• Fighting recession depression
• Helping people choose healthier lifestyles in difficult economic times
• Obama proposes controversial employer mandate, public option
• Tip of the Day: Cost-shifting, CDHPs, vendor management among 2010 cost-cutting options
• Key to achieving wellness goals may require combination of carrots and sticks
• Switch to generic drugs yielded savings
• Lasik still lacking
• Pulling the teeth out of dental plans
• To add or not to add? Finding a fit for LTC
• At the end of their rope
• Exercise Corner: Don't want a drill sergeant? Personalize your trainer
• Recipe Corner: Caramel-Glazed Apple Cake with Sweet Cream Whip

Although employers are becoming increasingly aware of the ability of employee assistance programs to offer a lifeline to employees in crisis, many are unaware of the effect of a less acute, yet still serious problem known as "recession depression," and how EAPs might be uniquely positioned to help companies fight it.

Anecdotal evidence from consultants and EAPs suggests that EAP use overall has seen a spike since the recession began. Betsy Andersen, M.A., the marketing and design specialist for Workplace Solutions, LLC, in Schaumburg, Ill., says that her company has seen "maintenance of January/February levels," which is typically the company's highest use period.

The EAP provider also is seeing more "critical incidents," she says. While some employers have dropped EAP services due to financial difficulties, she says, others have added benefits, causing WorkPlace Solutions to exceed its projected annual growth for 2009.

David Campbell, senior vice president for ComPsych, says that his company hasn't necessarily seen an overall increase in use, but rather a shift in need. These days, ComPsych is seeing increased demand for legal and financial services advice, and fewer requests for information on day camps and child care. Requests for "basic needs" like food banks, eviction, college planning and housing searches have skyrocketed.

"It's almost to the point that we've become a social service agency," Campbell says.

Resources for the jobless

It's not just demand from active workers that has EAP use surging. All parties interviewed also say that EAPs now are being asked to provide a service that many have never before considered - employers are asking them to work as outplacement firms.

In addition to training for managers and HR professionals about how to have "difficult conversations" with employees, says Janice Dragotta, senior consultant for health and productivity in Watson Wyatt's San Francisco office, many employers are asking EAPs to offer counseling services on formatting resumes, conducting job hunts and prepping for interviews.

Additionally, says Campbell, EAPs also are being asked to extend their services at least 30 days post termination, and in some cases as many as 60 to 90 days. This not only shows support to the employee, but bolsters morale across the board.

Employers are also requesting that EAPs extend their services to vendors whose partnerships may need be scaled back or cut entirely due to the economy. "Your employees are your number one, but you have to keep your eye on the bottom line," says Campbell, and the health of other business relationships can dramatically impact that.

Coping with 'recession depression' and 'survivor guilt'

Employers also need to remember to look beyond layoffs when considering the effects of "recession depression" on the workforce. Even if one's own company hasn't made layoffs, many employees could be dealing with issues of spouses, friends or other loved ones who are going through difficult times.

As a result, experts have cautioned employers to keep an eye out for signs of "survivor guilt." This phenomenon, accompanied with a general distrust of management, manifests itself as lower productivity and morale, higher absenteeism and turnover, and can deepen the effect of recession depression on a workforce.

Keeping lines of communication open and actively pursuing awareness tactics are recommended measures to battle this issue, another area where effectively promoting an EAP can help. In times such as these, "employers should be reaching out to employees about the linkage between benefits," as a way to cut costs, says Dragotta. Cut costs, not corners, she says, by encouraging employees to use the free services like EAPs that are available to them.

Already, as much as 10% of the working population suffers depression, including as many as one in four women. Apply these figures to your business and add in the effect of economic stress, job anxiety and fears about retirement, and it's easy to see how productivity can plummet if not effectively managed.

Risk and Insurance magazine estimates that the combined cost of medical treatment and lost productivity for depression annually hovers around $344 billion nationally, an astonishingly large number. The Journal of American Medicine estimates that as many 8.4 hours are lost per employee per week as a result of major depression. That's 26 lost work days per year, versus 17 days for cancer.

However, companies with EAPs in place have, on average, 21% lower rates of absenteeism and 14% higher productivity rates, shows research from the Department of Health and Human Services.

Marni Bobich, team manager for PEO Adminstaff, says that a study conducted by the company found as much as an 80% reduction in stress after employees used an EAP.

Incidentally, Dragotta says, she and her clients have not observed any increase in STD and FMLA claims as a result of depression, although they may begin to in the future. "What I have heard is that many employees are apprehensive about losing their job, so they're putting in extra effort in terms of being there [at work every day]."

Overall, she says, employers are doing a "very solid job" of advertizing the availability of EAP services, but it never hurts to put in extra effort during difficult times.

EAPs themselves are also increasing outreach, providing flyers, workshops and materials both to employers and employees about how to effectively manage stress. Workplace Solutions has issued flyers with titles like "Stress Reduction in Financially Trying Times."

"It's about making sure employers are engaging their employees and educating them about all benefits available to them," says Bobich.

Training time

Julie Marshall, PhD., CEEP, of Oregon's Cascade Center, says that the biggest change since the recession began is an increase in employer demands for onsite training. "We're seeing at least 50% more requests," she says.

Marshall says she would encourage all employers to take advantage of these services, often provided free up to a yearly allotment of hours. Many EAPs offer services specifically for management and HR teams that deal with issues like pre-layoff consultation.

