s time to get a mammogram? When does my child need a vision screening? Should I get a thyroid screening? If I have high blood pressure or diabetes, what is the best treatment for me?
For the providers who care for them, the key question is: How do we implement appropriate, science-backed treatments for our patients, testing where needed, but avoiding potentially harmful or unnecessary (and expensive) care? The answer is to seek guidance from and use clinical guidelines —along with existing clinical skills — wisely.
Clinical guidelines are sets of science-based recommendations, designed to optimize care for patients in areas such as screening and testing, diagnosis and treatment. They are developed after a critical review by experts of current scientific data and additional evidence to help inform clinical decisions across a spectrum of specialties.
Based upon this process, guidelines are then released by a number of sources and collaborations, including academic and non-profit healthcare entities, government organizations and medical specialty organizations.
From preventive care to treatment protocols for chronic conditions, guidelines provide a framework healthcare providers use with patients to help guide care. However, it’s important to note that clinical guidelines are not rigid substitutes for professional judgment, and not all patient care can be encompassed within guidelines.
The impact on healthcare and benefits
Clinical guidelines are used in myriad ways across the healthcare spectrum, and providers are not the only ones who utilize them. Insurers also may use guidelines to develop coverage policies for specific procedures, services and treatment, which can affect the care your covered population receives.
To illustrate a key example of an intended impact of guidelines on health plan coverage, consider those issued by the U.S. Preventive Services Task Force, whose A and B level recommendations comprise the preventive services now covered at no cost under the mandate of the Affordable Care Act.
As another example, the National Committee for Quality Assurance, which accredits health plans and improves the quality of care through its evidence-based measures, uses the American Heart Association guidelines when creating its quality rules for treating high cholesterol with statin drugs.
Other examples exist among commercial coverage policies. For example, some cancer drug reimbursement policies use components from nationally recognized guidelines for cancer care.
Because science is rapidly changing, guidelines are often updated, leading insurers to revisit their policies to decide if they will change how services and medications are covered for their members. Providers and health systems may modify processes of patient care in response to major changes in guidelines and/or resultant changes in payer reimbursement.
Not all guidelines are updated on a set schedule, making it even more important for providers and organizations that rely on guidelines to stay on top of changing information, as it can have a direct impact on how they work. Attending conferences, visiting the recently established ECRI Guidelines Trust, and regularly reviewing relevant professional association websites and journals can help ensure needed guidelines are current. Lack of current information can affect care decisions and potential outcomes for patients. Those who have access to the most up-to-date, evidence-based information are able to work together to make well-informed healthcare decisions.
Why it matters for employers
As employers or benefits consultants, it’s critical to ensure that your health plan, advocacy or decision support providers, and other partners that depend on this information to guide their practices and decisions understand and follow current, relevant guidelines.
Further, by combining information from relevant guidelines and data from biometric screenings, health risk assessments, claims and other sources, it’s possible for clinical advocacy and other decision support providers to identify employees with gaps in care and generate targeted communications (through a member website and/or mobile app) to help them take action to improve their health.
Clinical guidelines are science distilled into practical recommendations meant to be applied to most patients for quality healthcare. By maintaining current, relevant guidelines, organizations and providers who work with your covered population can ensure that all parties have the key information they need to make the best decisions for their health.
SOURCE: Sivalingam, J. (18 March 2019) "What HR pros should know about clinical guidelines" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/what-hr-managers-should-know-about-clinical-guidelines?feed=00000152-a2fb-d118-ab57-b3ff6e310000
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
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
Hospital pricing transparency: More information, more confusion?
As of January 1, a new rule that requires hospitals to list the prices of all their services and medications they provide is in effect. Read this blog post to learn more about this ruling.
As of the first of this year, a new rule is in effect that requires hospitals to list the price for all the services they provide and medications they prescribe for patients while they’re in the hospital. In theory, this should give patients more information that can help them decide where it makes the most economic sense to receive hospital care. In actuality, while there’s a wealth of new data available, it can be difficult to find — and nearly impossible for people outside the healthcare industry to understand.
