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DBGB Brown Paper - April 2009 |
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In this issue:
Benefits not on the chopping block
"The recession that we are experiencing in this country is really a wake-up call for both employers and employees," Bill Mullaney, president of MetLife's Institutional Business said Monday at MetLife’s 5th Annual National Benefits Symposium.
The forum served, in part, as a venue for the company to roll out findings from its 7th Annual Employee Benefits Trends Study. The study is composed of more than 1,500 interviews with benefits decision-makers, which were conducted last August and November.
The study allows us to keep our hands on the pulse of employee benefits trends, said William Raczko, vice president of MetLife’s Institutional Business. "These days that pulse is beating pretty rapidly due to the pace of change in the economy," he added.
Still, employers remain steadfast on preserving workplace benefits, according to the survey. Fewer than 15% of employers expect to scale back their benefits programs.
About 40% of small employers (those with less than 500 workers) and 50% of large companies (those with 2,500 or more employees) realize that there is a strong connection between workplace morale and the quality of employee benefits.
The survey also reveals that benefits are influencing employee loyalty far more than employers realize. For example, 72% of workers indicated that retirement benefits were a key factor in influencing loyalty, compared with 40% of employers.
"One of the things that was surprising to us last year was how grateful and appreciative employees were about benefits they received in the workplace, whether they paid for them themselves or not," reports Mullaney.
Mullaney thinks the findings indicate employees appreciate a broader range of benefits. He says the economy has served as a wakeup call to employees who now appear more interested in and appreciative of both their employer-paid and voluntary benefit plans than ever before.
Of the more than 1,300 full-time employees MetLife interviewed last August and November, 40% were highly interested in a wider array of voluntary benefits. But the problem is that only 17% of the more than 1,500 benefits decision-makers polled included expansion of voluntary benefits among their top strategies for 2009.
Building worker loyalty may also mean companies have to better leverage other employee benefits, like life, dental, disability and vision. About 70% of employees report non-health benefits play a strong role in workplace loyalty, a jump from 51% in 2007. Just 41% of employers said the same in 2008.
Source: BenefitNews.com, March 24, 2009
Group LTC coverage draws a younger crowd
Employees who buy long-term care insurance under a group plan at the workplace are younger than those who buy LTC coverage on the individual market, reports the American Association for Long-Term Care Insurance.
The California-based trade group found that 24% of buyers purchasing LTC coverage through an employer-sponsored plan were between the ages of 35 and 44, while only 5% of consumers who purchase LTC insurance on an individual basis fell into that age category.
Even in the 45-to-54 age range, the proportion of individuals buying LTC protection in a group plan (36%) outpaces the proportion of those buying the insurance on their own (24%). By contrast, 53 % of individual purchasers were between the ages of 55 and 64, compared to only 23% of group buyers, according to the 2008 data by AALTCI.
Group customers are more likely to select longer coverage and collect claims against their policy at a younger age, compared to individual buyers. The organization reports that 8.2 million Americans have LTC insurance, and about 400,000 new policies or group certificates are issued annually.
With group coverage, the average premium cost for employees between ages 45 and 55 was $690. The data shows, however, that participants in that age category could face premiums as low as $430 per year or as high as $985 per year.
In the study, the largest open claim under a group plan exceeded $490,000, and the member had been on claim for over nine years.
AALTCI also analyzed claims being paid to members covered by an employer-sponsored LTC insurance. For example, 13% of new claims opened during 2008 were for individuals younger than age 60, and 11.5% of new group LTC claimants file their claim during the fourth or fifth year of their coverage.
"Because many employer-sponsored plans offer some form of simplified underwriting or even guaranteed issue, we expected to find more people qualifying for benefits at younger ages,”"explains Jesse Slome, AALTCL’s executive director.
The trade group examined data on 95,000 purchasers of employer-sponsored LTC insurance and over 200,000 individual customers.
Source: BenefitNews.com, March 26, 2009
All this and a tooth cleaning, too
Dental spa services grow in popularity among consumers, practitioners
It would seem like a no-brainer that most people would much rather get a massage, a manicure/pedicure or facial than go to the dentist. But what if consumers - especially the most dentist-phobic among us - could combine all of the above?
Building a booming business out of this idea, dentists and providers of spa services have joined forces to create the latest trend in dental care: the dental spa. Touting themselves as a place where you have permission to be pampered - after all, experts recommend everyone should have a tooth cleaning twice a year, and more often for high-risk groups - as well as an atmosphere that can calm the fears of people scared of the dentist.
Going to the dentist shouldn't be this bad thing," Dr. Kimberly Baer, founder of the Bethesda Dental Spa in Bethesda, Md., told The New York Times. "It should be like going to get your hair done."