Training sessions and webinars for employees are also popular, says Andersen.

Debbie Johnson, R.N., health resources coordinator at the Beaverton School District in Beverton, Ore., says that her employees have benefitted greatly from their access to EAP-sponsored services. Her EAP offered a regular seminar called "Coping in Turbulent Times," which was popularly attended by employees.

However, Johnson cautions, like any good program, support comes from the "top down." Her school district's superintendent, Jerry Colonna, began a passionate campaign to help employees, making himself personally available every Friday afternoon to hear employee concerns. "He really practiced the open-door policy," Johnson says.

Early action

Johnson adds that starting the process early - as soon as the district found out that budget cuts might be necessary - was invaluable. She and her colleagues began putting programs and potential references together in November 2008, even though layoffs likely wouldn't need to begin until June 2009, half a year later.

Additionally, Johnson says that she and her EAP put into place plans for a potential "resource fair" of sorts, combining forces with benefits providers, counselors and the school's own HR personnel, which would be held after pink slips had been distributed. Thankfully, Johnson says, they didn't need to hold the fair.

Involving all parties early on in the process helps maintain a level of trust in the organization, Dragotta says. Consider doing so part of "risk management" best practices.

Top 10 to go

Here's a top 10: Five questions HR/benefits pros should ask their EAP, and five points to implement within their internal department.

For the EAP:

1. How many hours of corporate training am I allotted per year?

2. Do I choose from a list of predetermined training topics or can I design my own?

3. What programs are you offering to help my employees stay on track? Will you come onsite, or are these web-based?

4. I want to extend benefits beyond termination - how long do you typically offer the service?

5. What outplacement services do you provide?

For the benefits team:

1. Have a communications plan in place as early as possible if layoffs are to take place.

2. Practice "top down" communications to maintain high levels of morale.

3. Remember to focus attention on those left behind to avoid "survivor guilt."

4. Advertise EAP services as available to all benefits covered employees - including family members.

5. Consider including strategic business partners and vendors in major initiatives to maintain good business relationships. -E.B.N.

Source: EmployeeBenefitnews.com, September 1, 2009

Thomson Reuters research and a Harris poll from earlier this year show that economically stressed Americans are cutting back on preventive health care, as well as consuming less fruits and vegetables – favoring cheap and less nutritional options such as processed and fast food. Factor in a recent Gallup poll revealing that only 27% get the recommended amount of exercise, and a grim picture emerges on the overall health of Americans.

Preventive care, in conjunction with a nutrient-rich diet and adequate exercise, can help delay or curtail many chronic conditions such as obesity, diabetes, heart disease, stroke and certain cancers that affect almost 50% of the population.

“Employers can play an important role by adopting a wellness program that helps employees live healthier and enjoy a better quality of life,” explains Sean McNattin, vice president of wellness for OptumHealth, a business of UnitedHealth Group.

One promising solution is OptumHealthSM wellness coaching, a multi-channel program that helps people take better care of themselves by incorporating realistic healthy choices into their everyday life that will help them live healthier. Employers reap the benefits of healthy employees through reduced absenteeism, presenteeism and health care costs, as well as improved productivity and a better perception of their employer.

To help both employees and employers reach their goals and become healthier in tough economic times, OptumHealth recently made several enhancements to their wellness coaching program that better helps achieve program success without adding more costs. These industry-leading enhancements include referrals from claims and on-site screenings, ongoing communications, wellness consultants, cross-trained coaches, limitless enrollments and expanded reporting.

Referrals from claims and on-site screenings

Most wellness programs identify at-risk individuals through self-reported data whose validity relies upon the accuracy of the individual’s perception and willingness to be honest. OptumHealth’s referral methodology leverages on-site health screenings and claims in addition to the health assessment, self-referrals and other OptumHealth program referrals to identify at-risk individuals. The result is that 10 times more people are identified as prime candidates for wellness coaching over traditional referral methods.

Ongoing communication

Employee awareness and engagement are raised through ongoing promotions, targeted mass communications and outbound calls based on claims. This innovative formula enables employers to increase engagement and enrollment without having to rely on costly incentives – a model that has resulted in five times more enrolled individuals.

Wellness consultants

Each wellness consultant is assigned to an organization to help with overall strategy and promotions planning, report interpretation, and to evaluate the program’s success. If a strategy needs adjustment, they can re-evaluate the situation and implement the right components the organization needs.

Cross-trained coaches

Cross-trained coaches address all lifestyle-related health issues as part of a holistic approach. For example, many people who want to quit smoking are concerned they’ll gain weight. In this instance, a wellness coach can help the person kick their habit while at the same time help him or her focus on healthy ways to deal with the nicotine withdrawal instead of turning to food.

Limitless open enrollments

Most coaching programs limit the number of times a person can participate during an enrollment year, but OptumHealth’s approach allows individuals to enroll in multiple coaching programs to ensure they receive the right amount of coaching to suit their individual needs. In addition, wellness coaching is now available to all who wish to be coached, not only to those people who are considered to have health risks, which helps ensure that healthy people stay healthy.

Expanded reporting capabilities

Using more than 60 metrics focused on behavior change, program effectiveness can now be determined within months so organizations can make adjustments to get the most out of their investment.

