As you probably know, under the Affordable Care Act (ACA), preventive care is covered without being subject to deductibles or coinsurance. The idea was to remove financial barriers that might discourage people from getting preventive services. But a gap in the program left out consideration of preventive services required by people with a chronic condition.

For example, if a person who did not have diabetes went to the doctor and had a screening blood test done to see if they had diabetes, the visit and the test would be fully covered without a deductible or coinsurance. However, if a person with known diabetes went to their physician and had the same test done as part of the regular follow-up care for their condition, the visit would be subject to their deductible and coinsurance.

Interestingly, responsibility for many of the regulations that apply to the ACA falls under the IRS (since they are related to the taxability of health benefits). A July 2019 IRS update expands coverage for preventive care for those with chronic conditions so that these preventive services will now no longer be subject to deductibles or coinsurance.

It is well known that many people with chronic illnesses do not receive needed preventive care for their conditions because of the cost they have to bear for these services. This new regulation should help reduce this barrier to care and help those with chronic needs better care for themselves.

While this change applies to fully insured plans, what does it mean to self-insured employers? With many companies defining their 2020 benefit programs at this time of year, we think employers would be wise to examine their coverage for preventive care and adopt this coverage approach within their plan design. Evidence-based preventive care is always cost-effective and contributes to better health and well-being for employees and their family members.

To learn more about this update, read the IRS notice here. If you have questions about these changes or would like guidance defining the parameters for preventive care coverage, contact Health Advocate. Our clinical team will be happy to help.

By Bert Alicea | Employee Assistance Report

The headlines cannot be ignored – it’s become all too common to read or hear a news report about tragic incidents of violence in the workplace. In fact, the Occupational Safety and Health Administration (OSHA) estimates that approximately two million Americans are the victims of workplace violence annually. The threat is real, and while no one is immune, there are steps that can help minimize the risk as well as precautions to protect employees should something happen.

Understanding the Threat

While it may be difficult to ever feel truly prepared for a tragedy of this nature, understanding workplace violence is the first step toward reducing the probability of an incident and keeping organizations and their workforce safe.

Just what is workplace violence? Workplace violence is considered to be “any action, whether verbal, physical or written, that is intended to cause, or capable of causing, death or serious bodily injury, emotional injury or property damage.” This includes intimidation, disruptive and harassing behaviors, threats, and acts of sabotage, among others.

While active shooter incidents are often the first scenario that comes to mind when thinking of workplace violence, especially considering recent incidents in the news, it can encompass a wide range of situations, including:

  • Domestic violence;
  • Fights between colleagues;
  • Angry customers;
  • Property damage;
  • Written threats; and
  • Many others.

According to a recent study from the Federal Bureau of Investigation (FBI), of the 160 active shooter incidents that occurred from 2000 to 2013, approximately 80 percent happened in a workplace. Workplace violence, including these shootings, impacts two million Americans each year, causing an average of 700 homicides. In addition to the invaluable cost of human life, the annual economic cost of workplace violence is $121 million.

Outside of the obvious costs, violence in the workplace is a significant occupational hazard for both organizations and their employees, leading to:

  • Physical and emotional trauma;
  • Poor morale;
  • Increased healthcare and workers’ compensation costs; and
  • Decreased productivity.

So what factors can contribute to a threat of violence in the workplace? Issues that cause stress also have the potential to lead to violence. Outside of work, the fragmentation of the family structure, easy access to weaponry, TV and other media, substance abuse, and financial issues can all tip someone over the edge toward violence.

Domestic disputes that spill over to the workplace are also a major issue. Seventy-one percent of HR and security personnel have reported an incident of domestic violence on company property, endangering both the victim and his or her coworkers.

Within the organization, workplace stress, downsizing, feelings of being undervalued or unheard, or rigid management styles can all lead to potential issues. Failed office romances can also create problems.

Identifying the Threat

Knowing some of the factors that can lead to violence is key to identifying potential risks within an organization. So who poses the greatest risk of violence to organizations? While delusional people are potential threats, more frequently the perpetrator is a disgruntled employee or someone involved in a domestic disturbance that has spilled over into the workplace.

Issues at work such as downsizing or feeling undervalued could be triggers for employees, as well as personal problems like relationship trouble, legal issues or a financial crisis.

Early warning indicators may include:

  • Increased absences;
  • Deteriorating performance on the job;
  • Friction with managers or other employees;
  • Change in attitude or appearance;
  • Excessive complaints; and even
  • Substance abuse at work.

Further, increasing patterns of signals like acting out, crying, throwing objects, or paranoia could indicate the potential for an issue. Anyone experiencing situations such as divorce, loss of a loved one, or other issue may also be experiencing increased stress, which can put someone on edge and increase the probability they could act out. Demonstrating one of these signs is not a direct indicator of a threat of violence, but multiple issues could point to a potential problem that should be addressed.

In these instances, leadership determines outcomes. Many managers and supervisors may feel challenged to understand issues employees may be experiencing at home while concerned about privacy issues. However, by being supportive of employees, it is possible to have an open a dialogue that can allow for any issues to be addressed together, whether they be work-related or otherwise.

While a non-supportive supervisor may be demeaning or sarcastic to employees and look the other way when someone is experiencing an issue, a strong supervisor clearly defines expectations and communicates frequently with employees. If they believe an employee is facing a set-back or challenge, they reach out to offer support, either from HR or other outside resources like an EAP.

Further, they follow-through to ensure that employees feel supported and valued. When employees are treated with dignity and respect, they are less likely to act out, minimizing the potential threat to an organization.

Managing the Threat

Even before a potential issue is identified, organizations need to take the time to prepare in order to minimize risk and perhaps prevent incidents of violence. However, the majority of businesses do not currently have a program or policy in place to address this issue. Brokers and consultants have the opportunity to help organizations by connecting them with resources and training to ensure all supervisors have the knowledge needed to address potential problems and respond appropriately.

When creating a prevention and response program, it is important to consider the following:

  • Enforce existing policies – Enforcing anti-harassment and weapons policies as well as the code of conduct can go a long way toward prevention of violent incidents within the workplace.
  • Assess the risk – Leadership and HR can work together to analyze any previous incidents, determine the current potential for issues and assess preparedness in order to create a plan that fits the specific needs of the organization. Following the initial assessment, periodic reviews should be conducted to determine if any changes should be made to the program.
  • Establish policies and procedures – Consider adopting a zero tolerance policy that has buy-in from all levels of the organization and includes reporting and investigation procedures as well as intervention standards. Ensure this policy is communicated to all employees and posted prominently where people will regularly see it.
  • Introduce training – Both employees and managers should participate in expert-led training to raise awareness and recognition of potential issues, educate on diffusion techniques and appropriate intervention, and understand the policies put in place.
  • Create a crisis team – This cross-disciplinary task force can help establish and review policies, conduct training, connect people with resources and services, and be a first point of contact to investigate or respond to potential issues.


Many organizations already have access to resources that may be able to help when creating a program and in the event an incident occurs, including HR and security, emergency hotlines, local law enforcement, and Employee Assistance Programs.

While it may not always be possible to prevent an act of violence in the workplace, by preparing and planning ahead, it is possible to minimize the risk and protect employees and the organization.

Norbert “Bert” Alicea, MA, CEAP, Executive Vice President of EAP+Work/Life Services at Health Advocate, is a Licensed Psychologist and premier trainer with over 25 years of experience in the EAP field. He has a specialization with executive coaching and management consultations in assisting with difficult workplace situations and also conducts corporate training locally and on a national level on topics including Harassment Awareness; Violence Prevention; Drug Free Workplace; DOT Compliance Training; and EAP Supervisor Training for High-Impact Referrals.

