HRDive | December 15, 2016

Dive Brief:

• Health Advocate released the results of a recent survey on communicating benefits, finding that 73% of employees prefer to talk live with someone about their benefits rather than use an automated system. Millennials were found to prefer live interaction even more than boomers and GenXers.

• Infrequent communication about benefits was troubling to 41% of employees. Health Advocate says organizations sometimes partner with as many as six benefit vendors of medical, dental, eye care, life insurance and retirement plan coverage. Employees often find navigating through an array of vendors daunting.

• Technology might have made live easier for people, but workers in the survey preferred getting information about benefits, health and wellness through live conversations. For help managing chronic conditions, 67% of men and 53% of women preferred live assistance versus 35% of women and 18% of men who prefer using apps.

Dive Insight:

The survey points out that a one-size-fits all approach to communicating benefits could fail. Workplaces sometimes have three, possibly four, generations working together and therefore one approach that works for one group or individual might not work for another. Employers should use as many channels as is feasible to communicate benefits to employees.

This report comes at an awkward time for many third-party HR software providers. Firms like Zenefits, which recently launched its Z2 app, are depending on HR departments to make digital shifts in several areas, hoping to change the way employees interact with their employers.

73% of Employees Want to Talk Benefits with People, Not Apps Valerie Bolden-Barrett HRDive | December 15, 2016

BenefitsPRO | December 14, 2016

Although technology has spawned multiple methods of communication with employees on benefits, that doesn’t mean they’re solving all the problems in conveying information back and forth between employer and employee.

In fact, generational and demographic differences, varying levels of comfort with a range of communication methods and the complexity of information all mean that there’s no one-size-fits-all solution in workplace benefits communication.

A study from West’s Health Advocate Solutions finds employees’ expectations cover a wide range in benefits, health and wellness program communication. As a result, human resources and benefits managers have to dig more deeply in finding ways to convey information to employees.

One finding which may surprise them is employees prefer live-person conversations, although some do prefer the option to use digital communication channels in certain benefits scenarios. And 41 percent of employees say their top complaint about employers’ benefits programs is that communication is too infrequent.

The top choice of employees for communicating about health care cost and administrative information is directly by phone (73 percent) with a live person; second choice was a website or online portal (69 percent), while an in-person conversation was the choice of 56 percent.

For information about physical wellness benefits, 71 percent opt for the website/online portal, while 62 percent want to talk to someone on the phone and 56 percent wanted an in-person conversation. Interestingly, 62 percent of men and 44 percent of women prefer in-person conversations.

For personal/emotional wellness issues, 71 percent want that chat with a person on the phone, 65 percent want an in-person conversation and just 60 percent want to interact with a website/online portal.

When it comes to managing a chronic condition, 66 percent prefer to talk to someone on the phone, 63 percent would prefer the website/online portal option and 61 percent want an in-person conversation. Sixty-seven percent of men, compared with 53 percent of women, prefer in-person conversations, while 35 percent of women, compared with 18 percent of men, prefer mobile apps.

And there are generational differences, too, with millennials wanting in-person interactions more than either Gen X or boomer colleagues. But they all want multiple options, and the ability to choose the one they prefer, rather than simply being restricted to a single method.

Don’t expect tech to solve benefits communications problems Marlene Y. Satter BenefitsPRO | December 14, 2016

LearnVest | November 4, 2016

Welcoming a new baby into your family is an exciting time in your life. In addition to choosing a nursery room color and buying all the necessary—and probably some not-so-necessary-but-really-adorable—baby gear, you’ll no doubt start thinking about the road ahead with your little one as part of your daily life.

And a key part of that new journey is making sure your baby is immediately covered by health insurance. Certainly, deciphering health plans isn’t as fun as, say, wondering what your kid’s personality will be like, but it’s a critical step.

Here’s how to navigate your company’s health plans to pick the right one for your expanding family.

1. Evaluate both parents’ coverage options.

Before anything else, it’s important to take stock of your and your partner’s respective health care plans, especially if both of you get coverage through work. Pay special attention to the different coverage tiers available under your plans, says Kim Buckey, VP of client services at DirectPath, an employee engagement and health care compliance company. For example, some plans allow you to cover just yourself and one dependent, either a child or a spouse; others might require coverage for the whole family.

In some instances it may be worth having two separate policies. “If both parents are on the same policy, then adding a child can sometimes turn the policy into a family policy at a much, much higher cost,” says insurance agent Greg Sanders, a father of three. He

notes that, for example, a small company he works with offers an Employee/Children policy that costs almost $600 a month less than a Family plan that also includes a spouse.

In cases like this, it could be worth having your spouse on his or her own company plan instead of putting everyone on the same policy. Furthermore, adding a spouse to your own plan could lead to a spousal surcharge, Buckey says, in which your plan may charge extra to cover a spouse who is offered coverage through another employer and has declined to use it.

Bottom line: Be sure to read the fine print.

You may also want to check to see if your preferred pediatrician and nearby hospital are better covered by one company plan or the other.

2. Look at the total cost of a given plan, not just the monthly premium.

When you weigh the pros and cons of a plan, be sure to add in copays, deductibles and all other medical fees that you’re likely to have with a particular plan. As Buckey puts it, a plan with a low premium isn’t effective if you can’t actually afford the out-of-pocket costs that go along with it.

While you may have heard that the Affordable Care Act requires that certain preventive checkups be covered, it’s important to talk with your pediatrician, your insurance company and the benefits expert at your office to get the full picture for your situation.

The New Parents’ Quick Guide to Choosing Health Benefits Natasha Burton LearnVest | November 4, 2016

And be sure to factor in any potential visits to urgent care or the emergency room as well as lab tests and prescriptions, says Raffi Terzian, M.D., senior vice president of clinical operations and senior medical director at Health Advocate, a health advocacy and assistance company. “If available, a lower deductible plan with higher monthly premiums may be more cost-effective for a family with a new baby or young children, but it’s worth the time to run estimates on all available options to determine the best fit for you,” he adds.

Finally, when it comes to out-of-pocket costs, you’ll want to consider if the pediatrician you’d like to use and a nearby hospital are in-network, in case of emergency.

3. Understand what documents you need to add a newborn to your plan.

“Giving birth or adopting a child is a ‘qualifying life event,’ meaning that you have a certain window to elect coverage for your child even if it’s not open enrollment season,” Buckey says. New parents typically have about 30 days after the birth or adoption to enroll in an employer plan or 60 days to enroll with a marketplace insurer. If you become eligible for premium assistance through your state’s Medicaid or Children’s Health Insurance Program, you have 60 days from becoming eligible to request enrollment in your employer’s plan. Coverage is retroactive to the date of birth or adoption in these cases.

You may not know in advance, of course, when this life event will occur—women rarely give birth on their due dates, after all. And since some plans require documentation within a certain time frame following the birth or adoption of a child in order to retroactively cover initial medical costs, it’s worth getting as much of the paperwork done ahead of time as possible.

Your HR department or insurance company may be able to provide enrollment or application forms in advance, Terzian says. “Since it can take time to receive a birth certificate or Social Security number, check if a letter from the hospital or other records confirming the birth can be used in the interim.”