OptumHealth captures baseline metrics on weight, exercise, nutrition, tobacco intake, stress levels, as well as diabetic and heart health indicators and measures behavior change after each coaching session. Quarterly reports show how many employees enrolled, how many were engaged and self-reported member behavior change outcomes.

Results from the wellness coaching program’s second quarter book of business show that, of those who completed the program, 94% said they were making better health and lifestyle choices, 83% said their health was better, 82% said they take more responsibility for their health, 54% said they were more productive and 69% said they were more satisfied with their employer.

As employers struggle to manage rising health care costs, they will find that a well-managed wellness program can have a tremendous impact on the bottom line. McNattin reports a 1:1 return on investment in the program’s first year, 2:1 the following year and 3:1 in the third year. “It compounds and the more people you enroll, the benefits are seen over time,” he adds.

Source: EmployeeBenefitNews.com, September 11, 2009

As a test of how the speech was received by members of the business community outside Washington, Associate Editor Kathleen Koster checked in with Laurel Pickering, executive director of the New York Business Group on Health. In this interview she offers opinions on the highlights and lowlights of Obama's speech, how it is likely to be received by her members, and potential impacts of the provisions outlined by Obama.

“I’m not confident that reform is going to happen based on what President Obama said last night,” she says. Read on to learn more about what his speech means for small and large businesses alike.

So, what did you think of the speech?

I didn’t really hear much that was new. But I think it was good for the American people to hear it from him. Still, I was a little frustrated by [his speech] because the public option is going to prevent us from coming to some kind of consensus.

Should employers be worried about the public option?

Employers have been wary about that from the beginning, and one of their biggest concerns is the cost-shifting element. The fact that the public option will be self-sufficient is an interesting angle, but it remains to be seen how that will play out and what difference that will make.

Obama was vague when it came to what a public option would look like. How would a co-op versus a trigger system affect American businesses?

It’s unclear because I think it depends on what types of parameters and rules you put around the public option. The two things that could possibly happen are the cost-shifting element and the abandonment of the employer-based system. The public option cannot innovate the way employers can innovate, and I think that’s certainly a concern because people will be using the same physicians. The public option doesn’t provide any incentive around performance or rewarding the higher quality providers. It adds another chain of events that may not be doing that [paying for performance], which works against everything that we’ve been fighting for.

He didn’t really get into specifics, but do you think that the public option will cause the end to employer-based health care in the future?

His intention is that it won’t, and he seems aware that we don’t want this to happen by opening with ‘you can keep what you have.’ There’s a lot of investment in the employer-based system, but until there are specifics, it’s hard to say. But, philosophically, it seems that he’s on board with maintaining that system and hopefully protecting it.

Will the employer mandate affect small businesses, because he said that 95% of small businesses would be exempt?

I think that there are a lot of details that remain. But certainly among the employers that we represent, the employer mandate won’t affect them because they’re already offering coverage. Small businesses certainly would be affected by a mandate, and that’s why small business associations have always opposed it. I don’t know if they’re going to be required to pay the penalty into the pot—that was very unclear.

What will the final package of health care reform look like?

My understanding is that these quality and efficiency things, like health IT, comparative effectiveness and payment reform, everyone agrees on, so there’s not a lot of talk about them. It worries me that I don’t hear any talk about them. [Obama] did talk about how waste in the system was going to help pay for this, but with little specifics on where we’re going to find this waste.

Will that mean the end of Cadillac health plans?

I think so. I think that there are health plans out there that are really dinosaurs and probably not necessary. Most employers have worked hard to get that number down, so these plans are probably not necessary.
This won’t mean a reduction of coverage or companies dropping it?

I don’t think so, because comprehensive coverage can be achieved for a lot less.

In his speech, President Obama said he won’t rest until “those businesses that seek capital and credit can thrive.” Will his plan channel these results?

If you’re really able to reform health care, the idea is that, ultimately, it’s going to be less expensive for businesses to provide it. Health care in business prevents employers from being competitive in a global economy and is really a drain on their resources in our country, compared to other countries especially. And if you’re going to reform health care, then reducing that burden on business is going to be part of that. Let’s not even talk about quality, efficiency and payment reform, but if you can get even more people covered, then that’s going to help businesses because we’re paying for the uninsured in our premium dollars, effectively. If you add in delivery system reform, that’s only additive.

What was missing from his speech?

I think that the big thing that was missing was payment reform and health information technology.

I think that almost everyone in this country agrees that we have to stop paying for volume and start paying for value. So many of our problems with health care can be alleviated by changing that, and I know it’s not easy, but a payment system that rewards physicians for helping people to get better will provide a more likely chance that people are going to get better and healthier if the incentives are aligned. And also, we’re clearly going to save a lot on waste. There’s a lot of money to be found both in the health of Americans and in paying for care that can eventually finance everything we’re talking about. I know it’s long term, and it’s very difficult, but I think that’s a fundamental piece that he really didn’t address at all.

What issues did you take with the speech?

I think the only issue is the public option; it’s the most controversial piece of what he said. The exchange and the public option are the two big aspects of the plan that are so different from what we have now.

What was the most promising thing that came out of the speech?

For the employers that I represent and the kind of work that we do at the New York Business Group on Health, the most promising piece of what he talked about was making health care more efficient. He didn’t talk a lot about it, but for me that was the most promising thing—the focus on reforming the delivery system.