Or where you get your hair done, as dental spas and the services they offer continue to grow. Research shows about 5% of the American Dental Association's members define themselves the dental spas, offering traditional dental services (cleanings, fillings, tooth repairs), in addition to cosmetic dentistry like tooth whitening, veneers and implants, and spa services, including massage, nail treatments and facials.
Dental spas are even decorating their facilities to look the part, soothing consumers with soft colors and music, waterfalls, candles, aromatherapy, coffee and fresh-baked cookies. (See sidebar for additional dental spa amenities EBN discovered in our research.)
Apparently the strategy is yielding converts and cash. The Academy of Cosmetic Dentistry reports that cosmetic procedures have grown 12.5% in the last five years, driven primarily by demand for tooth whitening. As such procedures are not generally covered by dental insurance, the dentists who perform them can keep all of the profits. Research shows services outside the scope of traditional dentistry - never mind spa services - can range in cost from $300 to more than $10,000. And obviously, patients who leave the dentist's chair more relaxed and satisfied will be repeat customers.
However, John Chien, co-founder of Dental Spa, the first such facility in the nation, says what matters most at dental spas is not the profit or perks, but the patient. "With the recent interest around the world about dental spas and spa dentistry, dental spas are becoming more than just a trend, but rather a concept that has earned the attention of consumers and the dental industry alike. Our clients have been very clear in articulating their needs. We are responding to demand and letting the marketplace decide."
Health benefits
Call it a gimmick, but if it takes scented candles and pedicures to get Americans to get regular dental care, so be it, some dental experts say.
According to American Dental Association, more than 20% of Americans have gone more than a year without a dental checkup. A MetLife survey shows 38% of members haven't been to the dentist in at least 18 months. When asked why, 85% said because they are healthy. However, among those, 85% to 90% acknowledged they have experienced tooth pain, bleeding gums and rough edges along their teeth - all signs of periodontal disease.
In that regard, for the dental community, beggars can't be choosers.
"Our focus is on preventive care and raising awareness about the importance of good oral health," says Jill Roman, a spokeswoman for Cigna Dental. "If one of our individual customers chooses to have their oral care done with a contracted dentist in our network, which may also happen to be a dental spa, we wouldn't even necessarily know it, as we are billed for the same procedure codes from a dental spa as we would be from a regular office. The procedure codes for dental care are the same, no matter what office it comes from."
The dental community has taken great pains to cement the link between oral health and overall health, hammering home to employers that helping employees take care of their teeth and gums should be part of their general wellness effort.
A 2000 Surgeon General's report on oral health took the first steps in establishing the healthy mouth-healthy body linkages, and the dental community has been working to bring the message to employers and the general public.
"The knowledge has been out there for a while, but now because of concerns with the rising cost of medical care, there is more discussion around the part that oral care plays [in overall wellness]," says Evelyn Ireland, executive director of the National Association of Dental Plans. "Dental plans are starting to change benefit structures to support the science, and companies are becoming more willing to invest [in dental benefits] in the hopes that chronic disease costs can be avoided."
Research shows that patients with diabetes, heart disease and high-risk pregnancies all can have better health outcomes by practicing good oral health.
In addition to health benefits from preventive dental care, some dentists have found that spa services and amenities helped relax patients so that their blood pressure no longer spiked before they underwent dental procedures, and so that they had fewer negative reactions to anesthesia.
A first-hand account
Recently, EBN Editor-in-Chief Kelley Butler - an admitted dental-phobe - visited a dental spa. Her experience and opinions - limited to this one facility - are detailed below.
As I entered, I noted the calming purple and gray walls, lined with overstuffed and very comfy-looking purple chairs across from a flat-screen HDTV. Clearly, I thought, the dental spa biz is lucrative.
A kind nurse asked me if she could get me something to drink. My nerves were a mess, but since I doubted a vodka tonic was an available beverage, I simply asked for water, please.
I filled out the traditional paperwork - name, address, brief medical and dental history, HIPAA disclosure form - then I waited, alternately wanting and not wanting to hear my name called.
When I was taken back to the exam area, the chair I sat in was quite cushy, but that's where any similarity to a spa experience ended.
The walls were stark white, and none of the staff asked me a thing - Neck massage? Facial? Pedicure? - except for my credit card, as the facility does not take my insurance.
With the finances taken care of, I then saw the doctor. She put orange plastic glasses on me (and no, they don't show episodes of "The Office," - see sidebar) and got right to work with the Cavatron - the dreaded scraper that makes noises like a drill and also sprays water. It was awful. Not painful, just loud and uncomfortable. I wished for my iPod, or at least the classical music through headphones I'd heard about during my research for this article.
