Category Archives: healthcare

The Next Step for Wearable Tech

Wearable technology has been receiving a lot of attention in the press lately.

ThinkstockPhotos-126914550Just last month, FitBit—by far, the current leading provider in the field of tracking devices—scored a major client win when Target announced it would be giving its 335,000 employees a free Zip, the firm’s clip-on device retailing for around $60. Wall Street apparently was pleased by the news: FitBit’s stock price jumped as much as 22 percent following the announcement.

So I guess it isn’t terribly surprising to see wearable technologies quite visible at this week’s Benefits Forum & Expo in Orlando, Fla. Right?

Just a few steps away from the conference registration desk, FitBit employees were distributing complimentary devices to attendees who agreed to sign up for a charity competition. (Full disclosure: I picked up my first tracker on Wednesday, strapped it on my wrist and joined a team designated “MS Mercenaries,” though I’m clearly not contributing to our tally sitting here writing this post.)

I probably should also mention that FitBit did a similar competition at our Health & Benefits Leadership Conference last year and will be doing it again later this month at our HR Tech Conference.

I also counted at least three sessions dedicated to the wearables topic on the opening day of the Benefits Forum.

One of those sessions, titled “Wearables: A Believable Future or a Passing Fad,” featured David Spierer, president of human physiology at Wellness Science LLC, a New York-based data-intelligence company that focuses on wearable-tech validation.

Spierer shared his insights and perspectives on the phenomenon, including some of the drawbacks employers ought to factor in as they evaluate and implement these devices in their organizations.

Sustainability and accuracy continue to be two major hurdles facing device makers, he said.

According to Spierer, wearables have a life span of about five-and-a-half to six months before the novelty wears off and they end up in a drawer, he said. Either that, he said, or they break.

Still, the appetite for these devices is unarguably huge. Spierer said they’re shipping at a rate of more than 21 million units a year—and some predict that number could rise to 150 million a year by 2018. So people clearly want them!

Spierer also emphasized the need for better validation.

He specifically pointed to manufacturers’ claims that these devices can measure calories, when the only way to accurately measure caloric expenditures is to wear a mask. “Carbon dioxide, oxygen and nitrogen have to all be measured in order to get a true reading of caloric expenditure,” he said. “These devices just do an estimate.”

Yet despite such limitations, Spierer predicted that further innovation lies ahead for the technology and the future is promising.

By integrating the sensors with a complete system, he said, people will be able to do exercises at home and then send that information to their physician.

Spierer also predicted that the devices are going to become increasingly “invisible” and “personalized,” citing companies that have already added them to their clothing and are incorporating them in jewelry such as earrings.

He also expects the technology to get a lot smarter. “They’re going to be context-driven,” he said. “They’re going to know when it’s raining, what holiday it is [and] what your routine is during the day.” And they’re going to start to talk to other devices (for instance, the wearable on your wrist will be able to talk to your phone in your pocket).

“How great would it be if you were walking home with your groceries, the wearable senses your heart rate is going up, the smart lock on your front door opens … and because your sweating, your air conditioning goes on?” he asked.

I’d say pretty great—especially on a day like today, when temperatures in Orlando reached around 90 degrees.

The Ongoing Expansion of Worksite Health

Affordable Care Act uncertainties be damned—employers are going ahead with their plans to launch on-site health centers.

That seems to be the overarching message to emerge from Mercer’s new targeted survey on worksite clinics.

The New York-based consultancy’s poll is actually a follow-up of sorts to last year’s National Survey of Employer-Sponsored Health Plans, in which 29 percent of organizations with 5,000-plus employees that provide an on-site or near-site clinical site said they offer primary care services. (That figure marks a 5 percent increase in the number of companies saying the same in 2013.)

For this recent survey, all participants from the 2014 poll that reported offering a worksite clinic were invited to answer detailed follow-up questions about their clinic operations. Among the 134 respondents, 91 percent of those with clinics identified controlling total health spend as a “very important” or “important” objective in establishing an on-site center. For 77 percent of survey participants, reducing lost employee productivity was also a key goal, with 68 percent saying they consider improving member access to healthcare important or very important.

These findings are very much in line with what Towers Watson’s 2015 Employer-Sponsored Health Care Centers Survey uncovered earlier this year. In that survey, 75 percent of 105 organizations currently offering employer-sponsored health centers cited increasing productivity as a key goal, with 74 percent indicating the same about reducing healthcare costs, and 66 percent reporting they hope to improve employee access to healthcare services.

What experts at both Towers Watson and Mercer find most interesting about these figures, however, is the suggestion that the ACA’s infamous excise tax hasn’t deterred many employers from building new on-site health clinics, or from expanding existing centers.

“ … Companies are adding centers despite concerns around the Affordable Care Act and its excise tax, which [requires] that the cost of an on-site center has to be included in the cost of delivering healthcare to employees,” Allan Khoury, senior health management consultant at Towers Watson, told HRE in June.

“If that cost goes too high, you violate the Cadillac tax. But we’re still seeing great support for these clinics among employers.”