The document that aggregates the price information is called a chargemaster, and it can contain tens of thousands of entries. The new rule doesn’t require that the information be written in plain language, only that it be machine readable, so much of the data reads like it’s in a yet-to-be-discovered language. For example, if you download Memorial Sloan Kettering’s chargemaster, you’ll find an Excel spreadsheet that contains 13,088 entries such as “CAP MALE/FEMALE RAIL, $765” and “BX SUBCUT SKIN/INC, $1,771.” Even if a patient puzzles out the meaning of these abbreviations, the prices listed are different from the lower fees that insurers negotiate, so estimating how much you would pay for care is complicated at best and impossible at worst.
The goal of the hospital pricing transparency rule is to help patients understand the cost of their care and choose more wisely when deciding where to receive that care. Unfortunately, the information that is now available adds to the confusion and doesn’t help patients make one-to-one price comparisons when choosing where to receive care. In addition, the rule only covers care delivered by a hospital, so patients don’t have the information they need to make price comparisons for services performed in doctor’s offices, urgent care facilities, diagnostic test sites and outpatient surgical centers.
Though the new rule generally doesn’t help employees, employers can.
Even if price transparency doesn’t help workers better understand the cost of care and choose where to receive that care, there are strategies and resources that employers can provide to help their employees make more informed decisions about healthcare. Here are some of them.
Second opinions. Wrong diagnoses, inappropriate treatments (treatments that don’t meet the evidenced-based standard of care) and medical errors all drive up healthcare costs for both employers and employees and can lead to poorer health outcomes. One strategy to lower the risk of these types of problems is providing employees with streamlined access to second opinions from experienced physicians.
A second opinion can confirm or change an employee’s diagnosis, suggest other treatment options and pinpoint misdiagnoses, especially in the case of serious and complex conditions like cancer, autoimmune disease and back and joint problems. In fact, a Mayo Clinic study found that 88% of people who sought a second opinion from the hospital’s physicians for a complex medical condition received a new or refined diagnosis. Employers can make second opinions available to employees through several channels, including a health insurance plan or as a standalone benefit.
Care coordination. Duplicate testing and medical care is another source of wasted healthcare dollars. When communication between healthcare providers is inconsistent or medical records aren’t updated and shared among all treating physicians, employees may undergo repeat testing — for example, when a primary care physician and a cardiologist both order a cardiac stress test for a patient with shortness of breath. Employers can offer care coordination through a case manager for employees who are living with multiple health conditions.
This support can lower the risk of duplicative testing as well as duplicate prescriptions or medications that can result in interactions, which can put an employee’s health needlessly at risk. Another piece of this equation is the review and coordination of medical records, which is especially important when employees see multiple physicians. A medical records management service should include a review of the employee’s records by an RN or physician, consolidation of a comprehensive medical record, and the creation of a secure electronic medical record that can be shared with the employee’s permission with all treating physicians.
Guidance on where to receive care. While you can undergo a colonoscopy, medication infusion or a range of common surgical procedures at a hospital, that may not always be the most appropriate or cost-effective place to receive care. By offering employees the ability to talk with a care manager or adviser about the procedure they need and the options for where they can receive that care (a hospital, outpatient surgery center or doctor’s office), employers can help them receive the care they need and lower both claims costs and employee out-of-pocket costs.
Medical bill review. Another resource employers can offer to make sure healthcare costs are carefully managed is a medical bill review. Experts estimate that between 30% and 80% of medical bills contain errors that increase costs. There are many different causes of these errors, including the use of the incorrect billing codes and use of out-of-network healthcare providers. In addition to offering employees the services of a medical billing review and negotiation firm, they can provide education that lets employees know what types of errors are commonly made and how to spot them on their own bills.
SOURCE: Varn, M. (13 February 2019) "Hospital pricing transparency: More information, more confusion?" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/hospital-pricing-transparency-more-information-more-confusion?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001
Move over mainstream: Alternative health options a road to better value
A number of employers are seeking alternative ways to get better value for their healthcare spending. Read this blog post to learn more about alternative health options.
While employers may be the largest purchasers of healthcare outside of the federal government, rarely does one organization have enough influence when negotiating with the powerful health plans and provider systems. As a result, employers — and ultimately the consumers for whom they purchase healthcare services — pay the price.
Instead of taking these lumps of coal sitting down, there are a growing number of employers on the cutting edge of healthcare purchasing seeking alternative ways in 2019 to get better value for their healthcare spending. They are looking for the diamonds in the rough.