For more information about Health Advocate and the EAP+Work/Life program, visit Editor’s note: This article originally appeared on BenefitsPRO and is reused with permission. See

By Nancy S. Shriner | Employee Assistance Report

Two years ago, the country was reeling from the mass shooting at a country music concert in Las Vegas. Fast forward to this summer, and America has once again been shaken by not one, but two large-scale mass shootings in less than 48 hours. Following the recent tragedies in El Paso, Texas, and Dayton, Ohio, our nation and workplaces continue to be traumatized by these senseless events.

When I started working in employee assistance nearly 30 years ago, our organization would typically manage three counselor responses a month, usually less. Most frequently, clients requested support following a bank robbery or an unexpected employee death. Today the requests are numerous, daily, and much more violent.

Crisis Situations Abound

For example, our EAP recently assisted an independent construction company who had experienced a very violent incident. A small group of employees was working on a city street when one employee was targeted and killed by a perpetrator with a high-powered rifle driving by in a speeding vehicle. A nearby co-worker was then chased down the street while he dodged bullets.

This small, family-run company had never experienced anything like this in the past and did not know how or where to begin to provide support to its employees. Further, ownership struggled with remorse because they had unknowingly hired an employee involved with a gang, which led to this violent event happening at their worksite, impacting other employees and potentially the public.

Our EAP was on-site to support both employees directly involved in this traumatic event, as well as those struggling with mixed grief and betrayal issues. Equally as important, our counselor was able to support leadership through these uncharted waters by providing clearheaded, objective feedback, and guidance to help this organization move forward effectively.

Sadly, events like these drive home the importance of EAPs in helping surviving co-workers and families cope with the aftermath of a horrible tragedy. Of course, it doesn’t necessarily take such a dramatic event to require support for employees when a co-worker dies. It could be a heart attack at an office desk, cancer, or perhaps a car accident. It could be anywhere at any time, because every day people die, and the odds are high these individuals are in the workforce.

Disruptive Event Management Arrives

In the 1980s, Dr. Jeffery Mitchell and Dr. George Everly coined the term Critical Incident Stress Debriefing. The concept was designed to prevent or reduce post-traumatic stress for police, fire, and other first responders. For many years, EAP staff used that same terminology and applied parts of that same concept to our responses.

Recently, EAPs began using the term disruptive event management (DEM), a term that more broadly encompasses some of the reasons employee assistance professionals are called on-site in a post-trauma situation, such as the death of an employee, serious accident on the job, violent incident or natural disaster.

For instance, an EAP could be asked to have a counselor on-site for an incident that occurs out of state, or in a different location other than the company’s headquarters. Massively tragic events such as the El Paso or Dayton shootings, for example, also could negatively affect employees in various locations who may have friends or relatives who were injured or killed in these tragedies. EAP clients could request a counselor on-site to support their employees, even in some cases when they may not have been directly impacted other than what they saw through the news media.

DEM entails delivering a customized response to worksites impacted by any event that disrupts employees’ ability to work. In the case of an employee death or trauma, the central focus is to provide support to leadership and employees by helping to create a culture of psychological safety, decreasing stress, and acknowledging the employees’ reaction to the loss or devastation. This support results in less absenteeism, with a quicker return to the same level of functioning as before the event and continued productivity.

The overriding idea is people have a right to lead productive, meaningful lives, which means providing an objective, timely, and thorough response that helps with the human side of recovery.

Employee Deaths Drive EAP Involvement

It may surprise you that among common disruptive incidents, the biggest reason our firm gets involved is due to employee deaths, which account for 70 percent of clients’ requests for help. As we are all aware, not just the elderly or the very ill die; often death is unpredictable.

When an unexpected death occurs, it’s important that leadership acknowledge the event and freely share the information that they have with employees. Today’s social media can move information quickly, but not always accurately. Experience has proven that facts can reduce fear for employees. Certainly, it makes sense for employers to consult with their EAP regarding next best steps to support their staff through this loss.

Most of all, it’s good to remember that these scenarios can be very fluid, there is not necessarily a one-size-fits-all solution or response, or way of presenting the best possible strategy following an employee death. Some employee deaths come after a long illness, and co-workers have had time to grieve this potential loss. Other natural deaths are sudden and unexpected, and some deaths are a result of a tragic accident or situation. The impact to co-workers as well as the organization is likely very different. EAP counselors are able to adjust their strategies to the needs of a client. Flexibility is crucial.

Leadership’s Role in Managing through a Disruptive Event

When a tragedy strikes, employees look to leadership for direction. Leaders must present competence and compassion. An empowered leader demonstrates the seriousness of the loss, an awareness of the impact to the organization and its workforce, while also communicating an expectation of recovery.

It is important that whatever loss or trauma has occurred, it is acknowledged by leadership with transparency and accurate facts. The trauma or loss should be named with language that is specific. For example, if there is a fatality, don’t be afraid to use the word death.

Effective leaders acknowledge the personal impact as well as the effect on the organization, and most importantly, recognize the loss and devastation to the team members. Leadership should communicate an expectation of recovery while recognizing that the workplace will be flexible with reasonable accommodations as people progress back to work as usual.

Planning, EAP can Help

A critical incident or death of an employee is traumatic on many different levels. Yet, death is a fact of life. With proper planning and a strong EAP-driven program in place, employers can meet the challenge of helping their workers and families deal with their grief and its impact on the workplace.


Most of all, it’s important that leadership be prepared and plan for this kind of event, because if it hasn’t happened yet, it certainly will. When something as traumatic as a co-worker’s death occurs, employees are looking to leadership for direction and support.

Nancy Shriner is Training and Critical Incident Coordinator for Health Advocate, a national health and patient assistance company headquartered in Plymouth Meeting, PA. Health Advocate makes healthcare easier for over 12,000 organizations and their members by leveraging a combination of personal support, data and technology to engage people in their health and well-being.

By Dr. Raffi Terzian | IndustryWeek

Through these best practices, manufacturing organizations can significantly change the reduction and mitigation of MSDs, improve health outcomes, reduce costs and increase productivity.

Musculoskeletal disorders (MSDs) are common among all Americans; however, employees in manufacturing settings are especially vulnerable to developing these injuries due to a number of factors specific to their occupation. Heavy lifting, bending, awkward postures, reaching overhead, pushing or pulling heavy loads, and repetitive tasks are all risk factors, which increases the chance of injury on the job. According to the Centers for Disease Control and Prevention (CDC), 41 out of every 10,000 manufacturing workers experience a musculoskeletal issue or disorder.

A Growing Issue

These injuries have a significant impact on workplace productivity, absenteeism and healthcare costs. Across all industries, the Occupational Safety and Health Administration estimates that employers spend up to $20 billion each year on direct costs related to MSDs, with indirect costs due lost productivity and turnover far exceeding that amount. Work-related MSDs are among the most frequently reported causes of lost or restricted work time.

Further, a 2017 analysis by the Kaiser Family Foundation, which explored trends in the cost of treating diseases, found that MSDs were ranked among the leading contributors to overall health services spending growth. As additional evidence of the impact of this issue, the Bureau of Labor Statistics reports that among injuries and illnesses causing days away from work in manufacturing, MSDs accounted for 34 percent of the total cases for all workers.

Whether employees develop back pain, arthritis, carpal tunnel syndrome, rotator cuff injuries, or any number of other musculoskeletal disorders, it is critical that organizations take proactive steps to both prevent and mitigate these issues to preserve the health of their workforce and their bottom line. By improving ergonomics in the workplace, manufacturers can address many of the root causes of MSDs among their employees.

