Here’s an employee advocating for her own health: Before a medical appointment, she checks her health insurance to make sure the visit is covered. During the visit, she takes notes. Before the doctor writes the prescription, she asks, “Are there any generics?”
If more people had taken just that last step to use generic medications, consumers and employers could have possibly saved $25 billion -- yes, that’s billion with a B -- in out-of-pocket expenses between 2010 and 2012, the Journal of Internal Medicine reported in June 2016.
Persuading employees to be their own health advocates is a win-win-win for the employees’ health, their productivity, and the employer’s health care costs. Here are three steps to turn your employees into advocates for their own health:
- Tell employees they’re protecting themselves.
The physician may take the lead in providing medical services, but healthcare is ultimately a team sport. Because of the high potential for medical errors, patients are best positioned to play offense by asking a lot of questions and clarifying communications by all parties involved.
Medical errors may lead to serious or fatal events in 80,000 to 160,000 people per year, according to an April 2013 review of 25 years of medical malpractice claims by researchers at Johns Hopkins University. The most common errors are missed, incorrect, or delayed diagnoses.
The study underscores the importance of patients speaking up. Furthermore, seeking a second opinion results in revised diagnoses in 39% of cases, according to Advance Medical, a firm that helps patients obtain expert medical opinions.
- Point your employees to technology.
The palette of digital tools to empower employees to be their own health advocates is growing. Here are two:
About 30% of employers are encouraging the use of mobile health apps to help employees become more proactive about their health, according to Mercer’s 2015 National Survey of Employer Sponsored Health Plans. For those with chronic conditions, some apps could save up to $3,000 per patient each year, reported Health IT Outcomes in September 2014.
These tools pull back the curtain on healthcare pricing by comparing the price of specific procedures across providers in a given market. Given the wide range of prices charged for even common diagnostic services like xrays and MRIs, finding a lower-cost provider can save employees substantial out-of-pocket cost.
- Offer a “script.”
Many patients are murky about what to ask their doctors. However, questions like “What are all of my options?” can trigger alternatives that save money and have better outcomes.
The Agency for Healthcare Research and Quality lists 10 questions that can spark discussions between employees and their physicians. Consumer Reports even offers videos and brochures to help patients speak up about unnecessary tests and treatments.
Resources like these can teach your employees that self-advocacy is not only encouraged, but it’s also the key to value in healthcare -- managing cost while getting the best care.
Early results from a Mercer survey made headlines this week with the news that employers are projecting that per-employee health benefit cost will rise by an average of 4% next year after they make planned changes. That’s in line with the moderate cost increases we’ve been seeing over the past few years. What was more eye-opening was finding that underlying cost growth -- the change in cost employers would see if they made no changes -- has slowed to just 5.5%. That’s a gap of just 1.5 percentage points -- the smallest we’ve seen yet.
What does that mean? For one thing, it suggests that plan members might not see major increases in deductibles and out-of-pocket maximums. Employers have been pretty aggressive with cost shifting since the ACA was passed six years ago, and many feel they have gone as far as they want to go for now. The initial plan design changes required by the ACA added cost, driving up deductibles and out-of-pocket maximums as employers sought to absorb the increases. Since then, employers have been working to ensure their future costs stay below the threshold that would trigger the 40% excise tax.
The new survey results suggest these efforts are working to hold down underlying cost growth. That, along with the delay in the excise tax implementation date (and the potential for repeal), has given employers some breathing room. In 2017 we can expect to see them continue to nudge workers to move to lower-cost plan options. That nudge will likely take the form of a bigger difference in the employee contribution or maybe a little more funding in a health savings account. Most employers remain reluctant to offer a high-deductible plan as their only plan, but they have made progress in getting people to move to them.
You can find the press release with the preliminary survey findings here. Full survey results will be released later this year.
Open enrollment season is just around the corner, and HR professionals at companies of all sizes should be preparing to share benefit details with their employees as part of their 2017 enrollment process. Questions and some confusion are inevitable, but there are ways to make sure open enrollment goes smoothly:
- Put together a cohesive package
Work with your provider or vendor partner to create a package detailing the benefits available to eligible employees, so they have just one place to look for all the information they need. It should include summary sheets, pricing, how to use the benefits, and enrollment instructions and deadlines.
