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.
Worksite clinics are a convenient way for employees to undergo biometric screenings (offered at 77% of clinics), participate in face-to-face chronic condition coaching (60%), and take part in lifestyle management programs such as smoking cessation (59%) or weight management (56%). Pharmacy services are offered at 38% of clinics, and just over a fourth (26%) provide mental health or employee assistance program (EAP) counseling in their clinics.
For more than two-thirds of survey respondents (68%), improving access to care was also an important objective. As the Affordable Care Act (ACA) expands health coverage to more Americans, primary care shortages in some parts of the US could be exacerbated. Establishing a new clinic, or expanding an existing occupational health clinic to provide general medical services, is one way employers can ensure that their employees — and in some cases employees’ dependents — will have access to quality care.
While the ACA may have spurred employer interest in worksite clinics, an IRS notice released this February has clouded the picture by suggesting that the cost of care received through the clinic must be counted in the ACA’s excise tax calculation. Some respondents (15%) believe their general medical clinic will hurt them in terms of the excise tax calculation by pushing them over the threshold for the excise tax, and some (11%) believe it will help, presumably by holding down the cost of the company’s health plan. Another 28% believe it won’t have an impact either way, and 46% simply don’t know how the clinic will affect the calculation. Typically, the cost of the clinic accounts for 10% or less of an employer’s total health care spend and for about half of the respondents, it accounts for 5% or less.
Measuring clinic success
The great majority of respondents — 85% — say that their organization generally perceives the clinic as a success. Specifically, 63% say it has successfully reduced lost work days, and 58% say it has been successful in helping members control chronic conditions.
Measuring return on investment (ROI) remains a challenge for employers, and only 41% of respondents were able to provide ROI data. An ROI of 1.00 to 1.99 was most common (23% of respondents reported ROI in this range), and 13% percent reported an ROI of 2.00 or higher. Only 5% have an ROI of less than 1.00.
The best measure of employee satisfaction may be utilization. Respondents report that 45% of employees, on average, used the clinic in 2014. Nearly half of respondents (48%) with a general medical clinic don’t require any copayment for clinic services, and 25% require a lower copayment than the employee would pay for comparable services under the company health plan. The majority of respondents with hourly employees (61%) do not require them to clock out of work for visits to the clinic.
For many employers, employee satisfaction is a more important measure of success than ROI. If employees are using the clinic, it means they haven’t been taking time off work to visit a doctor, and that they’re getting the medical care they need to stay healthy and productive.
This week, all eyes are on the presidential hopefuls as the primary election season kicks into high gear. With health care on the docket as one of the key domestic policy issues of this election, it’s important for voters to know where each candidate stands, relative to the ACA and Medicare.
Our blog team put together the following summary that we share with a caveat -- these are our impressions of the candidate’s views based on what we have read in the news and seen on TV.
On the Democratic Side:
- Hillary Clinton is a proponent of the Affordable Care Act, albeit with a few tweaks that she says would reduce consumers’ out-of-pocket and prescription drug costs. For instance, she proposes having Medicare administrators negotiate with drug companies for lower prices for beneficiaries, requiring health insurers to cap out-of-pocket drug spending at $250 per month, and mandating that all plans (including employer-sponsored) provide individuals with three sick visits per year before needing to meet their deductible. She opposes any plans to privatize Medicare and she supports the state expansion of Medicaid under the ACA.
- A supporter of universal health care, Bernie Sanders thinks the ACA didn’t go far enough, creating an interesting rift in the Democratic Party. Sanders wants to expand Medicare to create a “Medicare-for-all” single-payer national health insurance. This tax-supported single-payer system would entail no premiums, deductibles or cost-sharing, and private health insurance would only exist to provide supplemental coverage. Until then, he supports the expansion and improvement of Medicaid for low-income families.