Utilizing Ergonomics to Reduce Risk

While the risks inherent in manufacturing facilities are not easy to mitigate, there are measures organizations can take to help protect their employees from developing MSDs and helping those with injuries return to work faster. To improve ergonomics within manufacturing facilities, here are few strategies and best practices to consider:

  1. Go beyond the standard assessment. Ensure that any workplace assessment not only takes into account the unique factors of the facility’s environment, but also the hazards specific to each employee’s role. While some employees may be standing on their feet all day, others may be lifting heavy objects or working in awkward positions. This should not be completed in a vacuum; it is critical to involve employees in this process to address the issues affecting each individual’s health and productivity. A comprehensive approach to the initial assessment will lay the foundation for implementing effective ergonomic improvements that make a positive impact.
  2. Select appropriate safety equipment. Based on the assessment, introduce and provide employees with suitable safety equipment that encourages safe postures, aids lifting heavy items and protects them from common musculoskeletal injuries. This could include, but is not limited to:
    • Cushioned floor mats for those who stand for long periods
    • Ergonomically designed chairs for those who are seated
    • Carts or machinery to assist with moving heavy or cumbersome items
    • Knee pads and similar items to reduce pressure if kneeling
  3. Take varying heights into account. Three employees performing the same job may be three vastly different heights, meaning it is unlikely that all of them are comfortable at their fixed workstations. Instead, they may be stooping or reaching repeatedly throughout the day, increasing the risk of developing a musculoskeletal disorder. Implementing height adjustable equipment when possible can ensure employees are working in a safe, comfortable posture, preventing injury. This could include adding stools, adjustable tables and similar fixtures that can compensate for employees’ diverse needs.
  4. Offer opportunities to mix it up. Spending too much time in one position, either sitting or standing, can lead to potential injury. Height adjustable workstations can also benefit employees by enabling them to alternate between sitting and standing throughout the day. Additionally, ergonomic chairs, apparatus that allow for leaning, and specialized stools that can adjust to support sitting or standing, are all great options that enable employees to minimize time in one position. Providing variety can reduce stress-related injuries. 
  5. Consistently communicate and educate.  Raising awareness of the risks among employees and reminding them to adjust repetitive movements, take breaks, use protective equipment, and avoid hazards can have a big impact on the number of incidents leading to injuries. While initial training is important, continuing to communicate this information through discussions with supervisors, posters, and other internal communications channels will keep this important information top of mind for employees. Introducing ergonomic equipment and other best practices into the workplace will only be effective if employees consistently utilize them correctly, and frequent outreach is critical to achieving this.

Implementing these strategies not only prevents new injuries from occurring, but can also support employees with existing MSDs, improving turnaround time to return to work and mitigating the otherwise detrimental effects on productivity and costs.

The Role of HR

Human resources professionals play a very important role in addressing MSDs in the workplace, especially in manufacturing settings, with key responsibilities including:

  • Coordinating worksite training that educates employees on reducing risk
  • Leading ergonomic assessments by the company’s health and safety units or external stakeholders
  • Instituting policies to support employees with MSDs and appropriate return to work guidelines
  • Liaising with the company’s worker’s compensation and medical benefits carriers, as well as occupational health providers and other involved parties
  • Guiding employees to appropriate resources to help prevent individual risk or treat existing MSDs

Through these best practices and more, manufacturing organizations can significantly move the needle on the reduction and mitigation of MSDs, improving health outcomes, reducing costs and increasing productivity. Musculoskeletal disorders are a significant cost driver for employers in terms of both direct and indirect costs. Developing a comprehensive strategy to prevent and reduce MSDs and promoting workplace health is of benefit to employers and employees alike.

Creating a new normal with EAPs

By Alan Goforth | BenefitsPRO

Well-designed and implemented employee assistance plans can provide significant benefits to both workers and employers.

Workplace mental health issues often go unreported and unnoticed. The cost to employee health and employer productivity, however, can be every bit as substantial as that caused by physical illness.

“When a person is experiencing a personal issue outside of work, it often spills over into the workplace and influences other employees’ productivity and morale,” says Bert Alicea, executive vice president of EAP+Work/Life Services for Health Advocate in Plymouth Meeting, Pennsylvania. The company offers a range of employee assistance programs (EAPs) and wellness benefits.

“For example, if an employee is experiencing substance abuse in their family and needs to make frequent phone calls during the workday to address the issue, the employees around them may also feel distracted, stressed or upset by the situation at hand,” he says.

Judi Braswell also sees a link between mental and physical health problems. Braswell is vice president, business development, for Behavioral Health Systems Inc. in Birmingham, Alabama, which administers a comprehensive suite of behavioral programs for employers nationwide.

“Research bears out the correlations between behavioral health issues and attendance, productivity and safety,” she says. “There is high comorbidity of behavioral health issues and chronic medical conditions, long recognized by employers as having an impact on workplace productivity and health care costs. A behavioral health program that can reduce non-compliance, provide education and actively engage members impacts not only the success and cost of those services but also physical health, prescription costs and workers compensation claims.”

Statistics show that a well-designed and implemented EAP can provide significant benefits to both workers and employers, says Rahul Mehra, M.D., CEO and chief physician executive for the National Center for Performance Health in Tampa.

“In larger, self-insured employer groups, a robust and responsive EAP can help save at least 30 percent in mental health claims, reduce emergency visits and reduce medical and pharmacy claims,” he says.

Bumps in the road

This leads to an obvious question: If mental health is such a pressing issue and EAPs are part of the solution, why are they often not as effective as they could be? Mehra has three general answers:

  • Stigma, which is improving but still faces huge hurdles.
  • Lack of awareness and education, such as health care literacy in mental health.
  • Access issues. Only 55 percent of practicing psychiatrists take private health insurance, which is the lowest number of any physician specialty.

The structure of many EAPs, which are embedded in medical plans, is another part of the problem, Alicea says. “While some people with mental health or substance abuse issues may utilize the service, those with temporary setbacks in life may not reach out for assistance. The medical benefit may be viewed as something to use only in the instance of a serious problem. If employees view the service as something that is only available for issues on the severe end of the spectrum, they may not reach out in the earlier stages when it is possible to address issues before they escalate.”

Braswell points out that before medical parity, most health plans covered mental health and substance abuse on a limited basis, often capping exposure at a set dollar amount for outpatient and number of days for inpatient care.

“EAPs began to reduce their cost, and competition resulted in very low cost for services on a capitated, per-employee, per-month fee,” she says. “That also resulted in little to no promotion or employee communications, limited network options or services provided by a limited number of providers employed by the EAP. As a result, they are very underutilized. Some companies felt the program’s low utilization meant they had no value in the workplace, with no return on investment from the capitated cost. While some companies continue with EAPs and accept this as just the way it is, others elected to not provide the services.”

The good news is that many employers are gaining a better understanding of the benefits of mental health EAPs.

“We are beginning to see a shift in employers recognizing the need for behavioral health services in the workplace beyond a poster with an 800 number,” Braswell says. “With mental health and substance abuse benefits now on the same cost-sharing structure as physical health benefits, and with arbitrary limits removed, employers are recognizing the need to provide services to assist in earlier problem identification, easy access to quality providers and workplace support, such as management consultation on problem employees, critical incident response and development of effective communication campaigns.”

Reducing the stigma

One of the biggest challenges for brokers and employers is the stigma often attached to engaging mental health services. Employees who would not think twice about seeing a doctor for an illness or injury often are reluctant to seek help with depression or a stressful situation at home. Alicea recommends shifting the focus to temporary setbacks.

“Position the EAP as an educational resource with mental health and substance abuse components without focusing entirely on mental health,” he says. “This can help employees feel more comfortable reaching out for help by not putting a label on what they may be experiencing.”