Source: EmployeeBenefitNews.com, September 10, 2009

Okay, so, there’s good news and bad news. The bad news is that, according to the latest data from Mercer, if employers make no changes to health benefits in 2010, they’ll see cost rise by nearly 9%. The good news is that most of you have no intention of doing nothing, and in fact plan to hold cost increases to about 5.9% next year.

Your peers who spilled to Mercer say that their first line of defense against rate increases is shifting cost to employees (63%), but this tactic can present a tough challenge for employers that feel their employee cost sharing requirements are already high. For example, between 2004 and 2008, the median family deductible for in-network services in a PPO rose from $1,000 to $1,850.

Nearly a fifth of respondents (18%) are eliminating those cushy PPOs altogether in favor of consumer-directed health plans with either an HSA or HRA.

Other cost-cutting actions for 2010 include auditing plans, for example, to ensure that all covered dependents are actually eligible for coverage (39%), and adding or renegotiating performance guarantees with health plan vendors. Performance guarantees have historically focused on accuracy and timeliness of claims payment or customer service, but some employers have expanded their guarantees to address overall program performance in managing care, driving quality improvement and engaging participants in behavior change.

Source: EmployeeBenefitNews.com, September 10, 2009

It’s easy for employees to fall short when it comes to achieving fitness, weight loss or smoking cessation goals if they become complacent about maintaining behavior change. This complacency can stem from their employer falling into the same trap by not adequately promoting their wellness program with fresh communications, relying solely on an incentive to create an impact.

Incentives can be effective in improving participation and behavior change, but are not sufficient to improve long-term outcomes on their own. To have the greatest impact, a well-designed health and wellness program should have an effective communications strategy and an emphasis on creating a culture of health in the workplace.

An effective communications campaign can shape an employee’s view of the incentive program and has the potential to impact the size of incentive necessary to generate the desired outcomes. A recent article on incentives by Healthways’ Center for Health Research cited evidence that employers that advertised their wellness programs more frequently and through multiple mediums could use much lower incentives to achieve the same results compared with employers that were less committed to promotion.

Employers also can improve outcomes by creating a culture of health in the workplace through stocking the corporate cafeteria or vending machines with healthier selections, sponsoring employee walking clubs and yoga classes, providing gym membership discounts or declaring a smoke-free workplace.

“If the culture is in place, then people feel more inclined to develop healthy behaviors,” explains Elizabeth Rula, Ph.D., manager of clinical research at Healthways Inc. “A lot of the research shows that employer commitment to the program is really a huge driver of success.”

Reward and punishment

One of the first things an organization must do is to carefully consider whether to adopt a “carrot or stick” approach to incentives, based on their objectives, comfort level and tolerance for controversial measures when determining the most effective means of achieving results.

Incentives are used to reward individuals for taking certain actions or for achieving desired results such as enrolling in a program, changing health behaviors or making measurable improvements to their health. Alternatively, disincentives penalize those who do not take an action or have a successful outcome.

A combination disincentive/incentive approach is often employed by increasing the cost of health insurance coverage for all employees, then providing a discount for program involvement. This strategy, if communicated properly, may avoid the stigma of a disincentive yet minimize the costs associated with incentivizing a program.

The key to success is how resources are deployed. Rula noted the success of the incentive program used in the SilverSneakers Fitness Program for seniors, even though the program is limited to using incentives that align with Centers of Medicare and Medicaid Services guidelines and generally involve small gifts, such as t-shirts.

Despite the fact that small tangible gifts are not typically effective at driving healthy behaviors, these gifts were promoted with great fanfare and rewards were given for discreet, time-limited actions such as visiting a fitness center a certain amount of times. Gifts also were emblazoned with the SilverSneakers logo, which helped create a powerful brand and fostered a sense of community among participants who greatly valued the program. Also, the demographic group targeted may have an impact.

Realistic goals

One challenge is to ensure that each incentive or disincentive reflects the perceived difficulty of the required action. Rula says some companies use focus groups to pin down these details and also need to be mindful that goals must be achievable. This may require the establishment of incremental rewards for ongoing participation or progress toward a goal.

In discussing how organizations monetize incentives, Rula cited a study by Great-West Healthcare that examined the minimum dollar amount that would encourage the adoption of healthy behaviors. The decision on where to spend those dollars ultimately hinges on the behaviors that are driving up health care costs within any given employee population.

“It’s not very difficult for someone to take an HRA or floss their teeth everyday, but to implement an exercise program, lose weight, eat healthier or stop smoking are big changes in one’s lifestyle that require larger dollar amounts,” she notes.

Healthways has found that in a health coaching program, people are more likely to take calls at off-peak times when it’s not so convenient if there’s a greater incentive involved.

“Incentives help to overcome perceived barriers to participation. The success of almost any program can be further enhanced through the appropriate use of incentives,” Rula says.

Source: EmployeeBenefitNews.com, September 9, 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: EmployeeBenefitNews.com, April 16, 2009

Laser surgery, one of the biggest innovations in vision care in recent decades, hasn't made a lot of headway as a covered benefit. The operation, called Lasik, permanently changes the shape of the cornea, the clear covering of the front of the eye, using a laser. It has been available in the United States for almost 20 years, but few vision plans cover it. Most Lasik patients pay for it out of pocket.

Terri Wilson, vice president of strategic accounts for VSP, a Rancho Cordova, Calif.-based vision insurer, says she has not seen an increase in employers covering Lasik surgery, partly due to the bad economy. "I don't think the utilization is really there and [don't think] the value for the client or all of their members is there," she explains. Don Yee, president of OptumHealth Vision Care, says, "You're not seeing more employers offer Lasik coverage. That's very much in the minority. That trend hasn't really changed much in the last two or three years."

