Category Archives: health insurance

The Pitfalls of Consumerism

Do you put as much thought into selecting your cellphone plan as you do for selecting which doctors and specialists to see for your medical plans?

This question was posed at the National Business Coalition on Health’s annual conference in Washington by Shawn Leavitt, senior vice president of global benefits at Comcast Corp., during his keynote address.

“More than half of all consumers say they’re dissatisfied with the cellphone plan they chose,” he said. “So, if people are having a hard time selecting a cellphone plan that’s right for them, then how do we expect them to make the right decisions with respect to their health plan and health providers?”

The subject of Leavitt’s presentation was that healthcare consumerism — high-deductible plans that put more of the onus for financing and managing healthcare on employees — will not work unless employees receive more expert direction and guidance to help them.

At Comcast, said Leavitt, HR has enlisted so-called “expert shoppers” to help employees with these crucial decisions. It’s coupled that with outreach to certain locations within its vast empire to focus on subsectors — such as call centers — where employees were making heavy use of emergency rooms (and driving up costs) to educate employees on alternatives such as urgent care centers.

“We understand that it’s hard to expect employees who are juggling multiple responsibilities to make the sort of far-sighted decisions we’d like them to make when they’re faced with something as immediate as a sick child,” said Leavitt.

Comcast is using its own marketing wizardry to help educate employees on making wiser healthcare choices, he said. “We have become very good at getting consumers to pay to watch bad movies and reality television shows,” said Leavitt. “We’re focused on bringing that same level of expertise to help our employees make good decisions on healthcare.”

The risks of consumerism were also highlighted by Dr. Mark Fendrick during a panel discussion on pharmacy drug benefits. One of the main questions the panel grappled with was whether it was right for plan sponsors to exclude certain medications from plan coverage.

“If you’re doing that just to save money, I don’t think it’s a good idea,” said Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design. “I think it’s OK if the drug has been proved to be ineffective or counterproductive or if cheaper generics of equivalent effectiveness are available. But do it for the right reasons.”

The trend of pushing more costs onto employees can end up doing more harm than good if it isn’t managed carefully, he said. “Raising deductibles and pushing more of the cost onto employees without giving them support necessary for needed treatment and medications will simply cause more of them to forgo what they need,” he said. “I’ve had patients tell me that until they exhaust their deductible, they’re not going to do many of the things I’ve told them they need to do to maintain their health. And that goes against what this whole idea of consumerism is supposed to be about.”

 

Twitter It!

Survey Finds Skepticism on Private Exchanges

skepticsimThe National Business Group on Health’s latest health-benefits survey finds that large employers anticipate holding their healthcare benefit costs to about 5 percent next year, in part by continuing to shift more of the cost burden to employees, broadening their use of wellness programs and making high-deductible consumer-directed health plans their only benefit option (the number of employers that plan to do this for next year jumped by 50 percent).

Another option that’s attracting interest from large employers is private exchanges. Just 3 percent of large employers will offer their active employees health coverage through a private exchange next year, the survey finds; however, 35 percent said they’re considering doing so for 2016 or beyond. But employers are skeptical about the ability of these exchanges in two key areas: Only 17 percent said they’re confident that exchanges will do a better job of engaging employees to make better healthcare decisions and just 10 percent believe they’ll control costs better than their own plans.

Another report, this one from Accenture, finds that private exchanges are experiencing “hyper-growth” and that enrollment could exceed that of the public health exchanges (which have enrolled about 8 million Americans so far) by 2017. Approximately 3 million individuals could enroll in health plans via private exchanges this year alone, according to Accenture.

Whether or not these exchanges will be successful in engaging employees and lowering or stabilizing healthcare costs may depend on the features they offer: According to an Accenture survey of 2,000 U.S. consumers, 87 percent identified “tools to help project my expenses and select coverage levels” as an important feature, and 58 percent identified this as a “very important” or “critical” feature.

For readers wanting a bit more information on private exchanges, check out this comprehensive checklist by HREOnline’s benefits columnist, Carol Harnett.

Twitter It!

A Few Surprises in Study on Hourly Workers

490136049 -- gavel and clockI met with some folks from St. Louis-based Equifax Workforce Solutions during the Society for Human Resource Management’s conference in Orlando (June 22 through 25) and they shared with me some stats they compiled recently reflecting the potential impact of the Affordable Care Act that even they admitted had some surprises in them.