Just as with any other benefit, communication is essential. “EAP utilization is driven by communications that are relevant and at the point the member is experiencing difficulty,” Braswell says. “Management acceptance and their knowledge about EAPs is a major factor in utilization by employees. Supervisors who are supportive of seeking assistance and know how the process works help dispel the myth that we shouldn’t need assistance. Normalizing seeking assistance for personal problems by integrating it in wellness initiatives can be very helpful.”

Employers should position mental health benefits as part of an overall health and wellness plan.

“It is important to recognize that mental health issues do not happen in a silo,” Alicea says. “By integrating the EAP with other services, including advocacy and wellness, it not only makes managing benefits programs simpler for employers, but it can also help to identify issues much earlier.

“We’ve found that a large percentage of referrals to our EAP originate from a medical issue with underlying emotional concerns. While the member may not have originally reached out for EAP support, it was still possible to connect them to services that could help them holistically address the issue at hand.”

Role of brokers

Brokers can do several things to help their clients maximize their return on a mental health EAP.

Do the homework. “Brokers who have an understanding of the components of the EAP are better able to match employers to the program that can best meet their needs,” Braswell says. “It’s helpful for brokers to at least know how account management is handled; who takes the calls and makes the referrals; how much flexibility exists in plan design; what the capacity is for training and communication campaigns; if that is driven by the company or if the EAP works with company personnel to monitor events that may warrant education; and if utilization trends are considered.

“It’s also important to know if the company values the cost savings and flexibility that come from self-insuring or the budget consistency of a capitated program that must clearly define what is included in the plan and set a rate that will cover the cost of delivering all of the services that could be utilized, even if they are not.”

Demonstrate value. “If you have 5 percent utilization for EAP services, it is possible to achieve a 10-to-1 return on investment, which does not take into account services beyond clinical utilization, including manager consultations, on-site training and support, and more,” Alicea says. “Look at other aspects of the EAP and not solely clinical utilization in order to appreciate and understand the true value.”

Make it specific. “There are a number of EAP models,” Braswell says, “including assess and refer, where a treatment plan is developed and the member is referred for the treatment within their insurance or as private pay; those that allow members to use all sessions available before referral; those that offer access to a network; those that allow access only to their employed staff; programs that offer access only to mental health professionals; those that also include psychologists and psychiatrists; models that allow access only for non-clinical issues, such as grief, marital and family but not clinical issues such as eating disorders and manic depression; as well as variances in communication and training capabilities.”

Maximize access. “We have found that making it easier for people to access EAP resources from anywhere helps drive utilization,” Alicea says. “Employees want to know that when they access the EAP, it is confidential and their privacy is protected. For example, offering videos, self-assessment tools, webinars and more enables them to get the information they need from the comfort of home or anywhere, really. This also extends to how employees access live support, including chat functionality on EAP websites, to protect their privacy and make the experience easier.”

Be visible. Mehra and his team make a conscious effort to be the face of the EAP.

“We attend open enrollment meetings, do lunch-and-learns and educate HR staff of supervisory referrals,” he says. “We also provide responsive on-site crisis counseling related to traumatic events in the workplace. NCPH also meets with senior management. A lot of effort is spent in building trust with the leadership of the organization such that a culture is created that supports emotional well-being.”

“EAPs can be a valuable partner to HR, managers and employees and dependents they serve if they have a seat at the table and are a visible presence,” Braswell says.

Engaging employees in effective mental health EAPs is simply the right thing to do from a human perspective. It also is a smart choice for employers trying to boost productivity and brokers looking to expand their product portfolios.

By Jocelyn Sivalingam, M.D., F.A.C.P. | BenefitsPRO

As employers or benefits consultants, it is critical to ensure that your health plan, advocacy or decision support providers, and other partners that depend on this information to guide their practices and decisions understand and follow current, relevant guidelines.

Employees and their family members frequently face tough questions about their health care: How do I know when it’s time to get a mammogram? When does my child need a vision screening? Is thyroid screening something I should get? If I have high blood pressure or diabetes, what is the best treatment for me?

For the providers who care for them, the key question is: How do we implement appropriate, science-backed treatments for our patients, testing where needed, but avoiding potentially harmful or unnecessary (and expensive) care? The answer is to seek guidance from and use clinical guidelines —along with existing clinical skills — wisely.

Establishing clinical guidelines

Clinical guidelines are sets of science-based recommendations, designed to optimize care for patients in areas such as screening and testing, diagnosis, and treatment. They are developed after a critical review by experts of current scientific data and additional evidence to help inform clinical decisions across a spectrum of specialties.

Based upon this process, guidelines are then released by a number of sources and collaborations, including academic and non-profit health care entities, government organizations, and medical specialty organizations.

From preventive care to treatment protocols for chronic conditions, guidelines provide a framework health care providers use with patients to help guide care. However, it is important to note that clinical guidelines are not rigid substitutes for professional judgment, and not all patient care can be encompassed within guidelines.

The impact on health care and benefits

Clinical guidelines are used in myriad ways across the health care spectrum, and providers are not the only ones who utilize them. Insurers may also use guidelines to develop coverage policies for specific procedures, services, and treatment, which can affect the care your covered population receives.

To illustrate a key example of an intended impact of guidelines on health plan coverage, consider those issued by the U.S. Preventive Services Task Force (USPSTF), whose A and B level recommendations comprise the preventive services now covered at no cost under the mandate of the Affordable Care Act.

As another example, the National Committee for Quality Assurance (NCQA), which accredits health plans and improves the quality of care through its evidence-based measures, uses the American Heart Association guidelines when creating its quality rules for treating high cholesterol with statin drugs.

Other examples exist among commercial coverage policies. For example, some cancer drug reimbursement policies use components from nationally recognized guidelines for cancer care.

The importance of up-to-date guidelines

Because science is rapidly changing, guidelines are often updated, leading insurers to revisit their policies to decide if they will change how services and medications are covered for their members. Providers and health systems may modify processes of patient care in response to major changes in guidelines and/or resultant changes in payer reimbursement.

Not all guidelines are updated on a set schedule, making it even more important for providers and organizations that rely on guidelines to stay on top of changing information, as it can have a direct impact on how they work. Attending conferences, visiting the recently established ECRI Guidelines Trust™ , and regularly reviewing relevant professional association websites and journals can help ensure needed guidelines are current. Lack of current information can affect care decisions and potential outcomes for patients. Those who have access to the most up-to-date, evidence-based information are able to work together to make well-informed healthcare decisions.

The value of clinical guidelines for employers

As employers or benefits consultants, it is critical to ensure that your health plan, advocacy or decision support providers, and other partners that depend on this information to guide their practices and decisions understand and follow current, relevant guidelines.

Further, by combining information from relevant guidelines and data from biometric screenings, health risk assessments, claims and other sources, it is possible for clinical advocacy and other decision support providers to identify employees with gaps in care and generate targeted communications (through a member website and/or mobile app) to help them take action to improve their health.

Clinical guidelines are science distilled into practical recommendations meant to be applied to most patients for quality health care. By maintaining current, relevant guidelines, organizations and providers who work with your covered population can ensure that all parties have the key information they need to make the best decisions for their health.

About the author

Jocelyn Sivalingam, M.D., F.A.C.P., is a Medical Director with West’s Health Advocate Solutions, a company that provides health and well-being solutions for over 12,500 organizations using clinical guidelines to inform preventive screening recommendations as well as ongoing disease management. Dr. Sivalingam is board-certified in Infectious Diseases and leads the Clinical Guidelines working group at Health Advocate. She also serves as a key leader of clinical operations for the Chronic Care Solutions program and provides clinical expertise across a number of areas at Health Advocate.

Wellness Programs Really Do Work

Dr. Abbie Leibowitz | HR Daily Advisor

study published recently in the Journal of the American Medical Association (JAMA) has raised questions about the value of workplace wellness programs.

