Posts belonging to Category healthcare

For most employers, preparing to comply with the ”pay or play” requirement of the Affordable Care Act is shaping up to be a world-class headache. Large employers with multistate operations face their own set of challenges, and these were the topic of a panel discussion on Day Two of the Health Benefits & Leadership Conference^™ in Las Vegas.

Brant Suddath, benefits director at Atlanta-based The Home Depot, said he was spending lots of time trying to figure out who, among the retailer’s approximately 120,000 part-time U.S. employees (out of a total employee population of 330,000) would qualify for healthcare benefits from the company. He added that it’s important to “work closely with your broker/consultants” on this and other ACA-related matters. Marisa Milton, vice president for HR policy, strategy and compliance for Bethesda, Md.-based Marriott International, said her company was working with financial models to determine how the law may affect Marriott financially.

“We’re taking a ‘the sky is falling’ approach, thinking about what the worst-case scenario could be,” she said. “The potential cost impact of this legislation is going to be huge, so we’re working with different departments–including finance–to figure out how this may affect the company and the changes we may need to make.”

Milton said the company was mostly taking a wait-and-see approach before making any major changes to its healthcare offerings, adding that she did not anticipate any big changes before 2015. “After 2015?” she said. “We’ll see.”

None of the participants–who, in addition to Suddath and Milton included Ed Bray, director of employee benefits at Hawaiian Airlines and Andrew Gold, vice president for total rewards at Pitney Bowes–said their companies were planning to stop offering healthcare benefits as a result of the new law, certainly not in the near term. Gold said Pitney Bowes may look at some options for potentially offsetting the cost of complying with the new law, including narrowing its network of healthcare providers and moving more employees into high-deductible health plans. However, the company is concerned about taking actions that may affect employee engagement, he said.

“Benefits are so important to employees now, and you have to make changes very carefully,” said Gold. “I don’t think we have the license to do the things we want to do just to drive costs down.”

A big concern for all of them is ensuring that employees understand how the law’s healthcare exchanges will work and whether they’ll make the right choices in terms of seeking coverage on the exchanges. “It keeps us up at night–who is going to be walking the employees through all these decisions?” said Suddath.

“The level of confusion among employees about this law is off the charts,” said Milton. “We’re starting to realize that we need to focus on helping employees gain a basic understanding of the law and what it means for them.”

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A big question was pondered on day two of the Health Benefits & Leadership Conference^™ in Las Vegas: Can companies change their employees’ behavior, and if yes, then how?

Benefits consultant and HREOnline columnist Carol Harnett moderated a panel to address that very question. HR is leading the charge to try and get employees to lose weight, become more active and participate in health-improvement programs, she said, yet this often involves getting them to not only change their behavior, but sustain those changes for the long-term. How can it be done?

HR has to “make it mindlessly easy to be healthy in the workplace,” said panelist Amy Moore, innovations design leader for Memphis-based Healthways, in response to a question from Harnett (who took questions texted by the audience to her cell phone) about how to sustain engagement with wellness programs. “You need to think about how you structure permanent changes so that people end up practicing the behaviors you want by default.”

As an example, said Moore, organizations can add low-priced healthier items to the food sold in their vending machines while raising the prices of the junky snacks just enough to cause inconvenience. For example, she said, raising the price of a brownie to $1.01 will force an employee to consider whether she really wants it, especially if she has to walk back to her desk to get a penny. “And, if she decides she’s going to buy it anyway, at least she’ll get the benefit of that extra walk back and forth from her desk,” said Moore.

Another audience member sent Harnett a question on whether carrots or sticks were most effective. “I think you need to look at the differences between people and determine what works best for them,” said Vlad Gyster, founder and CEO of benefits-communication firm H Engage.

“If you’re focused on helping people achieve quality of life, setting up punitive measures can have a negative effect,” said panelist Rosemary Passantino, commuications manager for the health service system of the City of San Francisco. “You need to frame it in a positive way–as in, we’re all working together toward this goal, so we can continue to have these things that we value … frame it nicely.”