When I asked about headphones - and where were the pedicures and massages, by the way? - the doctor chuckled and made note of the foot massagers in the front lobby. Seriously? What a rip-off.
I left with cleaner teeth and, since they didn't take my dental insurance, a lighter wallet.
I didn't, however, feel relaxed nor do I now hate the dentist any less. I'll try one more dental spa just as a comparison (I'll post the details of that experience on EBN's blog, the "Daily Diversion"), but I'm thinking I'll stick with the standard dentist from now on.
Source: BenefitNews.com, October 1, 2008
Retracing our steps: Medical missteps linked to 30% of health care expenses
Facing impending congressional action on health care reform and an increasing clutter of managed care and wellness benefit offerings, employers find themselves caught between a rock and hard place. Medical costs have continued to rise, in spite of decades of cost controls and managed care programs.
Instead of trying to squeeze more dollars from doctors and hospitals, employers have a better option: realizing significant cost savings and improved employee satisfaction and treatment outcomes by helping employees and their doctors make the right decisions about care.
Some experts believe that as much as 30% of our country's health care expenses are devoted to the problems caused by misguided medical decision-making, a problem that ironically has been worsened by the well-intentioned efforts of managed care.
The real-life experiences that employees encounter underscore the importance of fixing this problem. Consider the case of "Mary," an employee of a large company in the Midwest.
Mary found a small lump in her breast and was seen by her primary care doctor, who quickly referred her for a series of tests. The diagnosis was cancer in one breast and several lesions in the other breast that did not meet the criteria for cancer.
Mary's doctors explained that the current evidence-based approach was surgery to remove the cancer in the one breast, while taking a watchful-waiting approach on the other. However, she read on the Internet that, in some cases, it was best to be more aggressive and do a bilateral mastectomy.
She showed the articles to her doctors, who assured her she did not have to worry. Her case was straightforward, they told her, thanks to early detection and intervention. Eighteen months later, she was dead of metastatic breast cancer.
It turned out that Mary's cancer was more aggressive than anyone suspected. By the time of her follow-up mammogram months later, there were a number of tumors in both breasts, and cancer cells had spread to other parts of her body. Her doctors finally performed a double mastectomy and a series of different treatments over the next year, but to no avail.
The insurer played the odds on Mary's case. In some cases like hers, it is better to delay surgery as long as possible. But Mary's insurer paid for both the invasive treatment and the cost of an advanced disease that could have been avoided by doing the right thing from the beginning. The protocols of treatment encouraged by managed care often discourage doctors from doing more investigational work, and the time constraints doctors face every day reduce the odds of full clinical deliberation.
Point-of-care medical decisions like these are the greatest drivers of employer health care costs. It is the cancer patient trying to decide on the right course of treatment; the mother trying to decide how best to treat her baby born with a heart defect; the patient who has seen four doctors and can't decide between four opinions.
Recent research on treatment plans has shown that initial diagnosis and treatment decisions were either incorrect or inadequately supported in more than two-thirds of cases. Almost one-third of the cases featured insufficient workups, where additional testing was needed in order to make sound clinical judgments.
As a result, more than 20% of the cases had incorrect diagnoses, and more than 60% had incorrect treatment plans. Nearly half of patients reported that they felt something was going wrong in their care, and they weren't sure where to turn for help.
Employees' acute care decisions immediately affect their lives and the bottom lines of the businesses that pay for their care. Employers that can help their workers get the right diagnosis and treatment early will provide a concrete health benefit that saves money on medical costs, drives high levels of employee satisfaction and improves the quality of care.
In the current health care reform debate, the value of clinical accuracy for both patients and employers deserves greater consideration.
Source: BenefitNews.com, March 25, 2009
Yoga can help employees stretch away stress, anxiety, burnout
Yoga can play a strong role as part of an employer's overall efforts to promote wellness, disease prevention and physical activity among employees. It also can dovetail nicely with an employer's initiatives to encourage employees to take more personal responsibility for their overall health and health care decision-making.
Yoga is a combination of physical poses (called asanas), breathing techniques and guided meditation. It is proven to bolster strength, flexibility and balance, says Terri Kennedy, a yoga teacher and board chair for the Yoga Alliance.
It has been used to help patients with back pain, insomnia, anxiety, depression, arthritis, heart disease and fatigue — all big known sources of presenteeism and increased costs for employers. It's also been used to relieve stress for cancer survivors. "Yoga is increasingly used as medical therapy," Kennedy notes. "It's the most commonly used complementary and alternative medicine therapy."