The U.S. Army offers to pay for laser surgery for most of its soldiers. But some employers are reluctant to cover Lasik because they feel it would drive up the vision premium so much that employees would stop participating in the vision plan. There's also a concern about adverse selection, meaning people would stop enrolling in the vision plan after having the surgery. "It's typically a once-in-a-lifetime benefit. So once they have their surgery, they would drop off the plan the next year, so that could impact the employer's utilization [trend]," Wilson notes.

Steve Holden, president of Davis Vision, says, "We're hearing more about funded Lasik programs. Davis has done that for quite some time." Nevertheless, he predicts fewer employers will cover Lasik in the next two years, due to cost concerns.

Instead of full coverage, some employers provide access to discounts on laser surgery within a specific network of doctors, or simply give employees a flat subsidy for Lasik costs. A typical subsidy is around $300 to $500 per person. LCA-Vision Inc., a provider of laser vision correction services under the LasikPlus brand, recently announced its affiliation with National Vision Administrators, which will make laser vision correction less expensive for NVA's members nationwide. NVA members will have access to substantial discounts on laser surgery through LCA-Vision's National Lasik Network, comprised of 75 company-owned-and-operated vision centers.

About 1,145,500 U.S. residents had Lasik surgery in 2008, according to VisionWatch, a study conducted by Jobson Medical Information and the Vision Council of America. "More and more people are going out and getting laser surgery," Wilson says. "People are really curious about it. They would love to see that as a covered benefit, [but] it is cost-prohibitive." Some workers may be delaying or canceling their plans for Lasik surgery because of the economic recession. "The procedures are down overall in the Lasik industry over the last 12 months," Yee notes. "It's a high-value, high-cost procedure. It's a larger-ticket item. It's certainly deferrable to the next year [for those who can't afford it now] ... There's still demand for it. It's very stable demand." Likewise, Holden notes, "It's an elective procedure. It's expensive."

Cost of vision problems

Vision disorders are the second-most prevalent health problem in the country, affecting more than 120 million people, according to a recent report from the Vision Council of America. An estimated 11 million Americans have uncorrected vision problems. For the United States, the annual financial burden of major adult vision disorders exceeds $50 billion. On top of that, vision disorders alone account for more than $8 billion in lost productivity per year due to pain, discomfort or functional impairment. Nearly 90% of people who use a computer at least three hours a day suffer vision problems associated with computer eyestrain. In addition to computer-related vision problems, on-the-job eye injuries affect more than 800,000 American workers each year, and 90% of them are preventable, the report states.

Seventy-eight percent of employers offered vision benefits last year, up from 71% in 2004, according to the Society for Human Resource Management. Many workers still don't have coverage. About 43% of American adults are not covered by a managed vision care plan, the Vision Council of America reports. There's been a growing trend of employers offering vision on a voluntary basis, with employees bearing the full cost.

Likewise, more employers have been adopting a strategy of covering 100% of the eye exam for all employees, with the option for employees to purchase additional coverage for eyeglass frames and contact lenses, according to Wilson. "They want to provide good coverage, but they are trying to manage the company's expenses," Yee confirms. In addition to the trend toward voluntary coverage, there's been a trend toward bundling vision and dental plans, often to achieve lower costs, according to Holden. He expects that shift to continue in the next year or two.

Source: EmployeeBenefitNews.com, April 15, 2009

For all the discordant debates, sometimes violent town hall meetings and shouts of "You lie!" from lawmakers that have fraught the discussion of health care reform this year, it's more than likely that employers didn't hear the voice of a more civil participant in the proceedings - the dental industry.

However, the dental benefits that employers offer may be vulnerable under a reformed health care system, and leaders within the dental benefits industry are taking their case to Congress. Among them are Evelyn Ireland, executive director of the National Association of Dental Plans and Jeff Album, vice president of public and government affairs for Delta Dental of Calif., N.Y., Pa., and affiliates.

Together, the two have worn a path through the Capitol, meeting with lawmakers on both sides of the aisle in an effort to amend H.R. 3200 (the working health care reform bill in the House) and other reform proposals to better protect dental benefits.

Stand-alone struggle

The largest problem with the bill, they say, is that it would require that essential benefits (including dental coverage for children) offered through the proposed health insurance exchange must be bundled - grouping medical and children's dental health together - and only be sold through a medical insurer. After five years, the same requirements would be set for essential benefits sold outside the exchange. Stand-alone dental insurers - which, according to NADP, serve 97% of the estimated 174 million Americans with dental health coverage - would not be permitted to offer their plans through the exchange.

"Health care reform is not directed at dental, but by trying to do a good thing - covering children's dental and vision care - Congress is unraveling the dental benefits market for family coverage," Ireland asserts. This is because the bundling requirement applies only to children's dental coverage. Under H.R. 3200, coverage for their parents is another matter entirely. Yet, most dental policies are for family coverage.

While Ireland doesn't disparage medical carriers, she adds that "medical carriers are not prepared to offer dental. So, they will subcontract it to dental carriers, which adds to administrative costs for both."

In addition, Album says, the proposal "takes away [employers'] ability to shop, disrupts providers' relationships with patients, and disrupts the industry and the way it's been designed to compete."

