Category Archives: health

The Incredibly Shrinking Carrier Market

It’s official: Anthem announced this morning plans to purchase Cigna for more than $48 billion.

Word Cloud Merger & Acquisitions

Word Cloud Merger & Acquisitions

Coming on the heels of Aetna’s $37 billion proposed deal to acquire Humana, the Anthem-Cigna proposed merger, were it to be given the green light by regulators, would inevitably reshape the health-insurance landscape and provide employers with one less option to consider. But according to experts I spoke to earlier today, deals like the one announced this morning also have the potential of being a boon to employers and employees.

If the Anthem-Cigna transaction goes through, Anthem will have more than $115 billion in pro forma annual revenues, based on the most recent 2015 outlooks publicly reported by both companies. Anthem President and CEO Joseph Swedish would serve as chairman and CEO of the combined company and Cigna’s President and CEO David Cordani would take on the titles of president and COO.

Here’s Swedish’s take on the proposed merger …

“We believe that this transaction will allow us to enhance our competitive position and be better positioned to apply the insights and access of a broad network and dedicated local presence to the health care challenges of the increasingly diverse markets, membership, and communities we serve. The Cigna team has built a set of capabilities that greatly complement our own offerings and the combined company will have a competitive presence across commercial, government, international and specialty segments. These expanded capabilities will enable us to better serve our customers as their health care needs evolve.”

And Cordani’s take …

“The complementary nature of our businesses will allow us to leverage the deep global health care knowledge, local market talent, and expertise of both organizations to ensure that consumers have access to affordable and personalized solutions across diverse life and health stages and position us for sustained success.”

There’s been three national players for a while, with all three of them trying strengthen their portfolios through mergers, explained Tucker Sharp, global chief broking officer at Aon Hewitt in Somerset, N.J. “Someone can put out a headline that says, ‘Five carriers become three.’ But there really have been three national players and what’s happening here is really about building scale … .”

Sharp also noted that lately there’s a bit of merger one-upmanship going on between the carriers and providers. For some time now, he said, the hospitals and physician groups have quietly been merging to get the upper-hand in negotiating with the carriers. Now, much like “an arms race,” you’re seeing the insurer carriers trying to improve their leverage.

At the end of the day, he said, the operational efficiencies and greater scale gained from these mergers could lead to better deals with health providers and benefit employers.

When I asked Sharp if there’s anything HR leaders should be doing differently in light of the Anthem-Cigna news, he said nothing at the moment, noting it’s going to take time for things to work their way through the regulators. If you’re an HR executive, he added, there’s probably nothing you need to worry about for the rest 2015 and 2016.

I also asked Steve Wojcik, vice president of public policy at National Business Group on Health in Washington, for his assessment of the announcement.

His response: “There are some potential upsides and some potential downsides. In the end, we’re looking for some of the cost savings and pricing to trickle down to the employers and employees. But there also are obviously some concerns, because there are only a few players left standing—so employers that want to put their plan administration out to bid are going to have fewer bidders … .”

Wojcik predicts that the Aetna-Humana deal will probably meet less resistance from regulators than the Anthem-Cigna deal because Humana is a smaller player in the employer market, though a much bigger player in the Medicare market.

In evaluating these deals, he said, regulators need to factor in that the health insurance market is dynamic, not static. They’re going to need to weigh into their thinking, he explained, some of the new entities, such as accountable care organizations, that have emerged in recent years and the impact they’re having on the overall market.

 

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Drug Use, Addiction at Work Continues to Rise

The use and abuse of drugs in the workplace isn’t slowing down at all. Latest reports indicate the percentage of American workers 73267092 -- drugs at worktesting positive for illicit drugs such as marijuana, cocaine and methamphetamines has increased for the second consecutive year in the general U.S. workforce — putting an end to the decades-long decline.

Indeed, this article references a government report that finds nearly one in 10 full-time workers now has a substance-abuse problem. And the latest Quest Diagnostics Drug Testing Index shows an upsurge in the positivity rate of drug tests by 9.3 percent — from 4.3 percent in 2013 to 4.7 percent in 2014. (Here is an additional link to the actual tables/stats within the index.)

“American workers are increasingly testing positive for workforce drug use across almost all workforce categories and drug-test-specimen types,” says Dr. Barry Sample, director of science and technology for Quest Diagnostics Employer Solutions. “In the past, we have noted increases in prescription-drug-positivity rates, but now, it seems, illicit drug use may be on the rise, according to our data.

