Category Archives: healthcare reform

Employers and Contraceptive Coverage

In case you missed it, a federal court of appeals ruled last Friday that religiously affiliated nonprofit employers can’t block their employees’ health care coverage for contraceptives.

The ruling in Catholic Health Care System v. Burwell finds that the plaintiffs, which include Catholic health care systems and Catholic high schools, are not burdened by having to formally object to covering contraceptives for employees.

The American Civil Liberties Union  supported the government’s arguments by participating in a friend-of-the-court brief.

The decision by the U.S. Court of Appeals for the Second Circuit held that the religious accommodation in the Affordable Care Act’s contraceptive rule imposed no substantial burden on the plaintiffs’ religious freedom.

The plaintiffs challenged a requirement that employers that object to including contraceptive coverage in their employee’s insurance plans notify their insurers or the government of their objection.  The insurer must then arrange and pay for the contraceptive coverage separately.

“Today’s victory is not only incredibly important for the more than 12,000 employees who stand to gain contraception coverage, but it also sends a clear message that an employer’s religious beliefs can’t be used to deny health care benefits to employees,” said Brigitte Amiri, senior staff attorney for the American Civil Liberties Union’s Reproductive Freedom Project. “We fight hard to protect religious freedom at the ACLU, but that right doesn’t allow employers to discriminate against their female employees.”

With Friday’s decision, the Second Circuit joins six other circuits that have found that the accommodation poses no substantial burden on the nonprofits’ religion, including the D.C., Third, Fifth, Sixth, Seventh, and Tenth Circuits.  No circuit court has ruled the other way.

Viewed purely from an HR perspective, the ruling seems to be yet another small — but welcome — step toward full equality in the workplace.

Twitter It!

Payment Reform Urgently Needed

The way in which healthcare is paid for in the United States is a perverse mess — it rewards unnecessary procedures and is lacking in transparency while failing to reward providers for doing things that are actually needed.

“We know the way we pay for healthcare today is inherently inflationary and often does not lead to the outcomes we want,” said Suzanne F. Delbanco, executive director of Catalyst for Payment Reform, a coalition of employers and healthcare purchasers. She spoke at a general session on payment reform on Day 2 of the Health & Benefits Leadership Conference in Las Vegas.

The CPR is working to create a “critical mass” of employers that would push for changes needed to rectify serious problems — such as those uncovered by a report 15 years ago that found healthcare providers throughout the United States charging wildly varying prices for the same medical procedures that bore no relation to quality or outcomes. A decade and a half later, Delbanco said, little progress has been made.

That’s not to say there aren’t bright spots: New innovations such as accountable care organizations and patient-centered medical homes have proven to be viable alternatives to the traditional fee-for-service model and have resulted in lower prices and better outcomes, she said. The CPR is also encouraging employers to experiment with new approaches such as shared savings and non-payment for botched or unnecessary procedures.

One hurdle has been the fact that many employers are more comfortable making changes to benefit-plan designs that shift more of the cost to employees than in challenging the traditional way in which healthcare is paid for, said Delbanco. “Ideally, employers should be doing both,” she said, adding that employees have generally become more receptive to the need to control costs.

Delbanco was joined on stage by Anna Fallieras, G.E.’s program leader for healthcare initiatives and policy, who described her company’s journey to consumerism.

“Our message to employees is, ‘Be an active consumer: Think about managing costs and getting quality care,’ ” she said, adding that GE spends $2 billion per year on employee healthcare.

GE, which rolled out consumer-driven health plans to its employee population in 2013, also created new tools and services to help them make better healthcare decisions. These include a telephonic health-coach service designed to help employees get access to top-performing healthcare providers, and a treatment cost calculator that offers price and quality information on providers.

The cost calculator has helped employees save between 5 percent and 30 percent on their healthcare bills, said Fallieras. GE also offers a telemedicine service that’s garnered a 90-percent satisfaction rate from employees, she said.

Fallieras called on other employers to join GE in fighting for payment reform. “We can’t do it all ourselves,” she said. “We as employers have a central role.”

 

Twitter It!

Being a Disruptive Force in Healthcare

As snow began to fall on the nation’s capital yesterday morning, attendees at the National Business Group on Health’s Business Health Agenda 2015 conference were inside the J.W. Marriott (Washington) intently listening to NBGH President and CEO Brian Marcotte lay out the challenges and opportunities that lie ahead for healthcare in 2015—and beyond.

452031437During his talk, Marcotte touched on the “disruption” occurring in healthcare today and praised employers for the role they’re playing in “driving innovation.” He described those employers that are leading the way with such innovations as “disrupters.”

“Disruption” is certainly as good a word as any to describe what’s taking place in healthcare today.

No surprise that Marcotte — who was vice president of compensation and benefits at Honeywell for roughly 12 years before replacing Helen Darling as NBGH president and CEO last May — pointed to the Affordable Care Act as healthcare’s biggest disruptive force.

Six years ago, Marcotte said, “[w]hen the CEO would ask the question, ‘Why don’t we just get out of healthcare?’ the answer was simple [because] there was no place for people to go to purchase affordable, high-quality healthcare. Well, the answer is not as simple today.”

Nowadays, he explained, there are several options, including staying the course, private exchanges and public exchanges. As things stand today, he said, “staying the course” continues to be the most efficient way to deliver to employees affordable healthcare. As he explained it,  “[w]e haven’t seen good and consistent data” to suggest otherwise.

At the end of the day, Marcotte added, it all comes down to value and whether or not private exchanges can deliver greater value than today’s self-insured model.