4. Consider enrolling in your company’s Flexible Spending Account plan for Dependent Care.

If you know that you will need childcare, consider using a Dependent Care Flexible Spending Account (FSA) to get a break on the cost. “The 2016 limit for FSA Dependent Care is $5,000 for individuals or married couples filing jointly,” says John F. Knolle, CFP®, a financial planner at Saranap Wealth Advisors, LLC and father to an 18-month-old. “The $5,000 you’re spending is actually buying about $7,140 worth of services, since you’re not paying out taxes, which is essentially like receiving a 30% discount.”

Also consider timing: As Knolle points out, dependent care FSAs are “use it or lose it” plans. If you have your baby later in the tax year, you may consider contributing less than if you have your baby in January or February.

If you have a high-deductible health plan, your employer may also offer a Health Savings Account (HSA), an account to which you can contribute up to $6,750 of your pre-tax dollars in 2016/2017 if you have a family. This money can be withdrawn tax-free as long as it is going toward eligible medical expenses. While various health-care items are included, keep in mind that everyday costs like childcare or diapers aren’t considered medical expenses, so it’s important to know what’s covered before deciding if an HSA is right for you.

LearnVest | November 4, 2016

World at Work Benefits & Work-Life Focus | October 10, 2016

Health-care costs have skyrocketed over the past two decades. Employers and workers bear the brunt of this trend. Between 2005 and 2015, employer contributions to health insurance premiums increased by 61%, according to the Kaiser “Employer Health Benefits Survey.”

Naturally, employers are seeking strategies to counter rising health-care costs. One important strategy to consider is to focus on medication adherence. Why? According to the Network for Excellence in Health Innovation, medication non-adherence is a leading driver of high health-care costs, adding up to $290 billion annually. It’s the leading cause of preventable morbidity and mortality, responsible for 30% to 50% of treatment failures and 125,000 deaths annually, says the American College of Preventive Medicine. As the industry scrambles to improve quality and lower costs, non-adherence to medication is a topic that health-care providers, payers and self-insured employers should address.

The most common contributing factors of medication non-adherence are:

• Cost

• Lack of a clear immediate benefit/not understanding the reasons for taking the medication

• Confusion about the medication and how to take it

• Concern about side effects

• Psychological resistance.

Most of these barriers can be resolved through patient engagement, education and communication. Implementing a program to engage a large patient population effectively — to stay one step ahead of non-adherent behaviors, send patients refill reminders and ensure that patients have the education they need to take medications properly — isn’t easy to do.

That’s where targeted patient engagement solutions come into play. Intelligent, automated communications combined with live support from licensed clinicians enable organizations to proactively help patients take medications as prescribed.

Employers could potentially save hundreds of millions of dollars in employee productivity — not to mention additional savings in reduced health-care costs — by improving patient engagement and driving interventions around medication adherence for employees and dependents covered through their health plans. In particular, employers have an opportunity to save money by engaging those with common, but costly, chronic conditions.

How Much Could Medication Adherence Save Your Company?Wellness Moves from Bottom Lines to Positive Outcomes

Pam Mortenson World at Work Benefits & Work-Life Focus | October 10, 2016

These savings may sound like a pipe dream, but consider these statistics:

• 3.8 billion prescriptions are written every year, yet more than 50% of them are taken incorrectly or not at all.

• 75% of patients do not take their medications as prescribed.

• Patients who don’t take their medications as intended have a higher risk for hospitalization, re-hospitalization and premature death.

• Poor medication compliance is implicated in more than 125,000 U.S. deaths per year.

According to the Centers for Disease Control and Prevention, as of 2012, about half of all adults in the United States had one or more chronic health conditions. A Georgetown University study estimates that 34% of adults age 18-65 have at least one chronic condition. By 2020, half of the U.S. adult population will have at least one chronic condition.

For the purpose of this article, chronic conditions exclude obesity and include the top eight that require clinical intervention or support: asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), congestive heart failure (CHF), depression, diabetes, hypertension and metabolic syndrome/ high cholesterol.

A Cost-Savings Scenario for Medication Adherence

A study in the Journal of Occupational and Environmental Medicine found that employees with chronic conditions who adhere to their prescribed medications had up to seven fewer days away from work annually than those who were not adherent, translating into estimated annual savings of nearly $1,700 per adherent employee.

What does this mean for an employer’s costs in real terms? The average size of the workforce for a Fortune 500 company is approximately 50,000 employees.

Based on the most conservative nationwide statistics, we’ll assume that more than one-third of the workforce (adults age 18 to 65) covered by a company’s health plans has at least one chronic disease and 75% in any given year are not on the proper medications. Below is the potential financial impact in a single year:

• 50,000 covered employees x 30% with at least one chronic condition = 15,000 employees

• 15,000 employees (with at least one chronic condition) x 75% not taking Rx properly = 11,250 employees

• 11,250 employees (with at least one chronic condition and not Rx adherent) x $1,700 (amount that could be saved if employee was adherent to meds for their chronic condition) = $19,125,000

Employees’ adherence to medication could save a Fortune 500 employer more than $19 million annually.

Employees who are adherent to their medications also generate savings as the result of fewer emergency department visits and fewer inpatient hospital days. In fact, researchers for CVS/Caremark have found that adherent employees saved the following amounts compared to their non-adherent counterparts for these common chronic conditions:

• Congestive heart failure patients saved $7,823 per year.

• High blood pressure patients saved $3,908 per year.

• High cholesterol patients saved $1,258 per year.

• Diabetes patients saved $3,756 per year.

Employers seeking to improve the health of their employees and their health-care spend would be wise to consider a medication adherence program. Smart, automated communication solutions are valuable, cost-effective means to make this possible and realize the many benefits of improved medication adherence.

World at Work Benefits & Work-Life Focus | October 10, 2016

The adoption of consumer-driven, high-deductible health plans continues to surge. According to a survey from Aon Hewitt, 64 percent of employers reported offering consumer-driven health plans in 2015, but another 23 percent note they intend to add them in the future. As employees take on more responsibility for managing the costs of their health care, a plethora of pricing transparency tools and similar resources have emerged to help them identify cost-effective, high-quality care. When effective, pricing transparency offers a number of benefits for both employers and individuals. By helping people make more informed decisions about their care, it reduces overall health care costs and cuts waste while connecting patients with quality care.

However, despite the availability of these tools, utilization is lacking. A recent study published in the Journal of the American Medical Association found that only about 10 percent of employees with access to transparency tools had used them. Another survey from the Kaiser Family Foundation indicated that less than nine percent of people had used price information when making a health care decision. Consumers have access to pricing transparency tools, but very few are actually using them to make cost-effective decisions about their health care.

Why aren’t more consumers using these resources? Many people may not be aware they have access to a tool. According to a 2016 study from America’s Health Insurance Plans (AHIP), 58 percent of health plans report that members lack awareness of these resources. Further, even if they know about the tools, many people may underestimate the need or how they

can help. Research from Public Agenda found that 57 percent of insured Americans do not think there is a cost difference among in-network doctors for the same services, which is not the current reality. Finally, many early versions of pricing transparency tools were often difficult to interpret or understand, however they have since improved drastically.

Improving Engagement in Transparency

There are a number of steps organizations can take to improve engagement in these tools and realize the potential benefits – improved outcomes and reduced costs.

Educate, Educate, Educate. Comprehensive communication efforts can dispel any misconceptions about the need for pricing transparency and promote this service as the place to go for health care help. A 2014 Cicero Group survey of consumers found that 49 percent say better communication would drive usage of these tools. Further, making it easy to find can have an impact – integrating it into the employee portal can improve both awareness and accessibility.