But can it reduce the cost of medical claims related to physical inactivity, obesity and heart disease? "Being preventive, it's very cost-effective," says Sat Bir S. Khalsa, an assistant professor of medicine at Harvard Medical School, who has studied the effectiveness of yoga in treating insomnia. "The math is very simple. If you practice these techniques, you will reduce costs. If you use yoga as a therapy for one thing, you're not just treating that one thing. You're treating yourself as a whole."
In fact, yoga can help with conditions typically associated with office work, such as eyestrain, carpal tunnel syndrome and back pain, according to Rachel Permuth-Levine, a deputy director at the National Institutes of Health's Heart, Lung and Blood Institute in Bethesda, Md. She teaches yoga classes for NIH employees, and she organized a yoga week for NIH employees and local residents.
"The best thing you can do for your workers is provide as many stress management modalities as possible. If you are stressed at work, it creates a culture of stress," she says.
Twila Stevens, a yoga instructor in Corpus Christi, Texas, recalls one student who said yoga helped her deal with tension between co-workers. Another student said yoga helps her relax during hectic business travel. Likewise, Stevens credits yoga for a reduction in her own anxiety and back pain.
Yoga helps people become better at maintaining concentration and coping with their emotions, which is important in a workplace setting, according to Khalsa. However, he cautions, one yoga class per week is probably not enough to produce lasting stress relief and lasting health benefits.
Employer programs
Health considerations aren't the only reason employers provide yoga classes for their workers. "It's really to offer additional benefits to their team. It's stress relief, and it brings the people together in a way that you normally don't get," says Kimberly Wilson, the founder of Tranquil Space, a yoga studio in Washington, D.C. "It's a great bonding experience for the students."
About 10 employers contract with Tranquil Space to provide yoga classes for their employees at the worksite. In addition to regular yoga classes, employers can opt to provide a one-time workshop on a specific topic, such as newbie yoga, lunchtime stress breaks, desk yoga or mindfulness training.
Sandia National Laboratories, a national security laboratory in New Mexico, offers free yoga classes at an on-site fitness center for its 8,300 employees.
So far, yoga has been a hit. "There's a great deal of call for it. Yoga has always been consistently attended here. It's one of those classes you can take and go back to work and not smell really bad," comments Stephanie Holinka, a spokeswoman for Sandia. Unlike aerobics or other types of exercise, yoga doesn't require a shower afterwards — something that employees appreciate.
One of Sandia's main reasons for offering yoga is to help workers feel more relaxed and less stressed, she adds. "On the days that I've gone, I feel so much clearer when I get back here. You end up coming back with a lot of energy, which is nice," she says.
In addition, "The yoga instructors tend to be very accommodating for a variety of fitness levels, which is really important. They tell folks how to modify, and they're accepting when you need to modify because of an injury or illness," Holinka says.
Something for everyone
Some workers might think they're too old or too inflexible to try yoga, but experts say anyone can do it. "Yoga has many styles to fit everybody — every age, capacity, need," says Kennedy. "There's something for everyone." Permuth-Levine agrees that yoga is highly accessible and attainable for most people.
To increase participation for your yoga classes at the worksite, Permuth-Levine suggests keeping the cost low (or free) and talking about how yoga can help with productivity and focus at work.
A quick demonstration may be helpful because having a positive experience and directly feeling the benefits of yoga is what will attract more employees to participate on a regular basis, Kennedy says.
Although yoga comes from an ancient Indian spiritual tradition that includes meditation and chanting, a class does not have to include a spiritual component, so employers can assure their employees that the class will be nonreligious.
With layoffs, financial strains and employee stress at high levels, it's no wonder that some employers are looking for ways to relieve that stress. When employees are in downward dog or tree pose, they're not worrying about layoffs, travel budgets or the downward spiral of the stock market.
Source: BenefitNews.com, March 25, 2009
Minority report
Making disease management effective for African-American worker
Although disease management programs are a common benefit, if they are not well-designed and well-communicated, they may not benefit a common target group -African-American employees, who are at a higher risk for several chronic diseases. When employers measure the effectiveness of their disease management program, an important assessment is whether the program is meeting the needs of all at-risk groups, and African-Americans in particular.
According to Dr. Larry Luter, chief medical officer at Meritain Health, a third-party administrator and disease management provider: "Compliance for disease management programs remains low across the board, but especially for African-American employees. The information that is typically shared during interactions between a disease management nurse and the [patient] is significant and vital for the successful empowerment of the patient. Too often, this information isn't effectively delivered by the nurse in the one-on-one telephone encounter. We know this because of the poor participation rates of most disease management programs, often less than 20%."
