Benefits Buzz

Happy New Year and Health Reform!!

As if you didn't already have enough on your plate this holiday season, the Senate goes ahead and passes their Health Care Reform Bill on Christmas Eve. Of course, the final bill has yet to be seen (or passed), but the implications for employers are far-reaching--and chances are, the first questions you're going to get from your VP of HR and CEO right after New Years. This is going to make the typical start-of-the-plan concerns seem like a piece of cake (ID cards out on time? Who's counting!?!?).

While we wish we had a crystal ball and could tell you just what is going to go down in DC early next year, we can at least offer up what the experts are saying: 

Hewitt--U.S. Senate Passes Historic Health Care Reform Bill
The article contains a high level summary of some of the items contained in the new bill. Hewitt also has a bulletin that discusses the highlights of the reforms of the health insurance market, impact on employers, revenue-raisers and the impact on Medicare. A free teleconference series is being offered starting on January 7, 2010 to discuss health care reform in more detail.

Towers Perrin--The Stage is Now Set for a Joint House-Senate Conference Committee
Towers Perrin offers a point-by-point list of employer and employee-facing provisions in the new senate bill in their weekly column, “The Week in Health Care Reform.” There is an associated podcast with the article.

Deloitte--Health Care Reform Memo
Deloitte offers a summary of key features of the bill, broken down into sections based on
•    Increased access to insurance
•    Improved delivery system performance
•    Reduced costs “bending the curve”
The memo also contains information on the funding of the bill, what is next in the process, an AMA endorsement and other facts and quotes related to the bill.

Employee Benefits Adviser--A mixed bag: Senate bill is improved, but flawed
An opinion piece, this article discusses the changes made to the Senate bill surrounding insurance brokers and advisers before it was able to pass. More details of the provisions surrounding brokers can be found on the EBA podcast, Broker specifics in the Senate reform bill. The featured speaker is Jessica Waltman of the National Association of Health Underwriters’.

BLR--Senate OKs Healthcare Overhaul with Employer Mandate
BLR provides a brief description of the employer mandate outlined in the new senate bill, including the penalty amounts and deadlines for non-compliance.

New York Times--Senate Passes Health Care Overhaul on Party-Line Vote
The article discusses the politics behind the bill, including the fact that no Republicans backed it. It goes on to discuss some of the issues surrounding the bill, such as funding and impact on Medicare, but in little detail. Lots of other resources on their website, including daily opinion posts.

Business Week--Senate Passes Measure to Overhaul Health-Care System
This article is divided into sections about the compromise needed to become law, the expanded coverage that would result from the bill, the impact on health stocks and the environment surrounding the bill.

A lot to digest and a lot to be determined. Feeling totally overwhelmed? Compare health reform to everything else that's happened in the last 10 years and you might feel just fine. 

Editor's Note - Jennifer Benz is founder and chief strategist at Benz Communications, a boutique consulting firm that focuses on employee benefits communication. You can reach her at jen@benzcommunications.com or via Twitter @jenbenz.

The Nuclear Option: GE Moves to Only High Deductible Medical Plans...

If you're like me, you've pondered moving to high-deductible plans at some point in the last five years.  Whether you made the move or not, this much is certain:  Companies that started with a traditional PPO plan have generally kept those plans in place, bringing in the high-deductible/consumer-driven plans as an option, then attempted to draw employees into those plans with premium cuts and funding of health-care accounts (HCAs).

Not GE.  They went nuclear.  More from BusinessWeek:

"It's been a hard year to work at General Electric (GE). Salary freezes have hit its famously performance-driven employees, with some managers taking pay cuts. And now GE is making changes that could deal another blow to morale. The company is forcing its 75,000 salaried U.S. employees and 8,000 retirees under the age of 65 to choose what's known as a consumer-directed health plan, which includes deductibles that run as high as $4,000 a year. Traditional plans, where employees pay higher premiums in exchange for predictable co-pays up front, are no longer available for salaried workers. One employee says his colleagues "are looking at this as a cut in pay."