Offer Incentives. Incentives have been shows to drive engagement in wellness, and they can be an effective means to do the same for pricing transparency. According to the same consumer survey, more than 40 percent of respondents said reductions in their premium costs would encourage utilization of pricing transparency tools.

Provide Multiple Platforms. Today’s workforce spans

Getting Your Money’s Worth from Pricing Transparency ToolsMarcia Otto Institute for HealthCare Consumerism | August 18, 2016

Institute for HealthCare Consumerism | August 18, 2016

Institute for HealthCare Consumerism | August 18, 2016

multiple generations, so a one-size-fits-all tool will not work for everyone. While an app or website tool is a necessary component, offering telephonic support can make a big difference and help employees take the next step to access care.

Display Cost and Quality Side by Side. Cost alone does not tell the whole story. In the absence of credible information about quality presented simultaneously with cost details, many patients may assume higher prices mean higher value, which is not always the case.

Make Tool User-Friendly. The Cicero Group survey found that 33 percent of consumers thought pricing transparency tools were complicated. Consumers are more likely to use a tool that is intuitive and easy to use.

Incorporate Personalized Information. In order for users to make the most informed decision, tools should include company and employee-specific data to improve accuracy and relevancy. This includes breaking out the details of all related costs, including the full price of services as well as the consumer’s out-of-pocket responsibility.

Exceed Expectations. The most effective tools are engaging and provide users with more than they were looking for, such as connecting them with resources to help them take the next step after reviewing cost and quality information.

What’s Next for Pricing Transparency?

Pricing transparency tools continue to evolve and improve to meet the needs of health care consumers. However, in order to improve utilization, transparency needs to be coupled with other features and innovations in health plan benefit design that incentivize consumers to shop around for their health care.

The majority of people currently using these tools search for procedures that typically cost more than their deductible. If there will be no impact on their cost responsibility, consumers may lack the incentive to seek out a better value. Pricing transparency needs to be integrated into health plan benefit design in order to prompt people to select less expensive providers or

facilities. This can be done by tailoring plans to favor coinsurance versus flat copays to increase motivation to shop around. Reference-based pricing, which sets maximum reimbursement limits for common procedures, can also encourage employees to compare costs to ensure they are within the approved range and do not have to pay excess charges on their own.

Health care pricing transparency helps consumers make high-value, cost-effective decisions that can lower health care spending. However, in order for it to be effective, insurers, employers and others must take steps to motivate engagement and utilization. A standalone tool may not be enough to motivate consumers to utilize the resource; however, when combined with these strategies, pricing transparency tools have the potential to increase ongoing utilization and engagement.

HRDive | August 18, 2016

Overall cost increases of healthcare benefits will hold steady at 6%, the National Business Group on Health announced—but increases that are held in place are, alas, still increases. Sustainability of healthcare may be under threat, and if prices continue to rise at current rates, it could put serious pressure on healthcare affordability for employers, the CEO and President of the NBGH, Brian Marcotte, said.

Or, to put it simply: Sooner or later, something’s got to give.

The NBGH annual report provides employers an outlook on the direction the change may be going. For the first time since the report began, specialized pharmacy was considered the No. 1 cost driver for healthcare spend, reflecting a general industry focus on specialized healthcare issues overall. To tackle these problems, employers are reaching for new tools that serve their general populations and provide high-touch care to their employees with more specific and specialized healthcare problems.

HR Dive spoke with industry experts on to better understand what is going on and how employers are best solving these problems.

Cost pushers: Growing prescription spend, patient responsibility

Specialty prescriptions tend to be the very expensive drugs that cost $1,000 or more per dose, are challenging to dispense and have complex care management needs, Marcotte explained.

But employers may be asking: Why now? It’s not like specialty prescriptions are a completely new entity.

Ten years ago, many Americans were participating in more traditional healthcare plans with many co-pays, said Jeff Oldham, Vice President of Consumer Strategy at Benefitfocus, so when they purchased specialty drugs, the drugs seemed cheap. Now that consumer-directed healthcare plans (CDHPs) have grown in adoption, more employees are seeing the full-cost of such drugs.

“When people didn’t previously need to be engaged, they didn’t ask the right questions,” he said. “Now they are far more interested in understanding the price of drugs.”

In turn, more employers are trying to manage the high costs as well as employee needs by creating specialty pharmacies, creating certain specialty tiers in pharmacy plans and generally paying more attention to employees who require such services, the NBGH report said. In particular, there is renewed focus on paying attention to where employees go for treatment, and potentially pushing employees to cheaper high-quality locations instead (a stand-alone clinic versus a hospital, for example).

Plan design “is not the silver bullet,” Oldham said. It’s the same old problem of the new healthcare age: Employees have to be willing to change their behaviors, too. Often, money is the only way to encourage that change, which is one reason why CDHP adoption may have spurred employers to take a second look at their pharmacy programs.

Growth of specialized wellness and wellness tools

Employers are increasingly focusing on “high touch” care management programs. For example, opioid restriction and management has garnered more attention this year due to various reports on opioid abuses and concerns.

As Costs Rise, Employers Dial Up Digital Wellness Tools to Keep AfloatKathryn MoodyHRDive | August 18, 2016

HRDive | August 18, 2016

But in order to maintain such programs, employers are turning to third-party wellness management tech to ensure their success.

“I was in the wellness space almost 10 years ago, and employers were blindly throwing money away when they didn’t have a good understanding of core conditions that were impacting their healthcare spend,” Oldham said. Now, more employers are using wellness tools to understand the top five or 10 conditions that could be affecting employees.

One powerful tool that has emerged as more employers adopt wellness programs is the telephonic consult. Telehealth is “commonplace” now for most large employers, NBGH reports. By 2019, 97% of large employers are projected to have some form of telehealth in play. That rise is explained due to its cost-effectiveness. A $150 urgent care visit can be reduced to a $40 teleconsult, Marcotte noted, especially if an employee has a simple care need, like a cold or sinus infection.

Telehealth has also seen use in mental and behavioral benefit spaces, alongside the usual suspects of EAPs and self-help electronic resources, the NBGH report adds.

But the biggest trend that Oldham noticed is that more and more companies are putting effort into owning wellness data — literally. For a long time, most employers depended on insurance carriers to provide wellness data (BMIs, biometric screenings) and programming. Now, more employers are conducting research and analysis, and are “far better” at understanding their data, Oldham said — which means more focus on specialized forms of care.

“I think employers right now, when it comes to wellness, they have far more questions,” he added. That’s a good thing. It means that more wellness programs actually bring about outcomes.

Drilling down: The rise of concierge services and consumer choice tools

As always, wellness and healthcare programs struggle with engagement, Marcotte said. In turn, many of the new wellness technologies focus on grabbing employee attention and integrating all of an employer’s offerings. Consumer choice tools are a common example of this.

Another set of tools growing in popularity: concierge services. These tools are being used to address either specialty conditions or more broad health concerns, Marcotte said. Typically, concierge services provide employers with one phone number or access point that employees can use to gain information about their benefits and, in many cases, set up appointments. Trained nurses usually respond to the calls, and can assist in managing an employee’s case.

Oldham was optimistic about such tools as well. He praised their “bedside manner-type approach” and the way such programs actually lean away from automation. A real nurse often does the research and work to connect employees to what they need.