In addition, he notes, "Among the African- American community, there may be a trust issue with HR or benefits staff, which could further drive poor participation." (See related coverage about how benefit managers can more effectively target minority employees for disease management programs)
RACIAL DISPARITIES
African-Americans, who represent 13% of the U.S. population, are disproportionally impacted by certain diseases, including HIV/AIDS, diabetes, cancer, heart disease and stroke, according to statistics from the Centers for Disease Control and Prevention. For example, in 2001, African-Americans with diabetes were more than twice as likely to die than white Americans with the disease.
African-Americans also have higher rates of obesity, new gonorrhea infections and death by homicide, compared to white Americans, according to the CDC. In addition, three of the 10 leading causes of death for African-Americans are not among the leading causes of death for whites: homicide, human immunodeficiency virus (HIV) and septicemia.
In 2002, African-Americans trailed Caucasians in four positive health indicators: having health insurance coverage (81% of non-Hispanic blacks versus 87% of non-Hispanic whites); taking a flu vaccine (50% versus 69%); receiving prenatal care in the first trimester of pregnancy (75% versus 89%); and participating in regular, moderate physical activity (25% versus 35%), the CDC reports.
Health care can be strongly influenced by economic circumstances, language and cultural beliefs about disease and the human body. The CDC cites several factors to explain racial/ethnic health disparities, including differences in access to preventive care; education; employment; income; physical activity; alcohol intake; neighborhood conditions; work conditions; and racial/ethnic discrimination.
Dr. Tim Moore, executive vice president of health improvement and clinical services at Alere, a firm that provides disease management programs, explains, "There's some genetic predisposition to many of these conditions that are at a higher incidence. Sometimes there's been evidence of a lack of access to the same type of health care that their counterparts have achieved. It's a multitude of various contributors to this."
Because so many factors are involved, "simply expanding coverage is not going to eliminate disparities," says Cara James, senior policy analyst at the Kaiser Family Foundation.
SOLUTIONS
It's not a simple thing to figure out whether your disease management program is meeting the needs of African-American employees, but it's worth the effort.
In addition to addressing the conditions that are more prevalent in African-Americans, Moore recommends keeping an eye on health indicators, such as blood pressure and cholesterol levels, to see whether those indicators are improving among employees who are enrolled in a disease management program.
Patient satisfaction surveys are another way to gauge whether the disease management program is meeting the needs of African-American workers.
Sabrina Corlette, director of health policy programs for the National Partnership for Women and Families, says large employers should push insurers to collect data on race so that it's possible to know whether the health disparities are growing or shrinking.
In addition, employers should ask their carriers to explain what steps they are taking to eliminate health disparities and what the network doctors are doing to provide culturally competent care.
Meanwhile, James stresses the need to get more doctors into underserved communities and encourage them to stay there, so the local residents have good continuity of care.
Promoting a medical-home model centered on primary care and disease prevention can help to reduce some disparities in health care, according to Corlette.
PROMOTING THE PROGRAM
Like most benefits, disease management programs need to be frequently communicated and clearly explained to employees. Moore says, "It is really a sale that you have to do at the individual level. You can't just call them and expect them to want to participate in the program. It's very important that you make those benefits very personal for them so they can understand how these programs are going to personally improve their well-being, their family. At the end of the day, features are nice, but personal benefits are going to weigh a lot more."
Verbal communication in simple, plain terms is the most effective way to communicate about the health issues, so that's what disease management vendors and employers should be doing, Luter says.
"Getting the member's attention and conveying the relevance of the information is critical," he remarks. "Members must know that they have more control of their own health outcomes than they [realize]. There are many opportunities to get this information into the hands of the members, so that they can effectively manage their conditions along with their physicians. The HR professional should look for opportunities within the organization where this health information can be shared."
To engage African-American employees, Moore recommends relying on social networks, like local churches, community groups and health fairs.
But, he warns, "It's probably not reasonable to say, 'Here is one approach that works for all African- Americans,'" since there are regional differences that impact health.
A guide from the Office of Minority Health, an arm of the Department of Health and Human Services, sums up the reason for providing culturally competent programs: "Health care services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients can help bring about positive health outcomes."
Source: BenefitNews.com, March 24, 2009
Greasing the wheels
Research results from 500 employers offer insight into making wellness incentives effective
For decades, employers have offered health care benefits to help attract and retain skilled employees. Now, their interest is growing in the health-related productivity effects of their benefits programs.
Late last year, I presented a Web seminar hosted by Employee Benefits News that included Integrated Benefits Institute's recent research on the incentives and disincentives employers use to promote workforce health and productivity. The significance of health-related productivity was underscored by the results of a real-time survey during the program, in which more than 92% of the viewers said this is an "important" or "very important" outcome from their company's benefits program. None said it wasn't important.