That’s not to say companies aren’t concerned that on-site health centers’ operational costs could help push them over the threshold for the excise tax, of course. But, by and large, most organizations remain convinced that their clinics “will deliver positive net value,” said David Keyt, principal and National Onsite Clinic Center of Excellence leader at Mercer, in a statement.

In the latest Mercer survey, 15 percent of respondents said they believe their general medical clinic will hurt them in terms of the excise tax calculation, but 11 percent said they think it will help, “presumably by helping to hold down the cost of the company’s health plan,” according to Mercer. Twenty-eight percent think it won’t have an effect either way.

And, ultimately, most companies aren’t really using cost as a barometer for the value of their on-site health centers anyway, according to Keyt.

“For many employers, employee satisfaction is a more important measure of success than ROI,” he said. “If employees are using the clinic, it means they haven’t been taking time off work to visit a doctor, and that they’re getting the medical care they need to stay healthy and productive.”

Auto Workers’ Push for Pooling

The United Auto Workers is pushing for greater industry consolidation. No, I’m not referring to something along the lines of Fiat Chrysler’s CEO Sergio Marchionne’s on-again, off-again pursuit of merging with General Motors. I’m talking about employee healthcare.

ThinkstockPhotos-101922589A story in today’s Wall Street Journal titled “UAW Pitches Health-Care Co-op to Car Makers”  (subscription site) reports that the “United Auto Workers union is pushing Detroit car makers to put all their employees under one health-care umbrella, creating a powerful purchasing group that could upend traditional health-care markets.” It continues:

“The union’s idea would create a joint purchasing group for the three largest U.S. auto makers that would cover factory and white-collar workers and union-affiliated retirees. The group could total nearly 1 million members, a scale it believes would have unprecedented leverage in negotiating directly with hospitals, drug companies and others.

Assuming the idea even gets off the ground, it could take one to two years to set up and longer to generate significant savings, health-care experts said.”

As the WSJ story reports, “UAW President Dennis Williams previously has described the plan as a way for auto makers to gain more control over health-care expenses and win cost savings. He wants the purchasing group overseen by a board [consisting] of union and auto-industry executives. A prior effort to pull together employees of the three stalled in 2011 because auto makers weren’t interested in pursuing it.”

The UAW is currently negotiating a new four-year deal to replace the current contract, which is set to expire on Sept. 14.

I spoke to Steve Wojcik, vice president of public policy for the National Business Group on Health in Washington, and asked him for his take on the UAW move.

Wojcik says he can’t comment on the union’s plans, since he doesn’t know the specifics, but adds that he certainly understands where the motivation is coming from. Plans, he says, are under a lot of pressure to reduce costs, especially with the ACA excise tax kicking in in 2018.

Still, Wojcik says he isn’t convinced the UAW pooling strategy would be the most effective way to address the cost issue.

“The problem with these efforts,” he says, “is [they involve] voluntary participation—so employers with success at controlling costs or lowering healthcare expenses end up not participating and those having trouble [on these fronts do participate]. Because of this, I don’t think the track record has been that successful.”

Pooling, he adds, has typically found greater success among smaller organizations.

The WSJ story also touches on the practice of direct contracting. “One option for the purchasing pool, say people familiar with the matter, would be for it to establish ‘centers of excellence … ,” the article says. It cites Lowe’s Cos., which has a deal with the Cleveland Clinic and flies employees to Ohio for heart surgeries at no cost to the worker.

Commenting on this, Wojcik notes NBGH’s just-released Large Employer Plan Design Survey reveals that respondents put direct contracting close to the bottom of initiatives having an impact on controlling costs.

Wojcik points out that there’s probably good reason for this. A number of factors need to be in place for direct contracting to work, including the employer needs to have a “significant market power, opportunities need to exist for improving care delivery and there needs to be a decent amount of provider competition.”

“It’s not just about negotiating a discount,” he says.

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.

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.

 

CDHPs Are Closing the Satisfaction Gap

employee health 1Traditional health insurance plans may still be the most popular option among employees, but consumer-driven plans are beginning to catch on with the workforce.

That seems to be the biggest takeaway from new data coming out of the Employee Benefit Research Institute.

Along with Greenwald & Associates, the Washington-based non-profit research institute recently conducted a survey of nearly 2,000 adults between the ages of 21 and 64, who had health insurance through an employer or purchased health insurance on their own, either directly from a carrier or through a government exchange. According to EBRI’s report on the findings, employees enrolled in traditional health plans are expressing greater satisfaction with their coverage than those in consumer-driven health plans, “but the ‘satisfaction gap’ appears to be narrowing.”

Generally speaking, 61 percent of traditional-plan enrollees described themselves as “extremely” or “very” satisfied with their health plans, compared to 46 percent of those in CDHPs, and 37 percent of employees enrolled in high-deductible health plans.

According to EBRI’s Paul Fronstin, however, overall satisfaction rates have been on the upswing among CDHP enrollees in recent years, while the opposite is true for those participating in traditional health plans.