“It’s not inexpensive,” he said, “but if I am a large employer, there are intense productivity gains.” Especially if an employee doesn’t have to search for a specialist while on the clock.

HealthAdvocate is one company that provides a concierge-like service. Their specialists are trained to ascertain the “hidden questions” — issues employees may have but won’t ask about outright at first. Such programs seem to be particularly effective for those with untreated mental health issues, especially in contrast to the typical EAP.

“EAPs dig their own hole,” Bert Alicea, vice president, EAP+Work/Life Services at HealthAdvocate, told HR Dive in June. Their focus on utilization does them in, he notes, and is part of the reason why such programs come with considerable stigma and engagement issues.

Instead, HealthAdvocate and other concierge services present themselves as a “resource” for employees, a way for an employee to overcome a “temporary set-back” no matter what is going on in their current life.

“The one model of wellness, advocacy and one-stop shopping, it can help get behind the many issues employees have,” Alicea said. “And many of those are medical issues.”

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 something of this nature, understanding workplace violence is the first step toward reducing the probability of an incident and keeping organizations and their workforce safe.

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, 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 health care and workers’ compensation costs, and decreased productivity, among others.

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.

The real threat of workplace violenceBert Alicea BenefitsPro | August 11, 2016

BenefitsPro | August 11, 2016

BenefitsPro | August 11, 2016

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 random, 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, a change in attitude or appearance, excessive complaints or 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 another 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 Employee Assistance Program (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

BenefitsPro | August 11, 2016

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.

Workplace wellness programs are now widespread in the U.S., with more than 70% of larger organizations offering employees access to smoking cessation programs, fitness centers, nutrition counseling, stress management and other services. While these programs are intended to improve both employee health and reduce overall healthcare costs, many employers still struggle to engage their workforce in these programs.

So what can organizations do to improve their wellness programs and motivate employees to take action? By adopting a holistic approach and shifting from wellness to well-being, it’s possible to create a flexible, diverse program that meets employees where they are in their lives and fulfills their needs. For example, a young adult who is training for his first 5k and experiencing stress related to paying student loans will be seeking very different resources than a mother of three managing chronic high blood pressure and caring for her aging parents.

A well-being program goes beyond physical wellness to consider employees’ emotional, financial and social health. This more well-rounded view addresses employees’ needs and provides personalized, integrated solutions to help them reach their goals.

Here are a few best practices to consider that can help with this transition from wellness to well-being and drive employee engagement:

Assess health and culture: In order to inform the structure of a well-being program, it is critical to understand which issues are the most important to the organization’s workforce. For example, a recent

report from the U.S. Chamber of Commerce suggests surveying employees to learn more about the current culture and what types of programs might be well-received. Reviewing aggregate health data about the organization’s workforce, including insurance claims data, biometric screening results and personal health assessments, can also help steer the direction of a program based on the prioritized health needs of the employee population.

Select the right mix: A one-size-fits-all approach to wellness is not effective for most employees. Based on the results of the initial assessment, organizations can determine what types of offerings will be the most beneficial for their employees as part of an overall well-being approach.

The Wellness Council of America suggests incorporating core programs such as physical activity, healthier eating, stress management, smoking cessation, and medical self-care, which could include health advocacy to help people navigate the complexities of healthcare. Other initiatives may include employee assistance programs (EAPs), financial wellness and resilience training, among many other options.

Communicate often: In addition to understanding the types of programs employees are interested in, it is also useful to learn their communications preferences. Whether via phone, text, email or another channel, reaching employees where they are will have the most impact. Further, consistent communications from the organization, including emails, posters and intranet announcements, will help raise awareness and keep the program top-of-mind for employees.

Trend In Wellness Is Toward Well-Being ProgramsPam MortensonTLNT | June 6, 2016

TLNT | June 6, 2016

TLNT | June 6, 2016

Offer incentives: Because participation in wellness programs must be voluntary, incentives continue to be an effective means to get employees involved, and offering a mix over time can encourage initial as well as ongoing participation. Keep in mind that organizations offering incentives to complete an HRA or biometric screening are required to comply with recent regulations from the Equal Employment Opportunity Commission (EEOC), which limit both participation and health-contingent financial incentives to 30% of the cost of self-only coverage for both employees and their spouses.

Incentives to engage in other aspects of a wellness program, such as committing to talk with a wellness coach or participate in a walking group, instead fall under Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Find other ways to motivate employees: Competitions can also motivate employees to participate in fun, health-focused activities by building a culture of wellness and creating a support system among colleagues.

Continuously evaluate: By leveraging the initial aggregate data as a baseline, it will be possible to see year-over-year improvements to employee health, finances, productivity and more. This also provides a great opportunity to tweak the mix of well-being offerings to meet the changing needs of an evolving workforce and continue to see the benefits.

Taking steps to implement best practices and shift the focus of workplace wellness from a traditional method to an integrated approach can improve employee health and well-being, enhance engagement, increase productivity, and tackle some of the primary issues that drive healthcare costs.

About the Author

Pam Mortenson is the Executive Vice President for Wellness Solutions at Health Advocate, a subsidiary of West Corporation. She brings extensive experience in solving healthcare consumer engagement and communication challenges to West/Health Advocate clients. Her expertise and insights center on balancing best in class consumer engagement technologies with lifestyle coaching and support to drive healthier outcomes.

It should come as no surprise to learn that employees are stressed.

According to a recent survey from the American Psychological Association, nearly one-third of American workers reported feeling stressed or tense on a regular basis while at work.

This stress can stem from a lack of work/life balance; personal issues that may spill over into the workplace; feeling undervalued and under-compensated; and on the job stressors like tight deadlines, unclear expectations, and little or no feedback on performance, among many other factors.

Whatever the root causes, stressed workers tend to be fatigued, prone to mistakes and injuries, and are more likely to be absent. And most significantly, they incur health care costs twice as high than for other employees.

In total, the consequences of stress-related illnesses, from depression to heart disease, cost businesses an estimated $200 to $300 billion a year in lost productivity.

The impact on the bottom line has made the management of stress an urgent business strategy for American companies.

However, with a dual strategy of organizational change and individual stress management, brokers and leaders within the organization can help businesses take steps to be proactive and promote healthier, more productive employees while reducing health care costs.

The causes of workplace stress

Employees who feel they have little control over their work in one way or another are more likely to experience and report higher stress levels. Factors that can contribute to on the job stress include unpleasant work environments, low salaries, lack of opportunity for growth and poor management, as well as issues with work/life balance, among many others.

Issues such as caring for elderly parents or managing their own complex health issues compound the stress in employees’ personal lives, especially if they are also confronting strained financial issues and compressed time allotment for family obligations.

The effects of workplace stress

Stress has a major impact on both organizations and their employees, ranging from an increase in workers’ compensation claims to reduced productivity. For example, the American Institute of Stress estimates that one million workers miss work each day because of stress, costing companies an approximately $602 per employee per year.

But even when employees come to work, stress may reduce their ability to fully perform their duties at work. In one APA survey, 60 percent of workers reported losing productivity due to stress while at work during the past month. This can add up to nearly $150 billion a year in lost productivity, according to the International Foundation of Employee Benefit Plans. The cost may be even higher if the stress underlying presenteeism is not addressed, as absenteeism, job resignations, chronic illness, and disability may be the result.