The City and County of San Francisco is in the process of moving its employees to a consumer-directed health plan , changing plan designs to require employees to pay more for certain types of copays in order to change behavior related to utilization, which is a big change for those employees, said Passantino. “As public employees, they’ve been fairly well shielded from the rise in healthcare costs up to now, so we’re trying to incentivize them to change their behaviors,” she said. The city is also working with local healthcare providers to make it easier for employees to navigate the healthcare system and attain their healthcare goals, she added. Its primary cost management strategy is building collaborations with medical groups and hospitals to find common rewards in delivering more coordinated and efficient care (setting up two accountable-care organizations in association with Blue Shield, for example.). “For the average person, the healthcare system is like throwing someone into the Alaskan wilderness,” she said.

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As attendees gathered into the general session room for the opening keynote at the Human Resource Executive Health & Benefits Leadership Conference^™, the energy in the room felt much different — more charged, more urgent, more focused — than any other that I’ve been in over the last few years.

Even before keynote speaker Dr. Ron Leopold started his remarks, people were in their chairs early, ready to go—pens and notepads out, smartphones charged. I assumed they were just anxious to hear Leopold answer the question he’d posed in his session title (which he even admitted was selected to get tongues wagging), “Are benefits forever?”

However, as the session progressed, I realized attendees weren’t seeking paydirt on Leopold’s query and they weren’t looking to sit in a drum circle for a “PPACA therapy session,” as one pro in the room tweeted.

Rather, as the clock ticks down to mere months before practitioners face the full force of health care reform the attendees this morning wanted solutions. They wanted strategies. And by the looks on their faces, they weren’t leaving until they got them.

I had a lightbulb moment. I realized that employers are no longer panicked about PPACA. They are purposeful.

Following the Supreme Court’s affirmation of the health care reform law and the re-election of President Obama, us benefits communicators have been waiting for that shift from employers for a while now. We’ve been waiting patiently—some of us more so than others—for you to turn flimsy ideas into firm plans. Mostly so that we could stop writing stories about how you’re all in “wait and see mode,” and start writing about strategies about how to work now that you’re in “decide and do” mode. That makes our jobs waaaay more exciting, and also more meaningful.

As Leopold noted, “Most employers—according to most survey and research data—have decided to ‘play’ [under PPACA’s employers mandate], but it’s a different playing field.” From my vantage point, what brought practitioners here to Las Vegas for HBLC is much more than to spend three days in 90-degree weather (although it’s a nice bonus). They’re here this week because they understand, as Leopold said, “The answer to PPACA isn’t in the health plan alone, [and] even if employers get out of the health care business, they’ll never get out of the productivity business.”

So, to succeed on that new playing field, employers know they need some new plays. For example, I ate lunch with a woman today who is at HBLC seeking new ideas for her organization’s wellness program. I asked her about the current offering, and it sounded like a rousing success—in five years, the plan has garnered more than 50 percent participation using a well-structured blend of incentives and challenges to keep employees engaged. It also features employee health fairs where employees and their families can receive biometric screenings, so employees’ engagement via the fun stuff still can lead to actionable health conversations with their physicians. Further, it’s a collegiate environment, so she and her team leverage the school’s kinesiology students to serve as personal trainers for employees.

I know employers that would love to have resources and participation levels like that, I told her. What exactly was she looking to change?

The impact of PPACA has the organization considering self-funding, she said. So, instead of just wellness carrots, “it may be time to bring in sticks, too.”

Like Leopold said, employers are playing, but on a whole different playing field. I, for one, am encouraged that here at HBLC, HR/benefits pros understand that and are prepping new and improved benefits playbooks for game time come January.

