• Workers want to know how CDHPs work for them, not the company
• To improve access, first increase awareness
• Soothing swine flu fears in the workplace
• Tip of the Day: Use mental health month to separate fact from fiction
• President addresses health care at first-ever 'web-hall' meeting
• Switch to generic drugs yielded savings
• One size does not fit all
• Broader disability definition
• Finding an answer to the 'million-dollar question'
• Exercise Corner: Balancing work with the benefits of yoga
• Recipe Corner: Shrimp and Black Bean Salad

Consumer-driven health care is again on the radar of many companies as they search for ways to cut costs and keep their health plan budgets under control. Unfortunately, if not done properly, a move to consumer-driven health care can be perceived as no more than a massive cost-shift to employees, complete with confusing plan designs and a whole new language of undefined health plan terminology. It’s something that will aggravate low morale and productivity issues even more than the nightly news reporting another round of layoffs.

But, when done the right way (and there is a right way), a move to CDH can engage employees, motivate them toward better health, help them understand their employers’ investment in benefits — and save money. To do that, we have to keep a focus on employees’ needs (and their families’ needs) through the whole process — while designing the plans, launching and enrolling, and supporting employees as they manage their health throughout the year.

Plan design

It should go without saying that there is not a one-size-fits-all solution for CDHPs. You must look at the demographics and health needs of your population and then match the plan design. While HSAs have been the big push the last couple of years, they can be a harsh reality for lower-income employees, especially families who are subject to the aggregate deductible. Employees on expensive maintenance medications may also be in for a shock. An HRA may be a better choice to get employees thinking about their expenses while not exposing them to such high deductibles or the full out-of-pocket costs of prescription drugs. HRAs may make sense for the company too, who won’t see their employer-contribution walk out the door when employees leave.

Either way, a priority should be placed on generous coverage for preventive care and an employer contribution to the account. Make sure the plan design is consistent with the message of better health and more focus on prevention. Also, keep in mind, there’s no shame in keeping HMOs around. HMOs are a great fit for many families. CDH enthusiasts will say they shield employees too much from the true cost of health care. That may be what keeps some workers healthy and on the job.

Launch and enroll

Of course, we know that communication is critical to launching these plans and getting employees to enroll, especially when traditional options are still on the table. Where I see companies stumble is in keeping too much focus on the big picture instead of really explaining what the plans mean for individual workers. You can be guaranteed that eyes will glaze over at the first mention of the “millions of dollars” spent on health care. You can explain the company’s investment in health care and the dollars added to each individual employee’s salary in the form of medical benefits. And, you can use examples and simple profiles to show how the plans work and their value, without overwhelming employees with facts and figures. In-person (or virtual) meetings are of huge benefit too — don’t just pile on the print materials and expect employees to dig through it all.

Also, it is often the spouse or another family member making the health care decisions during enrollment and throughout the year. Don’t keep valuable benefits information locked up behind a hard-to-access firewall. Get that information on the Internet or to homes where families can access it.

Be supportive

Once you’ve got employees in the plans, remind them about what they need to do and how to manage the accounts. Simplify all the overlapping programs like preventive care and health coaches and disease management and keep employee communication simple and action-oriented.

Also, keep an eye on vendors for their claims processing and customer service. Nothing can derail a CDHP faster than major complaints about claims being paid incorrectly or frustrations over doctors’ bills.

CDHPs can be a shining star in a rough economy. Just keep the focus where it should be: on employees and their health needs.

Source: Employee Benefits News, March 23, 2009

Employer ignorance of ethnic health care disparities is persistent barrier to high-quality, low-cost care

A survey of more than 1,500 benefit managers by the Washington Business Group on Health found that nearly half believe that ethnic health care disparities "weren't a problem" for their employees, although 80% had never asked minority employees if their race affected their health care.