Combating the effects of employee stressBert AliceaBenefitsPro | May 25, 2016

BenefitsPro | May 25, 2016

BenefitsPro | May 25, 2016

Many employees who experience stress in the workplace also risk negative effects to their physical health. Workers who report that they are stressed incur health care costs that are 46 percent higher than for non-stressed employees, according to the National Institute for Occupational Safety and Health. Left untreated, prolonged stress can raise the risk for alcohol or drug abuse as well as developing chronic — and costly — diseases, including heart disease, diabetes, and even some cancers, which can collectively account for a vast amount of all health care costs.

Stressed workers have an elevated risk of mental health problems as well, ranging from anxiety and substance abuse, and perhaps, the most significant, depression. According to Employers Health, more employees miss work because of mental illness than physical conditions or illnesses, including cancer or heart disease. A survey from the Employee Assistance Professionals Association shows that stress and clinical depression — the two often go hand in hand — trail family crisis as the second and third most significant problems in the workplace.

In order to cope with this stress, many employees turn to unhealthy habits, including smoking, gambling, drinking, and overeating, a stepping stone to obesity, a condition that the U.S. Department of Health and Human Services reports costs businesses more than $13 billion each year in medical costs and lost productivity.

Addressing the issue

So what can businesses and their partners due to combat the causes and effects of workplace stress? Strategies need not be elaborate or expensive. Simply planning ways to improve communication and recognize employees can be effective.

The first step is to evaluate the scope of stress in the organization by looking at absenteeism, illness, and turnover rates and performance problems. Employee surveys, Health Risk Assessments and committees are all helpful means to determine specific stressors and if they are concentrated in one specific department or are company-wide. It is also important to work directly with employees to get their input as to what strategies may help address the causes of stress.

While some changes to corporate culture need to be managed internally, there are a number of strategies brokers and organization leaders can suggest to help organizations reduce employee stress, such as:

Provide access to an Employee Assistance Program (EAP): EAPs help assess and address personal issues that affect employee performance and productivity. Issues can range from substance abuse to family problems, and EAPs often include counseling benefits. Studies show that EAPs for substance abuse can reduce workers’ compensation claims, employer healthcare costs, and absenteeism.These programs can often help with other related work/life related issues, such as providing eldercare support for employees caring for older parents or loved ones.

Incorporate health advocacy into employee benefits: Offering an expert who can personally address health care issues, such as helping to resolve medical bills and interacting with insurance and providers, can help employees reduce worry and stay focused on their job.

Offer a well-rounded wellness program: A program that addresses the overall well-being of employees, including physical, emotional, and financial health, can effectively lower stress and improve health. Promoting engagement in onsite support groups and stress management workshops alongside traditional wellness program components can help reduce stress while increasing productivity.

Build in incentives: In order to encourage participation in these programs, it’s important to offer incentives for enrollment and sustained involvement, as well as reward positive changes.

Communicate consistently: Ongoing communications to employees about these and other efforts to address and reduce stress will not only demonstrate the organization’s commitment to their employees’ health but also keep these strategies top of mind for employees so they take action.

BenefitsPro | May 25, 2016

Create employee/departmental recognition opportunities: Improve morale among employees by organizing regular events to recognize success, mitigate stress, and provide opportunities to build team camaraderie, such as quarterly birthday lunches or breakfasts on Friday mornings, among many other ideas.

The benefits of reducing stress are numerous for both organizations and their employees. In addition to lowering health care costs, research shows that less stressed workers and those satisfied with their work/life balance are more inclined to stay with their companies. They are also more likely to recommend them as places to work. It all adds up to a healthier bottom line.

No matter what stress management techniques are installed, the key to success is to have a continuing commitment to improving the health and well-being of all employees. Addressing the management of stress can be a vital wellness strategy that makes for a healthier, happier workforce and a stronger, more productive organization.

Employees are better able to shop among health care providers when they can compare cost and quality data, say supporters of consumer-driven health care. But a May 2016 study published in the Journal of the American Medical Association (JAMA) found that only 1 in 10 employees actually use price transparency tools when they’re made available.

The researchers, who are affiliated with Harvard Medical School and Boston’s Beth Israel Deaconess Medical Center, looked at two large employers that offered an online health care price transparency tool to their employees. The tool gave users information about what they would pay out of pocket for services from different physicians, hospitals and other clinical sites.

But instead of the availability of a price transparency tool translating into lower health care spending per employee, the researchers found that health care spending from the control group—whose members lacked access to a price transparency tool—was actually less. Those who were offered the price transparency tool experienced a mean $212 increase in combined outpatient spending (out-of-pocket and insurer-paid), which rose from $2,021 in the year before the tool was introduced to $2,233 in the year after—larger than the increase among the control group, for which mean outpatient spending rose $153.

Among those offered the tool, mean outpatient out-of-pocket spending rose $48, from $507 in the year before introduction of the tool to $555 in the year after. Among the comparison group without access to such a tool, mean outpatient out-of-pocket spending rose $30.

“As someone who sees the potential for pricing transparency to drive down health costs while improving health outcomes, the JAMA study was disappointing,” said Marcia Otto, vice president of pricing and transparency applications at West’s Health Advocate, a Plymouth Meeting, Pa.-based firm that helps employees and their families navigate the health care system.

“Research indicates people are confused about the lack of correlation between cost and quality,” said Otto, who has nine years of experience building pricing transparency tools. “Often, even when paying out of pocket, they’ll choose a more expensive health provider because they think that cost signifies quality.” But “research has shown there is no correlation; there are high-quality, low-cost providers out there.”

Jennifer Benz, founder and CEO of Benz Communications in San Francisco, predicts a shift from a “consumer-directed” to a “directed-consumer” health care model, in which employees will be provided with access to personal guidance for health care shopping—rather than just given access to online tools. That could mean “real progress and perhaps better financial results for individuals and companies,” she noted, adding, “employees want—and need—more guidance in their health care decisions.”

Similarly, Otto said that the JAMA findings highlight the need for approaches such as one-on-one coaching and personalized notifications.

Health Care Shopping Tools Often Go Unused Communication, coaching and incentives can help transparency tools pay off

Stephen Miller SHRM Benefits | May 18, 2016

SHRM Benefits | May 18, 2016

SHRM Benefits | May 18, 2016

Widespread Misconceptions

Fifty-seven percent of insured Americans don’t think that there are doctors covered under their insurance plans that charge less than others for the same services, according to research by Public Agenda, a New York City-based nonprofit organization, published in March 2015. “They don’t know that there are price variances out there,” commented Otto.

“Every year, 58 percent of employees look for a new physician, and often they’re not equipped to find the highest quality physicians on their own,” said David Kaplan, senior partner and global leader for clinical solutions at Mercer, citing data from the federal Medical Expenditure Panel Survey. “Understandably, these employees often select doctors based on nonmedical aspects of care and patient satisfaction scores—factors which have limited correlation to quality.”

To increase the proper use of price transparency tools, Otto—drawing on the JAMA study findings and other research—advised employers to take the following actions:

• Educate employees. Forty-nine percent of consumers say better communication would drive them to use these tools, according to a 2014 study by the Cicero Group, a Salt Lake City-based consultancy. This means putting in place a comprehensive communication effort, not just sending an initial e-mail when you provide access to the tool and hoping that everything takes off from there.