Working toward Jan. 1, 2015, when the majority of the ACA’s employer mandate takes effect, the company had just released its Equifax Workforce Solutions June 2014 report, highlighting “key indicators of how the ACA will affect business[es] and what they can do to ensure compliance [thereby avoiding penalties] as the regulations continue to go into effect,” as Mike Psenka, senior vice president of Workforce Analytics for Equifax Workforce Solutions (formerly TALX), put it.

For the record, and some important reading, here is the press release and here is the infographic, based on Equifax data culled from 500 million consumers and 81 million businesses worldwide.

Surprisingly — and in keeping with employers making employee-schedule-and-status adjustments to prepare for the ACA’s mandate that all employees working an average of 30 hours or more per week be offered healthcare coverage — 66 percent of the current U.S. workforce is now hourly, accounting for more than 73.6 million active employees, and 59 percent of them are working more than 30 hours per week, according to the study. (Those numbers were higher than anticipated, the folks from Equifax told me.)

Remember, for these workers, employers must track hours for each employee over a 3-to-12-month measurement period to determine healthcare-coverage eligibility. The study found average workloads vary greatly by industry and can be a key indicator of workforce eligibility. “For example,” the report states, “hourly employees in the finance industry work an average of 37 hours per week while those in the restaurant industry work an average of 23 hours per week.”

Also somewhat surprising — to me as well — was the fact that 71 percent of hourly employees have been at their jobs longer than 12 months, which represents “a significant number of workers who may become eligible for coverage after their employer’s first measurement period,” the report says.

And don’t forget employers must also offer affordable coverage to all eligible employees, meaning the monthly premium cannot exceed 9.5 percent of the employee’s income. Based on the average hourly pay rate by industry, as computed by Equifax, estimated maximum premiums can range from $108.80 per month (in the restaurant industry) to $251.20 per month (in the healthcare industry).

The goal here in releasing these stats, Psenka said, is not only to offer employers a few more tools for protection from potential penalties, “but also [to] ensure their valued employees receive appropriate — and affordable — coverage.”

Just bear in mind, as was underscored in an otherwise enjoyable, stress-free SHRM meeting, the clock is ticking and time to get this whole hourly, ACA-eligibility thing right is running out.

Twitter It!

Listening to the Data

I was having lunch the other day across the street from a noisy construction site. It wasn’t the best location in the world to read a book and enjoy a sandwich, but it was one of the few places I could find with some comfortable shade.

122399493As I sat there consuming my sandwich (and drink), I remember thinking to myself, “How in the world do these folks work eight hours straight with all that banging and clanging? I’m sure they were wearing protective gear to diffuse some of that noise, but despite the protection, it still had to be loud enough to drive a sane person crazy. (I eventually moved.)

If you’re like me, you probably know a few folks who’ve lost a decent amount of hearing as a result of the work they do. Some recognize they have a problem and have taken steps to remedy it, say by acquiring a hearing aid. Others are less aware, perhaps in denial or simply reluctant to do something about it. (According to the National Center on Hearing Assessment, only one in four people with hearing loss use hearing aids.)

When we think of the health and well-being of employees, a host of issues comes to mind. Diet. Exercise. Regular checkups. Hearing loss? Not really. But as a Better Hearing Institute press release sent out the other day to raise awareness on this issue points out, the problem of hearing loss is widespread, affecting more than 40 million Americans. And costly.

In an effort to bring attention to the issue, the American Tinnitus Association recently sent out its own press release, encouraging both employers and employees to be proactive. It urged employers to develop engineering controls to reduce overall noise output and implement administrative procedures to minimize workers’ noise exposure. Meanwhile, it asked workers to take control of their hearing health by using appropriate ear and noise protectors.

Of course, before either of these things are going to happen, employers and employees alike are going to have to get on the same page and acknowledge that a noise problem exists. Soon-to-be-released research suggests there’s a definite disconnect here between the perceptions of the two.

According to a survey of 1,500 full-time workers and nearly 500 benefits professionals by EPIC Hearing Healthcare ( a hearing-care provider), employees and employers each have a somewhat different take on the situation. Asked how many hours a day they believe their workplace is noisy, more than half (55 percent) of the employee respondents said it is noisy for more than one hour a day and more than one-third (36 percent) said it was noisy for more than three hours a day. In contrast, nearly 80 percent of employers said their workplace is hardly ever noisy.

The EPIC research also found nearly half of the employees felt the level of noise at work was damaging their hearing, even though less than one in four have had their hearing checked in the past two years.