Kelley M. Butler is the Editorial Director at Benz Communications, a consulting firm specializing in benefits communications. Formerly the Editor-in-Chief of Employee Benefit News, Kelley has been covering news and trends in human resources and employee benefits for more than 12 years. Follow her updates from HBLC on twitter at @kelleytheeditor.

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Just got word from a source close to this subject that the Massachusetts Board of the Connector (the state agency that administers the state healthcare-law requirements) just approved a measure on Thursday that could mean big penalties for Massachusetts employees in 2014, when healthcare reform mandates kick in, and could affect employers there as well.

Rich Stover, a principal at New York-based Buck Consultants, who testified before the Connector Board back in January about this, tells me the board’s approval of amendments to the state’s idividual-mandate requirements will result in Massachusetts employees being subject to significant penalties even if they have comprehensive health coverage that satisfies the ACA requirements.

Employers there, he says, will have to revise their plan designs or complete an uncertain certification process with the state in order to ensure their employees aren’t hit with such penalities.

Since it’s involved and a bit confusing, here’s his rundown of the whole affair:

In 2006, Massachusetts enacted a health reform law that requires Massachusetts residents age 18 and older to have health coverage that meets certain minimum creditable coverage (MCC) requirements or be subject to tax penalties. This reform law was the model for the federal Patient Protection and Affordable Care Act. Although the MCC requirements only apply to residents and do not apply directly to employers, if an employer plan does not satisfy the MCC requirements, employees and family members enrolled in that employer plan may be subject to these Massachusetts’ tax penalties.  The maximum annual individual penalty for 2012 is $1,260.

With the ACA employer and employee mandates and penalties going into effect in 2014, Massachusetts had to decide whether to continue the individual mandate and MCC requirements [then].  On March 14, the Board of the Connector … met and decided to continue, and strengthen, the individual mandate in 2014. The 2014 requirements could subject Massachusetts residents participating in large employer plans to significant penalties if their employer coverage does not satisfy the new MCC requirements, even though the employer plan fully complies with the federal ACA requirements.

In 2014, Massachusetts will require that medical coverage provide 100 percent coverage for preventive-care service and limit out-of-pocket amounts paid by enrollees to certain maximum amounts.  ACA requires that non-grandfathered plans meet these requirements, but not grandfathered plans or certain retiree plans. In addition, ACA has a special transition rule in 2014 for prescription-drug benefits that Massachusetts is not providing.  So employees in grandfathered plans under ACA may be subject to Massachusetts penalties, even though the plan is fully in compliance with the ACA. Employers can help employees avoid these penalties by filing their plans with the Connector and seeking approval for the plan.

Here, by the way is a helpful link from Stover recapping the board’s Thursday meeting and actions, as well as previous ones.

In essence, Stover says, “employers who had assumed that the Massachusetts requirements would no longer apply with federal reform being effective in 2014 will be very disappointed to learn that the compliance efforts, administration and penalties will continue under state law.”

So what does all this mean for human resource professionals in Massachusetts and possibly beyond?

“As they plan for 2014,” says Stover, “human resource officers will need to make sure they address both the federal and state requirements, which [obviously and apparently] will put an additional burden on Massachusetts employers.”

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It’s pretty much impossible to listen in on a benefits panel without hearing the term ROI.  Maybe a lot more than once.

Certainly, as might be expected, that was the case during the opening panel at this year’s 2013 Health & Productivity Forum at the Fairmont in Dallas. (The event is jointly sponsored by the Integrated Benefits Institute and the National Business Coalition on Health.)

I strongly suspect it won’t be the last time the topic of ROI will be raised before the Forum concludes on Wed.

The one-hour panel, featuring three benefit leaders and one CEO (Sam Gilliland, chairman and CEO of Sabre Holdings), covered quite a bit of ground, including some of the ways benefit leaders are wrestling with metrics.

When benefits people are asked to identify the key metrics that affect business performance, IBI President Tom Parry said they respond that they don’t know, almost without exception. (Parry and NBCH President and CEO Andrew Webber jointly moderated the panel.)