• Integrate incentives into tool use. Similar to incentives that spur participation in employee wellness programs, provide incentives for using a transparency tool—or even for accessing the tool—to make employees aware of price differences among providers. Premium discounts, contributions to health savings accounts, or just a gift card for going onto the site and logging-in can work. Earlier this year, Lyndhurst, N.J.-based Vitals, providing health care transparency and engagement solutions, announced that

employers that made incentive payments to employees who shopped for health care using the firm’s SmartShopper platform saved an average of $625 per procedure.

• Provide multichannel access. The price transparency tool should be easy to find. If it’s not integrated as part of an employee benefits portal, make employees aware of how to access it via the web and on mobile devices, or—for those who want more directed help—through a call center that can provide cost information along with help scheduling an appointment or moving medical records, if necessary.

• Present cost and quality information side by side. A way to overcome the perception that higher cost means better quality is to present cost and quality metrics side by side, so consumers can make better value decisions.

• Make it personally relevant. Transparency tools should tell consumers how much they will pay out of pocket for a service, based on their particular health plan.

Adding in Reference-Based Pricing

Transparency tools also can be combined with other plan design features that promote shopping for high-quality, low-cost clinicians. For instance, the JAMA study showed how reference-based pricing—which sets a ceiling on what the plan will pay for certain common procedures that have wide cost variations, such as knee and hip replacements—can drive consumers to make smarter purchasing decisions.

The California Public Employees Retirement System (CalPERS), which purchases coverage for 1.3 million state employees and their families, has successfully used reference-based pricing. In the first two years after its adoption, reference pricing saved CalPERS $2.8 million for joint replacement surgery, $1.3 million for cataract surgery, $7 million on colonoscopies and $2.3 million on arthroscopies, according to a 2015 report in the journal Health Affairs.

SHRM Benefits | May 18, 2016

A 2014 Aon Hewitt study of large and midsize employers showed that 10 percent of U.S. employers were using reference-based pricing in their health plans, but 66 percent were considering it as a cost-controlling strategy for the future.

Especially when combined with transparency tools, “reference-based pricing can encour-age consumers to comparison shop for health care, while motivating providers to adopt lower prices without sacrificing quality,” Otto said.

When you’re in an emotional crisis, the last thing you need is to worry about a bill from a therapist or counselor.

The good news is that seeking help for mental health issues isn’t as taboo as it once was. Still, economic barriers remain. In fact, 45.7 percent of Americans with an unmet need for mental health services cited cost as a top reason for not receiving treatment, according to a 2011 report from the Kaiser Commission on Medicaid and the Uninsured.

“A lot of [providers] don’t take insurance, and the ones that do are pretty backed up, so it’s going to be a couple months’ wait to get in to see somebody,” says Mike Frazier, a psychiatrist who’s finishing up his residency at UC Irvine in Orange County, California.

For this reason, we’ve pinpointed several affordable options for accessing mental health care services, just in time for Mental Health Month.

Community resources. First, tap into local resources for free or discounted counseling. For instance, survivors of sexual assault, domestic abuse or other circumstances often have access to free counseling at local community centers. “I have previously worked for a rape crisis center, and my counseling services were covered 100 percent for anyone who had been through a sexual assault of any kind, male or female,” says Stephanie Adams, a Fort Worth, Texas-based counselor and business coach for counselors. “There are services funded by donations that cover counseling for the military and many more,” she adds. To find a free or low-cost center near you, check out resources like Rainn.org, a national anti-

sexual assault organization, or NAMI.org, which lists mental health resources for teens, young adults, the LGBT community and other groups.

Seek out therapists or counselors in training. If you live near a college that offers marriage and family therapist or master’s of social work degrees, you may be able to see a trainee at a reduced rate. But keep in mind that your therapist will be supervised by someone more experienced. “You may or may not meet this person [supervising the trainee], but your therapist will be talking to them about your case,” Frazier says. “This means that in a sense you will have two sets of eyes on you, which can translate to better care for you,” he adds.

However, there is one major downside. If you find someone you like, they’ll eventually graduate and leave the program. “You may only have a therapist for about a year before they graduate their program, though it is possible to work with someone longer term if their program is longer and if you catch them at the beginning of it,” Frazier says. Hopefully, by then, you will have made progress towards your goals.

Consider group therapy sessions. According to Frazier, group therapy sessions tend to “be [at a] lower cost and [have] actually been shown to be just as effective, and sometimes more effective, than one-on-one therapy.” Frazier recommends asking about group therapy at universities that offer a psychiatry program.

Oftentimes, group therapy brings together people with a shared concern, such as post-traumatic stress disorder or eating disorders, but a different type of session called

6 Affordable Mental Health Care Service Options Can’t afford therapy? Consider group therapy, telecounseling and other alternatives.

Susan Johnston Taylor U.S. News & World Report | May 4, 2016

U.S. News & World Report | May 4, 2016

U.S. News & World Report | May 4, 2016

process groups could help those who want to work more generally on how they interact with others. “Group counseling offers the unique benefit of hearing stories of other people’s struggles and triumphs in addition to the support of a therapist,” Adams says.

Find a therapist who works on a sliding scale. Some therapists offer services on a sliding scale based on income qualifications, so it never hurts to ask if this is an option. If you find a therapist you like, Adams also suggests asking if he will offer a rate reduction if you prepay for multiple sessions at once.

Some religious organizations also offer sliding-scale services or connect you to other therapists who do offer such services. “Every Jewish Family Service agency in the country provides mental health services to the community [whether you’re Jewish or not]. We accept all insurances, and provide sliding-scale fees to those individuals without mental health coverage. Our fees begin as low as $35 for private therapy,” says Ellen Finkelstein, director of marketing at Jewish Family Service of Bergen and North Hudson. Other religious groups, like the American Association of Christian Counselors, may also be able to provide a list of resources and clinics that operate on a sliding scale.

Employee assistance programs. EAPs began in the 1920s when employers realized it was more cost-effective to rehabilitate employees with alcohol or drug abuse issues rather than replace them. These programs have now expanded to cover a broader range of services, including assistance with childcare, work-life balance, legal and more general mental health issues, according to Bert Alicea, a licensed psychologist and vice president of EAP and Work/Life Services at Health Advocate, a national healthcare advocacy organization that works with employers to administer EAPs and other programs.

If your employer offers an EAP, you may be eligible for a certain number of in-person or telephone counseling sessions at no cost. “We know that there’s a lot of people out there who might be uninsured or can’t afford the out-of-pocket costs

associated with assessing mental health services,” Alicea says. “Coming to the EAP doesn’t cost them anything but their time,” he adds. If you have mental health coverage, organizations like Health Advocate can find you a provider who accepts your insurance so you can continue beyond the sessions covered by the EAP. If you don’t have insurance or can’t afford the copays, they can also refer you to less expensive resources in your community.

Online or telephone counseling. Options for online and telephone counseling are growing, which is good news for those with childcare constraints and those living in areas with a shortage of mental health professionals. Keep in mind that just as rates for in-person therapy vary widely, rates for telecounseling can be all over the map. However, Brittany Sherwood, a Florida-based psychiatric mental health nurse practitioner who works with patients virtually, says there’s typically more price transparency with this option because patients seeking online counseling expect to see clear pricing information. Like some other providers, Sherwood offers services on a sliding scale. She also offers a discount to college students who may not be able to see a counselor at school due to scheduling constraints.