In light of the above data and the impact hearing loss can have on productivity, employers shouldn’t be turning a deaf ear to this issue (excuse the pun). Indeed, they certainly have no shortage of tools available to them, ranging from reducing noise levels in their workplaces and providing employees with better protection to offering “financial support” through insurance products (EPIC’s business) and raising employee awareness.

Being this month is National Employee Wellness Month, I would think it might be as good a time as any for employers to revisit the state of their respective workplaces as far as noise exposure is concerned and the efforts that they’re taking to address the problem.

Twitter It!

The Problem with Free Health Screening

screeningThere was an interesting opinion piece in yesterday’s New York Times by Dartmouth professor H. Gilbert Welch, who argues that the Affordable Care Act’s incentives for free preventive care may actually work against one of the law’s stated goals of helping Americans become healthier.

Welch, a professor of medicine, says the ACA’s requirement that insurance plans include free screenings, such as mammograms, serve as an incentive for Americans to undergo screening yet do nothing to ensure they’ll follow up should those screenings uncover abnormalities that could be signs of disease. In other words, he writes, the law makes a distinction between screening and diagnosis that means people have an incentive to undergo screening while facing a disincentive to pursue additional tests and treatment should the screening uncover any abnormalities:

So the woman at lower risk for cancer — the one with no signs or symptoms of the disease — has an incentive to be tested, while the woman at higher risk — the one with the lump — faces a disincentive.

In many cases, this leads healthcare providers to, essentially, commit fraud by relabeling diagnostic tests as screening tests so patients don’t have to pay for services that can, in many cases, be quite expensive, writes Welch. Additionally, when screening tests are free, patients are less likely to consider the potential downsides of screening — false alarms, over-diagnosis and the “potential for a lot of out-of-pocket costs down the line.”

Welch suggests a fix: Eliminate the “mismatch between screening and diagnosis” by having patients share the cost of screening and diagnosis:

We need people to consider medical care carefully, and that’s what cost sharing is all about. Patients already share costs on what is arguably the most important preventive service, treatment for really high blood pressure, and for procedures as necessary for setting a broken leg. Why would we treat a much closer call — screening — any different?

Twitter It!

Will Employers Stop Offering Health Benefits?

Ezekiel Emanuel (an oncology doctor, professor of ethics at Penn and brother of Chicago mayor Rahm Emanuel) was one of the architects of the Affordable Care Act — which, as we all know, mandates that employers with at least 50 full-time-equivalent employees provide health insurance. So it’s a bit surprising to learn that Emanuel has just written a new book in which he predicts that, as a result of the ACA, most employers in the United States will have stopped offering health benefits to their employees by 2025.

Why will companies stop offering health benefits? Because, Emanuel argues in the book — Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System (how’s that for a title?) — the online insurance exchanges will provide employers with a viable alternative for doing so. Now, after you’ve picked yourself up off the floor from laughing so hard at the idea of Healthcare.gov being described as a “viable alternative” (although many of its worst bugs appear to have been fixed), note that Emanuel does acknowledge the botched rollout of the federal online exchange and some of the state ones, yet he describes others (such as Connecticut’s state exchange) that are working well. If all of the exchanges are fixed to the point that consumers can obtain health insurance by spending only 30 minutes or so enrolling, he says, then companies will indeed have a viable alternative to the expense and administrative hassles of providing benefits and can instead simply give their employees money to go out and purchase benefits on their own. The ACA’s excise taxes on high-cost health plans scheduled for 2018 are yet another incentive to get out of the health-benefits game, says Emanuel.

Private exchanges, which are essentially a defined-contribution approach to health benefits, have certainly sparked a lot of interest among employers lately. As many as 33 percent of respondents said private health exchanges would be their preferred approach to managing health care in the next three to five years, up from 5 percent now, according to Aon Hewitt’s Health Care Survey of more than 1,230 employers covering in excess of 10 million employees (Aon happens to be one of the vendors that offers a private exchange; others include Towers Watson, Buck Consultants and many smaller vendors). Brian Poger, CEO of consulting firm Benefitter, said at the just-concluded Health & Benefits Leadership Conference in Las Vegas that for many employees — especially low-wage workers with families — the health coverage available on public exchanges might be a better deal than that provided by their employers, considering that many have cut back or eliminated coverage for spouses and families.