However, they could not be more wrong, and their lack of awareness is costing them both people and money. According to research from various sources:

• Minorities are less likely than whites to get proper heart medication, heart bypass surgery, kidney dialysis and transplants.
• Black patients receive cardiac catheterization, a life-saving heart treatment, at a much lower rate than do white patients, regardless of the race of their doctors. 
• White doctors perceived black patients as more likely than white patients to abuse drugs and alcohol, to be unintelligent and uneducated, and to fail to comply with medical advice.
• Minorities have more communication problems with doctors and tend to feel, more so than whites, those physicians treat them with disrespect.

Adding to the weight of such differences in care and access to care is the fact that minorities are among the more vulnerable groups in terms of potential health risks. For example, African-Americans are four times more likely to get diabetes than non-Hispanic whites and should have a colonoscopy at 45, five years earlier than the general population, cites Corliss Hill, national director of business development for UnitedHealthcare's Generations of Wellness campaign.

Further, ethnic minorities' health risks may become more acute without meaningful intervention. Research from the Centers for Disease Control and Prevention shows:

• Black adults had an average of five bed days per person due to illness or injury in the past 12 months, compared with an average of four bed-days per person for white adults. 
• 44% of American Indian or Alaska Native adults and 53% of black adults had excellent or very good health, compared with 63% of white adults. Conversely, 23% of American Indian or Alaska Native adults and 19% of black adults had fair or poor health compared with 11% of white adults.

"When you look at the demographics and the sheer numbers of growth that are projected for the years to come, employers realize that they have to stay ahead of the curve in meeting the needs of their employees," says Hill.

Different approaches

Several insurers are strengthening ties and outreach to minority communities in an effort to combat disparities in care and access.

Regence Blue Cross Blue Shield has developed a Latino concierge program that provides bilingual and bicultural “consejeros” to aid its Hispanic members in Idaho, Oregon, Utah and Washington. These advisers help members navigate the insurance and health care process, which many Hispanic immigrants do not fully understand, as they come from a country with a nationalized health care system. In fact, many believe they can purchase insurance once they become ill.

"The key thing is that [the consejero program] is not a translation service, but a transcreation service," explains Francisco Garbayo, the emerging markets manager for Regence BCBS. "You have to explain what health care is before you can begin to translate terms like coinsurance, copayment and maximum out-of-pocket, you must help them understand the concept of health care."

While Hispanics often respond to outreach by creating bonds through their native language and culture, experts say, African-Americans tend to prefer communication via social networks, according to focus groups conducted by UnitedHealthcare. Therefore, Hill says, UHC communicates health care and benefit information to African-Americans through partnerships with churches, African-American community businesses and black Chambers of Commerce.

UHC also targets Asians who, despite generally being well-educated and on a high socio-economic level, are 5.7% more likely than whites to be uninsured. The gap may be due to superstitions concerning health, according to Amber Jia, the carrier's director of Asian-American markets.

To help offset these suspicions, Jia was meticulous in crafting UHC's communications to this group, even down to how she designed the multilingual Web site. She selected colors like red and yellow — which inspire strength and confidence in Asian culture — as opposed to black, white and gray, which would inspire thoughts of funerals.

Leveraging media

In addition to online resources, benefit service providers also are using other technology to reach a wider swath of minority workers.

The Segal Company, an actuarial and consulting firm based in New York City, sponsors a Latino education program that features podcasts and an electronic signboard in the parking lot containing wellness messages.
Regence also is using media to engage Hispanics. They created mini-telenovelas (soap operas popular in the Hispanic community) that show Hispanics in family settings discussing health care. In addition to telenovelas for its Web site, the outreach campaign features television ads and a radio show that transforms typical Hispanic recipes into healthy alternatives, such as replacing lard with oil in refried beans.

However, garbayo cautions, even with such targeted efforts, employers must realize that subsets exist within minority demographics as well. According to garbayo, 'latino' is more a culture than a race, and although 80% of the latino community he works with is Mexican, he is careful to use language appropriate for all groups. He recommends that employers have a workplace latino council or club to review the material before it is sent out.