“These findings,” says Sample, “are especially concerning because they suggest that the recent focus on illicit marijuana use may be too narrow, and that other dangerous drugs are potentially making a comeback.”

Dr. Robert DuPont, former director of the National Institute on Drug Abuse, says this latest analysis by Quest not only “suggests that illicit drug use among workers is increasing broadly for the first time in years in the United States [but that] public and private employers might want to consider revisiting existing substance-abuse policies to ensure that they are taking the necessary precautions to protect their workplace, employees and businesses.”

Equally concerning is the fact that abuse of legal drugs is also going up, as this news analysis by Andrew McIlvaine addresses. Drugs taken for attention-deficit-hyperactivity disorder — such as Ritalin, Adderall and Focalin — are now being abused by employees looking to add some sparks to concentration and alertness.

Will Wesch, Novus Medical Detox Center director of admissions, says many organizations are now updating their language in drug-free workplace policies to include potential impairment from a prescription drug. He urges HR practitioners to coach managers in how to engage employees suspected of such abuse and offer reasonable accommodations, up to or including modifying job responsibilities should an employee inform him or her that the medication he or she is on may impair job performance.

As for specific policies, concerns and approaches HR leaders should be considering right now when it comes to all workplace drug use, DuPont has this to offer:

“First, look at the big picture in workplace drug testing. There is much more to workplace drug testing than just testing for marijuana. An effective drug-free program includes testing for many widely used drugs [including prescription]. Second, consider the legal complications of workplace marijuana testing.  For example, several states allowing medical use of marijuana are now requiring an employer to show impairment before taking action against an applicant or employee who tests positive for marijuana. These provisions pose a significant limitation to workplace drug-testing programs for marijuana.

“I also recommend you provide clarity in your drug-free policies. … Every employee must be informed of the company’s substance-use policy and the reasons for the policy. Drug testing needs to be described in a written statement of the employer’s substance-use policy. This policy statement must clearly lay out the elements of the drug-testing program, including who is subject to testing, how testing is administered, how positive results are confirmed and what the consequences are for positive drug-test results. Supervisors and human resource staff should be trained in the employers’ substance-use policies and procedures, and be able to explain them to all employees and job applicants.”

And, again, when it comes to marijuana, DuPont says, “pay close attention to the specifics of state and local law,” obviously and especially in those states where it’s medically or recreationally legal. And make sure your drug-testing policies are being reviewed by attorneys “who are familiar with federal, state and local laws … particularly related to marijuana.”

Yes, folks, it’s a whole new world when it comes to drugs at work. DuPont says it’s time to consider “going beyond the urine cup and … the typical five-drug tests” and embrace the bigger picture now upon us.

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A Downside for Health Apps?

appsThis year’s Health & Benefits Leadership Conference saw a host of vendors and experts touting the benefits of the smartphone in promoting employee health. Checking in with apps such as MyFitnessPal (an app for tracking calories and diet) or the FitBit activity tracker will “engage” (that crucial word!) employees in their health like nothing else, they say.

Not so fast, cautions a new article in BMJ, a British medical journal. The BMJ piece features opposing viewpoints from two doctors: Dr. Iltifat Husain, who oversees a review site for medical professionals, writes that apps can help doctors hold patients accountable for their behavior. In a counterpoint, Dr. Des Spence, a Scottish general practitioner, argues that health apps encourage healthy people to unnecessarily record their normal activities and vital signs, ultimately turning them into “continuously self-monitoring neurotics.”

Health apps, Spence writes, are untested and unscientific and should be viewed with skepticism. “Make no mistake,” he writes. “Diagnostic uncertainty ignites extreme anxiety in people.”

This caution is warranted: The New York Times notes that federal regulators have been cracking down on health-apps vendors who’ve falsely claimed, among other things, that their products could accurately analyze skin moles for potential melanoma.

“If an app claims to treat, diagnose or prevent a disease or health condition, it needs to have serious evidence to back up those claims,” the Federal Trade Commission’s Mary K. Engle told the paper. In other words, although health apps clearly have the potential to get employees more focused on improving their health, they should also be wary of apps that claim to diagnose or treat a health condition.

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Making Workplace Meditation Work

Mindfulness appears to be alive and well in Fort Collins, Colo. Or at the Fort Collins Housing Authority anyway.