This commitment likely reflects the challenge employers now face to be more effective in driving bottom-line impacts from all their existing resources - including their most valuable asset, their employees. This goal for employers also fits well with the aim of employees to enjoy a healthy and productive life, both at home and at work.
IBI's survey
IBI conducted the incentives research in response to employers telling us that they need information and evidence about incentives and disincentives programs to help make the business case for improving workforce health and related productivity. Several researchers have studied employer use of health-related incentives and disincentives, but little information is available on the goals employers seek from such programs or their effectiveness in meeting those goals.
IBI surveyed more than 500 employers to document their use of incentives and disincentives to encourage health and productivity for their combined 5 million employees. We examined current programs and developed much new information for employers about barriers and challenges to implementation, goals employers seek from their programs, which incentives and disincentives are used for which goals, their relative effectiveness, the amount spent on programs and what employers would do differently.
One might suppose that employers would draw on those incentives and disincentives that they believe to be most effective to meet their bottom-line goals. This research shows, however, this is not the case, and suggests that employers still are in the early stages in designing incentives programs that meet their workforce health and productivity goals. Based on our findings, we advise employers to:
» Embrace incentive programs.
Ask almost any employer, whether large or small, and they'll say the burden of medical insurance, health-related absence and lost productivity can be a significant problem. IBI's survey shows that employers understand that this cost burden justifies substantial employer activity in encouraging healthy behaviors and discouraging unhealthy ones. Almost three in four implement at least one incentive to promote healthy, productive employee involvement. Disincentives are used less frequently, with only one in 10 penalizing employees that fail to cooperate in health and productivity promotion.
What's more, the breadth of that implementation is significant, with employers reporting, on average, almost five different types of incentives in place and 1.7 disincentives. Midsize employers provide the most incentives, but even smaller employers with fewer than 500 employees average more than four health and productivity incentives in place. Employers use cash-based and benefits-related strategies for incentives and disincentives most frequently; prizes and gifts are less common; while salary and job disincentives are used by just a few.
» Make a substantial investment.
For many employers, the true test of involvement isn't just having an incentives program, but rather, how much they're willing to invest or to penalize. We find that employers place substantial value on their incentives and disincentives programs. About 50% of respondents value their incentives and disincentives at more than $200 per participant, per year, and more than one in five value them at more than $400.
The current amounts may not be sufficient, however, to motivate the desired behavior. When asked about future plans, 42% of the employer participants said they would increase the dollar value of their incentive-based programs. This contrasts with the fewer than 12% who said they would impose higher financial penalties as part of their disincentives approach. When we asked respondents how much they would increase their investment, those currently offering in the $201 to $300 range would increase their investment by 42%; those in the $301 to $400 range by 117%; and those in the $400+ range by 19%.
» Link goals to bottom-line outcomes.
One of the unique issues explored in the IBI survey was to identify which of three health and productivity results employers seek- participation, behavior change or improved outcomes - in offering the different incentives and disincentives. One might think that employers would seek better health outcomes to justify their incentives investment. Instead, we found an emphasis on simply participating in a health and productivity program - or just "showing up."
Improved outcomes were significantly less sought after. We examined the frequency with which employers reported an outcomes goal for at least one of their incentive/disincentives programs. By this measure, we found that only half the employers surveyed seek to promote better outcomes through at least one of their programs. Encouraging employee participation in a health and productivity program is most common at 77%, and about two-thirds seek behavior change. By another more telling measure, outcomes are included as a program goal for only 14% of the incentives/disincentives reported, on average, by each employer.
This is the first disconnect the survey uncovered. Positive outcomes - such as weight loss, fewer health risks and heightened productivity - would best serve employers' health and productivity targets. Employers probably are at the early stages in development of programs of this type and are experimenting with interventions that are the least intrusive and where success is easily measured. There also may be confusion about what federal regulations allow when incentives/disincentives target outcomes.
» Choose the most effective incentives.
An apparent reluctance or inability to match goals to bottom-line business concerns isn't the only disconnect we found. The research shows that employers believe some incentives and disincentives are more effective than others, but they tend not to use the most effective programs.
Apparently, employers don't view the incentives they provide as optimal from the viewpoint of effectiveness. The same pattern exists for disincentives, where employers are notably unwilling to mandate disincentives they find most effective, such as salary reduction or job sanctions.
Perhaps this behavior also reflects a time of shaking out, where more experience with their programs will come to result in better focus. Or, perhaps they don't believe their corporate culture will support the use of effective incentives and disincentives.
This isn't always the case, however. Providing full benefits and full salaries for workers involved in transitional disability return-to-work programs is viewed as the most effective incentive, is frequently offered and tends to be associated with outcome goals more than any other incentive.