On the Republican Side:
- Ted Cruz wants to repeal the ACA (as do most of the Republican candidates) and cut the link between health insurance and employment. He also wants to expand health savings accounts and allow insurers to sell plans across state lines. But he has kept mum on what he would do to maintain the ACA’s coverage expansion, if he were to abolish the law. As for Medicare, he would raise the eligibility age and move to a premium-support system in which beneficiaries are given a fixed government contribution to buy a Medicare insurance plan; if the plan exceeds this amount, individuals would be accountable for the difference. Cruz also opposes Medicaid expansion under Obamacare.
- Donald Trump opposes both the ACA and the idea of a single-payer system. He says he would repeal the ACA and allow consumers to buy plans from insurers in any state, no matter where they live, and he supports the use of HSAs to pay for medical expenses not covered by insurance. He has said that he would preserve Medicare by strengthening the economy enough to support the program.
- Marco Rubio would like to repeal the ACA and replace it with a refundable tax credit to help people purchase health insurance, which would increase each year with a gradual reduction in the tax exclusion for employer health plans. He would also establish high-risk pools funded by the federal government to cover those with pre-existing conditions, allow insurers to sell plans across state lines, and expand HSAs to pay for medical expenses not covered by insurance. He says he would preserve traditional Medicare for current beneficiaries, but future generations would be transitioned into a defined-contribution, premium-support system. He also says he’d convert Medicaid into a capped state block grant program.
- The M.D. of the presidential hopefuls, Ben Carson advocates repealing the ACA and replacing it with health empowerment accounts (HEAs) to be given to all US citizens along with their social security numbers. Citizens would contribute to their HEAs tax-free and would be able to use the accounts to pay for medical expenses for themselves and their family members. The money is theirs, whether they change jobs or move across state lines, and would be paired with high-deductible health plans for catastrophic medical costs. In terms of Medicare, he’d give beneficiaries a fixed contribution with which to buy private health insurance, and if their plan of choice costs less than the government contribution, the remaining dollars would go straight into their HEAs (and if it costs more, the difference could come out of their HEAs). He’d also increase the Medicare eligibility age from 65 to 70, with beneficiaries able to use their HEAs for out-of-pocket expenses, deductibles, and co-pays.
- Like his Republican counterparts, Jeb Bush wants to repeal the ACA, but his plan seems to rely on the employer-based system more than the others. He says he’d offer a tax break for workers on health benefits they receive through their employers and let small businesses make tax-free contributions toward their employees’ plans. In addition, he’d provide a tax credit for catastrophic insurance plans and increase contribution limits for HSAs from $3,350 to $6,550. He’d also cap the employer tax exclusion so that employer-sponsored plans costing more than $12,000 for individuals or $30,000 for families would be taxed. He wants to privatize Medicare and provide lower government subsidies to wealthier people.
- John Kasich wants to repeal the ACA, though he expanded Medicaid in Ohio under the law as governor, and he has said that he supports coverage for pre-existing conditions. He thinks there needs to be more of an emphasis on patient-centered primary care, and he criticizes the fee-for-service system, wanting to reward value instead of volume.
We offer a few general observations about any possible changes being discussed:
- First thing to keep in mind is that more people have health insurance today than before the law was passed -- 12.7 million are enrolled in the public exchange with most getting a subsidy and an additional 7 million are covered by expanded Medicaid or CHIP. Those who favor ACA repeal need to keep in mind the challenge to make sudden any changes that would adversely impact 18 million new beneficiaries.
- From an employer perspective, over the past five years we have made benefit changes, taken on more administrative responsibilities and communication requirements, and paid significant fees to support the ACA. Several of the ACA requirements were very popular with employees -- expanded dependent eligibility to age 26 and the elimination of lifetime maximum benefits to name just two. While we might be happy to see all the ACA requirements go away, we realize some features may be hard to roll back. On the other hand, some of the candidates favor approaches that would rely even more on employer support.
- Finally, the excise tax on high-cost plans has long been the number one ACA concern for employers. The two-year delay is a step in the right direction and we are hopeful that step is actually a step closer to repeal of the excise tax provision. Stay tuned for a separate post on the lack of meaningful impact of the proposed changes in the 2017 budget.
Fasten your seat belts, it will be an interesting ride!
