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Mercer

When employers are asked how they plan to control health benefit cost over the long term, they talk about improving employee health. This focus on employee health is one factor fueling growth in worksite clinics. Last year, Mercer’s National Survey of Employer-Sponsored Health Plans found that 29% of employers with 5,000 or more employees provided an onsite or near-site clinic offering primary care services, up from 24% in the prior year. Mercer followed up with these employers in a new, targeted survey on worksite clinics. Of the 134 respondents, 72% of those whose clinics provide general medical services said that managing employee health risk and chronic conditions is an important objective for the clinic.

 

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Like most of my clients, you're probably immersed in health planning activities for 2017. I recently took stock of some of the interesting topics that I have been discussing during planning conversations with clients. I asked my colleagues to weigh in with their thoughts on things to consider now for 2017, or for the years ahead. Some of our best minds contributed posts in their areas of expertise that will help you evaluate initiatives around CDHP enrollment, behavioral health, value-based care, financial wellness, and more. Appropriately, we kicked off the series with a discussion of how to cope with – and maybe even enjoy – the challenges of innovation.

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Employee well-being programs have become a mainstay in employers’ overall benefit offerings. Most large employers offer programs designed to support health and well-being, and each year our National Survey of Employer-Sponsored Health Plans finds that more are contracting optional and niche services from health plans or specialty vendors, as opposed to offering just their plan’s standard services or in-house initiatives (48% did so  in 2015, up from 30% in 2012). That’s why we were surprised to see a recent Wall Street Journal article suggesting that employers may be taking a step back from wellness programs. The article pointed to SHRM’s 2016 Employee Benefits Survey, which found that certain wellness program elements have decreased in prevalence, notably onsite seasonal flu vaccinations and 24-hour nurse lines. But although certain services are being offered less, the study reports that more employers are increasing wellness offerings (45%) than decreasing them (19%). It also highlights that employers are becoming more strategic in their program offerings; if employers are taking a ‘step back’, they’re doing so to take stock of their current offerings and evaluate what works best for their workforce.

 

Other developments in the health care ecosystem may account for changes in wellness program offerings. As access to retail health clinics continues to expand, making flu shots easier and cheaper to obtain than with a primary care physician, some employers may pull back on this offering and dedicate those budget dollars to other well-being resources. And our survey found sharp growth in offerings of telemedicine in 2015 (from 18% to 30% of large employers) and advocacy services (from 52% to 56%), both of which may be taking the place of some previously offered 24-hour nurse lines.

 

Employee well-being programs will continue to evolve as employers assess their offerings, whether based on participation levels, employee surveys or ROI analysis. Health care market developments and innovations that arise will also impact well-being offerings, but it’s clear that these programs have become an essential part of the American workplace and are here to stay. There was lot of buzz earlier this year over a study published in JOEM (which we’ve written about here) linking robust health and well-being programs with better stock performance – perhaps because the findings resonated with many sponsors of high-performing programs who have been hoping for a better way to measure the value of their investments in employee health.

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According to a new Gallup survey, 15.5 percent of adults say the cost of health care is not affordable. That’s the lowest number since Gallup began tracking this in 2008, which is the good news. But we think there’s reason to be concerned about affordability in the future.

 

Mercer’s annual survey Inside Employees Minds includes questions on the affordability of health care. The latest survey found that only 9% of employees say health care is not affordable –- but that 30% say it is not easily affordable. And when we ask about the cost of health care in five years, 23% worry it will not be affordable, with an additional 36% concerned it will not be easily affordable. It is safe to say that higher deductibles and higher prescription drug costs are fueling this concern.

 

We all know stress and financial concerns impact employee health and job performance. There are many things employers can do to help –

  • Provide tips on how to “shop” for health care using cost transparency tools

  • Arm employees with questions to ask when making an appointment or at the doctor’s office

  • Raise awareness of lowest-cost options for accessing care (like telemedicine)

  • Promote use of health savings accounts for current expenses and also for retiree medical costs

  • Remind employees about services available through the EAP and other programs that can help them with household budgeting and financial planning to make the best use of their money

 

Employees have access to so many tools and resources that it is hard to keep track of them all and know when to use them. Once again, communications is the key.

 

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The e-file deadline for ACA reporting (Form 1094-C) is just days away. But before we take a collective sigh of relief, I would be remiss not to talk about corrections. After all, how often do you submit an electronic file to a third-party with zero errors? For 2015 reporting, the IRS will not penalize you for making a “good faith” effort to comply with the reporting requirements and error correction is part of that good faith effort.

