Research demonstrates positive impact on quality and cost for employers that screen for hyperlipidemia in the workplace

PLYMOUTH MEETING, Pa. — Intrado’s Health Advocate, a leading provider of health advocacy, navigation and integrated benefits programs, announced today that its recent peer-reviewed manuscript published in the American Journal of Health Promotion has been selected as one of five Editors’ Picks Papers of the Year for 2018. The award-winning research demonstrates that workplace health screening programs can identify undiagnosed hyperlipidemia in employees and motivate significant numbers of those employees to seek treatment.

Health Advocate analyzed medical and pharmacy claims data from nearly 19,000 individuals from 39 self-insured employer groups* participating in Health Advocate’s workplace biometric screening program. During the screening, 1,872 (9.9 percent) individuals who did not have a prior claims history of hyperlipidemia were found to have a cholesterol level of at least 240 mg/dL, or an LDL level of at least 160 mg/dL, both highly suggestive of hyperlipidemia. Further, in the month immediately following screening, the number of doctors’ visits with new diagnoses of hyperlipidemia doubled compared to the three months prior, and prescriptions for treatment also increased among individuals who were identified as having hyperlipidemia at the screening.

“Our analysis shows the value and the need for these onsite health screenings for both employers and their employees,” said Abbie Leibowitz, M.D., F.A.A.P., Chief Medical Officer, Founder and President Emeritus of Health Advocate. “By identifying issues like hyperlipidemia sooner, employees can access appropriate treatment earlier, leading to improved health outcomes and reduced costs.”

Importantly, approximately one year following the initial screening, more than half of those individuals identified as having hyperlipidemia were tested again and showed significant improvements in both total cholesterol (8.5 percent decrease) and LDL levels (10.2 percent decrease), demonstrating the effectiveness of the intervention.

American Journal of Health Promotion editors selected the award-winning papers based on wide-ranging criteria including the timeliness and importance of the topic, the quality of the research, and the findings’ unique contribution to the medical literature.

Health Advocate’s workplace screening program provides convenient, professional health screenings onsite to help identify employees’ risk for a number of common conditions. Because hyperlipidemia is often asymptomatic and can be effectively treated, screenings may be critical in identifying issues among employees who may not otherwise see a physician regularly. 

By encouraging employee participation in these programs, employers can take steps to improve outcomes among their workforce while reducing healthcare costs by identifying and addressing conditions like hyperlipidemia earlier.

The article, “Identification of Undiagnosed Hyperlipidemia: Do Work Site Screening Programs Work?” was published in the May 2018 issue of the American Journal of Health Promotion and is available hereAll four authors are part of Health Advocate’s data analytics team.

*Data were fully de-identified prior to analysis and were received and managed in compliance with HIPAA regulations

About Health Advocate’s Biometric Screening Program

Health Advocate’s Biometric Screening Program is a turnkey solution that provides convenient, professional health screenings and related services at the workplace. Available nationwide to organizations of all sizes, this customizable program offers a wide selection of screening options to identify employees’ risk for hypertension, diabetes, hyperlipidemia, obesity and other serious health issues.

About Intrado’s Health Advocate

Intrado’s Health Advocate makes healthcare easier for over 12,000 organizations and their employees and members nationwide.

Our solutions leverage a unique combination of personalized, compassionate support from healthcare experts using powerful predictive data analytics and a proprietary technology platform including mobile solutions to provide clinical support and engage members in their health and well-being.

Our members enjoy a best-in-class, personalized concierge service that addresses nearly every clinical, administrative, wellness or behavioral health need. Our clients benefit from high levels of engagement, improved employee productivity and health, and reduced medical costs, while simultaneously simplifying and upgrading their health benefits offerings.

For more information, visit us at www.HealthAdvocate.com.

About Intrado

Intrado, formerly West, is an innovative, cloud-based, global technology partner to clients around the world. Our solutions connect people and organizations at the right time and in the right ways, making those mission-critical connections more relevant, engaging and actionable – turning Information to Insight.

Intrado has sales and/or operations in the United States, Canada, Europe, the Middle East, Asia Pacific, Latin America and South America. Intrado is controlled by affiliates of certain funds managed by Apollo Global Management, Inc. (NYSE: APO). For more information, please call 1-800-841-9000 or visit www.intrado.com.