That's what's called a BOLD move people.  Like so much else in today's world, it all comes down to money:

"GE says the plan is being rolled out to make employees better health-care consumers and to coincide with its new "Healthymagination" strategy, a companywide initiative for health-care innovation. While GE says its future cost savings are unclear, people with knowledge of the situation estimate it could save $1 billion over the next decade or so. With three tiers of premiums and deductibles, GE spokesperson Sue Bishop notes, employees still have options. "It's not that different from their car insurance," she says. "You get to choose the amount of your premium, and that determines the amount of your deductible."

Moving from PPO to high-deductible only.  That's the nuclear option.  Will the bold move by GE spawn a bunch of similar "me-too" moves?  I suspect only after the move looks to be on track to save 1 billion with limited downside in terms of retention, etc.

Calorie Counter Apps -- Making Thanksgiving Way Better (or Way Worse?)

Thanksgiving may be one of our favorite holidays, but it sure does nothing to help anyone trying to lose weight or stay on a diet. This year, your iPhone or Blackberry may be to the rescue (or, just may be the bearer of bad news). Lots of calorie-counter apps can help you (and your employees) keep on track with eating right.

Just in time for Thanksgiving, MobileHealthNews.com has a run-down of the top apps. Here's what they say:

In the coming years these calorie tracking applications will become far more user friendly by being coupled with wireless peel-and-stick sensors that automatically count a person’s calorie intake. Companies like Philometron are working on those sensors right now — until then we have to manually enter or look up our food’s calories, which makes tracking a chore.

A chore, yes, but way easier than any online method or paper and pen. Some of these apps were designed for managing diabetes or keeping up with a specific diet plan--all good stuff.

These are just a few of the countless mobile apps putting health and fitness info in your employees' hands. This is going to be a fun, fun space to watch as more and more wellness companies and health plans get in the game of mobile apps, making tracking health and wellness easier and more fun.

As for me, I think I'll start using these apps after Thanksgiving. 

Editor's Note - Jennifer Benz is founder and chief strategist at Benz Communications, a boutique consulting firm that focuses on employee benefits communication. You can reach her at jen@benzcommunications.com or via Twitter @jenbenz.

Do As I Say And Not As I Do When it Comes to Wellness?

Could research in ethics and management shed any light on the impact that culture can play with regards to wellness? 

Studies have shown that management behavior influences workplace ethics.  A Deloitte and Touche study showed that among working adults, the behavior of management (42%) and that of direct supervisors (36%) were considered the top two factors contributing to the promotion of an ethical workplace.  Ethics training ranked much lower (16%) as a factor.

Other studies have shown that corporate codes of conduct and the degree of "implementation strength and embeddedness" of such codes seems to deter self-reported unethical behavior in employees.


If it works for ethics, can it work for wellness?

If corporate code and management conduct are so influential when it comes to ethics, could their example also improve workplace health and productivity?  A new body of studies in health promotion seem to point in that direction. 

An article published in the Journal of Occupational And Environmental Medicine, looked at nine quality components of worksite health management programs and compared the results of those programs between best practice and common practice organizations.  Best practice organizations showed higher levels of program engagement than common practice organizations and were 1-2.3 times more likely to see population health improve.

Everyone wants to be the best
So what are some of the distinguishing characteristics of best in class programs?

• Comprehensive program design
• Integrated incentives
• Comprehensive communications
• Management support
• Dedicated onsite staff
• Multiple program modalities
• Health awareness programs
• Biometrics health screenings
• Vendor integration

The first step in really showing the value of any wellness program is always to form a cogent plan, make the case to management and then to execute that plan with enough discipline and flexibility to achieve results.  It's no small job, but what worth doing is?