While the findings confirmed that employees who participate in wellness programs make positive behavior changes, the results of this study indicated that these changes did not influence health outcomes or costs.

For years, research has generated mixed reviews of workplace wellness initiatives. However, it is important to note that many of these studies, including the most recent in the JAMA, are limited in scope and do not account for the best practices successful organizations utilize to maximize their wellness programs and drive engagement, improve health outcomes, and lower costs.

A Narrow View Doesn’t Show the Full Picture

The study published in the JAMA analyzed results among employees participating in an 18-month-long, stand-alone wellness program. While this narrow focus may be necessary for a scientific study, it does not necessarily consider other factors at play in most organizations’ wellness programs. For example, participation rates were relatively low, at about 35%, which may have skewed the results. As the study authors acknowledge, employees participating in the program tended to be in good health already.

There are obviously benefits to having healthy workers engaged in a wellness program, but there is more potential impact to be made among the segment of the population in less-than-ideal health. This study did not examine some of the strategies organizations use to drive participation among this group.

Providing incentives is one way to achieve this participation. In the study, program participants received an incentive of about $250. While this is about average among most employers, higher incentives are more effective at motivating participation, which, in turn, can generate better results.

Additionally, the study did not mention what other population health initiatives the organization had in place. Enthusiastic support from management is important to the success of any program. A wellness program integrated into an overall culture of health is more likely to be more successful. This may include offering biometric screenings to help identify employees at risk or a chronic condition management program to further support their health goals.

Providing access to expert support from wellness coaches and others can also make a positive impact versus an online program alone. Wellness in a silo is not as effective as an integrated program, which could skew the results when compared with the broader, more holistic approach many organizations are now implementing.

Finally, looking for short-term “savings” from a wellness program is a mistake. Behavior change takes time, and it is premature to anticipate sweeping shifts in cost trends and outcomes in such a short window. The 3-year results the study authors plan to revisit may be more telling, but true return and value on investment in a wellness program are long-term realities that are not accounted for in this particular study.

Strategies for Optimal Wellness Programs

In order to widen the focus of workplace wellness beyond a narrow, siloed approach, there are a number of best practices proven to drive engagement and achieve successful outcomes.

  • Utilize data to inform the design of a meaningful program. Data, such as health risk assessments, claims data, and biometric screening results, can provide a more detailed picture of the specific needs of a population and enable the employer to tailor the program accordingly.
  • Address the full spectrum of population health needs. Providing multiple touch points to meet people where they are based on their health status, risk level, and readiness to change can ensure that employees will be able to access the right support at the right time to reach their personal health and well-being goals.
  • Energize participation, and make it fun! Weave the organization’s culture into the program with unique activities, incentives, success stories, and challenges.
  • Demonstrate internal support. Build a culture of wellness, incorporating both employee input and executive participation.
  • Create visibility. Work with a wellness expert to create an effective and impactful communications strategy so employees are aware of the benefits and resources available to them.
  • Make the program easy to access via technology and personal support. This includes taking advantage of telephonic support, health coaching, an easy-to-use website and mobile app, and personalized e-mails and notifications to drive awareness and utilization.
  • Integrate health and well-being programs for greater impact and engagement. Provide a streamlined, simplified, all-inclusive program to reduce confusion and maximize participation.

Implementing one or more of these strategies into workplace wellness programs can have a major impact on both employee participation and results.

The Value of a Holistic Approach to Wellness

Integrating wellness with other related health and benefits programs is one of the most effective ways to generate measurable results. For example, biometric screenings can establish a strong starting point for employees’ wellness journeys. Oftentimes, employees learn about a potential condition like hypertension or hyperlipidemia during a screening, prompting them to seek treatment from their physician and support from a wellness program. Furthermore, a better understanding of the health of an organization’s employees can help the employer customize the wellness program to meet their needs, increasing the odds of participation and success.

A recent analysis of a cohort of nine companies utilizing Health Advocate’s wellness program demonstrates that best practices like this make a difference. Each of the participating groups offered wellness coaching and strong incentives of $300 or greater, access to online workshops, and wellness information, as well as integrated biometric screenings. The research assessed changes in high-risk participants over 3 years. Of the 16,741 employees who participated in biometric screenings, 9,689 participated all 3 years. Among this group, 1,674 members (17%) reduced their risk level from high risk to normal or borderline risk within 3 years for the following conditions:


  • 1,497 people identified as high risk for hypertension
  • 76% reduced to normal or borderline within 3 years = 1,138 people
  • Potential savings of up to $1,378 pp./y x 1,138 = $1,568,164


  • 425 people identified as high risk for diabetes
  • 49% reduced to normal or borderline within 3 years = 208 people
  • Potential savings of up to $1,653 pp./y x 208 = $343,824


  • 3,775 people identified as obese
  • 9% were no longer obese and improved their health within 3 years = 340 people
  • Potential savings of up to $1,090 pp./y x 340 = $370,600

The savings estimates are based on data looking at the cost of medical care needed by people with these conditions. As these results show, when compared with a stand-alone program, utilizing best practices, including integrating a wellness program with on-site health screenings, will amplify the effects. By incorporating best practices into workplace wellness, it is possible to realize both improved health outcomes and cost savings, as well as maximize the impact of the overall program.

By Raffi Terzian, M.D., Senior Medical Director at Health Advocate

As you’ve seen during the devastating 2018-2019 flu season, influenza (flu) can have a significant impact on the business community in terms of employee illness and loss of productivity.  (Keep reading for a special offer to help keep your employees safe from the flu this upcoming season at a discounted rate!)

Fast facts:

  • The CDC estimates annual direct costs in the US related to flu (i.e. medications and hospital and outpatient visits) to be in the billions.
  • The CDC also estimates that influenza has resulted in between 34.9 million and 40.1 million illnesses, between 482,000 and 585,000 hospitalizations and between 32,900 and 54,800 deaths during the 2018-2019 flu season alone.
  • Estimates vary, but there is a significant economic burden counted in the billions of dollars related to sick days and loss of productivity due to influenza.

It is clear that flu presents a significant public health concern which warrants the attention of employers who are concerned about employee health, productivity and overall health costs. Implementing an annual flu vaccination program is a vital component of a workplace well-being program.

Annual flu vaccination remains the single best way to prevent the flu, so it’s important to plan ahead and be prepared. The program should also include education for employees about the benefits of flu vaccination as well as important preventive measures such as regular handwashing and maintaining good health habits.

Prepare for the flu now and take advantage of a discount on flu shots!

Early bird discount details:

  • $33.00 per flu shot (Minimums Apply)
  • Offer applies to quadrivalent shots only
  • You must sign a flu shot contract with us by July 1, 2019

Contact us today to learn more:

Matt Verdecchia | The TriStater

Harassment can have a detrimental effect in the workplace, yet identifying what exactly comprises harassment and distinguishing it from unprofessional disrespect can create a challenge for organizations.

It is important to remember that we work in the environment we create and tolerate. Every employee has the right to work in a respectful workplace. Every employee therefore has the responsibility to help create and maintain that culture. This applies at every level of the organization.

While easy to understand, this concept can sometimes be tough to put into practice. It is much easier to look away from inappropriate, disrespectful and potentially harassing behavior, rub a rabbit’s foot, and pray it goes away. With this approach, we do not have to get past our own barriers and can avoid confronting this behavior, setting an appropriate example, enforcing policies, and looking like the “bad guy, party pooper, goodie two-shoe leader,” etc. However, by doing so, we enable the behavior, we give it legs, essentially giving the perpetrator unspoken permission to continue.