Source: Employee Benefit News, March 24, 2009

Employers are not immune to the swine flu scare sweeping the country. For businesses, however, the likely pandemic may mean re-evaluating workplace policies on sick leave, travel and teleworking, labor experts report.

This is not a time to panic, but it’s important to be prepared, notes Carolyn Plump, a labor and employment attorney at Mitts Milavec, LLC. For example, employers should be familiar with the Family Medical Leave Act, which gives workers up to 12 weeks of unpaid leave to care for themselves or a family member.

She also explains that there are other ways employers can be prepared, such as revising attendance and leave policies and updating employees’ home phone and address lists.

“Employers have a keen interest in keeping staff healthy and in containing the spread of a disease, not only for the obvious reason of employee welfare but also to keep business operations running and to minimize liability exposure,” says Don Dowling, an employment attorney at White & Case LLP.

Still, “there are some serious legal implications for multinational employers to consider, including involving existing overseas health and safety committees and worker representatives, providing medical care/vaccinations in the workplace and imposing travel bans and quarantines – all while weighing these precautions against stringent privacy and employment laws,” he adds.

“Telework is not a ‘break glass in case of emergency’ solution,” says Cindy Auten, general manager, Telework Exchange. “As households stock up on necessities and watch for school notices, organizations must embrace telework now to inoculate themselves against the swine flu threat. We encourage workers across America to ask their managers about telework options now,” she adds.

So far, officials from the Centers for Disease Control and Prevention have reported 109 confirmed swine flu cases from 11 states, up from 64 cases in five states on Tuesday. In the United States, one death has been reported.

Law analyst Brett Gorovsky of business publisher CCH says: “Employers need to discourage both the ‘hero employee’ – and even more so, the ‘hero boss’ – who try to muddle their way through the day when they shouldn’t.” He notes that workers are “sensitive to the differences between what management says and what it means, and when they see their supervisors coming in sick, they’re convinced that’s what’s expected of them also.”

Moreover, employers should develop pandemic plans, which may also help address their everyday presenteeism issues. “Many organizations that take these steps will then roll out [pandemic plans] as part of their overall HR practices, making sure they’re adequately addressing employee illness, whether it’s just a mildly severe flu season or a serious pandemic,” says Gorovsky.

CCH recommends the following basic steps to prepare for a pandemic:

• Identify a pandemic coordinator or team with defined roles and responsibilities for preparedness and response planning;
• Identify key employees and key work processes required to maintain business operations during a pandemic;
• Establish (or review) an emergency communications plan;
• Seek up-to-date information from local and state health and emergency management resources; and
  Remind employees to get in the habit of washing their hands often and cover their mouths and noses when they cough and sneeze. Source: Employee Benefits News, March 23, 2009.

Source: Employee Benefits News, March 19, 2008

While the current recession is hitting employees hard financially, it may be taking even a greater toll on their mental health. A 2008 survey from the American Psychological Association found that 80% of Americans say the economy is a significant source of stress. Among those surveyed, 49% said they felt nervous or anxious; 48% reported feeling depressed or sad.

May is Mental Health Month, an opportune time to educate workers about fact vs. fiction of behavioral health issues. Marie Apke, COO at Bensinger, DuPont & Associates, points out four common myths and facts about mental health:

Myth 1: Stress causes mental illness.
Fact: Stress may occasionally trigger an episode or cause symptoms such as anxiety or depression, but persistent symptoms appear to be biological in nature.

Myth 2: There’s no help for people with mental illness.
Fact: There are more treatments, strategies and support than ever before. In fact, 80% of individuals with depression can be treated successfully. Further, the majority of people with behavioral health disorders improve when they receive appropriate treatment.

Myth 3: Mental health problems are best treated by a primary care physician or a general practitioner.
Fact: Mental disorders should be taken as seriously as any potentially chronic and disabling medical condition. That is why diagnosable mental disorders are best treated by a trained mental health professional, such as a psychiatrist, psychologist, or other clinician specially trained to diagnose and treatment mental health problems.

