Benefits Column

Employee Benefits Forecast

While the spring HR-related conferences showed there's still a heavy employer focus on the Affordable Care Act and employee health, companies are starting to bridge the gap that's existed between mental and physical -- and even financial - health.

Monday, May 5, 2014
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It's the spring conference season. That means I find myself at a spectrum of events where I speak to and meet with HR executives as well as insurance carriers and health, wellness and benefits professionals.

I adopted a presentation style several years ago through which audience members text message me questions during my sessions. It's a good way to gauge what's top of mind for them and shift directions, if needed. In my last column, I summarized answers for inquiries received during the panel I hosted on private exchanges at the Human Resource Executive ® Health & Benefits Leadership Conference in Las Vegas in March.

I recently skimmed my SMS stream and found a good number of great questions from the closing session I gave in Las Vegas with conference chairperson Jennifer Benz. There was also a string of comments we didn't have time to address at the World Heath Care Congress in Washington.

So, I find myself in the enviable position of responding to what's currently most important to HR leaders. And I don't have to go it alone. Once again, I'm partnering with a friend and colleague. This time it's Janet McNichol who is the human resources director at the Rockville, Md.-based American Speech-Language-Hearing Association. McNichol was a speaker at both conferences and recently wrote a blog post about her experiences. She also brings her unique perspective as an HR professional working for a relatively small employer.

HARNETT: Your takeaways from both conferences appeared to center mainly around healthcare delivery, including topics such as the patient-centered medical home, narrow quality-centered networks, hospital safety, medical necessity and evidence-based medicine. Is it healthcare costs that drive your interest, or something larger?

MCNICHOL: I'm motivated to help our staff receive the safest, most appropriate care. With 265 employees, I know all of our staff. I'm not dealing in the hypothetical when they're ill or they have a family member who is sick. I truly care about them and want them to have access to the best-quality healthcare.

At the World Health Care Congress, in particular, we heard a lot about misdiagnoses, overtreatment, medical errors and harm that patients sometimes experience from mistreatment. I want our staff to seek care from physicians who base their treatment plans on evidence-based medicine. If they need to be treated at a hospital, I want them to go to a health center with an A rating from the Leapfrog Group. If they're dealing with a serious diagnosis, my desire is for them to be evaluated at a center of excellence. I also believe the safest, highest-quality care is ultimately cost-effective. 

I took away from both conferences that large and small employers are passionate about their employees' health. For example, we talked about Sovaldi (new treatment for Hepatitis C) during the World Congress meeting. It costs about $1,000 per pill and more than $84,000 for a course of treatment. All the employers shared their intention to include the drug in their pharmacy benefit formularies. It represents a cure for a chronic and often fatal condition, so employers are willing to foot the bill.

HARNETT: I used to work in healthcare delivery and I'm always heartened when I hear HR executives like you express compassion for their employees' health.

Many employers need to justify the money they allocate for employee benefits - especially healthcare dollars. You mentioned your belief that safe, high-quality care is cost-effective. How do you attempt to measure cost-effectiveness? Do you use a combination of factors such as healthcare premiums, employee absence, performance and productivity?

MCNICHOL: This is where the size of our organization becomes a disadvantage. We review our health-plan rate increases and compare them to the trend. We have a pretty good idea of how and where we're spending our money.

I have data on family and medical leave and disability claims, of course, but cannot access data concerning the use of sick leave. We have good information on performance, but no way to tie it to health. And we know nothing about productivity.

Building systems to collect all this information is prohibitively expensive for us. I know a lot of employers gather employee-productivity data through worker self-report tools, but I personally question the legitimacy of this approach.

Frankly, I don't need a bunch of data to compel people to do the right thing here. But, I still wish I had more information available to me. 

HARNETT: Your situation is not a great deal different than a number of large employers with whom I work.