Cost differences may help explain the emergence of this trend, notes Fronstin, the director of EBRI’s Health Research and Education Program and author of the aforementioned report.

Forty-eight percent of traditional-plan participants said they were “extremely” or “very” satisfied with their out-of-pocket costs when EBRI conducted this same poll in 2014. At that time, 19 percent of high-deductible health plan enrollees said the same, as did 26 percent of CDHP participants. In terms of contentment with what they’re paying out of their own pockets, satisfaction rates for all three groups have been trending upward since 2011, according to EBRI.

In addition, employees in CDHPs or HDHPs were less likely than those in traditional plans to recommend their health plans to friends or co-workers, and were less apt to stay with their current plans if given the option to switch plans—as was the case in past years, according to EBRI.

But, as the survey found on a broader scale, “the percentage of HDHP and CDHP enrollees reporting they would be extremely or very likely to recommend their plan to friends or co-workers has been trending upward,” the report notes, “while it has been flat among individuals with traditional coverage.”

Looking to the Future for Total Rewards

It’s been 15 years since the American Compensation Association changed its name to WorldatWork, reflecting the group’s decision to increase its footprint beyond the world of compensation and embrace a broader total-rewards approach.

ThinkstockPhotos-175679126This year, the Scottsdale, Ariz.-based HR association celebrates its 60th anniversary. And with that milestone comes a revamped total-rewards model.

Announced during the opening session of this week’s WorldatWork’s Total Rewards 2015 Conference and Exposition in Minneapolis, the new model now includes the verb “engage” (which joins attract, motivate and retain in describing total rewards’ contribution to the organization) and the addition of “talent development” as a sixth element of the total-rewards strategy.

WorldatWork’s previous model, introduced in 2006, featured the following five elements: compensation, benefits, work/life, performance and recognition, and development and career opportunities.

Anne Ruddy, president and CEO of WorldatWork, noted that the time was right for the association to re-examine its total-rewards model and make it more relevant to the kinds of issues members are facing today.

Models aside, it would seem many of those attending this year’s conference have their sights set on the future. On Monday afternoon, I attended a packed session presented by Steven Gross, a senior partner at Mercer, entitled “Total Rewards 2020: What to Expect in the Next Five Years Based Upon a Lifetime of Experience.”

Five minutes before the session began, attendees were being turned away at the door because the room was already filled to capacity. (Fortunately, for those unable to attend, the session was scheduled to be repeated the following day.)

Gross, who is based in Mercer’s Philadelphia office, gave attendees a quick rundown of the external factors influencing total rewards today, a glimpse of what the future might look like five years from  now and what steps employers ought to take to prepare for that world.

As might be expected, Gross led off his presentation by acknowledging the crucial role changing workforce demographics is playing in shaping the future of total rewards.

“It’s not only about people living longer, but people working longer,” Gross said. “Think about the implications of one quarter of folks over age 65 and 15 percent of folks over age 70 in the workforce”—and the kinds of challenges these changes are going to present to employers.

Generational differences, he said, are also likely to have an impact, as employers face the formidable challenge of addressing “the different sensitivities” of traditionalists, baby boomers, Gen Xers and millennials.

Other external factors Gross cited included income disparities, diversity, globalization and technology.

Gross predicted that, five years from now, companies will be much more focused on “core employees” who are viewed as being crucial to their organization’s success, will continue to put more weight on individual accountability, and will pay greater attention to personalizing rewards to reflect greater workplace diversity.

Going forward, he said, companies will also be much more focused on “best fit rather than just best practice.” (In other words, he explained, does your total-rewards strategy fit the culture of your organization?)

What’s more, he added, do-it-yourself benefits programs will be far more common five years from now, with self-service becoming an even greater fixture of tomorrow’s workplace. (Gross also joined the chorus of those predicting employers will increasingly be getting  out of the “healthcare business.”)

I suppose we’ll know in five years which of Gross’ predictions were on target—and which ones missed the mark.  But of this we can be fairly certain: Tomorrow’s total-rewards landscape isn’t likely to look anything like the one that exists today. As Gross reminded those attending his session, there are simply too many significant forces at work to ensure that that’s the case.

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.”

 

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.

For the Record Book?

In the name of fun—and, oh yes, employee wellness!—some 1,800 University of Washington faculty, staff and student employees assembled at Husky Stadium yesterday to take part in an umbrella dance with the hopes of earning a Guinness World Record. (Promotional video is embedded below.)

The participants performed their would-be record-breaking dance to Taylor Swift’s “Shake it Off,” with the goal of kicking off “a new year of community and wellness,” according to UW.

In case you’re wondering, the previous record for the world’s largest umbrella dance was set across the Pacific in Japan by 1,688 participants last August.

To break the record, dancers are required to perform a synchronized routine for five minutes. In preparation, these participants held six group dance rehearsals. In addition, dancers took part at UW campuses in Bothell and Tacoma.

You can check out the actual event here at the Seattle Times website.