This all may sound a tad harsh, but in today’s busy environment, it is often easier to ignore inappropriate behavior than to supportively confront and correct it. While you may disagree on this point, what remains important is reducing risk for your organization. Your organization may employ managers and supervisors who do not want to deal with this issue, or have never been trained and do not know how to deal with this issue – either way they will be held accountable for addressing potential incidents.

Although harassing behavior is obviously a major issue, for organizations, another significant problem is how leadership chooses to deal (or not deal) with the presenting behavior, person, department, or even corporate culture.

The culture of an organization can have a major impact on tolerance and treatment of harassment and other similar behaviors. Keep in mind that not everything someone does or says to someone else is “harassment.” In fact, it likely isn’t. However, it may be disrespectful. There is no law that states “I have to respect you.” This behavior may constitute bullying, and there is also no law that states “I cannot bully you.” Although neither disrespect nor bullying are technically harassment or illegal, this does not mean these behaviors should be condoned or considered appropriate in your company’s culture.

This reinforces the importance of having policies and procedures in place to maintain a safe, productive work environment, including a code of conduct or ethics policy to help manage behavior and productivity. So even though the behavior is not illegal, it likely goes against company policy and is therefore subject to discipline. Managers, supervisors, and others in leadership roles are responsible for managing employee behavior and performance, including creating, maintaining and reinforcing the company culture.

Within the workplace, diversity and our differences contribute positively to the company culture. However, these same differences can also impact individual employee behavior. Even if the behavior is not considered harassment (i.e., against protected classes), it is important to remember that people have different levels of tolerance or perspective on what is appropriate or “reasonable,” and finding a consensus can be difficult. I believe in flexibility – a willingness to bend, stretch, and lean. It is in most people’s power to choose to acclimate to an organizational environment/culture. We hire not only for skills but for cultural adaptability. When incidents arise, it is possible to professionally address these issues and behaviors. If they persist, we have policy to assist and guide us as to a reasonable course of action. But when it comes to harassment – that stepping over the line between disrespectful, out-of-bounds behavior and into the realm of illegal harassment – we must be fair, objective, consistent, prompt, and “reasonable” in the enforcement of the policy, regardless of who the offending person is and what position they hold. Appropriately addressing these incidents in a timely manner will have a positive impact on company culture while mitigating risk for the organization. Remember: a respectful work environment is a safer work environment.

By Andie Burjek | Workforce

From wellness to high-deductible health plans to pharmacy spend, experts help dispel some of the myths surrounding health care costs.

Employers are doing everything they can to curb health care costs.

Sure, and if you believe that you may also believe in unicorns, the Loch Ness monster and Bigfoot roaming the Pacific Northwest.

Cutting health care costs is the elusive white whale for many businesses. Employers indeed may be putting forth a good faith effort to cut their health spend but oftentimes the results just aren’t there. It’s like the arcade game of whack-a-mole — try one new fad and miss, and another pops up followed by the same result.

In the meantime, health care costs have soared. In 1999, the average annual premium (both employer and employee contributions included) was $2,196 for an individual and $5,791 for a family, compared to $6,896 and $19,616, respectively, in 2018, according to the Kaiser Family Foundation 2018 “Employer Health Benefits Survey.”

Among the myriad solutions employers try, there are overriding myths about cutting costs that don’t save money, provide a nonexistent ROI or are just plain ineffective.

We’ve asked several leading health care experts to offer their thoughts on what we’ve determined are four prevailing myths to cutting employer health expenses. There are others, but this is a good start at peeking behind the wizard’s curtain.


A big misconception in cutting health care costs is that employer expenditures rely on addressing what costs the most, said Jaja Okigwe, president and CEO of First Choice Health, a Seattle-based national health provider network. In fact, sometimes cost control doesn’t rely on addressing employee benefits at all. There’s a link between health costs and environmental factors like how employees are treated and how they think about their job, he said.

“Those things carry over into the potential for more serious illness. And there aren’t very many companies who have an easy time at getting at that,” Okigwe said.

There are some companies that have acknowledged the direct relationship between environmental factors and health and done something about it. It’s a positive step when employers decide that “we’re going to do things that create an environment that allows our employees to be their healthiest and most productive, and that’s going to spill over into our health care cost,” Okigwe said.

Utilization of Health Care Services

Health Advocate’s Arthur “Abbie” Leibowitz, chief medical officer, founder and president emeritus at the national health advocacy, patient advocacy and assistance company, also believes that companies can’t control costs by controlling price. Rather, health care costs are driven by utilization.

This brings up a different problem for employers: Motivating employees to use the health care system effectively and efficiently.

One thing that employers can do is help employees connect with trusted medical professionals and offer a path for employees to foster a consistent patient-doctor relationship, Leibowitz said.

This does not necessarily mean that employers should encourage employees to see the doctor for a physical every year, he added. In fact, that can be a fallacy because there’s little reason for the average person to see a doctor annually. “The likelihood of discovering a problem you didn’t know about at a visit like that is so low that it makes it almost [impossible],” he said. Instead, employers can promote getting in touch with one’s doctor when the employee actually needs help.

Promoting the idea that it is good for patients to connect with a trusted physician is smart because many plan designs now don’t require a patient to choose a primary care physician, Leibowitz said. When HMOs were more popular, a patient initially needed to select a primary care doctor in order to access the health system, but fewer models require that now.

“So, in that regard, employers can encourage people to select a doctor even though their plan design may not require it,” he said.

“It’s the attitude — people call it a culture of health — that the employer creates within the work environment that is the best trigger to getting people plugged into a physician relationship that will come in to pay dividends if not immediately then down the road,” he added.

Okigwe offered suggestions to establish a culture of health other than promoting the doctor-patient relationship. For one, companies can have regular walking meetings, since research shows 30 to 40 minutes of walking a day changes one’s risk of heart disease over time.

“Yet sometimes employers don’t think that’s really their job,” he said. Rather, their focus is on the bottom line and employee productivity. But small investments in making the workplace healthier to work in can pay off. 

Long-Term vs. Short-Term Costs

It’s hard for most employers to think long term with health care costs, Okigwe said. “I do think the vast majority are looking at the annual spend and trying to figure out how to reduce it in one year, and that’s just very difficult.”

But thinking long term is something that could help with heath care costs. Employers and employees alike may have to pay short-term expenses in order not to have the shock of major medical expenses in upcoming years. “In general, we tend to think of any spend as being bad,” Okigwe said, but that’s not an accurate way to view health care costs.

It’s almost as if employers believe employees want to spend money on health care, he said, while in some cases what causes costs to skyrocket is that they don’t want to. There needs to be some sort of balance on spending a little bit on the care and activities that deter crises from happening down the line.

Employee cost concerns aren’t necessarily founded in reality in some cases, according to Leslie Michelson, chairman and CEO of Private Health Management and author of “The Patient’s Playbook,” a book about how to become an effective health care consumer. 

“People are always concerned that the best care is the most expensive care, and that’s just not true,” he said.  “In the rest of our economy there’s a pretty tight coupling between cost and quality. In health care there isn’t.”

About 80 percent of the U.S. population lives within an hour drive of at least one large city where there is at least one major medical academic center. Virtually all of these centers are in-network for most carriers. Patients could access specialists on complex conditions here, and care at these facilities is likely to cost less than going to an out-of-network provider.

Michelson’s organization works with patients who have medical problems and identifies for these patients the most advanced doctors with promising and cost-effective interventions.

“If you want to address the cost bar, what  you need to do is sweep in a supportive way to help people who are going to become expensive cases, identify the top experts for their care, educate them about the treatment options available, and provide a coordinated, integrated support system to channel them to the best doctors and to ensure they’re getting the care they need,” he said.

The key to control health care costs is addressing this small subset of patients with the most expensive cases, he said. Ten percent of patients represent 65 percent of health care costs, and 1 percent represent 25 percent, he said.