During a session later in the morning, Julie Stone, North America health and group benefits leader for Towers Watson, shared, for the first time, the results of her company’s just-completed 2015 Emerging Trends in Health Care Survey. Among the findings: While 17 percent of 444 employer respondents believe private exchanges provide a viable alternative for employer-sponsored coverage for active full-time employees in 2016, confidence in the approach builds to 37 percent by 2018.

In addition, the Towers Watson study found companies that have done extensive analyses of private exchanges are twice as likely to consider them a viable option in 2016 (29 percent versus 14 percent).

Despite this somewhat promising data, Marcotte said, employers aren’t going to embrace private exchanges until they see more data suggesting it’s the right move to make.

Early on in his remarks, Marcotte emphasized the need for more data, recalling an episode at Honeywell when CEO David Cote put him on the spot at a meeting to back up a statement he made with meaningful data.

CEOs make their decisions based on data, Marcotte said. But with the exception of cost, he continued, the data needed to make the right healthcare decisions aren’t available yet.

In his talk, Marcotte also touched on other disrupters, such as the industry consolidation that’s going on in healthcare. “When will we begin to see the synergies from the consolidation?” he asked.

Another disrupter: emerging delivery models, such as accountable-care organizations. Despite an “explosion” in the number of these organizations, he said, the jury is still out as to “what to make of it.”

“Employers,” he said, “need to know what they’re buying.”

In other words, he said, they need to understand the “value” they’re getting.

As he put it, if you’re going to go to your CEO and say, “We’re going to change the plan design and encourage people to go to ACOs,” that CEO is going to respond, “Why? What’s the value proposition?”

So be ready for that question. And, I would think, be ready with the required data to back your proposal up, because you know you’re going to need it.

Twitter It!

Adapting to the Affordable Care Act

ACAHow are we going to respond to the Affordable Care Act?

That’s the question CHROs have been asking themselves since President Obama signed the ACA into law in March 2010.

The University of South Carolina Darla Moore School of Business recently asked that question of CHROs, in its annual HR@Moore Survey of Chief HR Officers.

Distributed to more than 560 chief HR officers at Fortune 500 firms as well as members of the HR Policy Association, this year’s poll asked these HR leaders to specify the actions they’ve already taken, or plan to take over the next 12 months, as a direct response to the Affordable Care Act.

The answers of the 200-plus respondents indicate that most companies are responding by pushing costs and responsibility on to employees. For example:

  • 73 percent of respondents said they have moved or will move employees to consumer-directed health plans.
  • 71 percent said they have raised or will raise employee contributions toward health insurance.
  • 30 percent of organizations have moved or will move their pre-65 retirees to ACA exchanges.
  • 27 percent have either cut back the coverage eligibility of employees’ spouses and dependents or plan to do so.
  • 23 percent have or will more rigorously ensure that part-time employees work fewer than 30 hours per week.

The study, which the University described as a “definitive look at how medium- and large-sized firms have been affected by the changes to the health insurance and healthcare system,” could serve as a “valuable benchmarking tool” for CHROs weighing their organizations’ options in terms of mitigating ACA-related costs, says Patrick Wright, a professor of strategic human resource management at the Darla Moore School of Business, and director of the school’s annual CHRO survey.

“Up to now there has been only speculation as to [the Affordable Care Act’s] impact on business and workers,” says Wright, in a statement. “This survey provides the facts about that impact and specifics on changes to employment practices as a result.”

Twitter It!

Adding to ACA Uncertainty

ACAA pair of appeals court rulings made just hours apart yesterday seem to have compounded employers’ confusion surrounding the Affordable Care Act.

First, the 4th Circuit U.S. Court of Appeals in Washington ruled in the case of Halbig v. Burwell that the ACA does not permit the Internal Revenue Service to distribute premium subsidies in the 36 states where exchanges are run by the federal government.

Later in the day, a federal appeals court panel 100 or so miles down the road in Richmond, Va., took the opposite view, determining the ACA’s “ambiguity” affords the IRS the authority to issue the subsidies.

Reaction to the contradictory rulings—which seem to pave the way for a likely Supreme Court case—was swift, strong and, politically speaking, true to party lines.

Noting his dissent in the later ruling, D.C. Circuit Judge Harry T. Edwards described the decision as a “not-so-veiled attempt to gut the Patient Protection and Affordable Care Act.”

Meanwhile, the conservative side of the aisle commended the Richmond panel’s decision.

Speaker John Boehner, for example, described the ruling as “further proof that President Obama’s healthcare law is completely unworkable,” saying in a statement that the Affordable Care Act “cannot be fixed.”

For employers in the majority of the U.S., what happened yesterday just seems to further cloud an already uncertain future with regard to the ACA.

“The D.C. Circuit’s decision is significant in that it calls into question whether employers [in the affected states] could be subject to a penalty under the ACA’s ‘pay or play’ penalty scheme,” according to Peter Marathas, a Boston-based partner in Proskauer’s employee benefits, executive compensation and ERISA litigation practice center.

Yesterday’s decisions are “not the final say on this issue,” he says, “but [they] certainly underscore the thin thread much of the employer penalty hangs on, particularly if other courts agree with this decision.”

The matter “seems destined for the U.S. Supreme Court,” said American Benefits Council President James A. Klein, in a statement.

Klein also offered his take on how things may ultimately shake out.

“Since the employer mandate penalty is triggered when employees receive a subsidy, some employers may be relieved of penalties, or may have different levels of penalties, depending on which states their workers reside.”

In addition, some companies have weighed whether employees may be better served through steady coverage in exchanges, especially those who frequently change jobs, said Klein.

“The lack of subsidies for workers in some states certainly would change the dynamics in that decision making,” he noted, adding that further uncertainty over the implementation of the healthcare law “chills” the decision-making process for employers.

“The courts need to quickly resolve this critical issue,” he said, “one way or the other.”

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!

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!