Making further progress
To help employers better reach their wellness goals, IBI created a member solutions board from its supplier and employer members to offer expert advice based on research findings. Among the board's advice:
» Change your corporate culture.
Employers may believe their corporate culture won't support an aggressive, outcomes-based program. When we asked employers with no incentives program why not, corporate culture was the most important reason. Certainly, any incentives/disincentives program must fit an employer's culture or the culture must be changed to support an employer's goals. By the same token, any culture change will involve effective communications. When we asked employers with programs what they would change, their most pressing need is a more effective communications strategy.
Among many suggestions, MSB tips regarding corporate culture include: top-down participation and communication; listening carefully to what employees value; beginning culture change with a simple, understandable program and building on successful results to more complex programs; and assuring that the information sent by outside partners fits with and reinforces your corporate culture.
» Build toward outcomes goals.
In interviews, employers told us they aren't sure which outcomes to seek or how to measure results. The board advises employers to justify their programs by measuring results broadly and holding any suppliers accountable for measurable, defined results across benefits programs. Fortunately, affordable, accessible measurement programs now are available in the marketplace, including through IBI.
The board suggests setting simple, short-term participation goals at first, as they are easy to measure, present less of a culture challenge and have fewer regulatory restrictions. After a few years of communicating and educating workers about the importance of health, employers should be more aggressive and able to target multiple outcomes to justify the investment in incentives that will drive savings to the bottom line.
» Move to more effective rewards and disincentives.
Refining and adjusting the corporate culture will help employers move to offering the most effective incentives and disincentives over time. The board suggests, however, that employers may be right in delaying use of disincentives until they can be justified by measurable benefits against the risk. For now, employers might consider using disincentives to target unpopular and costly behaviors, such as smoking, or to obtain such important information in health risk assessments. HR/benefit managers may look to the experience of risk managers within their own company in using incentives and disincentives to encourage safety and workers' compensation compliance.
For a summary of the incentives research and for more about the challenges identified and expert tips for meeting them, go to IBI's Web site, www.ibiweb.org. You also can access information on IBI's research, measurement and forum programs.
Source: BenefitNews.com, March 1, 2009
Weight loss programs gain popularity
About half (49%) of employers who have wellness initiatives offer a weight loss program, with 46% citing the need to control health care costs and 35% claiming quality of life for employees as their reason for the offering, reports the International Foundation of Employee Benefits Plans.
"Helping employees maintain a healthy weight is one way employers believe they can control health care costs," says Kelli Kolsrud, senior information and research specialist at IFEBP. "Employee weight loss programs have gained popularity in recent years. These programs are often successful because participants have a built-in support system. Morning donuts are replaced with fresh fruit, lunch hours are spent walking with colleagues - it's really about building a culture of wellness that encourages success," she adds.
The survey on wellness programs found that wellness competitions were the second most popular program under fitness and nutrition, with 48% of respondents offering walking and fitness challenges. Forty-two percent of employers provide healthier food in the cafeteria or snack areas, while 33% supply on-site fitness equipment and 32% offer off-site fitness programs and gym reimbursements.
Companies are getting the word out that they want their employees to lead a healthier lifestyle though online resources (61%), health fairs (57%), nurse advice hotlines (53%) and wellness newsletters (52%), the survey report notes. Most wellness programs are relatively young, with 67% of employers indicating that their initiatives have been in existence for four years or less.
To drum up participation by employees, four-fifths of wellness programs entail some type of incentive. The most popular incentives include non-cash prizes (39%) and gift cards (32%). Of those companies that use wellness incentives, 22% offer cash rewards and insurance premium reductions.
Source: BenefitNews.com, February 24, 2009
Risky behavior: Employees scrimp on Rx costs
Americans have become blindsided by prescription drug costs recently, leading many to partake in unsafe practices to control those costs, a Consumer Reports poll discloses.
Physicians, as well as employers, should aid patients and employees in fully understanding the dangers associated with medication noncompliance, as well as introduce other options available to patients for combating rising drug costs.
According to the survey, 66% of responding consumers didn’t know the price of their medication until they picked it up at the pharmacy counter, while a mere 4% discussed pricing options with their doctor.
Ignorance breeds hazardous behavior as 28% informed the magazine that they’d taken potentially dangerous measures to save money on prescriptions, including not filling prescriptions, skipping doses and cutting pills in half without consulting their doctor.
In a separate study featuring Hispanic American respondents, half of the demographic said they were not adhering to their doctor’s prescriptions, and almost 3 in 10 had chosen to not fill a prescription for financial reasons.
Even more troubling, Hispanic Americans and the greater population do not fully trust, let alone take advantage of, generic drugs. Forty-seven percent of Americans had reservations or misconceptions about taking generic medicine, with 43% of Hispanics claiming that generics sometimes or never work, leaving them with misgivings for the low-cost option.