Myth 4: Depression is just a normal part of life; everyone gets depressed when bad things happen.
Fact: Being sad or feeling blue is a normal part of life, and everyone feels this way from time to time. Depression, however, is not normal. Depression interferes with a person’s daily life and there are times they cannot function normally.

Source: Employee Benefits News, March 23, 2009

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: Employee Benefits News, March 28, 2009

The expanded use of generic drugs — up five percentage points from 2007 to 2008 — among Blue Cross and Blue Shield Plan members has led to at least $2.5 billion in savings, according to the company.

In a recent survey, BCBSA analyzed the prescription use of 51 million subscribers in 32 of its companies. The findings highlight the value of promoting generic drug utilization.

“Health care spending growth in 2007 slowed to its lowest rate since 1998, driven in large part by steady increases in generic dispensing rates,” said John Frick, director of pharmacy initiatives for BCBSA, at a press conference announcing the results.

Joel Owerbach, Excellus BCBS’s vice president and chief pharmacy officer, points to the need for generic drug promotion in a 2007 survey that found 35% of respondents in upstate New York had never asked a physician if a generic alternative was available. Additionally, 55% said their doctor had never asked them if the cost of a drug was a concern for them.

Excellus launched its “Generics are Real” campaign in 2005 to inform consumers about the benefits of generic drugs through television commercials, online programs, print advertisements and partnerships with employers.

Benefit designs can be manipulated to promote generic drug use by reducing the cost-sharing burden on patients opting for generics over name-brand prescriptions, as well as waiving copays for generic drugs altogether, said Frick.

Birds Eye Foods, a national company with 3,500 people covered under its benefits plan, is a corporate sponsor and participant in Generics are Real. Already above the national average for generics usage, Birds Eye has saved approximately $200,000 since the program started, said Diane Mohorter, senior benefits manager.

“For every one point increase in generic fill rate that we have, our drug benefit plan experiences a savings that adds up to over $50,000 each year,” said Mohorter. “Our employees share in that savings. This equates to a full-time, regular employee who’s benefit eligible and their whole compensation package.”

Source: Employee Benefits News, April 3, 2009

Source: Employee Benefits News, April 19, 2009

Federal lawmakers, believing that recent Supreme Court decisions have taken a narrow interpretation of the term "disability" under the Americans with Disabilities Act, recently used legislation to set the record straight, and President Bush this fall signed into law the Americans with Disabilities Act Amendments Act of 2008.

Architects behind the law report that they wanted to reestablish "a broad scope of protection" under ADA in light of recent decisions by the Supreme Court.

Overall, the new amendments don't alter the core definition of a disability, which means a physical or mental impairment that significantly restricts one or more major life activities, such as seeing, hearing, sitting, standing and sleeping.

The new rules, effective Jan. 1, 2009, call for a much broader definition of the term disability that will encompass more individuals. For example, whether an impairment restricts a major life activity is to be determined regardless of the availability of measures that can improve performance and functioning, such as medication, equipment or prosthetics.

"The ADA Amendments Act is a major victory for employers, the disability community and the American workforce," says China Miner Gorman, chief operating officer of the Society for Human Resource Management.

"The new law is a true compromise measure, protecting those individuals most in need and addressing court decisions that have limited the effectiveness of the original ADA. It is a prime example of Congress putting aside differences to pass needed legislation," she adds.

Labor analysts say employers should understand that, even though a disability is a prerequisite to acquiring relief under the ADA, no violation is committed when a group health plan offers equitable benefits to participants with disabilities and individuals without disabilities.

Even if there are differences in health benefits, there is no legal violation if the differences are not due to a disability-based distinction or if benefits are provided through a bona fide benefit plan that is not a subterfuge to evade the ADA's purposes.