But what's the big problem, truly? Most major medical insurers - the Aetnas and Cignas of the world - have a dental business as well. It's not that simple, Ireland says.

"It's not Aetna medical that's operating your Aetna dental coverage. They are separate systems, separate cards, separate policies with separate operations. Only a handful of carriers are affiliated with a dental carrier. Most are not - about three out of four."

Thus, she argues, if H.R. 3200 or a similar bill passes, "it ends up being more complicated and costly for consumers."

In addition to the increased costs, approving such a measure would raise a major PR problem for the president, Album says. "President Obama has said previously and continues to say, 'If you like your plan and like your doctor, you can keep them.' But that's not even close to being true on the dental side under this model."

However, a key congressional aide says the bill's intent is to ensure that all children have quality and affordable dental coverage, and dismisses these claims as hyperbole. The source, agreeing to address the issue for background purposes only, also notes that an amendment accepted during the legislative markup period noted that nothing would prohibit the offering of stand-alone dental plans.

The bundled approach is best because it provides "a vital benefit" for scores of children who remain uncovered because their parents cannot afford stand-alone policies, says House Committee on Education and Labor Press Secretary Aaron Albright. He says insurers "might need to change the way they do business, but they can still flourish," noting that nothing in the bill would prohibit them from managing dental and or vision benefits for other insurers.

Letting their reputation precede them

So, why haven't employers and consumers heard more about this issue? Perhaps because dental benefits are so steadily cost-effective that they don't garner the attention of health benefits, with costs spiraling upward for more than a decade.

However, it's specifically that reputation that Album says the dental industry can use to its advantage to get lawmakers to listen.

"If we hadn't been so cost-effective, we wouldn't have so much standing on how to work with Congress on this issue," he says. "That we've had the opportunity to get into meetings [with House members], let alone shape policy, is because we have such a good story to tell."

Hoping to strike while the iron is hot on reform, Album says he, Ireland and other dental leaders plan to meet with key senators "on some stand-alone proposals for dental and see how receptive they are to it," as they craft the Senate version of reform legislation. He adds: "We'll also continue advising members of the House and Senate, so that when the time comes to reconcile bills, it won't be the first they've heard of the issue."

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Is separate equal? The advantages of stand-alone dental plans

• Stand-alone dental companies have experience designing and administering cost-efficient dental and vision plans, where medical carriers specialize in adjudicating and paying medical claims based on policies, systems and processes unique to the practice of medicine. Many of these insurers lack the experience and infrastructure to do the same for dental benefits. 
• Subcontracting dilutes accountability. Dedicated dental and vision plans are directly accountable to subscribers for the quality and cost of this specialty care, and are experts on the capture and use of outcomes data to monitor and report on the metrics used to improve health and the service experience of dental and vision subscribers. 
• Excluding stand-alone dental plans from participating in the exchange is inconsistent with the current dental coverage market and President Obama's pledge to not make people who like their current plans and providers switch. Ninety-seven percent of all dental and vision coverage is purchased and priced separately from major medical, not bundled. 
• Disallowing stand-alone dental plans to provide the mandated benefits for children will force a separation between child and adult dental and vision coverage that does not currently exist. Families would have to contend with one policy for children's dental benefits and another for the rest of their family. 
• Under bundled medical and dental programs, how and where premiums are spent can be difficult to track; the true cost of dental and vision could be easily lost within the much larger medical portion of a bundled benefits program

Source: EmployeeBenefitNews.com, October 1, 2009

At presstime, the debate over health care reform still was raging in Washington, and employers remain in the dark about what health plans will look like in the near future. So, as we consider renewal for 2010 while waiting on the action of Congress, HR/benefits pros find ourselves focusing our attention on the rest of our benefits packages.

The rapid aging of the U.S. working population is particularly acute in the local government setting. Palm Beach County is primarily a population of baby boomers. In considering the host of benefits for our employees, my colleagues and I recently contemplated adding long-term care coverage as a voluntary option. Financial planners have been touting this benefit for a while - it's not surprising, given research the Met Life Mature Market Institute that shows annual long-term care costs in some cases can reach $100,000.

It's also not surprising that employees often request this coverage, since although it is unpleasant to think about, many of us eventually will find ourselves or loved ones in need of a long-term care facility. As too many caregivers know, long-term care costs easily could wipe out savings or put an unfortunate financial burden on relatives.

What's less clear, though, is whether it's wise for an employer to offer this coverage. This type of coverage is not a short-term commitment that can be swapped out with a better-priced carrier at renewal. It is a multiyear commitment that must be maintained annually to pay a benefit in employees' later years (although statistics do warn that younger Americans need long-term care more often than we like to think), and employers must consider the benefits and risks.

One advantage of offering LTC in the workplace is the convenience of payroll deduction. No one can forget to pay a monthly premium if it's automatic.

Also, large employers can negotiate guaranteed issue policies for employees. Although LTC policies increasingly are becoming popular on the individual market, the underwriting criteria may disqualify many Americans for coverage due to pre-existing conditions or family medical history. Guaranteed issue can negatively affect insurance premiums, but a group policy offered though an employer often attracts younger policyholders, thus offsetting the increase in premiums.