Jettisoning traditional health benefits has yet to become a major trend among U.S. employers: Accenture estimated that 1 million employees enrolled in private exchanges last year, a tiny percentage of the nation’s workforce (although it also estimated that number could grow to 40 million by 2018). There is also the risk that employees on private exchanges will “buy down” — that is, purchase less-costly plans that may ultimately leave them with less coverage and worse health outcomes than traditional health plans, which tend to have “marginal” price differences, Mike Thompson, healthcare practice leader at PwC, told me last year. Companies that switch to private exchanges may also risk breaking the linkage between benefits and wellness, he said.

The expression “paradigm shift” is an overused cliché, but it’s clear we’re in one now when it comes to health benefits. Rest assured we’ll continue to cover this area closely.

Twitter It!

Innovation Central

One of the most dynamic sessions at this year’s Health & Benefits Leadership Conference was the “Ideas and Innovators” session, in which experts from a variety of fields give five-minute presentations summarizing their thoughts on what HR leaders should do differently with regard to benefits.

Here’s a sampling of what some of them had to say: Lindsey Pollak, a millennial workplace expert and spokeswoman for The Hartford insurance company, called on companies to encourage mentoring between baby boomers and millennials. “Ninety percent of the millennials we surveyed said they appreciated guidance from boomers,” she said. “Millennials are digital natives, so they can mentor boomers in the use of technology.”

Millennials want the ability to customize their benefits, she said: “Millennials weren’t given teddy bears as kids; they were taken to Build-a-Bear workshops — they’re used to having things tailored for them.”

The same Hartford survey found that 70 percent of millennials consider themselves leaders, whether in their families, workplaces and communities. Companies can harness this leadership spirit for health and wellness, said Pollak — yet must keep in mind that millennials have also proven to be slow to sign up for benefits such as disability insurance. “Millennials aren’t taking advantage of these benefits — you must reach them on this.”

Brian Poger, founder and CEO of consulting firm Benefitter, urged employers to consider getting out of the business of providing health benefits (perhaps an odd thing to hear at a conference devoted to employee benefits). “Most employee raises are being absorbed by rising healthcare costs,” he said. “Why not offer cash instead of health benefits?”

Poger cited a McKinsey survey that found 85 percent of employees would stay with their employer even if they stopped offering health benefits. Many employers are charging signficantly higher premiums for spousal and family coverage or dropping it altogether, he said, which can be a major hardship for families earning the U.S. median household income of $51,000 a year. “Giving employees cash to purchase a family policy on the exchanges may be a better deal for them,” he said.

Lexie Dendrinelis, health promotion and wellness leader at manufacturing firm Barry-Wehmiller Cos., discussed how her company has made leadership and culture — rather than exercise and eating well — the centerpiece of health and wellness. “People can’t focus on their personal health if they’re stressed out about an unsafe workplace,” she said. “Building trustworthy leaders and cultures is the best intervention.”

At Barry-Wehmiller, the company has committed to building a “caring culture” where “we are committed to sending our friends home safe, well and fulfilled.” The company uses incentives and rewards to highlight positive behaviors and takes a “holistic approach” to caring for its employees and families, said Dendrinelis. “We are looking at creating a thriving culture that will bring down healthcare costs.”

 

Twitter It!

Lessons from a Trusted Source

Consumer Reports has been a trusted source of information for folks in the market for a new car, a toaster oven or a snowblower. So why not healthcare?

I could be mistaken, but as a long-time subscriber, I’ve been noticing an increasing number of healthcare-related articles in Consumer Reports as of late. Articles86507521 like “Six Last-Minute Health Insurance Buying Tips” and “Six Tips for The Last Month of 2014 Health Care Open Enrollment.” But as Tara Montgomery made quite clear in her March 18 keynote during HRE‘s Health & Benefits Leadership Conference at Caesars Palace in Las Vegas, CR‘s commitment to healthcare these days goes well beyond an article here or there.

In its very first issue, Montgomery pointed out, CR covered healthcare, with a story on Alka Seltzer and whether it lived up to all of its claims.

But it wasn’t until around 2003, she explained, that CR expanded its efforts in the healthcare arena. Then, five or six years ago, she said, CR really stepped up its efforts as quality data started to emerge.

Montgomery, who is senior director of health partnerships and impact at CR, walked attendees through the multitude of products CR offers, and the partnerships it’s engaged in, that are aimed at informing consumers and giving them tools for making better decisions. (HRE also recently interviewed Montgomery, if you’d like to read more.)

Leveraging the trust inherent in the CR brand, Montgomery said, “We want to teach consumers how they can become better shoppers for healthcare.”