News of the potential benefits of generic drugs has not fully infiltrated the public psyche, as 52% of the population is spending more than $50 per month on prescription drugs. Physicians are one of the parties to blame for not fully educating their patients about generics, as 46% of consumers said their doctor never or sometimes recommended generics.
The pharmaceutical industry has greatly contributed to misappropriating the value of generics, pushing more individuals to doubt the efficacy and safety of these drugs.
One-fifth of individuals who regularly take a prescription medication have requested a drug from their doctor that they had seen in an ad campaign, with 67% reporting that the doctor wrote that prescription. Within that original group, 80% had received free drug samples from their physician.
“The pharmaceutical industry undermines generic drugs very effectively through advertising and free samples of brand-name drugs, while using more subtle tactics to tell patients and doctors that generics are something to be afraid of,” said Dr. John Santa, director of the Consumer Reports Health Ratings Center.
Tactics committed by the industry that instilled the most concern include rewarding doctors to write more prescriptions (82%), giving them fully paid trips (77%) or gifts over $50 (76%), and paying for a doctor’s attendance at meetings (67%)
Source: BenefitNews.com, March 26, 2009
President addresses health care at first-ever 'web-hall' meeting
Earlier this afternoon, I posted live Twitter updates on President Obama's first -ever online web-hall meeting. Taking a variety of questions from Internet viewers and a live White House audience, the president addressed several queries on health care.
One online questioner asked: Why can't we have a universal system based on patients' need, not finances?
Calling the employer-based system "an accident of history that works," Obama confirmed that employer-based health benefits should continue to be the foundation of the nation's system of care, but that we need to "fill gaps" in access and focus on prevention. Further, addressing critics who said his current budget proposals will swell the country's deficit, the president responded that one of keys to reducing the deficit is addressing problems in accessing and purchasing health care.
An audience member asked the president about how to amend insurance rules so that individuals with preexisting conditions still can obtain care and coverage affordably.
Referencing his mother's difficult struggle with ovarian cancer that was made even harder by "fighting on the phone with insurance companies," Obama emphasized that any reform of the health care system has to address pre-existing conditions in that insurers must be obligated to provide coverage.
Lastly in a humorous moment, the president addressed the question that won the most online votes: Is legalizing marijuana a sound strategy to aid economy? Joking about the interests/focus of the voting audience, Obama confirmed no, legalized marijuana is not an economic recovery tool.
I thought the web-hall was a great way to include "regular people" in government. If President Obama hosts another web-hall meeting, what question would you most want him to answer? Comment and let me know.
Meanwhile, see EBN coverage of health experts' wish list of topics for Obama to address, and join our live discussion of all benefits topics on Twitter at www.twitter.com/ebneditor.
Source: BenefitNews.com, March 26, 2009
Exercise Corner: Buttocks Deskercises
Whether you sit all day or not, buttocks are an area of the body that we often neglect until we notice the area increasing in size! This exercise can be done while sitting in a chair or lying on your back with your knees bent. Do it several times a day to tighten those buttocks and firm your fanny!
Tighten and squeeze your buttocks, hold five to ten seconds, and release. Repeat six to eight times. Really concentrate on the "squeeze" for maximum results.
Double-Apricot Glazed Ham
Ingredients:
 1 cup dried apricots
1 cup Swanson® Chicken Stock
1/2 cup packed brown sugar
6 -to 8-pound fully-cooked whole boneless ham *
2 tbsp. butter
1/2 cup finely chopped shallot
2 jars (12 ounces each) apricot preserves
1/4 cup Dijon-style mustard
2 tsp. grated orange zest
Directions:
Place the apricots and stock into a microwave-safe measuring cup. Microwave on HIGH for 2 minutes. Let the mixture cool. Remove the apricots and cut into strips. Reserve the stock. Stir the apricots, sugar and 1/4 cup reserved stock in a small bowl.
Place the ham into a roasting pan. Bake at 325°F. for 2 hours or until the ham is heated through. Brush with the apricot mixture during the last 30 minutes of baking and baste frequently with the pan drippings.
Heat the butter in a 10-inch skillet over medium heat. Add the shallots and cook until they're tender. Stir in the preserves, mustard, orange zest and remaining reserved stock and heat to a boil. Reduce the heat to low. Cook and stir for 10 minutes or until the stock mixture is slightly thickened.
Slice the ham and serve with the apricot sauce.
*You can use a 3-pound fully-cooked half boneless ham for 16 servings. Prepare as directed above, but reduce the remaining ingredients in half and the cooking time to 1 hour or until the ham is heated through.
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