Your new employee is 26 years old. He’s rarely sick -- maybe some occasional weekend-warrior soreness. His biggest health expense is his refrigerator full of grape Mountain Dew Kickstarts.
Then, there’s your vice president. She’s 55 and takes insulin for diabetes, just quit smoking, and has a husband and kids who rely on her insurance. She’s working hard to improve her health.
Obviously, these two have different health insurance needs. But many small and mid-sized employers would be challenged to offer more than one medical plan. In fact, about half of employers with 50 to 499 employees only offer one plan. How can they offer health benefits tailored to employees like these two, plus everyone in between?
A Market-based Solution
Private health exchanges are one approach that a small, but growing, number of companies are using. These exchanges cover some 6 million Americans and offer an array of plans, from traditional broad-network PPOs to high-performance narrow networks, and from plans with first-dollar coverage to HSA-eligible high-deductible plans.
They’re designed to address today's most challenging aspects of benefits delivery, including:
High Health Benefits Costs
Exchanges usually include employees from multiple companies, so they can leverage their volume to lower health premiums for employees, as well as plan costs for companies. Employees are also given more plans to choose from. They have the option to select higher-deductible health plans that lower their premiums, while lowering costs for employers as well. Converting to a private health exchange has saved companies up to 15% on their medical costs in the first year.
A Potpourri of Employees (the multigenerational workforce)
In the digital age, even small employers can hire staff from coast to coast. Millennials Skype with baby boomers. Generation Xers instant-message with seniors.
And everyone’s bringing different health needs to the table. Despite this, nine out of 10 employees say benefits are just as important as salary, and 63% say benefits are a major factor in choosing where to work.
Exchanges can offer a wide range of options to suit everyone, such as:
- Traditional health plans with HMOs and PPOs
- Narrow networks
- Provider-owned plans
- Plans for self-insured employers
- High-deductible health plans
Today, 80% of employees say a choice of health plans is critical to their job satisfaction. Employees are becoming smarter healthcare consumers. They want to shop around for healthcare and health benefits like they would anything else.
Sometimes, giving employees options is the best choice. For employers turning to private health exchanges, that means offering a variety of plans plus benefits counselors who can advise employees of all their options. The employees can select the best solution for themselves and their families. And that’s a solution everyone can live with.
Faced with the prospect of an already-fragmented health care system strained further as more Americans gain health insurance in the public exchanges and through employer plans, employers are turning to onsite clinics as a critical component of their health care strategy. Worksite health services are a way for employers to directly influence health care delivery and provide a convenient and quality product to their employees — enhancing the benefit package while improving productivity.
While the first worksite clinics primarily served to provide first aid and urgent care, today the majority offer general primary care services — and the number is growing. Among employers with 5,000 or more employees — the size group most likely to have implemented a clinic — 29% offer an onsite or near-site primary care clinic, up from 24% last year. An additional 9% offer a clinic for occupational services only. While onsite clinics may be more practical for large worksites, near-site/shared clinics situated in office parks or urban office buildings offer access to smaller employers or large employers with smaller locations.
A Mercer survey of 131 employers that offer an onsite or near-site clinic found that while screenings and immunizations are the most common general medical services offered at worksite clinics, more clinics are introducing expanded comprehensive primary care in which patients with chronic illnesses can be managed on an ongoing basis. Pharmacy services and laboratory tests are the newest offerings, each offered at about a third of the clinics Mercer surveyed.
But the concept of how worksite clinics can be used has shifted and broadened. For example, many employers have positioned their clinics as onsite centers for wellness and health promotion and use them as a way to create a “culture of health” in the workplace and to encourage employee participation in the wellness programs. Of the employers surveyed, the majority use their worksite clinics as a convenient way for employees to undergo biometric screenings (72%), participate in face-to-face chronic condition coaching (63%), and take part in lifestyle management programs such as smoking cessation, weight management (both offered by 60% of clinics), and nutrition management (57%). More recently, worksite clinics have begun to play a role in telehealth — either by offering services directly using clinic providers, or by coordinating with a separate telehealth vendor so that the clinic providers are notified of off-hours activity and get a copy of the record.