Some states require insurance providers to cover telecounseling services, but Frazier says the trend is moving towards more coverage for telemedicine. Sherwood says patients often have more success paying upfront and getting reimbursed rather than the provider billing the insurer separately. “If the patient decides to do a cash rate and I provide a bill, they are much more likely to get reimbursement in some manner from their insurance company,” she says. “Insurance companies tend to be more flexible when it’s coming from the patient and not the provider,” Sherwood adds.

Regardless of why you’re seeking professional help to optimize your mental health, the need for help should outweigh concerns about cost. “When you’re concerned about the high cost of mental health treatment, it’s important to remember that early intervention and treatment will end up costing much less in the long term,” Sherwood says.

Cost transparency remains a vital aspect of healthcare reform among both providers and payers. Uninsured consumers and those who have employer-sponsored health coverage are continually finding the costs of premiums, deductibles, and general insurance plans too high for their wallets.

In order to meet the needs of consumers and ensure more citizens obtain healthcare coverage, payers, providers, and federal agencies will need to work together to improve cost transparency and enable the everyday customer to choose the most cost-effective and high-quality healthcare services.

The health insurance industry is likely to change significantly over the coming years in order to meet the demands of consumers and advance toward value-based care payment reform.

New models of reimbursement including healthcare bundled payments will continue making an impact over the next year while the CMS Innovation Center is expected to innovate healthcare delivery and mergers may continue to dominate the health payer world.

Marcia Otto, Vice President of Pricing Transparency Applications at Health Advocate, offered her perspective on the future of the health insurance industry and the movement toward greater cost transparency in an interview with HealthPayerIntelligence.com.

With regard to where the health insurance industry will be in the next ten years and what the future has in store for payers, Otto began, “What’s certainly in store for the future is the continued rise of

consumer-driven healthcare. More and more people will have high deductible plans and more financial responsibility for their healthcare dollar.”

“Each year, The Kaiser Family Foundation reports the percentage of Americans with employer-sponsored insurance that have high deductible plans. In the 2015 survey, 46 percent have high deductible plans of $1,000 or more, which is up by 10 percent from 2006. Many employers are no longer offering zero deductible HMOs, and PPOs with low $250 annual deductibles are also extremely rare. Most deductibles are now in the thousands, and taking steps to reduce out-of-pocket healthcare expenses is quickly becoming a high priority for many people.”

“Not surprisingly, another huge trend is the integration of technology in the healthcare field. There’s an app for everything, and that’s really true! Mobile apps are playing an increasingly large role in how consumers managing their health. I think that will only continue to grow with the introduction of even more advanced devices and apps that track health and wellness data.” Otto explained.

“For example, Health Advocate has created a mobile app to help users get convenient access to our cost and quality information,” she continued.

“Another big issue in healthcare right now is increasing engagement – driving the right member to the right service while improving outcomes and reducing medical spend. If you build it, will people use it? It’s important to consider how we drive utilization of available tools. How do we encourage and motivate them to take action? This might be

Cost Transparency, ‘Consumer-driven Healthcare’ Impacts PayersVera Gruessner HealthPayerIntelligence | February 4, 2016

HealthPayerIntelligence | February 4, 2016

achieved through personalized incentives, mobile apps, texts, email, and more. Without engagement, if you build it, will people know how to utilize it?”

“For example, in pricing transparency, which I specialize in, Catalyst for Payment Reform reported that 98 percent of all health plans have an online pricing transparency tool but only 2 percent of health plan members have used them. And there was just an article last week in JAMA showing most people with high deductible plans still weren’t comparing cost or looking for different doctors for their care.”

“People still aren’t yet making the decision to do this, and there needs to be a way to motivate them to take action and improve their health by participating in a wellness program or completing health screenings, among other steps. The industry is taking steps to improve engagement in order to see an impact.”

“Health Advocate is the nation’s leading health advocacy and healthcare assistance company. We help our members navigate the healthcare system by offering clinical assistance through nurses and doctors, by educating and explaining benefits, and by resolving complex issues around claims, EOBs, and bills, among other topics. We also help our members understand consumer-driven health plans and obtain cost and quality information. We have many touch-points to get members aware and engaged with their care.”

Otto notes incentives are also an effective means to increase engagement. “We’re definitely seeing incentives being used in the marketplace in a variety of different ways, including reduced premiums for signing up for programs like health coaching, using a pricing transparency tool, or showing progress on measures like blood pressure or BMI. Some of our clients are currently using this strategy to promote engagement.”

“When you look at incentives, the research shows that people like something tangible and more short-term to motivate action. For example, in addition to

or instead of reduced premiums, if you use a pricing transparency tool, you may be eligible for a gift card or something more immediate. This demonstrates that the industry is beginning to trend away from just lowering premiums toward giving people immediate rewards for making some important decisions.”

When asked about emerging trends taking place right now to reduce healthcare costs, Marcia Otto responded, “Pricing transparency is continuing to gain traction and grow.”

There’s a lot of talk in the marketplace about pricing transparency.”

“The goal of pricing transparency is that, as people have higher deductible plans, it’s giving them a tool – and hopefully a tool that is personalized to them with their insurance in mind and knowing what providers they’ll see – to pick the best value doctor or facility. Value is a combination of highest quality and lowest cost providers, which do exist.”

“You can pick someone who is high quality and low cost to help reduce medical spend. With the higher quality, you are also improving the medical outcome with patients.

“There was a study published in Health Affairs showing when patients are given the option to select an MRI provider based on cost, they select a more cost-effective option and reduce the cost by an average of $220 per person. There is proof out there and scientific evidence that you can lower cost by having people use pricing transparency tools.”

We also have a wellness program with wellness coaches to help people with their tobacco cessation. That certainly will reduce healthcare spend.”

“We have coaches to help manage chronic care solutions and more personalized programs to get people who require ongoing care to make better, smarter decisions for their health, which again lowers healthcare spending.”

HealthPayerIntelligence | February 4, 2016

HealthPayerIntelligence | February 4, 2016

When asked how health payers can provide more cost transparency for the average consumer, the VP of Pricing Transparency Applications answered, “Most payers today do provide a tool. The problem is no one is using them. That can be for a variety of reasons - lack of awareness, lack of personalized information, or lack of resources to help consumers make the next steps with their care.”

“In order to improve utilization, it’s critical to enhance member engagement. One-size-fits-all doesn’t work for everybody. It needs to be more personalized to help drive people to it. They need to receive the information in a way that is best suited for them.”

“One of the unique things that Health Advocate does to engage people in the pricing transparency solution is to integrate it with our Advocacy solution. Not only can our Advocates drive utilization by directing members to the tool or running estimates for them, but the Advocate can also help the member understand the information and guide them to take the necessary actions to be a true healthcare consumer.”

Requesting a second opinion can be a touchy subject for a patient. I’d like to think that when I was in practice, I was never offended when a patient’s family requested a second opinion, but that probably doesn’t universally reflect my response in every circumstance. But I am confident in saying that as often as not, I would be the one suggesting that we get another pair of eyes to look at the problem. As physicians, second opinions often help us learn from each other and expand our knowledge of new treatment options. And second opinions can help patients make better informed decisions about the care they receive.