- Be clear
Communication is essential to engage employees and ensure they understand the benefits and their options. Even if plans have not changed from the previous year, new employees will be accessing benefits for the first time and other employees’ family situations may have changed. Avoid the temptation to provide communication that is too technical and granular. Provide short, bite-sized pieces of information and offer ways to find more detail if an employee needs it.
- Test systems
Make sure your online enrollment system works. Testing it ahead of time prevents problems later. It’s better to get input on whether the system is easy to use and navigate before open enrollment than during it.
- Set up meetings and align resources
Regardless of all of the preparation and communication, employees are going to have questions. Set up times with your provider or vendor partner for employees to ask questions about the coverage and learn what options may work best for them. Provide your partners with resources and guidance they need to help you get your messages across in a clear and consistent manner.
- Highlight the value
Since benefits packages are part of employees’ total compensation, it is important that they understand the value they get from it. The open enrollment process is a good opportunity to convey the organization's total benefit value -- especially the hidden dollars being contributed towards benefits like life insurance and retirement plans.
Follow those five steps and you’re likely to have a solid open enrollment. To take it to the next level, consider these:
Go mobile: Introduce mobile or add more mobile options into your enrollment communications. These can be simple text messages to communicate enrollment dates or more involved interactive, mobile-friendly videos to educate employees.
Be concise: Provide clear, simple descriptions along with links to get more detailed information. Charts and infographics are a visually appealing way to convey information without making it appear overwhelming. Provide FAQs and have other resources available to respond to employees’ questions.
Be compliant, but not boring: The Affordable Care Act (ACA) is complicated and there are compliant-based communications like Medicare Part D enrollment information that must be distributed in a timely fashion. While these are important to share, they can be overwhelming so be sure they are not the focus of your communications.
When employers are working on strategies to manage health benefit cost, behavioral health benefits aren’t often top of mind. After all, only about 4% of claims are related to treatment for behavioral health problems. But what’s missing from that picture are claims for comorbid conditions – other health problems that go along with the mental illness or behavioral health issues. According to one analysis, together these account for 22% of total medical spend. 
In other words, behavioral and medical health problems very often go hand in hand. One study found that patients with depression visited their primary care doctor nearly twice as often as patients without depression in given year (5.3 visits compared to 2.9 visits, respectively).  That’s why prevention, early diagnosis and effective treatment of behavioral health issues could have a big impact on total medical spending. It’s also estimated that 24% of patients with chronic medical conditions have undiagnosed depression. Diagnosing and treating the depression might result in improved medical health.
There is also the indirect cost of productivity losses to consider. One study estimates that productivity loss related to behavioral health issues amounts to $2,025 per employee per year.  The growing problem of opioid addiction is a contributor. It’s definitely a workplace problem: 70% of people using illicit drugs, including non-medical uses of opioids, are employed. And it’s not just employees, but their dependent children that factor into the equation. With 12% of 18–25 year olds reporting that they use opioids for non-medical reasons, adult dependent substance abuse is driving medical costs for employers. And substance abuse is impacting your youngest members as well; 6% of 12–17 year olds report using opioids non-medically.  Between the direct (medical) and indirect (lost productivity) cost, opioid abuse could be costing employers as much as $8 billion per year. 
The purpose of this post was to get your attention! If it worked, now check out Sandra Kuhn’s post about what you can go to support better behavioral health in your organization.
 Castlight book of business and clinical review and indirect costs = $2,025 PEPY. 20% of $10,128 PEPY, based on Edington DW, Burton WN. Health and productivity due to behavioral health based on analysis from Castlight Clinical Team.
 Luber MP, Hollenberg JP, Williams-Russo P, DiDomenico TN, Meyers BS, Alexopoulos GS, Charlson ME. Diagnosis, treatment, comorbidity, and resource utilization of depressed patients in a general medical practice. Int J Psychiatry Med. 2000;30(1):1-13.
 Melek S, Norris D. Chronic Conditions and Comorbid Psychological Disorders. Seattle: Milliman, 2008. The National Council on Alcohol and Drug Dependence.
The nonprofit organization Catalyst for Payment Reform is hosting a series of webcasts this month focused on “Addressing Today's Leading Challenges.” I was invited to cover behavioral health -- specifically, the changing behavioral health landscape for employers and the need to develop innovative strategies to bend the cost trend and improve care.