Many disability discrimination cases filed under ADA against employers never made it to the discrimination issue because the first issue the courts have to decide is whether a disability exists, says Debbie Leung, an attorney at the Groom Group, a Washington, D.C.-based law firm. "If you have no disability, then we are not going to examine whether you were discriminated against," explains Leung.

The Supreme Court viewed what constituted a disability under ADA as vague and overly board, says John Kemp, executive director and general counsel of the U.S. Business Leadership Network, an organization that focuses on disability issues.

"With the new amendments, there is a shift away from proving that you are a member of a protected disability class. That is the overarching shift, which is going in the right direction," Kemp explains.

Pursuant to the new amendments, employers do not get the opportunity to question whether an individual is disabled and eligible to bring the lawsuit, thus stopping the person before he or she gets to the courthouse. Under the new rules, the plaintiff asserts that he or she is a member of a disability class and that the organization has committed disability discrimination.

While the courts can still determine whether an impairment restricts a major life activity, under the new rules they may no longer factor in the availability of measures that improve a disabled person's performance or functioning, such as medication, equipment or prosthetics.

The Supreme Court interpreted ADA in such a way that a person with artificial limbs who wore prosthetics may not have been protected under the law, because he or she has been able to overcome certain limitations associated with the disability, explains Kemp. The same is true for people with epilepsy who are keeping the condition under control with medication.

"That was not the intention of ADA. It would be wrong because either a person has a disability, or the perception of other people about the disability may cause bias," Kemp says. "ADA intended that people with medical conditions that rose to the level of disability were supposed to be covered under the law."
He further explains that, despite the new rules on a major disability law, successful employers realize that it is not in their best interest to limit their applicant or promotion pools. Smart employers are looking for top talent, regardless of disability. "They get the fact that they need to be looking for talent, and talent lies with people with disabilities and others," says Kemp.

Whether the new amendments affect employers' HR and workplace policies depends on how those policies are drafted. For example, if the employee handbook says the company does not discriminate based on a disability, then that does not change because that has always been the law, says Leung.

If the company, however, has any specific language in internal and HR policies on what is a disability and what is not a disability, then those policies will probably have to change.

With the new amendments, there is a larger range of conditions and impairments protected under ADA. As a result, there is some concern that a number of lawsuits will reflect new disabilities that are not covered under the law as a disability.

In addition, under the ADA, there is an exception written into the law for employee benefit plans.

For example, an employee benefit plan can make a disability-based distinction as long as the plan meets certain requirements and is not a subterfuge to evade the purposes of the ADA. It is known as the insurance safe harbor clause, which allows employers not to offer coverage related to certain disabilities. Some observers believe that, because the new amendments allow more disabilities to come into play, there could be more claims against benefit plans regarding a disability-based distinction.

Once you have a disability-based distinction, someone could say that this disability-based distinction is not really part of a regular plan design, but is really discrimination against disabled people.

Source: Employee Benefits News, April 13, 2009

Four Easy Steps to a Successful Workplace Yoga Program

As yoga has steadily stretched its way into our mainstream culture, most of us have heard about its many remarkable benefits. Yoga relieves stress, increases strength and flexibility, and, as research is now confirming, even helps prevent some chronic disease.

You may be convinced that a yoga program would be a valuable addition to your wellness program or a welcome stand-alone benefit for employees. What are the significant points to consider, and what are the necessary steps to take, to put a successful program in place?

1. Create the right setting

While paying for off-site classes is certainly an option, if you have an appropriate space, on-site classes offer the advantages of accessibility and saved time. Limited time is often cited as the greatest obstacle to participation in any exercise program. Since yoga need not leave participants wringing wet, changing from business attire to workout gear and back again can be a quick and simple affair. Lunchtime classes are practical, as students can devote nearly the entire hour directly to the practice. However, some provision must be made for participants to eat afterward. Since it is best to avoid eating anything substantial for at least two hours before yoga, many students eat lunch at their desks as they start back to work after class.

