By Antonio Legorreta, M.D., MPH | HR News

As data analytics continue to evolve, they promise to play key roles in shaping employee benefits and engaging employees in taking steps toward better health. In fact, data can be leveraged to inform program design, provide opportunities for customization, drive engagement and measure success. This matter because improved workplace health and wellness programs make positive impacts on the health of the workforce and the organization’s bottom line.

Designing Effective Health and Well-being Programs

Data analytics allow employers to understand both the current health of their unique workforce and the biggest drivers of benefits costs. Gaining these insights can help organizations develop targeted initiatives and programming to address priority issues. By analyzing health care claims, reviewing biometric screening results, developing aggregate personal health profiles and conducting health risk assessments, it’s possible to uncover the most prevalent health conditions among employees, as well as the costliest.

For example, if the analysis reveals that chronic conditions like heart disease and diabetes are contributing to higher costs, adding a chronic care component to the wellness program can help employees access the resources they need to improve their health and manage their care. And if a population includes a large number of smokers, adding a tobacco cessation program could be extremely helpful. Quitting tobacco has near-immediate positive health effects that increase the longer people stay tobacco-free.

Additionally, reviewing incentives data can further contribute to the larger picture of what is and is not effective in motivating employees to participate in programs and take actions to improve their health. If, for instance, dta show that offering employees a health savings account contribution to visit a primary care provider is not making an impact, an organization can use that information to adapt its approach. A solution could be increasing the amount offered or incentivizing some other beneficial activity. Making such tweaks based on an analysis of data can ensure time and money are not wasted and that efforts are directed toward the most effective initiatives.

Last, surveying employees about their needs and goals can also generate helpful data to guide program development. If employees report being stressed about matters outside the workplace, introducing an employee assistance program (EAP) can provide welcome support. For organizations with employees looking for extra guidance on budgeting or saving for retirement, a financial wellness component can add value.

Driving Sustained Engagement

Following program design, data analytics remain important for driving ongoing engagement in workplace health and well-being programs. A key insight that can be gleaned from data is the identity of employees who are at risk. This enables the organization to provide personalized communications to movivate those employees to seek out interventions to improve their health and plug gaps in care.

Not only can data customize messages, it can also help guide the delivery of messages via the communication channels each employee prefers. This lets the employer connect with employees through multiple touch points. For example, a 2016 Health Advocate study found that individuals may prefer texts or emails for a reminder to get up and walk, but a phone call about remembering to speak with a counselor through their EAP was more likely to drive higher engagement.

Creating a streamlined, data-driven, automated web and mobile engagement platform can be effective for sending voice, text and email reminders to encourage employees to use the components of the wellness program that best meet their needs. The data should come from both employees and the employer, and biometric screening results, claims and eligibility should be included. Action alerts can address a range of things, from filling a prescription to getting a diabetes test and sticking with a walking goal.

Likewise, building an online hub for all the related services an employer offers gives employees access to a one-stop engagement portal for accessing services.

Enhancing proactive alerts with meaningful information about resources like wellness coaching, service pricing and clinical decision support improves employees’ total well-being by driving them to appropriate services. Surveys suggest this can result in higher engagement, better health decision-making and lower medical costs.

According to a 2012 Towers Watson/National Business Group on Health survey of employers, organizations that successfully lowered their health care cost trends were twice as likely as their counterparts to utilize targeted messaging to drive employees to tools that can improve their health, including benefit decision support, clinical decision support and promoting access to a primary care doctor.

Further supporting this approach are findings from a 2018 Health Advocate analysis of 13 large employers who incorporated data into their integrated health and well-being programs. Across the study group, more than 26,000 employees were identified as being at risk for health problems based on claims data, biometric screening and lab results, and self-reported information. Those people received personalized communications in the form of letters, emails and phone calls, encouraging them to participate in nurse-led coaching sessions. These efforts yielded millions of dollars in savings, including a 10.3% reduction in medical costs among the highest risk employees and a 5-to-1 return on investment.

Ensuring and Measuring Success

Following the initial launch and implementation of a health and wellness initiative, it is critical to begin analyzing data at regular intervals to assess the program’s effectiveness. Using the initial aggregate data as a baseline makes it possible to see year-over-year improvements to employee health, finances, productivity and more. An annual review of the data also provides a great opportunity to make necessary changes to health and wellness programs to better address the evolving needs of the workforce and continue to see the benefits.