In more than half of the healthcare markets in the U.S., providers have merged reducing competition and leaving employers and consumers with little choice for their care. Employers must stop insisting that health insurance products provide access to the broadest network of healthcare providers — if providers know they’ll be kept “in network” no matter how they behave, employers and payers further reduce their negotiating position. Employers also should band together to be sizable enough to call the shots, but this rarely happens.
While this lack of market power and influence is a major frustration for employers, it’s far from the only one. Educated employers also know that the healthcare system produces uneven quality and high prices have nothing to do with excellent care. The amount an employer pays for a service merely represents the relative negotiating strength of the health insurance carriers and providers.
As prices continue to drive healthcare cost growth, Americans are finding their healthcare unaffordable and are willing to trade choice for affordability. Many Americans no longer view having the ability to pick any doctor they choose as essential if it means increased premiums and cost-sharing that comes at the expense of other basic needs. These shifting attitudes represent an opportunity for employers seeking diamonds to pursue the following new healthcare benefits options. Here are some.
Narrow networks: Health insurance plans built around a narrower network that cuts out care providers who are outlandishly expensive or have a particularly poor record on quality. Alternatively, center a smaller network around a direct contract with an accountable care organization selected for its potential to deliver higher quality and value. More commercial health insurance carriers and lesser known third-party administrators are offering and supporting these options. Premiums and cost-sharing are typically lower for the consumer than with broader network plans.
Centers of excellence (CoE): Steer patients to designated high-quality providers with expertise in a given medical area who are willing to enter into an alternative payment arrangement or offer a more reasonable price in return for more patients. Make CoEs attractive through more generous coverage or make them mandatory if employees want an elective or non-emergent procedure (e.g., bariatric or spine surgery). Either way, employers reduce the risk that employees will receive subpar or low value care.
Alternative sites of care: Increase access to and use of alternative sites of care including onsite or near-site clinics and telehealth services. These enhance the convenience of primary or behavioral healthcare for employees and can help the employer better control referrals to overpriced hospitals or specialists.
So, move over mainstream. When it comes to the tactics employers use to purchase healthcare, alternative is likely to become less fringe. Narrow networks, CoEs or alternative sites of care may not solve all of the frustrations. But employers’ pursuit of these new models sends a strong signal that lumps of coal aren’t going to cut it. Employers are on the hunt for a shinier, more attractive set of solutions.
SOURCE: "Move over mainstream: Alternative health options a road to better value" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/move-over-mainstream-alternative-health-options-a-road-to-better-value?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
Analytics are key to wellness success. Here’s why
How can benefits managers utilize analytics to maximize their companies’ investments? Continue reading to learn how analytics can help employers optimize their health, wellness and other benefits programs.
What do benefits managers have in common with Walmart? Both have the power to leverage data to create a sustainable competitive advantage.
Like other leading retailers, Walmart mines vast quantities of data and applies predictive analytics to fuel solutions that improve store checkout processes, maximize inventory turnover and optimize product placement. Data analytics also helps the company identify shoppers’ preferences and personalize their shopping experiences. New parents, as identified by prior purchases, might receive digital coupons for infant products, for instance.
Walmart’s data intelligence gives the international retailer the ability to act upon insights quickly. One Halloween, for example, a novelty cookie generated high sales across the United States, but no sales at all in two U.S. stores. The company’s data analytics swiftly ascertained that the cookies were never put on the shelves at those stores. The problem was resolved immediately through high-visibility product placement.
Employee benefits managers have similar opportunities to maximize their companies’ investments. The effective use of disparate data can help employers optimize their health, wellness and other benefits programs, and pinpoint the true value of their total rewards.
A data-driven approach to benefits analytics
Three out of five U.S. employers use health screenings and risk assessments to help employees detect conditions earlier, when treatment might be more effective and costs lower. However, the majority of employers do not measure the impact of these programs.
Those that do assess a program’s impact typically compare the dollars spent on it with the medical claims saved. Forward-thinking benefits managers, however, are examining the total value of investment (VOI) instead. This innovative approach analyzes not only the effect of a wellness initiative on medical costs but also its influence on productivity, absenteeism, disability costs and other factors.
By aggregating and analyzing different types of data — such as claims and non-claims data — benefits managers can determine crucial correlations between preventive screenings, health outcomes and healthcare costs. Thus, they can develop more targeted benefits packages that reduce costs while improving overall employee health and productivity.
Case Study: Implementation of predictive analytics in preventative screenings
One recent initiative undertaken by a state employee health plan demonstrates the power of data analytics to reveal the VOI of preventive cancer screenings.