Editor's Note - It's hard to be humble when you're bloggin' straight out of Portland, Oregon.  Tanya Barham is the Founder and CEO of Recess Wellness, a company where all the staff works like little elves at Christmastime to transform their client's workplaces into healthy, happy, productive places akin to Santa's workshop at the North Pole.  Seriously.  Of course, Santa's fat, so they still have work to do.

A Fully Insured Renewal Story - Feel the Pain...

Here's a fully-insured renewal story from a small company I'm networked with... Feel the pain, my friends....

Here’s What You Need to Know:

1. Premiums paid by company to BCBS: 323K

2. Claims paid out by BCBS to cover company claims: 181K

3.“Pooling Effect” Applied by BCBS: 139K

4. Administrative Costs Applied by BCBS: 56K

5. Sum of #2 through #4, BCBS Stated Cost Line: 376K

6. Result: BCBS gives company 1% rate increase

*** Note: BCBS uses past premiums paid, not resulting in claims cost, to decrease the % increase that would be called for (#5-#1).

That's right - this company had claims representing 60% of the total fully-insured premiums paid into the system for the year - a great year in claims experience by any measure.  And took a 1% increase...

 

Sigh...

 

Doctors and Coke, sitting in the tree, k-i-s-s-i-n-g....

Two food and health partnerships really got under my skin this past month.
 
First, the American Academy of Family Physicians’ sponsorship deal with Coke for the AAFP’s consumer-  
facing website, familydoctor.org, where Coke will underwrite content development on beverages and sweeteners. This deal is the first for AAFP’s new Consumer Alliance, a corporate partnership that—and I’m quoting from the AAFP’s press release here— “allows corporate partners like The Coca-Cola Company to work with the AAFP to educate consumers about the role their products can play in a healthy, active lifestyle.”
 
Is it me, or do these two seem like strange bedfellows? This is the same organization that published a study linking soda consumption to unhealthy weight gain and, possibly, to diabetes, right? Who in an article, titled “Assessment, Prevention and Treatment of Childhood Obesity,” outlined these recommendations to their physicians counseling young patients and their parents:

· Drink less 100-percent fruit juice. While fruit juice contains many important nutrients, it is also high in calories. Drinking too much fruit juice may contribute to weight gain.

· Drinking too many sugar-sweetened beverages, such as soda or juice drinks, can contribute to weight gain. For example, drinking one soda each day adds enough extra calories to result in a 10-pound weight gain each year.

· Water is the most important nutrient. Pack water instead of juice boxes for lunches, sports or travel.

Maybe this alliance wouldn’t be so galling if it didn’t follow right on the heels of the beverage industry’s sharp attack on a potential soda tax and the launch of the Smart Choices Program™. The program’s simple. Companies pay up to $100,000 to display the Smart Choices seal of approval. Their products are given a nifty green check mark to signify they’re healthy choices and are identified on the Smart Choices website. Fruits, vegetables, whole grains, and low- and nonfat dairy are all included. So are full-fat mayonnaise, Froot Loops, Lucky Charms, Lunchables Chicken Dunks, and Fruit Roll-Ups Crazy Pix.
 
The problem is that the program’s too simple. It’s not a “smart,” “smarter,” “smartest” food labeling system. There’s no path—from Froot Loops to fruit and low-fat yogurt, for example—to help consumers make increasingly better choices. Buyers, like my kids or your employees, can now walk into the grocery store and—with a straight, validated face—tell themselves (or their parents) that they’re making a “smart” choice and go on their merry way.  
 
Look, Lucky Charms aren’t the devil. Neither are soda and fruit juice. My family’s the oddity in our group of no-dessert or dessert-once-a-week friends. We have dessert twice a day, and I don’t mean fruit. We also tip back a can of soda now and again. I also recognize that my disgust is preemptive. Nobody knows how this new alliance will play out.
 