State-of-the-art CRM system improves efficiency and engages members at the point of contact

PLYMOUTH MEETING, PA – Health Advocate, a leading provider of health advocacy, navigation and integrated benefits programs, announced today that it has been granted three U.S. patents for the technology behind its state-of-the art customer relationship management (CRM) and case tracking system, MemPHIS (Member Personal Health Information System). MemPHIS was purpose-built by Health Advocate to support its entire suite of fully integrated products and programs while optimizing their impact on health outcomes and medical costs.

“Since its introduction, MemPHIS has been a game changer for Health Advocate because it allows us to fully and seamlessly integrate our many member-facing and care management programs into one platform,” said Matt Yost, President of Health Advocate. “Winning these patents demonstrates the innovative structure and capabilities of MemPHIS while signifying its uniqueness in the health and benefits industry.”

Health and benefits programs are most successful when they blend integrated solutions and a high-tech/high-touch approach. MemPHIS has made this a reality by providing an integrated environment in which all user benefit information is assimilated and accessible at the time of an employee’s call or online contact.

The first granted patent covers the technology in MemPHIS that automatically opens a member’s health and benefits profile when they contact Health Advocate, enabling the Personal Health Advocate to immediately begin assisting the member in ways that are personalized to their medical history and any gaps in care that may need to be addressed. Advocates can track details of the member’s benefits, recent interactions with Health Advocate staff, and the status of any open cases, enabling them to efficiently respond to questions and proactively coach the member to take additional steps to improve their health.

The second and third patents apply to the transfer and conferencing capabilities within MemPHIS that allow member and case information to be automatically transferred to the receiving advocate. In Health Advocate’s collaborative environment, multiple Personal Health Advocates may participate in a case behind the scenes. These features allow our staff to share information seamlessly so that our clinical professionals and claims and benefits experts can all contribute to the case. These same capabilities will be featured in the upcoming chat capability being introduced later this year.

For more than 18 years, Health Advocate has provided integrated clinical and benefit solutions to companies and organizations seeking ways to improve medical outcomes, enhance employee well-being and save money on healthcare costs. As demonstrated by these three patents, MemPHIS improves efficiencies and greatly enhances the impact of the data Health Advocate collects. The system’s architecture ensures that all information is secure and available in one place, resulting in seamless service and an improved member experience.

About Health Advocate:

Health Advocate makes healthcare easier for over 12,000 organizations and their employees and members nationwide.

Our solutions leverage a unique combination of personalized, compassionate support from healthcare experts using powerful predictive data analytics and a proprietary technology platform including mobile solutions to provide clinical support and engage members in their health and well-being.

Our members enjoy a best-in-class, personalized concierge service that addresses nearly every clinical, administrative, wellness or behavioral health need. Our clients benefit from high levels of engagement, improved employee productivity and health, and reduced medical costs, while simultaneously simplifying and upgrading their health benefits offerings.

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.

Matt McPartlin, Director of Benefits with Hexcel Corporation, shares how Health Advocate has partnered with his team to integrate and maximize their benefits program, making healthcare easier for Hexcel’s employees.

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:

Hypertension

  • 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

Diabetes

  • 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

Obesity

  • 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.

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.

Join Health Advocate at the CUPA-HR Spring Conference, when Matt Verdecchia, MS, CEAP, Senior Trainer/Organizational Development with Health Advocate’s EAP+Work/Life Division, will present a concurrent session on HR’s Role in Addressing Behavioral Health on Campus and in the Workplace on Saturday, March, 30, at 1:15 p.m., ET.

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.

MYTH 1: LOWER PRICES! SAVE MONEY!

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.

MYTH 2: WELLNESS WORKS

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.

MYTH 3: THE CONSUMER RUMOR

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.

MYTH 4: WE’RE DOING ALL WE CAN ALREADY

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.


Episode 20: Maximizing Benefits Reporting

The transition from one year to the next is a great time to review the results of benefits programs in order to make adjustments for the future. In this episode of Health Advocate’s Ask the Expert series, Product Specialist Dan Shields discusses the uses and value of reporting for benefits programs.