Data can strengthen effective programs for individuals as well as the workforce as a whole. For example, biometric screening results inform and empower employees to make positive behavior changes. A series of studies from Health Advocate demonstrated that new diagnoses and prescriptions for employees who showed signs of being at risk for chronic conditions like high blood pressure and high cholesterol increased within one month of when the employees participated in biometric screenings. These employees also showed improved results when screened one year later. When an organization has information like this, it can make adjustments to benefits and wellness programs to ensure more employees participate in screenings and further realize the value of that.

Additionally, HR professionals can review dashboards of aggregate data from across their covered population to identify and address trends, both in regards to the health of their workforce and to the success of wellness initiatives. If the data indicate an uptick of avoidable ER visits, HR can work with their partners to create a communications campaign to drive people to urgent care when appropriate. Reviewing data about utilization and outcomes can also give employers the ability to see how services are performing and to redesign those that are underperforming, thereby improving the value and ROI of all services.

PMPY = per-member-per year
The chart comes from a report on the study Health Advocate conducted of 40 large employers who use data analysis for their integrated helath and wellness programs.

A recent Health Advocate study demonstrated how it is possible to compound the power of data by both incorporating it into a benefits program and leveraging the insights generated to measure success. A key finding is summarized in the accompanying chart.

Researchers looked at 40 large employers who use data analysis for their integrated health and wellness programs. When compared to their counterparts in the market as a whole, employees at the studied organizations demonstrated higher levels of engagement, leading to significant savings and improved clinical outcomes.  For example, employees who received targeted outreach with information about how to improve their health experienced a 13 percent decreased in cost trend. This compared to a 4 percent increase across the market as a whole.

By incorporating data analytics throughout the lifecycle of a health and wellness program, from inception through implementation and evaluation, it is possible to create a more personalized offering that more effectively engages employees and promotes positive behavior change. Utilizing data can, in this way, help ensure success of health and wellness programs, which results in improved health for employees and reduced costs for the organization.

Antonio Legorreta, MD, MPH, is the managing director of Health Advocate’s engage2Health division. He is also an adjunct professor at UCLA’s Fielding School of Public Health and a senior natural scientist at RAND.

By Jennifer Carsen | HRDive

Experts say large companies are leading the way, adding vaping to workplace tobacco policies.

Reports on the health concerns associated with vaping and e-cigarettes are mixed. While some say the products are less harmful than traditional cigarettes, others link them to serious health consequences such as lung disease, noted Julie Stich, vice president of content at the International Foundation of Employee Benefit Plans (IFEBP). 

Given the popularity and risk associated with vaping, it’s made an impact on employers. “Vaping and the use of e-cigarettes pose many of the same risks of cigarette smoking to employees and the workplace,” Haynes and Boone Partner Jason Habinsky said in an email to HR Dive. What’s more, workers who choose to use e-cigarette products can put those who share their space at risk as well.

A lack of vaping policies

Vaping has been around for a little while now, said attorney Marissa Mastroianni, an associate at Cole Schotz, but a lot of employers still haven’t created policies.

Stich concurred, noting that only 46% of U.S. employers in a recent IFEBP wellness survey reported having a vaping policy, with a “large chunk” of respondents say they weren’t sure if they did.

But this may soon change. A recent increase in vaping-related illnesses, combined with a warning from the Centers for Disease Control and Prevention has driven some employers to take a second look at their policies, said Kerry Sylvester, director of product management, wellbeing solutions at HealthAdvocate. In the absence of specific vaping-related laws, company culture and priorities are driving policy. “Many larger employers including Target and Wal-Mart are leading the way by including vaping in their workplace tobacco policies, and many smaller employers are following their example,” she said.

Mastroianni concurred: “There is a trend that employers have been adding vaping to their no-smoking policies,” she said. This is a good thing, according to Habinsky. “[I]t is important that employers review all policies which regulate smoking or other health and safety considerations and modify the scope of such policies to include vaping and e-cigarettes,” he said.

For employers that lack policies putting boundaries on vaping, the first step is to consider any applicable local laws, Mastroianni said. New York and New Jersey, for example, have adopted vaping laws relating to smoke-free workplaces and smoking in public areas. “If a law like that exists in your jurisdiction, you need to comply,” said Mastroianni.

Stich noted that laws in some areas may treat vaping differently than smoking, and employers need to be aware of this (she cited a list of current vaping laws here). Additionally, employers will need to note that vaping and e-cigarette use “may also be prohibited in certain industries and work environments where health and safety may be at risk,” said Habinsky.

Competing priorities

When no specific law applies, however, employers have more flexibility. This is the point at which priorities begin to compete.

“Vaping has been viewed as a substitute for traditional tobacco use both for recreational users as well as by individuals who are trying to cut back or quit smoking,” said Sylvester, speaking to HR Dive via email. “Employers want to support employees who are trying to make positive changes in their health by quitting smoking, but must consider the needs of their entire workforce.”