It may go the way of the Smart Choices Program. The Friedman School of Nutrition Science and Policy at Tufts, the American Diabetes Association, the American Dietetic Association, and the Center for Science in the Public Interest—all original board members—have either dropped off or asked that their organizations be removed from the board, stating that individuals, not the institutions, are involved. Just last week, the Connecticut Attorney General announced he’s investigating Smart Choices, calling it “overly simplistic, inaccurate and ultimately misleading.”
 
But on the face of it, these deals and others like them make it increasingly difficult for consumers to make sound decisions and to know where to turn for reliable, unbiased information. They smack of trading a pound of flesh for our trust…and a ton of cash.

UPDATE: As of Friday 10/23, “Smart Choices,” a food industry labeling program that launched this summer and was backed by a bunch of food-business heavyweights will “voluntarily postpone active operations,” according to this statement. 
 
Editors Note: Fran Melmed is the owner of context communication consulting llc, an employee communication consulting firm. She blogs at free-range communication on communication, HR, and health and wellness. You can find her on Twitter @femelmed. (image credit: http://www.flickr.com/photos/coca-cola_art_gallery)

Tweet Your Way to Better Benefits Communication...

Do you tweet?  If not, you ought to think about it.  Chances are a lot of your employees are either tweeting or are following tweets of friends, newsgroups, or other organizations.  You yourself may be following any number of firms that work in the HR consulting space: @towersperrin, @hewittnews, @watsonwyatt, etc.  And if you’re reading this blog, you probably follow the tweets of various bloggers, as well.  Why, then, would you not consider tweeting to your employees about their benefits?

Think about it.  Annual Enrollment is just around the corner for most employers.  And setting up a Twitter account couldn’t be simpler.  All you need is a name and an e-mail address, both of which I’ll assume you have or can scrounge up.  Then, in your more formal communications to employees, simply add somewhere, “Follow me on Twitter @inserttwitternamehere”.  That’s it.  Interested employees will subscribe, and those who aren’t won’t.  The initial investment outlay is almost nothing.

I know what you’re thinking: “How could I communicate, in 140 characters or less, enough information about our benefits to be of value to employees?”  Well -- you could use it as a mechanism to point employees to articles posted to your intranet about benefits changes for the new plan year, remind employees about that start and end of Annual Enrollment, and direct employees to resources they can use to make intelligent benefits decisions.

This is going to be a hard sell for some people.  Even as social media has grown so explosively over the past several years, Twitter seems to be the medium that’s received the least attention.  Facebook and MySpace are easy to explain to not so tech savvy people.  They’re simple applications that allow you to connect with and follow the lives of friends, colleagues, bands, movie stars, etc.  Your grandmother may even have a Facebook account.

Twitter, on the other hand, generally requires some explanation.  When you tell your vice president of compensation and benefits that you think tweeting during this year’s Annual Enrollment could help drive active participation and facilitate effective benefits communication, you may be met with a blank stare and/or glazed eyes.  S/he is going to ask the same question you were thinking earlier: “How could I communicate in 140 characters or less enough information about our benefits to be of value to employees?”  The real investment here may be the time spent garnering support from management to implement Twitter as a communication mechanism.

Full disclosure -- I’m not an attorney.  There may be legal implications to using Twitter to communicate with employees in your organization regarding benefits.  You should consult with your own legal counsel before doing so.  You may also be opening yourself up to employee responses to your tweets with how they really feel about your company or its benefits offering.  These responses can (and likely will) be read by people outside of your organization.  There are two ways to view this.  On one hand, it’s good to get candid feedback from employees.  On the other, most of us would rather not air our dirty laundry for the viewing public.  You’ll have to weigh the risks and benefits of this before taking any action.  If you ultimately decide that tweeting leaves your organization too exposed, you may want to consider private microblogging networks like Yammer.  I think the primary issue with these private networks will be adoption by employees, since they won’t already have accounts setup.