The issue: Just to put things in perspective, mental health is a bigger issue than most realize. One in five adults and 43.8 million people experience a mental illness each year in the US, according to the National Alliance on Mental Illness. Behavioral health issues are often not addressed and tend to exacerbate other health issues. About one quarter of patients with chronic conditions have undiagnosed depression. In addition, the US is seeing a rapid rise in opioid abuse (as discussed in an earlier post). Along with the cost of medical claims (direct and co-morbid spend), employers may also feel the effects of behavioral health issues in increases in absence and disability and worksite accidents or safety incidents.
Not easy to fix: To start with, there is a stigma associated with obtaining care. Those who need care are often hesitant or unwilling to seek help. But even if a person is ready to begin treatment, access to care can be challenging. There is a shortage of behavioral health providers such as psychiatrists, and only about 50% of providers actually participate in networks. In some cases, programs are not integrated and so it is difficult for the plan member to know which program to use and when. On top of that, poor member compliance with treatment strategies is not unusual.
Good news: There is a lot of innovation going on in this area. Greater awareness of the major barriers to accessing behavioral healthcare (such as cultural influence, access issues, and cost) have spurred the development of tools and services that address them. A myriad of apps, niche vendors, and targeted programs are available to fill gaps in care delivery and offer solutions across the continuum of behavioral health needs. ACOs and other integrated care models have emerged and continue to evolve.
What should employers do?
- Focus data-driven discovery on your existing workforce. How are current behavioral health issues affecting your organization? Are you getting the most out of the behavioral health offerings?
- Offer a variety of programs. Explore the latest innovations for options that may work better for your population and needs. Select programs that will maximize appropriate use of prevention and treatment services. Make access easy.
- Build a supportive work culture. Integrate emotional health with other pillars of well-being (e.g., physical and financial).
This last point is perhaps the most important of all. You can have great programs but if your people are not comfortable using them, not much will be accomplished. The challenge is to promote acceptance of the fact that we all have problems, that sometimes we need help, and that asking for help is the quickest, most courageous way to get better.
One way to improve engagement is to provide plan members with their own personal “health guide”. Mercer is helping plan sponsors do that a couple of different ways. Mercer also just announced an alliance with Accolade: Mercer Complete Care, powered by Accolade. Check out this interview with our leader of specialty consulting services, Jean Moore, and Rob Cavanaugh from Accolade as they provide their perspective on the alliance and why we think it has the potential to enhance engagement. Now is a good time to consider the tools you are providing your employees and family members to help them access the right health care, and how that is working to support smart consumerism and effective use of care.
There was an interesting study published in JAMA this week that compares the health status of low-income individuals in two states that expanded Medicaid (Arkansas and Kentucky) with a state that did not (Texas). Respondents in Arkansas and Kentucky were 5% more likely to than their peers in Texas to say they were in excellent health at the end of 2015. This is a wider gap than was seen when the same question was asked at the end of 2014, when Medicare expansion was a year old. Because it takes time for someone to benefit from having insurance – due to the time it takes to actually get care and then for the care to have a positive impact on health – we may see continued improvement in Arkansas and Kentucky relative to Texas. While the study does not prove that Medicaid expansion caused people to be healthier, it makes sense that having insurance would have a positive impact on one’s health. This made me wonder whether the ACA has also had a positive impact on the health of those in employer-sponsored plans. Certainly the mandate for 100% coverage for preventive care comes to mind, although many employers covered preventive care prior to the ACA (and utilization is still not what we would like to see). Will the individual mandate mean more individuals seek coverage in employer-sponsored group coverage, and will that in turn result in better health in the workforce? Ultimately, it may be that because so many aspects of employer-sponsored coverage have changed since the law passed, it will be difficult to attribute any change in the health status of employed Americans (good or bad) to the ACA.