Parry suggested that benefit leaders need to start to close the gap between what they are doing and what business leaders are doing, remembering as they do that they’re competing for scarce dollars.

During the panel, R. J. Paczkowski, director of benefits for Capital One, pointed out that his benefits team regularly uses pilots to test the effectiveness of new wellness initiatives; just as the company wouldn’t think of launching a new credit card without first doing a pilot.

Paczkowski added that Capital One has established a “health score” so business leaders would have some insight into the health of their respective organizations.

Because many initiatives involve changing behaviors, Greyhound Director of HR Tyneeta Morris said that “sometimes it could be two or three years down the road [before a company might see a return].”

On occasion, she added, some expenses may initially go up.

Chris McSwain, vice president of U.S. benefits at Walmart, told those attending that he believes benefits professionals have an unprecedented opportunity to change the conversation from one that’s focused on “cost” to one that’s focused on “investment directly tied to the business.”

At Walmart, he said, the benefits team has worked closely with the operations side of the business to better understand how they measure the performance of their businesses and determine how its work fits into that.

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Figured flu season makes this infographic from Best Choice Reviews a viable post, even though much of the information is stuff you already know about germs at work.

Like just how germy your mouse, phone and keyboard are. Or just how much rhinovirus sits on surfaces in restrooms and lunchrooms. Or just how filthy co-workers’ hands really are (indeed, the graphic — based on 5,000 swabs of office surfaces and corresponding interviews with several thousand of the folks who touch them — shows 15 percent of workers avoid shaking hands to avoid germs … wonder how that plays out in sales meetings??).

Surprising as some of the new stats are (79 percent of vending buttons are dirty, 1 in 3 office workers have witnessed people leaving restrooms without washing their hands, 53 percent of workers don’t wash their hands after exchanging money), there’s not much more you can do with them beyond communicating the importance of hand-sanitization and making sure dispensers are strategically placed throughout your company.

What I found more troubling were Best Choice’s findings that 72 percent of Americans typically go to work when they’re sick and 55 percent of workers feel guilty when they call in sick.

I wonder how many HR departments out there are seriously and aggressivley communicating the importance of staying home when you don’t feel well, considering all the work that needs to get done today with fewer resources and less money. And surely, it doesn’t stop there. Training managers and supervisors to respond to “I’m sick and staying home today” calls – or ”I’m sick but I’ll be there around noon” calls – so health is being promoted just as much as, or even more than, productivity has to be the next and necessary step.

Considering how prevalent and scary the currently spreading flu bug is, this may be something worth thinking harder about and taking up with your powers that be.

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Came across this helpful post on the headcount-accounting rules for providing healthcare coverage under the Patient Protection and Affordable Care Act.

The post, courtesy of the Society for Human Resource Management (subscription required), makes note – with links provided – of two recent releases you should know about. One is a Jan. 2 publication in the Federal Register by the Internal Revenue Service of its proposed “Shared Responsibility for Employers Regarding Health Coverage,” with guidance on complying with the requirement that large employers provide affordable healthcare coverage under the act. The other is the IRS’s online post of questions and answers regarding those “shared responsibility” provisions.

What’s essential to note here, according to the release, is the healthcare mandate’s application “to employers with 50 or more full-time employees or a combination of full-time and part-time employees that is equivalent to at least 50 full-time employees.” Granted, this sounds like it affects smaller employers more than large ones, but it needs to be worked into all headcount calculations, and large employers choosing to opt out of healthcare-plan provisions need to know what they’re getting into.

To quote the release:

… large employers that do not offer coverage to their full-time employees face a penalty of $2,000 times the total number of full-time employees if at least one employee receives a tax credit to purchase coverage through a state-based health insurance exchange established under the PPACA.