Employees who want to sit at their desks and vape may say they’re not bothering co-workers, but this is not necessarily true, said Stich. “There can be a residual odor and co-workers can find this annoying.”

Annoyance is not the only thing e-cigarette users may inflict on coworkers. “Vaping can pose challenges for individuals with scent sensitivities, not to mention the concerns related to secondhand exposure to vaping aerosol,” said Sylvester. And, unlike traditional cigarettes, “[a]n e-cigarette can also malfunction or even explode, causing harm to individuals in the workplace,” said Habinsky.

Productivity concerns also factor in. “[E]mployers must also consider the positive or negative impacts on productivity by allowing employees to take vaping breaks away from their workspace versus vaping at their desks,” said Sylvester.

Once employers have updated or created vaping policies, it’s up to them to make sure employees know about the changes. “Employers should also update any related employee training to include a discussion of such prohibitions,” said Habinsky. “Employers should also examine any wellness policies and employee education to ensure the inclusion of such use.”

A call employers need to make

“While supporting employees who want to quit tobacco is a priority, employers must decide if allowing the use of nicotine products that are not [Food and Drug Administration-]approved is beneficial in the short and long term,” said Sylvester. It’s worth noting that “the jury is still out” as to whether vaping and e-cigarettes actually do help people stop smoking regular cigarettes, Stich said.

“It’s kind of tough at the moment,” said Mastroianni, and it’s an area with a lot of nuance. “On the one hand, you want clear air for employees to work and to protect against inhaling secondhand smoke. On the other hand, a lot of people do use vaping and e-cigarettes as a way to stop smoking actual cigarettes.”

Ultimately, said Mastroianni, “employers need to make a judgment call and decide, ‘what’s better for us?'”

Reading the tea leaves

Insights and predictions on benefits and health care in 2020

By Alan Goforth | BenefitsPRO

In the 1950 film “All About Eve,” Bette Davis spoke the famous line, “Fasten your seatbelts, it’s going to be a bumpy night.” That might sum up how many brokers feel as they look ahead to the election year of 2020.

“The election will be the hottest topic in 2020, but most of what is discussed will not be implemented until further down the road,” says Emily Bremer, president and owner of Bremer Benefits in St. Louis. “The more urgent issue is that we are coming to a tipping point when it comes to the cost and transparency of health care that may not be able to wait until after the election. Surprise billing, pharmaceutical trends and hospital price transparency are making the news daily, along with the myriad of lawsuits cropping up on all sides.

“Without real government intervention or regulation, there is a wave of start-up companies and employer benefits strategies that is building to combat these issues using every tactic you can think of, from sending employees to Tijuana for their drugs to direct contracting with doctors and hospitals, and many more.”

Uncertainty about election outcomes goes hand in hand with another key issue on the horizon: economic uncertainty.

“The state of the economy has the potential to have a big impact for all of us in the year ahead,” says Dr. Arthur “Abbie” Leibowitz, chief medical officer, cofounder and president emeritus of Health Advocate in Plymouth Meeting, Pennsylvania. ”If there is a business slowdown in 2020, it could have major repercussions across the benefits industry.

“However, during the last recession, our business actually increased as many employers, including our clients, made changes to their health care benefits to curb costs and realized the need for an effective and inexpensive service to help employees deal with the changes and lower their overall health care costs. We’ll be watching this closely in the coming months.”

Predicting the future is always an iffy proposition, and especially so in a contentious presidential election year. However, although it is difficult to predict exactly what the benefits industry can expect in 2020, it is possible to determine which issues are likely to dominate. BenefitsPRO asked a group of industry leaders for their insights on what to expect on several hot-button topics.

Election and politics

“The 2020 election will decide the future of the American health care system. We know voters list health care as a top issue, so I expect to see candidates spending a significant amount of time on the campaign trail addressing their specific vision for how our system should work. I view it as a responsibility of our industry to help provide our clients and family members with the appropriate context for evaluating the proposals that will be at the forefront of the debate.”

—Scott Wham, director of compliance services, Kistler Tiffany Benefits, Berwyn, Pennsylvania

“Democrats believe that health care is an issue that voters trust them with more than they do Republicans. It appears unlikely that Republicans will promote the repeal of Obamacare like they did in earlier elections. Republicans believe that tagging Democrats with Medicare for All may make voters concerned about losing their current employer-based health care and increased taxes.”

—William Sweetnam, legislative and technical director, Employers Council on Flexible Compensation, Washington, D.C.