Data on return on investment make a good case for companies to add or reshape worksite clinics. Most employers that are able to measure say that the cost of running the clinic accounts for less than 2% or between 2% and 5% of their organization’s total annual health care spending (37% and 36%, respectively). And among employers that have been able to measure ROI, more than half reported a return of 1.5 or greater — and a quarter reported a return of at least 2.5. Only 12% say they have not yet broken even on their investment.
At a time when employers are looking for any possible source of health cost savings, they may find a worksite clinic can deliver that, and more. But increasingly employers are coming to view worksite clinics as a way to ensure that employees — and in some cases employees’ dependents — have easy access to quality care. Significant improvement in productivity is gained by reducing employee time away from work. Most employers in the survey reported average wait times in their clinics of 10 minutes or less. In addition, the convenience of onsite clinics allows and encourages employees to get the preventive care they need every year instead of putting it off.
Tara Lewis assisted with the reporting for this article.
This has been a busy week for healthcare in DC -- and the week’s not over yet! On the heels of the leaked Republican reconciliation bill language last Friday (that is already being described as out of date), the governors arrived over the weekend for a National Governors Association meeting that included dinner at the White House on Sunday. While the President tweeted that they “might” talk about healthcare, you can be sure the future of the Medicaid program and, more specifically, Medicaid funding, was at the top of the governors’ list of topics. Certainly, the 31 states that expanded Medicaid fear the funding implications of a block-grant program.
On Monday, the White House hosted a meeting with executives from the insurance companies to discuss government action required to "save" the failing individual market and convince (or perhaps, strong-arm) the carriers to stay in the game. Earlier this month, HHS announced revisions to the deadlines to file individual products to be offered in 2018 on the public exchange. This allows more time for legislative and regulatory action that might influence carrier decisions.
On Tuesday, the POTUS addressed the full Congress for the first time. He took a few minutes to lay out his five requirements for a replacement strategy. I’ll give you the short version below, but I recommend you also check out this Vox article, in which Sarah Kliff decodes the actual wording of each:
- Ensure Americans with preexisting conditions have access to coverage
- Help Americans purchase coverage through the use of tax credits and expanded health savings accounts
- Give states the resources and flexibility they need with Medicaid to make sure no one is left out
- Implement legal reforms to protect patients and doctors from unnecessary costs (presumably malpractice lawsuits) -- and bring down drug prices
- Allow the sale of health insurance across state lines
Meanwhile, it is widely reported that the Republican version of the reconciliation bill is changing constantly as various contributors attempt to balance the requirements of a very divided party -- all the while knowing that the Senate is working on its own replacement plan. We understand members of the House are reviewing the new bill and it is scheduled to go to committee for mark up next week.
Like I said, it’s been a busy week -- and there is no sign of the pace slowing anytime soon.
Our sister company, Oliver Wyman, recently released a white paper on the “New Front Door to Health Care” -- namely, telemedicine and retail clinics. We shared their latest survey data on consumer perceptions and use of these newer access points for health care. While employers have incorporated telemedicine and retail clinics into their health benefit offerings and plan designs, it is important to think about how these access points will evolve as the health care delivery system continues to transform itself.
According to OW’s Sam Glick, “This year will usher in a new era of retail health. Retail clinics 2.0 will be different; they will be the hub of the provider network of the future. These clinics will still provide inexpensive urgent care at convenient hours and locations, but they’ll also provide insurance enrollment (like Walmart is doing); care coaching (a la Rite Aid); full primary care (as Walgreens is piloting); a community-health focus (like Target); and whole-health services (like CVS). The retail healthcare experience will be like the best of any other retail experience -- that is, tailored, affordable, and easy. In the coming year we will also see traditional health systems embrace retail care as an extension of their impact, not as a competitor.”
The advantage to employer-sponsored plans and consumers? These access points are more convenient and less costly. They also have the potential to provide coaching and educational support to drive healthy habits.
So what should employers be thinking about to maximize the benefits to themselves and their employees?