A 2013 Harris Interactive poll found that only 19 percent of those surveyed said they sought a second opinion for a medical condition. That actually sounds about right to me overall, but it would seem low if one focuses on serious and complex conditions. In most settings, I think that it would be unusual for physicians not to encourage patients with serious or life-threatening conditions to get another opinion from an expert. So why doesn’t this happen? It is likely due to a number of reasons. From the patient’s perspective, there can be fear of offending the treating physician, blind acceptance of the initial diagnosis or treatment plan, feeling that a second opinion will delay treatment, or a lack of available alternatives in the local community.

The first few concerns can be addressed through education and open discussion, but is there something we can do about geographical limitations? Technology has expanded the reach of our networks and access to resources, enabling physicians to connect with colleagues nationwide and around the world, and now, so too can patients.

As medicine continues to evolve, so does access to second opinions. Emerging partnerships between

health systems, ranging from community hospitals to major academic research centers, enable patients in even the most remote areas to get second opinions from specialists around the country.

Leading health systems like the Cleveland Clinic, Johns Hopkins University Medical Center and others make top doctors available to patients nationwide. Insurers and employers also see the benefit of providing coverage for remote chart based or online second opinion services to patients. The result can be not only improved patient outcomes but frequently, reduced costs. Providing the right care is not only the best thing to do to assure the most successful medical outcome, it is cost effective as well.

For the patient unable to travel or with limited access to local experts, remote consultations that take advantage of video chat and electronic image sharing can make all the difference in the care one receives. FaceTime and Skype are not just for talking to the grandchildren any more! And in most cases, patients don’t have to leave their community to take advantage of these expert opinions. Many specialists in academic medical centers have become accustomed to collaborating across great distances, effectively co-managing patients with their local physicians and bringing the resources of the university center to the patient, wherever they live.

Second opinions are not always different than the first, or better, and sometimes the right facility for that patient is the one in their backyard. But by using evolving technology to access a second opinion not otherwise available, patients can feel more confident and in control of their decisions, which can have a big impact on outcomes.

The evolution of the medical second opinionAbbie Leibowitz, M.D.KevinMD.com | January 31, 2016

KevinMD.com | January 31, 2016

And because we’re no longer limited to the local area or required to travel to meet with far away specialists, patients can obtain trusted second opinions quickly and efficiently, helping them feel more secure in their care and helping us ensure they get the best treatment when they need it.

Second opinions are a valuable tool to ensure patients are engaged in their health care. By helping

patients understand and utilize all available options to get a second opinion, whether from near or far, we can help them make the best decisions for their health.

Abbie Leibowitz is co-president and chief medical officer, Health Advocate.

KevinMD.com | January 31, 2016

Most of us would like to think we left bullies behind in middle school. Yet according to a recent survey from the Workplace Bullying Institute, 27 percent of adults report having experienced bullying in the workplace, and this number may be misleading as many people are hesitant to report incidents of bullying. This issue not only impacts the individuals involved, but has negative repercussions for the entire organization, so it is critical that employers take steps to both prevent and address bullying in the workplace.

Identifying bullying in the workplace

The first step to address this issue is to know what to look for. Workplace bullying is a form of harassment and can include both verbal and nonverbal behavior that is threatening, humiliating, and intimidating. Often, this mistreatment is ongoing by one or more perpetrators against others in the workplace. Bullies may target a specific individual or multiple people in the office. Examples of workplace bullying include, but are not limited to:

• Frequently criticizing the work of colleagues or direct reports, despite excellent performance

• Constantly changing guidelines, deadlines, or scheduled meetings last minute

• Spreading hateful gossip about someone, or purposely humiliating a colleague in front of others

• Isolating a colleague, such as leaving that person out of group events or “forgetting” to invite them to meetings or social gatherings

• Disturbing or tampering with someone’s personal items

• Intimidating or threatening someone

And bullying does not have to happen face-to-face. Cyber-bullying is prevalent in the workplace and can happen over e-mail, social media, and other online platforms. While surveys vary on the prevalence of cyber-bullying, one study indicates that 14 to 20 percent of employees experience it on a regular basis.

According to the Workplace Bullying Survey, workplace bullying impacts 65.5 million employees across the country. The pervasiveness of this issue makes it critical that employers take action to protect their employees and put an end to workplace bullying.

Understanding the potential impact

Workplace bullying can create a ripple effect throughout an organization, from impacting revenue and creating legal challenges to increased turnover and lower morale.

Bullying in the workplace causes stress-related issues among employees, leading to absenteeism, presenteeism, reduced productivity, and other factors than can cost a company tens of thousands of dollars each year.

When employees are distracted or upset because of bullying or related issues, they are not able to perform at their best, so bullying not only causes companies to lose potential income, but can negatively impact employee morale as well.

Workplace bullying also generates extra costs due to turnover. Eighty-two percent of employees targeted by bullies leave the organization as a result. If this happens, the company must now spend time and money to recruit and train a replacement. This does not include lost revenue if that employee was responsible for specific clients or accounts that leave with them. And if the bully remains employed with the company while a high-performer leaves, it’s likely that the cycle will continue repeating.

Putting a Stop to Bullying in the WorkplaceNorbert “Bert” Alicea, MA, CEAPHR.BLR.com | January 20, 2016

HR.BLR.com | January 20, 2016

Further intensifying the issue, each time an employee submits a complaint of bullying or harassment, the company must spend thousands of dollars investigating and resolving the issue, but this number can climb much higher if a lawsuit is filed.

Finally, bullying in the workplace is a drain on employee morale. When people do not feel comfortable or safe in the office, they are not engaged in their work or performing at the highest level. Even for people who are not the direct target of bullying, negative behavior within the organization contributes to increased stress, a reduction in trust among colleagues, a drop in productivity, and overall decreased morale. Workplace bullying can have a major impact throughout an organization, further demonstrating why employers should step in to address this issue.

Addressing the problem

The best way to stop bullying in the workplace is to prevent it from happening in the first place. While this is not always possible, there are strategies employers can implement to create a positive workplace culture that inhibits negative behaviors like bullying.

Creating a formal policy regarding workplace bullying establishes a clear process for addressing any issues that may arise and also demonstrates the organization’s commitment to a safe and supportive work environment.

This policy should include, at a minimum, a procedure for reporting and documenting incidents, including how to file a complaint and the appropriate point of contact. During training, employees should review the reporting procedures involved, should an incident of bullying take place. This will help ensure employers’ HR departments have the information needed to efficiently investigate and resolve issues.

In order to successfully implement a formal policy, training is a key component in a bullying prevention plan. This can cover a wide range of related topics, including interpersonal skills, online etiquette (addressing cyber-bullying), and harassment awareness, among others. Offering this training provides an opportunity to raise awareness of this important issue and open the lines of communication between employees and management, a key step toward halting workplace bullying.

There are many benefits to introducing a training initiative geared toward preventing and addressing bullying. Not only do managers and employees understand what to look for and how to take action, but providing antibullying training to all employees can also offer some legal protection for organizations if an employee files a lawsuit due to the bullying.

There are many resources available to help organizations establish policies and take action to address workplace bullying, including an Employee Assistance Program (EAP). For organizations who work with an EAP, experts are often available to offer insights on company policies, provide training to all employees, and work with individuals who may be experiencing challenges that could lead to behaviors like bullying.

Awareness and understanding are critical to effectively addressing and preventing bullying in the workplace. By taking steps to offer training and plan ahead, it is possible for employers to protect their employees from bullying and other forms of harassment, and preserve a positive workplace culture.

HR.BLR.com | January 20, 2016