139980668-- meditationJust before the holidays, I came across this release about the FCHA completing a month-long mindfulness program for its staff.  Seems the organization’s top leaders took its annual wellness survey seriously when a common complaint came back suggesting improvements in work/life balance and health and general well-being were needed.

In the words of FCHA Chief Executive Officer Julie Brewen: “We are committed to implementing new programs for the health and well-being of our staff.”

In an industry that deals with tough issues such as poverty, homelessness and families in crisis, she says, the program was a step in the right direction. The program consisted of daily, hour-long sessions during work hours that blended presentations, group discussion and meditation practice.

The results? According to Brewen, lowered stress and depression, and an increase in work/life balance.

What’s even more impressive is what she shared with me just recently, that her organization’s commitment to this lives on, with additional mindfulness training planned for this year, and some added questionnaires and wellness-survey questions designed to keep a close eye on the workplace well-being meter.

“Many of the participants [intend] to continue [their] meditation and mindfulness exercises” into the rest of 2015, she says.

Of course, putting this kind of program together takes a huge and collective commitment to the idea and the practice. It needs to come from the top and be ingrained into the culture, as this column a year ago (to the month) by our benefits columnist, Carol Harnett, suggests.

Her column also suggests the concept could use some booster shots in the business community. “In my experience,” she writes, “most employers pay scant attention to stress and defer to employee-assistance programs as check-the-box solutions — despite poor utilization of this service.”

So what’s it going to take for the Fort Collins approach to become the approach of most? Perhaps when employers start acknowledging they have nothing to lose and everything to gain, even as it relates to your brand and reputation. As Harnett writes:

” … mind-body curriculums will please a growing portion of your employee population and improve your workers’ perceptions of the workplace culture. And that may be an employer’s greatest consideration of all.”

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Shaking the Mental Health Stigma

mental healthJust a few short weeks from now, our March issue will see the light of day. In it, you’ll find the second installment of a three-part series on employee health.

This Carol Patton-penned feature looks at how more employers are “recognizing the destructive footprint of depression on their workforce and bottom line, and are taking direct aim at the illness.”

There’s no doubt that many companies have made great strides in identifying the signs and understanding the insidious impact of this illness, and are acting to help employees affected by depression as well as those dealing with other mental health issues.

But, that doesn’t mean there isn’t still a ways to go.

The Disability Management Employer Coalition’s just-released 2014 Behavioral Risk Survey posed 42 online questions to 314 employers of various sizes between July and August of last year. The results suggest the stigma surrounding mental health in the workplace still very much exists, to say the least.

For example, respondents were asked what level of, or change in, stigma associated with “having a psychological/psychiatric problem” they have witnessed in the last two years. (DMEC conducts its Behavioral Risk Survey on a biennial basis.)

Overall, 41.4 percent of respondents said the stigma remained the same, with 25.1 percent indicating that the stigma has actually decreased in that time.

Another 24.2 percent, however, said the stigma has increased since 2012. And, consider that just 7.6 percent reported feeling the same way two years ago.

Troubling as some of these figures are, the survey does show signs that management awareness and acceptance of behavioral health issues is growing, though. When asked how their upper management’s opinion regarding the need to review behavioral health issues has changed over the past two years, for instance, 36.8 percent of respondents replied, “yes, it has become more open” in that time. In 2012, 25 percent of respondents said the same.

In addition, 32.8 percent of survey participants said their organizations screen for underlying psychological or psychosocial issues, marking a slight, 3.2 percent increase from 2012.

In a statement detailing some of the survey’s findings, DMEC Executive Director Terri L. Rhodes described employers’ increased adoption of screening and other tools to identify and address mental health conditions as “heartening.”

But, she adds, “there is much more to be done to reduce the stigma still attached to these illnesses and create a consistently collaborative approach to treating them.”

(A full report on the 2014 Behavioral Risk Survey is available by contacting John Jordan at jjordan@principor.com or 202.595.9008.)

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The Challenges of Walking While You Work

Good news for those of you who believe that treadmills and office desks go together like peanuts and chewing gum!

New academic research based on a 12-week study of overweight employees by an Oregon State University researcher found that the increase in physical activity from using a treadmill desk was small and did not help workers meet public health guidelines for daily exercise.

And while their positive effects may be small, introducing treadmill desks in the workplace also can pose big logistical challenges that may not make such a program feasible for many companies, said John M. Schuna, Jr., an assistant professor of exercise and sports science in the College of Public Health and Human Sciences at OSU.