“If you aren’t doing something that meaningfully addresses that very small portion of the cases, you’re not going to have a significant impact on the costs,” he said.

Bad Incentives

One health care myth related to costs is that quality and prices aren’t improving because of cheaters in the system, according to Rob Andrews, CEO of the Health Transformation Alliance, a nonprofit group made up of 47 companies whose goal is to fundamentally transform the corporate health care benefits marketplace.

Of course, he said, there are some in the health care system who have committed wrongdoings, but they are rare.

“The problem isn’t that insurance companies are bad, or that drug manufacturers are bad, or that hospital systems are bad or that government regulations are bad. Some of all that is true. But the main problem is that incentives are bad,” Andrews said.

Over the past 60 years or so, he said, a system has been built where incentives aren’t aligned with what’s best for people’s health, giving the example of two hypothetical practices. If there are two radiology practices — one that does 1,000 images a week and produces wrong results 5 percent of the time, and the other that does 500 images a week and only gets incorrect results 1 percent of the time — the first practice would make more money under Medicare. That’s because Medicare rewards are based on the number of procedures done, not how well they’re doing.

Not to say that medical practices or insurers are incompetent, he said. This problem exists because the incentives aren’t aligned correctly in the health care system.

“What we aim to do in the HTA is align the $27 billion a year our members spend on health care with value.” Andrews said. “We want to identify and reward the producers who produce the best value.”

“We chase the shiny object — the price — but we need to be focused on the real issue of value,” he added.


Creating a successful wellness program isn’t as simple as offering one and watching the savings roll in, said Gary Kushner, president and CEO of benefits consultancy Kushner & Co.

Workplace wellness programs have gone through numerous iterations in the past several decades. While there have been health-related work programs dating back to the 1920s, it wasn’t until the 1980s and ’90s that wellness programs took off on a much larger scale. The first iteration of this more recent workplace wellness boom is what Kushner called “An Apple a Day” wellness. If an employee eats right and exercises, health care costs will drop. This was not successful, Kushner said.

The second iteration took the original idea a step further, with organizations subsidizing health club memberships and contracting with nutritionists to show employees how to prepare healthy meals. This also didn’t work to reduce costs because the types of employees taking advantage of these subsidies were the ones who already worked out regularly and had healthy lifestyles, Kushner said. The habits of employees who didn’t go to the gym remained the same.

The third iteration of wellness features employers who target their own workforce based on the health needs of that specific population. An employer with a large population of employees with type 2 diabetes may track things diabetics should be doing — like A1C testing and eye exams — through their health plan and encourage at-risk employees to get appropriate testing done.

This type of program, which is more altruistic in nature, has slightly better results. Still, “Every CFO I’ve talked to with these employers keeps coming back to wanting to see savings in the health plan. And they’re having trouble quantifying those. They’re not seeing the difference,” Kushner said.

Where Art Thou, ROI?

Investing in employee wellness is a good thing, but it’s not a short-term policy, said David Henka, president and CEO of ActiveRadar, a health care analytics and patient education company based in Gold River, California.

Although there’s value in wellness programs, he said, that value is not a financial return on investment. Wellness companies often cite huge ROIs for their programs. But academic research reveals that wellness programs do little to reduce health care costs.

A University of Illinois at Urbana-Champaign study published in June 2018 found that workplace wellness programs don’t change employee behavior much or save money on health care costs. Similarly, a University of Pittsburgh clinical trial whose results were published in JAMA in 2016 found that the use of monitoring devices and wearables — often a hallmark of corporate weight loss programs — may have no advantage over traditional weight loss strategies.

“As an employer, if you go into the wellness space thinking you’re going to get an ROI, then you’re going to be greatly disappointed,” Henka said. “But if you go into it by saying it’s the right thing to do for my employees because I want them to maintain healthier habits or lifestyles, then I think you’re tracking along the right frame of mind.”

The realistic value of wellness is more cultural, he said. Wellness companies claiming big returns are not accurate, but it is the right thing for employers to do. It lets employees know that the company values them, he said.

Many employers are not holding wellness providers accountable for the results of their programs, said Cheryl Larson, president and CEO of Midwest Business Group on Health. There are reliable wellness programs on the market, but unfortunately the average employer only pays attention to what the vendor tells them, Larson said.

Employers need to know the right questions to ask wellness vendors and the best way to research their options. Simply asking fellow employers about their programs is one way to conduct research.

Another way to improve vendor services is only agreeing to terms that suit both parties, Larson said.

“I would say if you ask [the vendor] for things, and they say, ‘We’re not going to do that’ — and you’re being fair, you’re doing industry standards, yet they still won’t do it — maybe that’s not the right vendor for you,” Larson said.

Henka suggested providing flu shots as a clear way to show ROI since the flu accounts for lost productivity and absenteeism in the workplace. As last year’s flu season showed, it can be deadly. According to the Centers for Disease Control and Prevention, 80,000 Americans died of the flu and its complications in the winter of 2017-18.

Wellness Done Right

First Choice Health’s Jaja Okigwe addressed potential issues with health screenings — a common component of wellness programs.

One staple of preventive care is annual health screenings and checkups. But the younger a person is, the less likely they are to need regular screenings, according to Okigwe. It’s not until they get older that they need annual screenings.

“It’s a big production to take off time from work and do your screenings,” he said, especially if a patient also has to do something additional like fast for a certain amount of time before the screening. “From a person’s [point of view], there’s a barrier to do it, and then in the end you get this set of information that you probably already knew.”

Companies such as Chicago-based Visibly and Tel Aviv-based 6over6 Vision allow people to get an eye exam using the camera in their phone. The process only takes about 15 minutes, and with results that are 95 to 98 percent as effective as the results they’d get at the optometrist’s office, it’s beneficial for employees who simply need a new prescription for glasses, Okigwe said. While a virtual test can’t diagnose glaucoma, it has a clear benefit for a specific need. A patient who doesn’t need a glaucoma test won’t need to take an hour out of their day to see an optometrist.

“I’m at the age where I wear two pairs of glasses. And sometimes when I’m in that in-between zone I get headaches. Updating the prescription becomes very important and allows me to be more productive,” Okigwe said.


Employers often turn to the consumer-directed health care plan — commonly referred to as a high-deductible health plan — in part to make their employees smarter health care shoppers.

These organizations have a lofty goal when they seek to turn employees into sophisticated health care consumers. Although the goal itself is admirable, the reality is that the health care delivery system is too complex and patients don’t touch it with enough frequency, said Brian Marcotte, president and CEO of the National Business Group of Health.

An employer might have a comprehensive program that gives employees treatment options and resources when they face a surgical decision. But that may be a decision a person has to make once a year or lifetime. “It ends up being a resource that’s out of sight, out of mind,” Marcotte said.

The idea that giving employees more resources and price transparency information would make them more sophisticated consumers did not pan out like employers thought it would, he added. Employers started rolling out HDHPs in the early 2000s and ramped up the strategy when the Affordable Care Act was passed with the Cadillac tax provision. Since health care is generally not part of most people’s regular spending routine like grocery shopping, organizations need to find a way to fit it into employees’ everyday lives.

The Growth of Virtual Solutions

One way organizations are trying to make health care more a part of employees’ routines is through virtual solutions. While people today can find basically any product or service on demand, what is lacking in health care is the ability to get on-demand service, Marcotte said.

The promise of virtual solutions is that they open up avenues to access, convenience and quicker response times from medical professionals.

Virtual care covers a lot of bases including chronic disease management for conditions like diabetes, lifestyle coaching and virtual second opinion services.

However, virtual care can create complicated issues when a patient has to rely on an outside care team rather than the primary care physician with whom they might already have a strong relationship. “The challenge for all these virtual solutions as well is, ‘How do I integrate them back into care and get it within the delivery system itself?’ ” Marcotte said.