At the World Health Care Congress, attendees spent a lot of time talking about having employees funneled to narrow quality-centered networks and centers of excellence. But, I've heard you say on more than one occasion that employees will travel farther to go to a good restaurant than they will to be treated at a good chemotherapy center.

How do you influence where employees seek healthcare? Do you have to force their hand by how you reimburse them for the healthcare practitioners and physicians they select?

MCNICHOL: I've been thinking about this a great deal. No one wants to go to a provider with poor-quality outcomes. They wind up at one because they don't know how to distinguish their choices, or they put too much trust in a particular doctor and follow his or her advice without thought.

We can tackle the first problem by educating people. The second problem is tougher and may have to be addressed by changing the plan design.

Right now, I'm looking at tackling this in stages:

·         Stage One: Educate people and nudge them to seek care at higher-quality hospitals.

·         Stage Two: Offer an incentive to get employees to use higher-quality hospitals.

·         Stage Three: Eliminate the poor-quality hospitals from our network.

The challenge for me is if each stage lasts one plan year, we could have employees receiving care at hospitals with poor-quality ratings for two more years. I'm also not confident that an employer of our size will be able to influence the hospitals available in our network. For that reason, I'm looking into getting involved with the Mid-Atlantic Business Group on Health.

HARNETT: What's fascinating to me about your employees is that many of them are healthcare professionals. Their use of questionable quality, yet conveniently located, healthcare practitioners and facilities further convinces me that all decisions - including healthcare choices - are often emotionally based.

At the HRE conference, a consistent subtheme concerned mental, emotional and behavioral health. Almost every session (including Jen's and my closing session) ended with acknowledgement of the disconnection between mental-health services and medical, wellness and financial initiatives.

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Your most recent blog post addressed a change you're considering in how you deliver traditional employee-assistance services. Some of your thinking was influenced by how Nate Randall from Tesla Motors described the company's concierge services, which are really a robust EAP in disguise.

How do you intend to address emotional health going forward, and will you consider tackling the overlap between mental health and medical, wellness and financial health?

MCNICHOL: I've found the lines between our traditional employee benefits and our wellness initiatives are blurring. In large-employer settings, it seems as though distinct areas with different staff run individual efforts. At ASHA, I'm involved in it all.

Last autumn, I looked at each aspect of our wellness program and evaluated our vendor relationships. That assessment caused me to make some changes with our EAP. But, I still feel there is a detachment among the various pieces of our health, wellness and mental-health programs. I have a different vision for how I see our overall wellness initiative evolving.

My thoughts started to take shape when I listened to the CoHealth radio show you and Fran Melmed recorded with Alexandra Drane (founder of the Eliza Corp.) concerning the Vulnerability Index, resilience and contextual life factors that impact health and productivity. In that interview, Drane described three categories:

(1)   Life obstacles such as caregiving, financial stress and relationship difficulties;

(2)   Buffers (or positive coping mechanisms) that included enjoying the support of peers, having a sense of spirituality and engaging in exercise; and

(3)   Magnifiers (or negative coping responses) such as substance use, feeling sad and not getting enough sleep.

I compared this perspective with ours and realized we were focusing on individual choices and behaviors. We hadn't given enough consideration to helping employees deal with the life circumstances that made them more or less vulnerable to negative health outcomes. Up until now, we relied on our EAP to provide those services. And that's just not enough.

Going forward, we are going to broadly focus on helping our staff build their resilience. We will organize our education and resources under the umbrellas of dealing with life obstacles, building buffers and minimizing magnifiers. I'll share what we do and what we learn on my blog as we move forward.


So, there's a taste of the big topics HR executives discussed and debated at two of the 2014 spring conferences. While there's still a focus on the Affordable Care Act and employee health, companies are starting to bridge the gap that's existed between mental and physical, and even financial, health. And they're also trying to consider how to help workers cope with the growing challenge of caregiving, financial stress and relationship difficulties in ways that go beyond traditional employee-assistance programs.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.


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