The state provides medical benefits to around 205,000 employees and dependents. The agency that administers the benefits program wanted to know whether preventive cancer screenings improved health outcomes, and whether the program was cost effective. Analyzing screening and claims data showed that 6% to 8% of those who underwent screenings for breast, colorectal or cervical cancer received a diagnosis of cancer or a related condition. The follow-up and all-important question was: did those members experience different outcomes than members whose cancers were not detected through screenings?
The results indicated a high VOI for members’ preventive cancer screenings:
- The majority of new cases of breast, colorectal and cervical cancer were detected through preventive screenings.
- Among members who received preventive screenings, 5% to 11% underwent treatments because of screening results — and not just for cancer. Treatments included removal of benign tumors or polyps.
- Those diagnosed with breast, colorectal or cervical cancer through the screenings experienced less invasive treatments and had fewer complications than those diagnosed through other means.
- New cases of breast and cervical cancer diagnosed through the preventive screenings had lower costs, on average, than cases detected through other means.
Positive action through data
This cancer screening example illustrates how data analysis can empower benefits managers to improve employees’ health outcomes while reducing costs. Analytics can help employers invest in more effective care management resources, as well as design benefits packages that provide positive VOI in wellness, screening and preventive care.
With the cost of health benefits continuing to rise, it’s critical to leverage data to determine the total value of wellness investments. Just as retailers use data analytics to improve the retail experience and increase profits, benefits managers should use data analytics to guide the design and evaluation of benefits and other rewards.
SOURCE: Kramer, M. (21 January 2019) "Analytics are key to wellness success. Here’s why" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/analytics-are-key-to-wellness-success-heres-why
4 ways to help employees master their HDHPs in 2019
Do you offer High Deductible Health Plans (HDHPs) to your employees? Whether your employees are HDHP veterans or newbies, there are things companies can do to help improve employee understanding. Read this blog post to learn more.
With 2018 in the books, now is a great time to give HDHP veterans and newbies at your company some help understanding — and squeezing more value out of — their plans in 2019.
Here are four simple steps your HR team can take over the next few months to put employees on the right track.
1. Post a jargon-free FAQ page on your intranet
When: Two weeks before your new plan year begins
Keep your FAQ at ten questions (and answers!), maximum. Otherwise, your employees can get overwhelmed by their health plans and by the FAQ.
When writing up the answers, pretend you’re talking directly to an employee who doesn’t know any of the insurance jargon you do. Keep it simple and straightforward.
Make sure your questions reflect the concerns of different employee types: Millennials who haven’t had insurance before, older employees behind on retirement, employees about to have a new kid, etc. To get a clear sense of these concerns, invite a diverse group of 5-7 employees out for coffee and ask them.
Some sample questions for your FAQ might be:
• Is an HSA different from an FSA?
• Do I have to open an HSA?
• How much money should I put in my HSA?
• This plan looks way more expensive than my PPO. What gives?
2. Send a reminder email about setting up an HSA and/or choosing a monthly contribution amount
When: The first week of the new plan year
When your employees don’t take advantage of their HSA not only do they miss out on low-hanging tax savings, your company misses out on payroll tax savings, too.
So right at the start of the new year, send an email that explains why it’s important to set up a contribution amount right away.
A few reasons why it’s really important to do this:
- You can’t use any HSA funds until your account is fully set up and you’ve chosen how much you’re going to contribute.
- If you pay for any healthcare at all next year, and don’t contribute to your HSA, you’re doing it wrong. Why? You don’t pay taxes on any of the money you put into your HSA and then spend on eligible health care…which puts real money back in your pocket. (Last year, the average HSA user contributed about $70 every two weeks and saved $267 in taxes as a result!)
- There’s no “use it or lose it” rule! Any money you put into your HSA this year is yours to use for medical expenses the rest of your life. And once you turn 65, you can use it for anything at all. A Mediterranean cruise. A life-size Build-a-Bear. You name it.
3. Give your HDHP newbies tips on navigating their first visit to the doctor and pharmacy
When: The week insurance cards are mailed out
When employees who are used to PPO-style co-pays realize they have to pay more upfront with their HDHP, they can get…cranky. And start to doubt their plan choice — or worse, you as their employer choice.