“Politics and health care reform are closely connected in the current environment. Health care reform, the Affordable Care Act and other proposed plans are front and center on both sides of the aisle, and with the election right around the corner, I expect this focus to remain. While it’s too early to predict what the final outcome will be, we do know this will be a key issue in debates next year.”

—Arthur Leibowitz

“Medicare for All will be front and center, but I’m pretty sure that not all Democrats agree that this is a good solution. Use of the term ‘Medicare’ is intentional, as it has positive connotations with most Americans. However, Medicare for All is not Medicare as we know it today. People need to get clear on that and be educated.”

—Suzy Alberts, account director, Comprehensive Benefits Inc., Southfield, Michigan

Health care reform

“It remains to be seen how employer-based health plans (including consumer-directed health-care plans) will fare under a Medicare for All program. At one end of the spectrum, the favorable tax treatment of employer-provided health plans will be eliminated and everyone will go into a Medicare-like health plan. On the other end would be the continued availability of employer-sponsored health plans, giving everyone the opportunity to buy into a lower-cost Medicare-like health plan as an alternative. I anticipate a spirited discussion, particularly since labor unions, an important constituency of the Democrat party, want to continue to provide tax-free health care benefits as part of the collective bargaining agreements negotiated for their members.”

—William Sweetnam

“This used to mean health insurance reform to most people, but I think the tide is finally turning. People are beginning to understand what all of the cost drivers are. And hopefully that will lead to better conversations and more innovation going forward.”

—Emily Bremer

“The only health care cost issue that’s even being considered is whether the government becomes the single-payer. Then they can set prices. I don’t think people understand the repercussions that would have on health care in the United States. Providers can’t survive on the Medicare pay scale.”

—Ken Stevenson, vice president, employee benefits, Earl Bacon Agency, Tallahassee, Florida

Health care delivery

“Domestic tourism, reference-based pricing and specialty drug programs are the three areas of greatest impact to the bottom line for organizations. While not all employers are ready, we are at least educating them on what is in their market. Employers are looking for innovative solutions to solve their complex problems, and this is exciting to me. The conversations are shifting. We are seeing a lot of conversation around the RAND study—it’s bringing providers, pharma and carriers/TPAs.”

—Susan Rider, consultant, Gregory & Appel, Indianapolis

“Primary care continues to be a challenge. We need more physicians in this space, and hopefully DPC and concierge medicine will make internal medicine more attractive to medical students and residents as a field. The ER also continues to be a problem. I am grateful for the many terrific urgent care centers that have cropped up around the country, but there are just times when you need the ER.”

—Emily Bremer

“I believe we’ll continue to see a push for more accessible primary care delivered by non-physicians. Access to primary care is foundational to positive health outcomes, and employers of all sizes are interested in removing barriers to primary care for their employees and their families. While many large companies offer on-site health clinics to their employees (as well as their families), the vast majority of companies cannot afford to maintain an on-site health clinic. I’m excited by the number of nurse practitioner/physician assistant-led primary care clinics entering the market looking to partner directly with employers at a reasonable price-point.”

—Scott Wham


“Expect increased implementation on all fronts. Our agency uses quoting tools, online enrollment portals, CRM software, new group online submissions to the carrier, etc., that were not in place even two or three years ago. While there is a cost to these tools, they create greater efficiency in our office procedures and allow us to streamline. We can also more easily access client information and provide quicker service. Carriers are increasingly using technology to track and manage care, claims and behavior, as well.”

—Debbie Stocks, Your Benefits Partner, Glen Allen, Virginia

“What most people don’t know is that there is a movement behind the scenes to get away from 834 EDI data exchange by health carriers. It’s been done that way since the mid-1970s. If Employee Navigator is successful with its pilot of UnitedHealthcare changing to HTML, that could be a game changer for data transfer.”

—Ken Stevenson

“We will continue to see more use of technology to streamline every aspect of the benefits industry. It provides better access to information to the consumer, results in fewer errors and makes managing benefits much easier. However, not all consumers will be adopters due to lack of access and education.”

—Suzy Alberts

“Technology is both a boon and a bane to our industry. Health insurance was way behind P&C and other industries. Now we are playing catchup and experiencing growing pains. Every time someone comes out with some fabulous new app or website, all I can think of is the direct in-person communication that too often will be eliminated because it isn’t ‘needed’ anymore. While I am grateful for the technology tools that make it easier to communicate across distances and store information in an easily accessible way, I worry about formats that focus more on being pretty than being functional, and result in losing direct employee interaction.”