If large employers do offer coverage to their full-time employees and their dependents but the coverage is “unaffordable” to certain employees or does not provide minimum value, the employers face a penalty of $3,000 times the number of full-time employees receiving tax credits for exchange coverage (not to exceed $2,000 times the total number of full-time employees).

Here’s the general mandate behind those calucations, according to the release:

Employers with 50 or more full-time employees (including full-time equivalents) must offer all employees working an average of 30 hours per week or more in a month healthcare coverage with “minimum value,” beginning in 2014, or pay penalties.

In other words, although large employers are not required to provide healthcare coverage to part-time employees working less than 30 hours per week, these part-time employees are included in calculating the threshold number of 50 workers (including full-time equivalents) that would require employers to offer affordable coverage to all full-time employees.

It gets even more involved:

As explained in the new Q&As, because under the PPACA a full-time employee is an individual employed on average at least 30 hours per week, half-time would be 15 hours per week, and 100 half-time employees would equal 50 full-time employees. In another example given in the Q&As, 40 full-time employees employed 30 or more hours per week on average plus 20 half-time employees employed 15 hours per week on average are equivalent to 50 full-time employees.

In addition to spelling out more details on how FTEs are to be calculated under the new law, the release includes specifics on other types of employees, such as seasonal workers and transition relief.

Obviously, as with all aspects of the ACA, you should be conferring with your legal and benefits consultants first and foremost.

Given the intricacies of these FTE calculations, it might behoove you to confer with some mathmeticians and accountants as well.

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Healthcare facilities can be a virtual breeding ground for influenza, especially during this time of year. With that in mind, Indiana University Health Goshen Hospital recently mandated that all of its employees receive flu shots, for the well-being of patients and staff alike.

And they take the requirement seriously: A refusal to comply with the new directive is apparently a fireable offense, at least for some.

According to the hospital, 1,300 employees declined the vaccine. Eight of them, including at least three experienced nurses, were let go as a result.  

One of the nurses, Ethel Hoover, cited her religious beliefs as grounds for refusing the shot. She filed a religious exemption, two medical exemptions and two appeals in an attempt to forego the mandatory flu shot. Each request was denied, and Hoover’s employment with the hospital ended on Dec. 21, six days after the IU-imposed Dec. 15 flu shot deadline had passed.

IU Health is certainly not the first healthcare organization to mandate flu shots for its employees, and Hoover isn’t the first employee to challenge the legality of such a requirement.

Consider the recent case involving a vegan healthcare worker at a Cincinnati children’s hospital, who was fired after refusing a flu shot on the basis that chicken eggs are used in the preparation of flu vaccines. A federal court judge refused to dismiss the claim, determining it possible that the plaintiff’s veganism could be a moral or ethical principle she abides by with the same conviction as a religious belief.

Such cases should remind employers with a duty to accommodate for religious beliefs that performing individualized assessments may be wiser than imposing blanket policies “that apply across the board,” says Frank Chernak, partner and labor and employment attorney in the Philadelphia office of Ballard Spahr.

For instance, oblige employees to fill out a form stating the reasons why they seek an exemption, says Chernak. “Then you’re engaged in a dialogue with the employee. And maybe [you find] there’s another way to handle the situation, and to make an accommodation.”

For example, the Cincinnati hospital’s HR team could have explained to the vegan employee—who worked in customer service and didn’t have frequent, direct contact with patients—that a vaccination without animal products was also available. Or, in the case of Hoover, the organization could have considered putting her in a role with less or no patient contact during flu season, assuming such a move could be made without undue hardship.

 “A lot of employers will simply ask the employee, ‘Is there any reason you can’t do it?’ And have a form to document the employee’s reasons, whether it’s a medical exemption or a religious exemption,” says Chernak. “That’s a good way to do it.”

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No harm in reminding one and all that you have until March 1 — according to the recently enacted Affordable Care Act — to notify your employees about state-specific healthcare exchanges to be set up before 2014.