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Consumer-directed health plans (CDHPs) have become a mainstream benefit offering. Spurred on by the need to avoid the excise tax, employers have added these low-cost plans at a fast clip over the past few years. In 2015, 29% of all employers – but 59% of those with 500 or more employees – offered an account-based CDHP, and a total of 25% of all covered employees were enrolled in one, according to Mercer’s National Survey of Employer-Sponsored Health Plans. Now more than a decade old, CDHPs were designed with the goal of holding down cost by encouraging cost-consciousness among consumers. The best CDHPs promote personal responsibility for maintaining or improving health and for choosing cost-effective, quality health care providers.  

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The House Republicans released a white paper outlining their plan to provide “High Quality Health Care for All” – the GOP’s proposed approach to replace the ACA. While it lays out some interesting strategies that could potentially be attractive to employers, the paper lacks the details necessary to be able to evaluate the impact on employer-sponsored health benefits as we know them today. And we all know the devil is in the details.

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Model ADA notice for wellness programs posted

The Equal Employment Opportunity Commission (EEOC) has posted a sample notice for employer-sponsored wellness programs that must comply with recently issued Americans with Disabilities Act (ADA) regulations. An accompanying set of Q&As explains who must provide the notice, what formats are acceptable, and when employees must receive the notice. Employer-sponsored wellness programs that collect health information must provide the ADA notice. Employers can craft their own version to use in lieu of the EEOC sample, as along as the notice contains all required content. The ADA notice requirement takes effect for the plan year starting in 2017.

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Here are a couple of eye-opening statistics. Behavioral health issues account for 4% of all medical claims on average, yet contribute to 21% of health care costs[1]. And for employers, there are other consequences of failing to address behavioral health in the workplace: Costs associated with employee absenteeism and lack of productivity due to behavioral health issues account for nearly $17 billion dollars annually[2].

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Wow, it’s June already. Kids are playing outside, the smell of barbeque is in the air, and some of us, just maybe, are feeling the onset of the innovation summertime blues. What, you’ve never heard of this particular brand of the blues? Let me paint a picture and maybe it will look familiar.

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You won’t find many business leaders who would disagree that a healthy work-life balance is important for employee well-being and ultimately good for business. But when I looked at the most recent results from the HERO Health and Well-being Scorecard in Collaboration with Mercer, only 22% of the nearly 500 respondents say that their organization’s leaders are role models for prioritizing health and work/life balance – for example, they don’t send e-mail while on vacation. When I mentioned this disturbing statistic to my colleague Tracy, she pointed me to a recent WSJ article in which Marsh & McLennan CEO Dan Glaser discusses his approach to work-life balance. Over time, he says, he got better at keeping work and family life separate, but he wishes he’d figured it out sooner: “Your kids are only young once, and you can’t get that moment back,” he said. Others quoted in the article acknowledged the importance of setting an example for employees rising in the ranks. “It is critical for the CEO to set the tone,” said one exec. “If he doesn’t, there’s a secret kind of code, ‘if you take vacation, you’re not as serious an executive.’ ”

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There’s been a lot of discussion lately  about the gig economy. According to the Bureau of Labor Statistics, 15 million people in US were self-employed in 2015. It is predicted that by 2020 more than 40% of the workforce (60 million people) will be independent workers – freelancers, contractors, temporary employees. Harvard Business Review called it “the rise of the super-temp” and predicted that – perhaps contrary to current perceptions – these contractor positions will be held by the best and the brightest. There are even new platforms to pair talent with businesses, like Contently, Hourly Nerd, Field Nation, and our own Mercer PeoplePro.

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New tri-agency proposed regulations implementing the Expatriate Health Coverage Clarification Act of 2014 (EHCCA) outline the conditions an expatriate medical plan or policy must meet to exempt the plan, sponsoring employer, and expatriate health insurers from certain Affordable Care Act (ACA) requirements. Generally, EHCCA exempts plans or policies that meet the law's definition of an "expatriate health plan" from certain ACA market reforms, fees, and aspects of the "Cadillac" excise tax on high-cost health benefits. The proposal clarifies which individuals are qualified expatriates, which insurers can issue qualified expatriate coverage, as well as other important requirements to take advantage of the EHCCA relief.

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