- Communicate with employees about any retail clinics and telemedicine services available to them to make sure they understand what each offers and how the costs vary. Otherwise, they may not realize how significant these differences are. For example, the cost spectrum could range from as little as $40 for a telemedicine visit, to $70 for a retail clinic visit, to $150 for a primary care office visit. It’s also important to reinforce that an urgent care facility is an alternative to the emergency room, not for a primary care visit.
- Keep a pulse on what the hospital systems in your locations are doing. We know from the OW survey that people value retail offerings that are associated with a health care name they trust. Promoting these new options could also be beneficial.
- Talk with your vendor partners about their approach to including these new options in the provider network and communications with plan members.
- Look for opportunities to link convenient retail resources to chronic condition management programs and communications. For some plan members, the personal interaction could have a significant impact on their success in managing their condition.
More access points means more opportunity to have a positive impact on plan members’ health and health improvement efforts. In the busy world we live in, that’s a good thing!
If trends around childhood obesity stay on their current course, for the first time in US history we may see life expectancy start to fall. There are some scary statistics on the topic:
- More than one third of children and adolescents are overweight or obese.
- Childhood obesity is now the No. 1 health concern among parents in the United States, topping drug abuse and smoking.
- More than 30% of children eat fast food on any given day.
- Overweight children miss four times as many school days as children of a healthy weight.
- Of overweight high school students, 58% of boys and 63% of girls report daily teasing, bullying, or rejection because of their size. Being the target of this kind of behavior can lead to school delinquency, self-harm, depression, and anxiety disorders.
- Many parents with overweight or obese children underestimate their child's excess weight.
The head of the CDC, Tom Frieden, has said that combating childhood obesity is one of his top priorities. As awareness of the problem has grown, we’re seeing signs that public and private efforts to improve children’s nutrition and promote physical activity are having an effect. Nationwide, there’s been a decline in obesity among very young children (ages 2-5), and some cities, like New York and Philadelphia, and even some states, like Mississippi and California, have reported improvements in obesity rates among schoolchildren in various grades.
Hoping to be part of the solution, Mercer recently formed an alliance with Kurbo Health, a Silicon Valley start-up that has created a compelling offering combining an intelligent mobile food and activity app, real-time feedback and one-on-one support from coaches. I’m excited by their ability to engage children in their health -- 88% reduce their BMI -- and even more intrigued by their ability to engage parents to lose weight as well -- 55% of parents reduce their own BMI! It’s a neat example of a positive side effect that goes beyond the initial focus of a solution.
If you’ve been less than satisfied with efforts to promote weight loss among your workers, maybe shifting the focus to improving the health of the whole family is something to consider. Meanwhile, here are a couple of interesting tidbits I turned up in my research:
- Kids who have a younger brother or sister before preschool have a lower risk of becoming obese
- Peanut butter may help prevent childhood obesity, while fish may cause it.
Ok, maybe that last one needs more research!
A scan of news headlines from the past couple of months netted articles discussing genetic links to anxiety, glaucoma, weight gain, intelligence, athletics, cancer, and smoking. It’s not unimaginable that genetics could play a role in managing every aspect of our health. The trick will be figuring out how to counterbalance genetic predisposition with behavioral changes and clinical support.
Genetic testing companies fall into different buckets, based on whether they’re focused on the past, present, or future:
- PAST: To help you determine your ancestral origins, trace your lineage and find new genetic relatives, there are tests with a genealogical focus offered by Family Tree DNA, 23andMe, and Ancestry DNA.
- PRESENT: Genetic screening is being used to determine genetic variations and personalize recommendations and coaching based on your specific needs. As an example, Newtopia tests for genetic variations affecting body fat, eating behavior, and appetite, and adapts its program based on your results.
- FUTURE: Some companies focus on DNA screenings for the important moments in your life; for example, Counsyl and Color Genomics offer tests aimed at family planning, pregnancy, and cancer screening.
With the ability to test potential parents for inheritable conditions like cystic fibrosis, or risk for diseases like Parkinson’s, genetic testing may one day become the expected standard for care delivery. In the meantime, there are still some privacy concerns. While the Genetic Information Nondiscrimindation Act (GINA) bars health insurance companies from denying coverage to those with risky gene mutations, the law doesn’t extend to life insurance companies, long-term care, or disability insurance.