—Emily Bremer

Industry Consolidation

“I believe we will continue to see major industry players looking to consolidate and create economies of scale. Some are likely looking to be a player if we eventually see more health care reform (i.e., Medicare for All). The FTC and other agencies will be closely scrutinizing these deals so we don’t create a whole new set of problems with markets controlled by one or two companies.”

—Suzy Alberts

“Across the country, we’re seeing hospital systems consolidate at a rapid pace and compete with each other to own the ‘feeder points’ throughout their regions. As more physician practices are owned by hospitals and consolidated by health systems, the landscape of care delivery will continue to change. Access to care will continue to be a consumer challenge and costs may rise as availability of other options decreases. We also expect continued increases in accountable care, patient-centered medical home care and other integrations across the medical care system. Physicians will take on additional financial risk for population management and outcomes as patients are likely to be increasingly confused by the nature of these new arrangements.”

—Arthur Leibowitz

“We continue to see consolidation. Personally, I work for a firm that remains fiercely independent and that is not up for sale. This has allowed us the fortune of being able to remain nimble to meet client needs.”

—Susan Rider

Business strategy

“Customer service is still the top priority; it’s how I have grown my business and retained my clients. We’re just streamlining our operations to be more efficient and effective in dealing with client service.”

—Debbie Stocks

“This year is a difficult one, with double-digit increases. We continue to stress the importance of developing a three- to five-year strategy rather than a Band-Aid approach. We do work with many employers that are forward thinking and want to do what’s right for their staff while incorporating cost-containment strategies to help for the future. Communication is key, and it’s not a once-a-year strategy, but rather several touchpoints throughout the year.”

—Susan Rider

“Flexibility has been my watchword since 2010, and it will be in 2020 as well. Laws and regulations change, clients merge with other companies, carriers come out with new products, or new opportunities arise. No two years have been the same since the ACA appeared in our lives. As a broker and employer, I try to keep an open mind. I am always on the lookout for new ideas and revenue streams and know I have to be able to let go of what isn’t working, even when I feel like I have invested my heart and soul into it.”

—Emily Bremer

Reasons for optimism

Even amid the uncertainty, however, brokers have reasons to be optimistic as they look ahead to the new year.

“I always have hope,” Bremer says. “I am probably the only optimist in insurance, but I believe in this country and our capabilities. Change and transition are hard for everyone, and we have definitely been through a lot of change over the last nine years. However, I always remember that this is the country that invented personal computers, GPS systems, 3D printing and lasers. Not to mention putting a man on the moon.

“It is hard to believe that when it comes to health care, our best idea is ‘let’s just do whatever Canada is doing.’ At our heart, we are a nation of innovators, but we need to get to work and stop waiting for the politicians to solve our problems for us.”

Brokers’ resolutions for 2020

It wouldn’t be a new year without a few resolutions, and several brokers shared their hopes for the industry and their own businesses in 2020.

“From a business perspective, I will be focusing on compliance and technology. Making sure that our clients have their bases covered from a compliance perspective is always a moving target. We also need to work toward getting our clients up and running on technology platforms that streamline benefits management for them and for us. Because our agency’s client-base tends to be in the small- to mid-size market, it’s more of a challenge to find vendors that are a fit.”

—Suzy Alberts

“In the year ahead, we will continue to develop and innovate our services to meet the changing needs of consumers in the ever-evolving health care environment.”

—Dr. Arthur “Abbie” Leibowitz

“Keep an open mind, listen to client requests and find solutions that benefit both the employer and employees.”

—Susan Rider

“My resolution for myself and my employees is to step back and make time to put on our own oxygen masks first. We have been running and gunning for so long it has become the norm, and you have to take care of yourself and your health. I went to a great local women’s conference this year where a non-profit leader said, ‘You cannot pour from an empty cup.’ So my resolution for 2020 is to stop feeling guilty and fill that cup up to the brim.”

—Emily Bremer

“We will continue to promote consumer-directed health plans as a means of helping employees become more conscious of health spending and providing them opportunities to finance their health care expenses. Even if the United States moves to a Medicare for All world, individuals will need to be responsible for some of the costs of health care and consumer-directed health plans should continue to be looked at as a way to help employees finance those health care costs.”

—William Sweetnam

“2020 should be the year our industry offers a zealous defense of our value proposition. I’ve seen a significant amount of ink in books, news articles and LinkedIn posts dedicated to questioning the value and motivations of our profession, and this should be the year we fight back by telling our story or, even better, having our clients tell our story for us.”

—Scott Wham

“It’s not a resolution, but keep pushing the conversation for change. But the change is addressing delivery and outcomes tied to health care cost, not whether private insurance or government should be the payor but are just abused mechanisms for financing the ever-burgeoning cost.”

—Ken Stevenson

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.