This alert from the Society for Human Resource Mangement lays out what you need to be doing next, according to the new law, after you’ve satisfied your January 2013 healthcare-benefit cost-reporting requirement for 2012 W-2s, that is. (Appropriate informational links are included in the SHRM piece; note, though, that the SHRM site is a subscription-based one.)

In the piece, Jennifer Benz, CEO of Benz Communications, lists three specific communication requirements employers must satisfy by March 1:

• State exchange basics. This is a description of the state exchange, the services provided by the exchange and how to contact the exchange (website and customer service number). One wrinkle: not all states have decided how they’re going to comply (the National Conference of State Legislatures provides an up-to-date chart of state implementation efforts). Employers in multi-plan states will have an even more challenging time.

• Individual plan value. This explains whether employees will receive at least 60 percent coverage of essential health benefits through employer-provided coverage, and whether employees may be eligible for a premium tax credit if they purchase a plan on the state exchange.

• Tax implications. Because health-insurance premiums under employer-sponsored coverage may be paid with pre-tax dollars, buying coverage through a state exchange may change an employee’s tax obligations. Employees using an exchange to purchase coverage may lose their employer’s tax-free contribution (if any) to their health coverage, also.

Although many benefits and HR experts are predicting the March deadline will be extended, considering the U.S. Department of Labor has yet to release proposed regulations or samples of a model notice, Benz suggests integrating the three-part notice into your overall health-benefits-communication strategy regardless.

“No matter what deadline the DOL ultimately sets,” says Benz, “employers need to be prepared to include [these three points] in their communication plans for 2013.”

“Communicate your 2014 position before the legalese does,” she adds. “Be sure to use language that fits the notice into your big-picture approach to healthcare-reform compliance. For many employers, this strategy is going to include high-deductible health plans and incentive-heavy wellness programs, two benefit strategies that require robust, thoughtful communications in their own right.”

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On this, the last Saturday in 2012, I went hunting and pecking for a few things I might share about the HR profession — looking back on the year that will soon be history as well as anticipating the one to come.

With healthcare and the impending Affordable Care Act enactments that much closer, this list from Mercer of the top five priorities for employer-sponsored health plans in 2013 seemed a helpful one. I was especially drawn to its specific suggestions for customizing plan designs and contributions in today’s high-health-cost environment, and for making health exchanges work best for you.

One blog post from an Edwardsville, Ill.-based employment, payroll and workforce-services company, Extra Help Inc., lays out its leading seven concerns HR professionals should be attending to right now. Though some of the list is aimed at Missouri and Illinois businesses, and promotes its services, it’s still a nice, succinct rundown of things you should have on your front burner — such as whether you’re fully versed in healthcare-reform requirements, whether you’re up on all you’re supposed to have posted around your environs and whether you really have the best plan in place when employees start leaving as the economy continues to improve.

Looking across the pond, I found this post from CIP HR, based in Buckinghamshire, England, that — interestingly — echoes many of the same cost-centered concerns HR professionals in the United States face in 2013: making sure the right talent gets into the right post to begin with, making sure younger workers get the kind of development opportunities that will encourage them to stay since they can’t climb the corporate ladder the way their parents did, and making sure social-media policies are crafted correctly, to keep you out of court.

Couldn’t find quite as much out there on top HR issues of 2012, but probably wouldn’t/couldn’t have found anything better than our own Winners and Losers list for 2012 from HRE Editor David Shadovitz. And, in keeping with other lists’ overriding focus on healthcare and healthcare reform, no surprise that his No. 1 winner is Obamacare.

Also, for the record, here again is Web Editor Michael J. O’Brien’s blog post on what you blog readers read the most this past year on The Leader Board. May be a reflection of what caught your eye more than what has been or will be keeping you up at night, but a reflection nonetheless.

And, as I intimated up top, there’s probably no better time to reflect than when one year bites the dust and another one is born.

Happy New Year everyone.

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