Speed of testing, accuracy, financial cost, counseling support, and privacy are all factors that should be considered when evaluating services in this space. But the possibilities certainly seem to warrant discussion. Are you starting to think about these new types of services and how they might benefit your workforce?
In Mercer’s most recent survey of employer-sponsored health plans, we saw PPO deductibles increase and more employers move to consumer-directed plans, which typically have higher deductibles than traditional PPO plans. For many, escalating upfront deductibles are a real financial burden. What are employers doing to soften the blow? According to our survey, 18% of employers are offering a telemedicine option for employees, up from 11% in 2013. The largest employers are moving fastest — 34% of those with 20,000 or more employees offered telemedicine services in 2014, nearly double the number offering it in 2013.
Telemedicine provides members with on-demand access to physicians who can diagnose, treat, and prescribe medication, when appropriate, for many medical issues. Members are required to complete a medical history prior to consult request. Doctor consultations are available 24/7 via telephone or video and in many instances can be arranged with very little lead time. A board-certified physician licensed in their state reviews their medical history and provides a consultation over the phone or through video. The physician recommends the treatment for the member’s medical issue. If a prescription drug is required, the physician will electronically send the order to the member’s pharmacy of choice. The physician documents the consultation in the member’s history, and information is made available to the member through an online archive and, if requested, to the member’s primary care physician.
So what does a telemedicine visit cost? Typically between $30 and $50, depending on the vendor. The real savings come because a telemedicine visit frequently replaces a more intensive setting of care, whether a doctor’s office, urgent care facility, or emergency room. If the member is paying out of pocket for the visit because they have not yet met their deductible, they can save a significant amount of money.
Obviously, consulting a doctor from home is also more convenient than making a trip to their office. But do people feel confident that an electronic visit will produce the same result as a live visit? There’s evidence they do — especially if they and the doctor can see each other. Harris Poll did a survey for American Well and found that 64% of those surveyed said they were willing to see a doctor via a video telemedicine visit. Further, about the same percentage (63%) said they thought a video visit would result in a more accurate diagnosis than a phone or email consultation. (See full infographic below.)
Don’t currently offer telemedicine? You can add it now — no need to wait for open enrollment. This benefit is very easy to add in the middle of a plan year. Employees will appreciate a lower-cost alternative especially early in the year when the re-set button has just been applied to their deductible.
This post is part of our “Driving Transformation” series, in which Mercer consultants share key take-aways for employers from the 2016 Oliver Wyman Health Innovation Summit, a recent conference hosted by Mercer’s sibling firm, management consultant Oliver Wyman.
The rise of the consumer has already caused a seismic shift in the strategic direction for most hospitals and health systems. These providers recognize the imperative to find new and different ways to demonstrate value across the care delivery continuum. This means focusing attention on what consumers of most products and services look for: cost, quality and an engaging and convenient experience. Integrated clinical and commercial strategies must be developed to successfully address each of these elements. With increased focus on improving population health and patient satisfaction, re-thinking how multi-generational consumers access healthcare providers will be critical to future success. There will be various patient-centric “front doors” to healthcare, including retail health, telemedicine, onsite clinics, digital health, care navigation and a re-invented doctor’s office experience.
To execute this transformation, hospitals and health systems must also evaluate the need for strategic partnerships along the way. These organizations have traditionally taken a “develop from within” approach to innovation and business development. Speed to market and immediate access to existing intellectual capital, on the other hand, may dictate the need for a different approach going forward. There will likely be bumps and missteps along the way. That said, organizations looking to differentiate themselves in the new consumer market must also be willing to step outside the box and take some level of risk.
The current healthcare ecosystem is large, complex and very fragmented. This is frustrating, inefficient and expensive for the consumer to navigate. Hospitals and health systems have a unique opportunity to change this dynamic and create new models that provide real value in the health market. Those organizations willing to embrace this challenge will likely be the industry leaders of tomorrow.