Further, group LTC demystifies the complexities of purchasing coverage on one's own. Although various carriers and levels of coverage are available, employers typically choose just one carrier, allowing for streamlined communication and education. However, this also means that employers must do their homework when considering what levels of benefits to offer. Inflation protection and non-forfeiture provisions are perhaps the most important components to offer employees when offering group LTC. A 45-year-old employee, for example, who purchases an LTC policy without inflation protection will come up short should he need the benefit 30 or 40 years from now.

Also, since a LTC policy must be maintained for years on end, it is reasonable to assume that at some point in a policyholder's life, a change in his financial circumstances could occur, resulting in missed premiums and even the loss of coverage. Non-forfeiture provisions allow for a reduced benefit in the event of a policy lapse. This ensures that the employee hasn't paid all those premiums only to lose the investment and the coverage entirely.

But in the group setting, LTC is a different animal than other benefits offered. Regardless of an employer's turnover history, coverage must be portable. Termination or retirement doesn't end the need for the policy. Also, in a local government setting such as mine, where vendor contracts are limited to three to five years and must then be competitively bid, transition to new carriers complicates offering of this type of coverage.

Ultimately, our team decided not to offer a group LTC benefit because the local market didn't provide us with many quotes to consider. However, I remain committed to monitoring this benefit as it becomes more frequently offered in the aging workplace. Whether employers choose to offer a LTC plan or not, they should consider doing the research and homework on behalf of their employees so that they can be prepared to answer questions about the coverage, which are becoming more frequent. If they choose not to offer a plan, they should offer employees the benefit of education and information about local resources through which they can obtain coverage.

Source: EmployeeBenefitNews.com, October 1, 2009

With more employers scaling back their workforces, fewer workers are around to keep businesses up and running. Stress levels are bound to rise, forcing employers to keep an eye out for overwhelmed and emotionally drained workers, especially those with chronic conditions.

Experts say if employers hope to hold on to the hard-won gains of their health management programs, then those same programs' services have to recognize stress and incorporate stress-management features.

"We have found that workers with chronic diseases are much more susceptible to complications if they don't manage their stress appropriately," says Anita Messal, chief operating officer at OptumHealth Care Solutions. "Our data shows that people with chronic diseases that have comorbidity behavioral conditions have 30% to 50% higher medical costs."

The HR consulting firm Mercer recently reported that two-thirds of all large employers and 85% of those with 20,000 or more employees offer a disease management program for one or more conditions. About 76% of employers offer a nurse advice line, up from 67% in 2007.

In its 2008 National Survey of Employer-Sponsored Health Plans, Mercer also found that DM programs typically target diabetes (63%) and heart disease/hypertension (59%). The survey is based on data from 2,873 employers that sponsor health plans.

DM programs primarily are offered through health plans, but 15% of employers contract with a specialty vendor to provide targeted programs. Among employers with 20,000 or more employees, 39% contract with a specialty vendor, up from 35% in 2007, Mercer reports.

Holistic help

Although it's up for debate as to whether stress can cause some chronic conditions, medical research shows that patients with chronic diseases who also suffer from depression tend to be less compliant with prescribed medications, explains Allan Khoury, chief medical officer at Pennsylvania-based Take Care Health Systems, a provider of worksite health and wellness centers.

Worse, employees with chronic conditions who are experiencing high stress levels may be even less compliant with treatment regimens, Khoury says.

As such, some disease management programs will have a behavioral health component to their services. For example, for a patient with diabetes, clinicians routinely will screen for depression and other anxiety-related symptoms. "That way, you are not only helping the employee, but also reducing costs," he adds.

Nurse-coaches in DM programs are trained to recognize the signs of stress and educate patients on diffusing stressful situations, says Ann Meyer, executive vice president of clinical programs at ActiveHealth Management, a New York-based firm specializing in health management services.

"We assist members with depression or other significant needs by offering support and coaching, and offering to connect members to other resources, such as making referrals to the employee assistance program," she says.

Some workers with chronic conditions may have seen their hours reduced, resulting in a smaller paycheck. They feel stress over paying their bills, and medication adherence may take a back seat.

Consequently, some employers are turning to valued-based insurance design in which employees with a chronic condition, or those who are fully engaged in a DM coaching program, receive a reduced copayment on their prescription drugs or free genetic drugs, explains Meyers.

A VBID program ensures that workers with chronic conditions are able to afford their medications. "It goes a long way to reducing stress because it offers financial support during these challenging times," she adds.

A stress-free zone

According to a recent survey by the Society for Human Resource Management, only 11% of employers offer stress-reduction programs in 2009, compared to 18% in 2005.

However, some employers are paying attention to stress-management opportunities by creating stress-free zones and rooms within their workplace where workers can relax, says LuAnn Heinen, vice president of the National Business Group of Health.

Companies are looking at stress as part of the environment, and fine-tuning programs to help employees manage stress. "For some employers, it maybe time to say, 'We need to add a few more perks to our health promotion programs or offer more flextime options to our workers to make their lives a little more easier,'" says Heinen.

Carl Mowery, managing director at SMART Business Advisory and Consulting, notes that some workers may be dealing with a spouse who has been laid off, taking an emotional toll that can affect workers' productivity.
Mowery urges employers to push stress-management options offered by their EAP vendor. In addition, employers need to educate managers to look for signs of stress among its workers and suggest that they use the EAP program.