This interesting piece in Kaiser Health News sheds some light on a real gap in healthcare: Physicians are barely trained in medical school on how to identify and treat addiction. In fact, only a few hours in the course of four years of medical school are devoted to teaching addiction medicine. Schools have been so slow to change that medical students at Harvard University, for example, have started conducting their own training on how to buy and administer drugs that reverse the effects of an overdose. And Stanford’s medical school adjusted its curriculum so that lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit, relevant to future doctors in any subspecialty – and that training will continue when the students leave the classrooms for clinical rotations. As the story notes, medical schools have traditionally avoided teaching about addiction, partly because so many doctors have viewed it not as a disease but as a vice resistant to treatment in a medical context. But as this outmoded view fades, pressure is being put on medical schools to expand their curriculum in this area. While this is good news for employer sponsored plans, it will obviously take time for providers to be better trained on addiction treatment.
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.
The thinking on financial wellness has evolved a lot in the last few years. It’s no longer just about planning for retirement—it’s about how to make progress towards goals and reach financial independence. In a diverse employee population, people are in different life stages and have different mindsets, which affect their financial concerns. Here are five tangible ideas to start a conversation about financial health in your workplace to bring about positive change.
1. Understand the strategic benefits
Financial stress can lead to absenteeism, presenteeism and low productivity among employees, but financial wellness programs can tackle these problems and complement talent acquisition, retention and other people-related issues that determine an organization’s future success.
High-performing programs have a clear tie to business results. Improving your workers’ financial wellness has an effect on how patient, productive and engaged they are on the job – and ultimately on revenue and profits.
2. Provide individualized content
An effective financial wellness program resonates with each and every individual. Say “401(k)” to the 23-year-olds just out of college and they might just tune out. However, they may be more likely to listen if the conversation is about saving to move out of their parents’ house or paying off their student loans. Gathering quality data about your own employees lets you know what vendors and resources to invest in. Don’t make assumptions about your people – ask them what is top of mind. Of course, there are some issues with self-reporting – some might be overly optimistic about the true state of their financial affairs and others might not know – but this is a good place to start.
3. Focus on real action
A lot of Americans aren’t financially savvy, which has real consequences on their finances. Even when financial education programs are offered for employees, it is difficult to get them to make the connection between learning and acting on what they have learned. Employees should be given the proper tools to be guided on an action-oriented path for their individual circumstances in order to make significant strides towards financial wellness.
4. Rely on thoroughly vetted, integrated and monitored vendors
Every day, there seems to be a new services provider offering ways to improve your employees’ financial health. It’s a jungle out there – and picking the wrong vine to swing from could land your employees in an alligator-infested pond! Every vendor chosen for employees should be highly regarded in their area of expertise and then monitored to confirm that they maintain this standing, uphold the promised level of service, and minimize ongoing reputational and operational risk.
5. Employ insightful metrics
As you start to understand statistically significant segments of your population, you can then think of targeted strategies for each group, rather than speaking to your employees as a homogenous whole. For example, cluster analysis is a statistical method of grouping people based on important shared characteristics: gender, ethnicity, age, location. While there will always be exceptions, this “profiling” does generally provide a relatively accurate picture of the needs of different employee groups because it’s based on actual data.
As a new field, financial wellness is not yet well-established and is evolving rapidly. As we learn what works and what doesn’t work, we need solutions and products that can adapt and respond rapidly. A key buzzword in this area is “iteration,” where we see what is working or not and adapt the solution in response to that feedback. In the case of digital solutions, this can lead to weekly or monthly releases of enhanced solutions.
If you’re thinking of introducing a financial wellness program in your organization, find out what’s keeping them your workers from meeting their various financial goals, instead of just making assumptions. Then you’ll be better equipped to find the solutions that will fit for the needs you discover.
This post is part of our 2017 Planning Checklist series.
The latest and top iPhone App – Pokémon Go – has some unexpected health benefits. The new app from Nintendo (that’s right, the makers of Wii and Wii Fit) requires users to walk around outside and capture the Pokémon around them. The app has users walking, running, and jumping through their neighborhoods to capture the Pokémon. Check out the description in this Mobi Health News article. Perhaps this app will inspire your next workplace wellness challenge.
I was interested to read about a Harris poll on millennials’ savings priorities. The good news is that they are saving – in fact, they are saving more than their Gen X counterparts. The not-so-good news is that they have a lot of priorities that come before saving for retirement – and they’re hoping to retire, on average, at a youthful age 62! Just another nudge for employers to step up communications encouraging optimal use of all the employer-sponsored benefits and provide tools to support effective financial planning. We’re not talking about adding new benefits – just better packaging and communications for higher employee engagement and appreciation.