Employers have a role to play in hastening this healthcare transformation. Collectively, employers are the largest purchaser of healthcare in the country. They can make a difference by consistently demanding higher-value services and a laser-focus on the consumer experience – and by giving their business to the providers that are moving the fastest in the right direction.
How to start? Pay attention to what is going on locally – where you do business – with healthcare providers. Find out who is organizing, how are they changing and whether they are really changing in a meaningful way. Depending on how many locations your organization operates in, this could be a major undertaking. Lean on your health benefit partners and local colleagues to help.
In late May, Martin Senn, the former CEO of Zurich Insurance Group, took his own life just months after leaving the company. Only three years earlier, the company's former CFO, Pierre Wauthier, also committed suicide, and not long after that, so did Swisscom CEO Carsten Schloter.
Statistics about senior executive suicides are scarce. Often, these tragedies are hidden from public view, with only the most prominent making the news. But suicide has cast a shadow on Silicon Valley. A disturbingly high number of founders and entrepreneurs have chosen this path: Austin Heinz, with Cambrian Genomics. Aaron Swartz, with Reddit. Jody Sherman, with Ecomom. Ovik Banerjee, with Venture for America. Matt Berman, with Bolt Barber. Ilya Zhitomirskiy, with Diaspora. Ian Gibbons, with Theranos. (And I worry that the problem is moving downstream. Last year, in the Silicon Valley town of Palo Alto, home to Stanford University and Facebook, there were four high school suicides.)
The pressure on executives and entrepreneurs is daunting. Picture feeling overwhelmed, at your most vulnerable, and not being able to share it because it might put at risk funding, or an acquisition, or an IPO. Who wants to follow or invest in a leader who is exhibiting weakness? On the entrepreneurial roller-coaster, there can be amazing highs and crashing lows.
The general statistics on suicide are sobering enough:
- Suicide is the 10th leading cause of death in the US for all ages. (CDC)
- More people die from suicide than homicide and war combined. (WHO)
- There is one death by suicide in the US every 12.3 minutes. (CDC)
- Depression affects 20-25% of Americans age 18 and over in a given year. (CDC)
- Suicide takes the lives of over 38,000 Americans every year. (CDC)
- 45% of suicide victims had contact with primary care providers within the prior month. (American Journal of Psychiatry)
- An estimated quarter million people each year become suicide survivors. (AAS)
Yet executives and entrepreneurs are apparently at still higher risk. Dr. Michael Freeman, a clinical professor at UCSF and himself an entrepreneur, has studied the connection between mental health issues and entrepreneurship. Of 242 entrepreneurs surveyed, 49% reported having a mental-health condition. Depression was the most reported condition, present in 30% of the group, followed by ADHD (29%) and anxiety problems (27%). As a point of comparison, the general US population only reports 7% as depressed.
This is a problem that needs to be addressed. There is a lot of loneliness and depression in this world, and many people feel like failures because they can’t live up to impossibly high standards they see in the media or set for themselves. Perhaps Silicon Valley can heal itself. There are any number of new startups attempting to solve different issues in the mental healthcare space, which may include access to care, delivery of care, or quality of care. Notable names include Lantern, Ginger.io, Lyra, and Breakthrough (acquired by MDLive).
But this is also a cultural issue. Suicide needs to be openly discussed; stigmas need to be removed. On National Council Hill Day 2016 last month, hundreds of behavioral health providers, administrators, board members, consumers, and community stakeholders gathered in Washington DC and visited Capitol Hill to advocate for better resources for mental health and addiction treatment in their communities.
It’s been painful to read some of these statistics and stories as I researched this post. There are times during my own academic and professional career when I have gone through periods of depression, and wasn’t sure how to ask for help. (Fortunately, I’m in a happy place now.) If you’re reading this as a benefits professional, do your employees -- and your execs -- have easy access to help? And if you yourself are going through a hard time, remember there are people you can talk to, without fear of judgement or implication.
If you're struggling and need help, reach out to the National Suicide Prevention Lifeline by calling 1-800-273-8255 anytime.