Near the end of her presentation, Montgomery offered attendees some of the lessons CR has learned along the way, including:

  • How valued its brand is to employees. “There’s a lot to be said for using a trusted messenger in this alienating healthcare system,” she explained.
  • There are a lot of good, positive stories that can be told regarding health and well-being, and people who have taken responsibility for their health.
  • You have to “push” your messages, because people are not out there seeking this kind of information, just yet.
  • When you put the right tools at the point of decision-making, good things happen.
  • Personalize what you do.  “One size fits all is not very helpful,” she said. “Don’t talk to everyone at once, but segment your audience.”
  • Use entertainment and humor in your communications. The organization is able to take advantage of its team of journalists, who are talented storytellers—and that is much better than sending out official documents.
  • Put safety first, which almost always results in cost-savings, too.
  • Write your materials at the 7th grade level. CR‘s research has found that even consumers with a high literacy level are extremely comfortable with communications at that level and didn’t feel the material was dumbing down to them. (Also, don’t make it text heavy and use graphics.)
  • It’s OK to incorporate games, but make sure that they’re truly helpful and not just gimmicky.
  • Make sure your messages have cultural relevance. “Don’t just show generic individuals sitting in the doctor’s office,” she said.
Twitter It!

Creating a Culture of Well-being

The breakfast spread—fresh fruit, yogurt, oatmeal, muffins—preceding yesterday’s opening keynote at the 2014 i4cp Conference at the Fairmont Scottsdale Princess should have been a clear giveaway as to the focus of this year’s opening keynote.

457068405Author Tom Rath, whose latest book is Eat Move Sleep, opened the conference with an engaging and thought-provoking talk on well-being and productivity. (Rath apparently delivers keynotes all the time, but this was the first time I personally heard him speak.)

Rath notes that the big question far too few corporate leaders ask is: How do we ensure that employees have the energy they need to be effective on a day-to-day basis? (Rath noted that only 8 percent of employees say their well-being is better off because of their employer.)

If organizations want to build an engaged and productive workforce, he told attendees, leaders are going to need to begin to ask that question.

One interesting sound bite from Rath’s remarks was that the relationship employees have with their boss or manager has a huge influence on their well-being and engagement. (In other words, bad bosses will inevitably result in unhealthy outcomes.)

Based on the research out there today, he said, “we wonder if the quality of your immediate manager may be more important for your physical health than the quality of your physician.” That’s certainly a sobering thought.

Rath noted that, when followers were asked what they want from their leaders, trust was at the top of the list. But right up there as well was caring. “If you were to step back and say, ‘What’s the hallmark of any great relationship between a leader and manager, and someone who works for him or her?’ ” he said, “I would say it’s that sense of caring … .”

At a little more than 200 pages, I’m looking forward to reading Eat Move Sleep (which was generously included in attendees’ registration packets) on my trip back to Philadelphia. I’ll be the first to admit I could probably do a lot better on all three fronts. Perhaps Rath’s book could be of some assistance.

Twitter It!

Employees’ Share of Healthcare Costs Going Up

employees paying moreHealthcare costs for large U.S. employers rose at the smallest rate in 15 years last year (at 4.1 percent), and are expected to rise at 4.4 percent this year, according to a just-released survey from Towers Watson and the National Business Group on Health. The annual survey, based on responses from 595 large U.S. employers, also finds that while the vast majority remain committed to providing benefits to active employees, they expect to make moderate to significant changes to their plans in the next few years.

Employees are continuing to bear a greater share of healthcare costs, with the survey finding that employees now pay more than $100 more per month for healthcare compared to just three years ago. Employees’ share of premiums increased by nearly 7 percent to $2,975 this year, while the total share of costs borne by employees has climbed from 34.4 percent in 2011 to 37 percent in 2014.

Employees can expect to continue paying more for spousal and dependent coverage, with nearly half (49 percent) of employers having increased employee contributions for dependent tiers at higher rates than for individuals and another 19 percent expecting to make this move next year. Nearly one quarter (24 percent) of companies now use spousal surcharges of $100 per month when other coverage is available elsewhere to the spouse. Notably, only 56 percent of companies believe subsidized healthcare for spouses will be “very important” for 2015 and beyond — down from 70 percent who say it is very important today.

Before jumping on the “let’s dump spousal coverage” bandwagon, though, employers may want to consider an EBRI report last month that found doing this may not save companies money after all.

Twitter It!