In a small study of treadmill desk use by overweight and obese office workers, Schuna and his colleagues found that workers who used the desks increased their average number of daily steps by more than 1,000, but did not record any significant weight loss or changes in Body Mass Index after 12 weeks. The employees only used the treadmills about half the time they were asked to, averaging one session and 45 minutes a day on the machines.

“Treadmill desks aren’t an effective replacement for regular exercise, and the benefits of the desks may not justify the cost and other challenges that come with implementing them,” Schuna said.

His findings were published recently in the “Journal of Occupational and Environmental Medicine.” Co-authors include Damon L. Swift of East Carolina University and several researchers from the Pennington Biomedical Research Center in Baton Rouge, Louisiana. The research was supported by Blue Cross and Blue Shield of Louisiana.

Interestingly enough, researchers faced several challenges with the study, including difficulty recruiting employees to participate. Initially, more than 700 employees of the company were targeted for recruitment, with roughly 10 percent of them expressing interest in participating. Some of those employees were deemed ineligible for the study for a variety of reasons, while others did not receive approval from a supervisor.

They also found work considerations often kept employees from using the desks, even though the company had approved and encouraged employees to participate in the program. Employees shared the treadmill desks, which required scheduling the time they would be using them.

Schuna said the findings from this study indicate that future research on exercise in the workplace should focus on interventions that avoid some of the pitfalls that come with treadmill desks.

“We need to identify some form of physical activity that can be done simply and at a low cost in an office setting,” he said.

Preferably while sitting.

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Another City Tackles Paid Sick Days

The Philadelphia City Council today is debating a hot-button topic with potential HR ramifications that may reach far beyond the city’s limits: whether to enact a paid sick days bill into law.

If passed, the City of Brotherly Love will join San Francisco, Washington, D.C., Seattle, Portland, Ore., New York City, Jersey City, Newark and the state of Connecticut as municipalities with such laws on the books.

While the debate around such laws has been growing over the years, momentum for its passage increased after President Obama’s recent State of the Union Address, which called for cities to ensure paid sick days for millions of Americans. The president is also urging Congress to require companies to give workers up to seven days of paid sick leave a year.

According to the National Partnership for Women & Families, San Francisco became the first locality in the nation to guarantee access to earned paid sick days in 2006.

In 2008, the District of Columbia and Milwaukee passed paid sick days standards that included paid “safe” days for victims of domestic violence, sexual assault and stalking. In 2011, the Connecticut legislature became the first in the nation to pass a statewide paid sick days law, and Seattle became the fourth city, with Portland, Ore., and New York City joining their ranks in 2013.

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The Hanging Gardens of the Future

greenIf you’ve always wished you could have visited the legendary Hanging Gardens of Babylon, one of the Seven Wonders of the Ancient World,  perhaps you’ll take heart from “Organic Grid+,” the winner of an architectural contest to design the “Workplace of the Future.”

Designed by London-based architects Sean Cassidy and Joe Wilson, Organic Grid+ is intended to meld together innovations such as green walls, open-plan offices and vertical greenhouses into a soothing, healthy, light-filled space. The proposal would entail attaching  multistory vertical greenhouses — or “sky gardens” — onto existing skyscrapers in which employees could both work and … harvest fresh vegetables for their lunch. As they write:

… Sky gardens provide fresh food for employees to enjoy, as well as natural cooling and acoustic buffering throughout the building. The intrusion of green spaces into the structure itself also generates a more welcoming and overall pleasant atmosphere in which to work, ultimately boosting morale for those inside.

Naturally, there are potential downsides: John Metcalfe of The Atlantic’s CityLab blog writes that “What’s worse than chatty coworkers interrupting your flow? How about a dude harvesting zucchini from a vertical garden falling and crashing through your desk in a hollering heap?” Putting aside the snark, however, innovations such as green walls, office gardens  and workplace farmers markets are becoming increasingly popular — although still rare — as a way to not only provide relief from the drab concrete and industrial carpeting of the traditional office space but encourage healthier living by employees. Who knows: in the future maybe we’ll be bringing gardening gloves to work in addition to our smartphones and travel mugs.

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Bullish on Wellness

Good news out of the Society for Human Resource Management yesterday for those looking to move the needle on greater employee buy-in for wellness.

174186054According to the association’s Strategic Benefits survey, more than one-half (53 percent) of the 380 responding employers said employee participation in wellness programs climbed last year. This follows similar findings in 2013 and 2012, when 56 percent and 54 percent of the respondents, respectively, reported a jump.