Barriers to Health Care Navigation

One reason for the “rampant confusion on how these plans work” — which unfortunately sometimes leads to employees avoiding care — is that “the industry has never done a good job teaching people how to shop for coverage,” said Kim Buckey, a health compliance expert and vice president of client services with benefits compliance company DirectPath.

A person can’t be a good consumer if they don’t know the prices of services, and there’s no easy-to-read or readily available price list, said Buckey’s colleague, Bridget Lipezker, senior vice president and general manager of advocacy and transparency at DirectPath. She referenced what she called the “myth of transparency.” 

“The lack of control the consumer has over what they’re paying for something, or even understanding what they’re paying for and what their level of responsibility is — to me, consumerism becomes a myth because of the that. Because you don’t have choice,” Lipezker said.

Another barrier to employees is time.

Patients can call their doctor and ask for options and prices, Lipezker said, but finding this information is a difficult and time-consuming process, and, as Buckey pointed out, most doctors are only available during business hours, so employees need to find the information they need while at work, adding to their stress and cutting into their productivity.

“Some employers are taking the bull by the horns and are offering advocacy and transparency services to their employees to give them a source of support where they can turn over these issues to someone else to fight on their behalf,” Buckey said.

Socioeconomic Issues With HDHPs

Socioeconomics also is an important factor that employers must consider in health care strategies. One problem that HR has, according to technology-led business process services company Conduent’s Bruce Sherman, is that “we design benefits for people like us,” thus isolating people with different benefits needs and life experiences.

Low-income workers have been especially impacted by employers’ attempt at cost containment through HDHPs. According to the February 2017 Health Affairs article “Health Care Use and Spending Patterns Vary By Wage Level in Employer-Sponsored Plans”— which Sherman co-authored with Teresa B. Gibson, Wendy D. Lynch and Carol Addy — cost shifting in benefits plans has meant a 67 percent increase in deductibles since 2010. That’s six times more than the rise in workers’ wages (10 percent) and inflation (9 percent).

The article explored patterns of health care usage relative to employee wages and found that workers in the lowest wage group ($24,000 or less a year) were the most likely to have (had) an avoidable emergency visit, while the highest earners ($70,001 or more a year) were the least likely.

“It may be helpful to ask employees in different socioeconomic groups what benefits they’d like to have,” said Sherman, a longtime researcher of health issues. “This opens the door for information sharing and doesn’t obligate the employer to provide what employees request.” 

While more employers are talking about establishing a “culture of health,” oftentimes they also fail to address social and economic determinants in that culture of health, he said, suggesting that employers review organizational policies and practices and keep that perspective in mind to give themselves a broader understanding of where there’s opportunity to improve workplace health for different groups of people.

Some employers offer hourly employees a half day every year specifically to see their doctor for preventive care services, he said. Other employers offer paid sick leave to all employees, including hourly workers. And other employers have ditched “just-in-time” scheduling practices and opted for fixed work hours for all employees — a perk for hourly employees since variable scheduling limits predictable income for employees living paycheck to paycheck.

Some organizations are utilizing wage-based cost-sharing arrangements to address socioeconomic disparities, according to the National Business Group on Health’s 2019 “Large Employers’ Health Care Strategy and Design Survey.” According to the survey, 34 percent of employers offered a wage-based premium contribution in 2018, with 32 percent of employers planning to do the same in 2019. Similarly, 8 percent of employers offered a wage-based cost-sharing arrangement through deductibles or out of pocket costs in 2018, compared to 7 percent planning to do that in 2019.


Many employers are doing a lot to help employees with health care costs. But in actuality they demand more from insurance companies and other providers, said DirectPath’s Bridget Lipezker.

Employers comprise the largest group of payers for health care in the United States. According to 2017 National Health Expenditure data, private health insurance accounted for 34 percent of health spending, beating out Medicare (20 percent), Medicaid (12 percent) and out-of-pocket (10 percent).

Employers have a responsibility to do more and they carry a lot of clout. But there are many barriers hindering that influence, she said. It takes a lot of time, energy and focus, and most organizations don’t have the luxury of hiring a person solely focused on benefits.

A majority of small- and midsized businesses only have one person managing HR, and oftentimes HR isn’t even their primary responsibility, according to HR platform BerniePortal’s 2019 “HR Today and Tomorrow” report.

“I think that employers do try to act in the best interests of their employees, at least in my experience. But they don’t always have the expertise in-house or the dollars to hire consultants to help them figure it out,” Lipezker said.

Disruption Will Cut Costs … Not

Counting on disruption to save on health care spend (think major policy changes like the Affordable Care Act) is a strategy, but it’s a poor one for plan sponsors, said ActiveRadar’s David Henka. Employers need to be proactive.

There’s only so many levers employers can pull to affect cost, Henka said. With trends like the consolidation of health systems and influential health care industries like pharmacy benefit managers clashing with employers, organizations have limited options to influence costs.

The most valuable and accessible lever is at the pharmacy, Henka said. Pharmacy costs and formularies are decided on a national scope, unlike hospital and provider networks, which are often decided on locally or regionally. This adds an additional challenge for an employer with offices or employees in multiple states to trim costs.

The lack of transparency in pharmacy benefits is noteworthy, Henka said, and the reality is that for many drugs, there are alternatives that have the same therapeutic benefit for a fraction of the cost. For example, the brand name drug Lipitor has an average cost $184 while Atorvastatin, the generic version with the same active ingredients, has an average cost of $36, according to Henka.

He suggested reference pricing programs, with which costs go down in the short term and, in the long term, patients became more compliant with drug treatments. Reference-based pricing uses complex algorithms to identify the most expensive drugs used by the employee population, highlights more cost-effective alternatives and then encourages members to switch to the most affordable drug.

While reference pricing is trending in parts of Europe, it’s mostly gaining traction in the U.S. among large employer groups, Henka said. He added that many employers think that by switching to a generic-mandated program, they’re doing enough — but they can do more. They could save money by switching from one generic to a different, more cost-effective one.

The types of U.S. organizations mostly adopting these programs are union trust funds and private employers, he said. 

The second largest health care purchaser in the country, CalPERS, is also a proponent of reference pricing, he added. Second only to Medicaid, CalPERS purchases health care benefits for employees in the state of California that work for school districts and other public agencies and covers about 1.2 million lives. They have “already implemented reference pricing for a number of medical procedures and are in serious discussion of implementing it for their pharmacy program as well,” Henka said.

Enter the Chief Medical Officer

A conversation that is gaining traction among employers is working to get more control of health care costs in unique ways, said of First Choice Health’s Jaja Okigwe.

Cable and internet provider Comcast was among the first companies to hire a chief medical officer. In 2005, it hired Tanya Benenson to have an expert solely focused on health care outcomes. Similarly, Google hired David Feinberg, former CEO of Geisinger Health, in November 2018 to lead its health strategy, and banking giant Morgan Stanley hired David Stark as its first chief medical officer in October 2018.

“The novelty of Comcast’s situation was that they were taking charge of crafting the whole benefit program and experience for their employees,” Okigwe said. “This is typically done by carriers and benefit consultants.”

The role of the chief medical officer varies by industry, said DirectPath’s Kim Buckey. In a hospital, that role likely will oversee clinical outcomes, while at an insurance company the position is responsible for decisions on what should be covered, or to help develop health and wellness programs. For organizations like Comcast, a CMO will identify opportunities for savings, oversee the organization’s health vendors to control costs, lead negotiations with providers and analyze claims data.

Large employers can afford to have someone in this position, Buckey said, but most are “a ways away” from the chief medical officer being a common corporate title.