So set expectations ahead of time to avoid employee sticker shock and to prevent you from getting an earful. Specifically, remind employees which types of visits are considered preventative care (and likely free) and which aren’t. Then explain their options when it comes to paying for — and getting reimbursed for — the visit.
4. Share tips on saving money on care with all your HDHP users
When: Any time before the end of the first quarter of the year
Specifically, you might recommend that your employees:
- Check prescription prices on a site like Goodrx.com before they buy their meds
- Visit an urgent care center instead of the ER, if they’re sick or hurt but it’s not life-threatening
- Use a telemedicine tool (if your company offers one) to get free online medical advice without having to leave their Kleenex-riddled beds
Sure, following this communication schedule requires extra elbow grease. But if you defuse your employees’ stress and confusion early, they’ll feel more prepared to take control of their healthcare and get the most out of their plans. And as a bonus, you and your team get to spend less time answering panicked questions the rest of the year.
SOURCE: Calvin, H. (2 January 2019) "4 ways to help employees master their HDHPs in 2019" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/4-ways-to-help-employees-master-their-hdhps-in-2019
The case for self-funded health benefit plans and reference-based pricing
Small businesses are starting to explore self-funded plan designs that use reference-based pricing. Continue reading for more about self-funding and reference-based pricing.
Self-funding and reference-based pricing are hot topics with small businesses. They are so popular, in fact, that a recent survey shows an overall increase in their 2019 projection of small employer clients having a reference-based pricing health benefit plan design. Small businesses are seeing these savings, and they’re starting to explore how reference-based pricing can help them, too.
Before we get to why self-funded plan designs that use reference-based pricing are becoming more popular for small businesses, let’s review the basics.
Reference-based pricing is a methodology of calculating payment to providers for covered treatments and services using a “reasonable fee” based on a reference point. A common reference point is the Medicare fee schedule. Some self-funded health benefit plans calculate the reasonable fee as a percentage of the Medicare fee schedule to determine reimbursement for services rendered.
Bottom line: Self-funded health benefit plan designs that use reference-based pricing can allow for a great deal of flexibility with a variety of arrangements and overall cost-savings.
So, what’s behind the recent trend toward reference-based pricing for smaller employers? A few key factors.
First, a self-funded health benefit plan design that uses referenced-based pricing can mean less expensive coverage for employees and employers.
When coupling a self-funded health benefit plan with stop-loss insurance, reference-based pricing provides an affordable way to extend coverage to employees through lower employee contributions. So, employees are happy because they’re saving money.
And employers are happy, too, because they’re allowing for more coverage to more employees. There’s a refund potential for employers if claims dollars are less than funded. There’s also a premium tax savings of around 2% since self-funded claim dollars are not subject to state health insurance premium taxes.
Moreover, self-funded health benefit plan designs that utilize reference-based pricing may also include transparency reports with aggregate health claims data and demographic information, which allow employers to better manage costs. Overall, anytime you can design a plan that’s beneficial for employees and employers, it’s a win.
Second, reference-based pricing can provide employees more flexibility when it comes to choosing a provider. Typically, an important feature of any health benefit plan design for employees is the ability to choose the provider they want. Some self-funded plan designs that use reference-based pricing give employees the chance to pick the provider that’s right for them. And, when employees are happy with their health plan, employers are usually pretty happy, too.
Finally, self-funded plan designs that use reference-based pricing can help employees become smarter healthcare consumers because of all the transparency and choice involved. When employees better understand the healthcare processes and system, costs come down for both the employee and employer. In fact, just understanding their coverage better may help employees better use their health benefit plans.
For example, using telemedicine when appropriate, establishing a relationship with a primary care doctor and using client advocacy services can all help employees better utilize their health benefit plans. In the end, employees get smarter about how they manage their care, and employers win with reduced costs.
These factors are driving more small businesses to consider reference-based pricing self-funded health benefit plan designs with stop-loss insurance. And, for good reason. These plan designs can give employers the opportunity to offer their employees affordable health benefits, provide more choice in their health plans and providers, and encourage more employee engagement. While moving to reference-based pricing may be too big of a leap for some employers, self-funding continues to provide a means for employers to offer comprehensive major medical health benefits at lower costs.
SOURCE: MacLeod, D. (6 December 2018) "The case for self-funded health benefit plans and reference-based pricing" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/the-case-for-self-funded-health-benefit-plans-and-reference-based-pricing