What’s more, more than two-thirds of the employers that offered wellness indicated that their initiatives were either “somewhat effective” or “very effective” in reducing the costs of healthcare in 2014 (72 percent), 2013 (71 percent) and 2012 (68 percent).

The SHRM study also found two-thirds (67 percent) of organizations with such initiatives in place offered incentives or rewards aimed at increasing participation, representing an upward trend from 2013 (56 percent) and 2012 (57 percent).

Of those organizations offering wellness incentives or rewards, 85 percent said these incentives were “somewhat” or “very” effective in increasing employee participation.

The study also found the number of organizations with wellness programs was on the rise in 2014, with about three-quarters (76 percent) of the respondents saying they offered some type of wellness program to employees last year, an increase from 70 percent in 2012.

In all, these findings paint a fairly positive picture as far as wellness is concerned. But one weak link uncovered in the SHRM research, not surprisingly, continues to be on the measurement front. Few companies, SHRM reports, are actually measuring the ROI or cost-savings analyses of their efforts (18 percent and 30 percent, respectively).

Nine in 10 (90 percent) of the respondents whose organizations had wellness initiatives said their organizations would increase their investments in its wellness initiatives if they could better quantify their impact.

(Some critics would argue that, were they to measure the effectiveness of these programs, they might not be nearly so bullish.)

The SHRM research also looked at flexible-work arrangements, finding that about one-half (52 percent) of organizations provided employees with the option to use FWAs, such as teleworking. Of those offering employees such options, about one-third (31 percent) said participation in these initiatives increased last year, compared to the year before. Just 1 percent indicated employee participation had decreased.

Though one in two employers provided employees with the option to use flexible-work arrangements, the survey found only one-third (33 percent) reporting that the majority of their employees were actually allowed to use them.

Something I would think employers will need to address, sooner rather than later, considering Gen Yers (big proponents of flextime) are projected to represent the majority of the workforce in the not-too-distant future.

 

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Starting the Ultimate Conversation

Last holiday season, I posted a piece on this blog about what employers should do when employees come to them with news that 465319021 -- difficult conversationthey are dying. It featured advice from Lynne Curry, president of Anchorage, Alaska-based The Growth Co., who stressed the importance — for employers, and HR and benefits professionals — of going over plans and benefits with any and all employees who come to them with such difficult information.

Recently, it seems, The Dow Chemical Co. took that discussion many steps further by partnering with a company called The Conversation Project. Founded by journalist Ellen Goodman, the project offers a step-by-step guide, called the Conversation Starter Kit, designed to carry managers, HR professionals, family members and loved ones through what I would call the ultimate conversation.

The idea to offer such a project and kit to her employees came to Dr. Cathy Baase, global director of health services at Midland, Mich.-based Dow, when she heard Goodman speak at a health conference about her own experiences as her mother’s caregiver and healthcare decision-maker for many years, and her resulting mission to change the way Americans talk about and deal with death.

As Goodman shared then, had she had conversations with her mother before dementia impaired her ability to share her desires, she might have felt more secure in making the decisions she faced.

Dr. Baase was driven by her own experiences as well, not only in seeing employees through this difficult time, but having engaged her own family to talk early, and often, about their mother’s chronic illness. She and her older sister, a nurse, were the forces behind the bi-weekly and sometimes weekly conference calls they would have with their two younger brothers, committed to staying on the same page about their mother’s care until she passed.

“Having these conversations actually made us closer as a family,” says Dr. Baase. “We knew how things were going and what to expect in the future, and we talked through everything until we came to an agreement. It did make things easier — although these things are never completely easy.”

With the help of The Conversation Project, Dow has begun a focused effort to educate employees and retirees about the merits of getting it all out in the open. Information about the project is now on the Dow internal website and has been distributed at retiree-health fairs.

The company also sponsored two webinars for its employees, retirees and staff, and its magazine, Dow Friends, which reaches more than 50,000 retirees in the United States and Canada, featured an article on the effort. It also shot a video recently for use in meetings and promotions, and plans are under way to hold role-playing events to help people break the ice and initiate these conversations at home.

“If we can help Dow employees be less stressed, more comforted and at peace,” says Dr. Baase, “then that leads to less distraction and a break from worry. … We have a history of confronting challenging problems that affect our society, and end-of-life care is an extension of that.”

Mega kudos to Dow, Dr. Baase and the project.

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