Yoga, except those styles that make extensive use of props, does not require much equipment, so there is no need for additional space to store anything at your facility. Each participant can easily bring all items needed only on class days. A checklist of the most common props is provided at the end of this article.
A conference room, or any extra room on premises, can make an adequate yoga space. The room temperature should be around 70 degrees or warmer. Since the classes will involve deepening the breath, the room should be free of dust or contaminants such as air fresheners, insecticides or chemical cleaners. The room should be quiet and afford the group some privacy. Ideally, the instructor should be able to dim or turn off the lights.

The floor surface, as long as it is even, is not critical for most styles. Participants can bring a mat and, if necessary, use a blanket for additional padding.

2. Evaluate teachers’ credentials

Once you have decided whether it is feasible to hold the classes on-site, it’s time to search for a teacher. The most obvious way to locate a teacher is to call local yoga studios. However, if you plan to host the program at your worksite, don’t overlook the possibility of finding an independent teacher who has experience in a workplace setting.

Teachers’ credentials vary widely, and the only way to know what an individual’s training and experience levels are is to ask. Has the instructor learned solely through experience, or has he or she had formal training? If the teacher did have formal training, what is the extent of that training?

Having a certificate to teach yoga can mean any level of education from a single weekend workshop to hundreds of hours of structured training. While there are some excellent teachers with thousands of hours of valuable experience who have never completed a lengthy formal training program, I would have reservations about choosing someone with little formal training unless their experience is quite extensive. Quantifying experience in terms of hours as well as years can provide a clearer picture of expertise, due to differences in full and part-time work. It is worth your time to ask very specific questions in this area.

One good resource is the Yoga Alliance (www.yogaalliance.org), which sets training standards for teachers and schools and maintains a registry of teachers who have met those standards.

3. Choose a yoga style

In addition to inquiring about a teacher’s credentials, ask if he or she teaches a particular style of yoga. While teachers can modify poses to suit an individual student, some styles of yoga are inherently more strenuous than others. A young, very fit group desiring a vigorous workout may enjoy a strenuous style such as Ashtanga, Power Yoga, or one of the more challenging flow styles. However, these styles would probably not be among the best choices if the participants have not exercised regularly, are older, or have some health concerns. And, just as with any exercise program, participants should check with their doctors before beginning yoga classes.

4. Set the proper schedule

While it is possible to start your workplace yoga program offering one class per week, I have found that results and motivation seem to improve significantly when a second class per week is added. Also, if a student must miss a class due to an especially busy day or business travel, offering a second weekly yoga session means an opportunity for that student to work in at least one practice session that week.

Yoga is a calming, health-promoting practice that offers myriad advantages for body and mind. As individuals benefit, the company wins as well, because the sense of joy and well-being students feel in their classes is associated with the employer providing them that nurturing experience.—E.B.N.

Employee Benefits News, April 1, 2009

This is the most delicious salad; plump and tender shrimp combines with fresh tomatoes, corn, black beans and a honey mustard salad dressing. Yum.

Ingredients:

• 1 (16 ounce) package frozen fully cooked shrimp
• 2 (15 ounce) cans black beans, rinsed and drained 
• 2 cups frozen white and gold corn 
• 2 cups cherry tomatoes 
• 1 cup chopped tomatoes 
• 1/4 cup lemon juice 
• 1/4 cup olive oil 
• 1/3 cup honey mustard salad dressing 
• butter lettuce leaves

Preparation:

Thaw shrimp as directed on package; remove shells if attached. Place in large bowl with black beans, corn, and both kinds of tomatoes. In small bowl, combine lemon juice and olive oil and mix until blended. Add honey mustard salad dressing and whisk to blend. Pour over shrimp mixture and gently toss. Cover and chill for 2-4 hours to blend flavors. Serve salad on butter lettuce leaves. Serves 4-6.

Source: www.busycooks.about.com