HRAs and wellness programs

Wellness programs can help employees to better manage their stress. "Once you have identified someone with risks factors, whether it's clinical or behavioral, you can design your wellness programs to reflect the stressors that your workers are facing," explains Tracey Moorhead, president of DMAA, a Washington, D.C.-based trade association representing 200 health-improvement organizations.

Health-risk assessment programs are increasingly useful tools to identify where workers are in terms of their health status.

One of the target points on most HRAs is stress.

For example, on an HRA, "you can ask: How many hours do you typically sleep? How many meals in the day do you eat? Do you frequently feel overwhelmed?" Moorhead says.

Those are basic questions that can reveal some significant risk factors for stress and depression.

The HRA will allow employers to identify early on those individuals who may be at risk for complications of an existing chronic condition because of a self-reported increase in their stress level.

Within the context of population health management, HRAs can help employers to understand where on the continuum employees fall in terms of the health management services they might need, notes Moorhead.

Source: EmployeeBenefitNews.com, September 15, 2009

When it comes to personal training, not everyone responds to the “Drop and gimme 20!” drill-sergeant approach. Some people want a kinder, gentler push from their trainers, and others want something in between.

A personal trainer can provide motivation, expertise and individualized attention — all important factors in helping you reach your health and fitness goals. But not all personal trainers are the right fit for you. They can vary greatly, not only in experience, costs and availability, but also in approach, philosophy and personality.

If you take the time to check out different trainers, though, you can find one who clicks with you. Here are some tips to help in your search:

*Consider what you really need and can afford
Trainers charge anywhere from $25 to $125 an hour, but do you really need a trainer for every workout? Or would seeing one on just one day a week help you stay on track with your own program? Maybe you only need a trainer to perform an assessment and then design a workout regimen tailored to your needs. This would allow you to just check in with your trainer every couple of weeks.

*Check qualifications
There are hundreds of certifications for personal trainers, and not all are created equal! Your best bet is to look for a trainer who is certified by one of the following nationally recognized organizations:

American College of Sports Medicine
National Strength and Conditioning Association
National Academy of Sports Medicine
American Council on Exercise
Cooper Institute for Aerobics Research
Aerobics and Fitness Association of America

Beyond certification, practical experience is important too, especially if you have special needs or goals. Some trainers have extra experience working with athletes, older adults, pre- and post-natal clients or people needing injury rehabilitation. Ask to see the trainer’s resume and look carefully for experience that indicates an ability to meet your needs. Some trainers also have Web sites that you can peruse to learn more.

*Meet them
Give careful consideration to personality. Make sure your trainer’s approach matches your style. You will get better results if you are comfortable with and energized by your trainer. Don’t be afraid to buy a few single sessions with different trainers and then pick the one you click with most. After all, you will be spending good money, so you want your trainer to exhibit practical expertise and a personality that is compatible with yours.

Source: thefitlist.com

3 cups all-purpose flour
1 tablespoon ground cinnamon
1/2 teaspoon salt
2 teaspoons baking soda
3/4 cup buttermilk
3 large eggs
2 cups sugar
3/4 cup canola oil
1/4 cup orange juice
1 tablespoon pure vanilla extract
3 cups grated peeled apples, about 3 medium
1 cup flaked coconut
1 cup chopped walnuts or pecans

Preheat oven to 325 degrees. Grease and flour 12-cup bundt pan. Set aside.

Sift flour, cinnamon and salt together. Set aside.

In a 2-cup glass measure, combine buttermilk and baking soda. Set aside.

In large mixing bowl, beat eggs, sugar, canola oil, orange juice and vanilla together at medium speed of an electric mixer until mixture is smooth. Add buttermilk and soda mixture and blend well. Add flour mixture, beating at low speed until blended. Fold in apples, coconut and nuts. Pour batter in prepared pan.

Bake in preheated 325-degree oven for about 1 hour, or until wooden pick inserted into cake comes out clean. Remove from oven and allow cake to cool in pan for 15 minutes. While cake is cooling, prepare glaze.

Glaze:
1/2 cup butter
1 cup sugar
1 1/2 teaspoons baking soda
1/2 cup buttermilk
1 tablespoon light corn syrup
1 teaspoon pure vanilla extract

Bring butter, sugar, baking soda, buttermilk and corn syrup to a boil in a large Dutch oven over medium heat. Boil, stirring often, 4 minutes, or until mixture is golden brown. Remove from heat and stir in vanilla.

Turn cake out of pan onto wire rack. Place rack on a large sheet of waxed paper. Spoon hot glaze over hot cake. Continue slowly spooning the glaze over the cake until all of the glaze has been used. Scrape some of the drippings from the waxed paper and spoon over the cake. Allow cake to cool completely. Serve with Sweet Cream Whip.

Sweet Cream Whip
4 ounces cream cheese, room temperature
1/3 cup powdered sugar
Pinch table salt
1/2 teaspoon pure vanilla extract
1 cup heavy whipping cream

In mixing bowl, use electric mixer to beat cream cheese, powdered sugar and salt at medium-high speed until light and fluffy. Scrape down bowl with rubber spatula as needed. Add vanilla and beat to blend. With electric mixer at low speed, add heavy whipping cream in slow steady stream. When almost fully combined, increase speed to medium-high and beat until mixture holds soft peaks when beaters are lifted.

Tip from the cook

--You would think with so little of just a few ingredients, the glaze could be cooked in a smaller pot. It bubbles up, though, while cooking. Use a big pot.

Source: http://www.echopress.com/event/article/id/68610/