Can Twitter replace your formal benefits communications materials?  Of course not.  It’s impossible to explain all that needs to be understood about your company’s benefits in 140 characters or less.  And I suspect employees would be less than receptive to receiving multiple 140 character tweets in consecutive order that, when combined, communicate a cohesive message.  But using it as a mechanism to point employees in the direction of more formally developed communications, sending reminders about key dates during Annual Enrollment, and guiding employees to resources that help them make educated decisions about their benefits would be useful.

So let’s hear it.  Have you used Twitter or other forms of social media to communicate to employees about their benefits?  What were your biggest challenges in rolling it out?

And, if you’re interested, follow me on Twitter @g_dagley.

Editor's Note - Greg Dagley is a Benefits Consultant for a large multinational employer in Houston, TX. While his company has employees all over the globe, his job keeps him focused on US benefits and spending a lot of his time managing external vendors.  Is there any doubt his Excel skills are more advanced than yours?

How to Annoy Your Benefits Administrator: Ask for a Mobile Enrollment App Now...

... and maybe, just maybe, you'll get it by next year.

It is almost open enrollment and, by default, about that time to be testing your online enrollment system. Chances are you've gotten in there and realized that, much to our dismay, most online enrollment sites are just not as intuitive or user-friendly as the Amazon/Facebook/Google online world we've become accustomed to.

There is such a disconnect between the mostly clunky HR systems online world (enrollment websites, HRIS systems, etc.) and the rest of the online world of super-personalized consumer, social media and gaming websites. Do employees tolerate this because they have to? Yes. Is it preventing them from being engaged in their benefits and enrollment decision-making? For sure. 

It is long past due for most HR platforms to have a major face-lift. For years and years, many enrollment sites haven't even met basic usability standards. Now, social media, personalization and gaming (just to mention a few factors) have totally changed the game when it comes to the online experience, setting the bar even higher. Four out of five adults are using social media sites and mobile phone usage of the web is skyrocketing.

In the benefits world, we tend to think that if an employee isn't sitting in front of a desk at work all day that they don't have access to the internet. Not so, especially when you factor in mobile devices. In fact, mobile may prove to be a much more effective way to reach the "un-wired" workforce than websites ever could be. And, there is so much exciting work going on with mobile apps for health care. From monitoring diabetes to managing HIV/AIDS to fitness. Not to mention all the other amazing things you can do with an iPhone or Blackberry and a data plan. This is going to be the new standard and what your employees expect--seamless, ridiculously simple, fun, engaging and integrated both online and through mobile devices.

So, while you're in there testing your enrollment platform and making sure all your price tags are accurate, go ahead and tell your benefits administrator that it is time for a major upgrade to the user experience. Ask them for a mobile enrollment app too. Let their jaw drop before you add on "next year." And, then, keep asking until you get it! 

By the way, do you have an online enrollment site that actually IS as intuitive as Amazon or Google? If so, please send it our way (pretty please!) and we'll show it off here! 

Editor's Note - Jennifer Benz is founder and chief strategist at Benz Communications, a boutique consulting firm that focuses on employee benefits communication. You can reach her at jen@benzcommunications.com or via Twitter @jenbenz.

Flu Prevention--Mostly Common Sense, but Do Your Benefits Policies Support It?

The Chicago Tribune's cover of the Sunday business section has a story, like dozens we're seeing now, about Firms bracing for a rash of flu absences. While I hope the H1N1 flu season doesn't prove to be much worse than a typical flu season, most companies (and certainly the major media) are already assuming the worse.

What struck me from this Tribune article was the prevention advice: 

Tips for H1N1 flu prevention and treatment

-- Cover your nose and mouth with a tissue when you cough or sneeze.

-- Wash your hands often with soap and water, or use alcohol-based sanitizers, especially after you cough or sneeze.

-- Avoid touching your eyes, nose or mouth to limit the spread of germs.

-- Avoid close contact with sick people.

-- If sick, stay home for seven days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer.

-- Follow public health advice regarding school closings, avoiding crowds and other social-distancing measures.

-- Get both the seasonal and H1N1 flu vaccinations, when available. This is especially important for pregnant women, caregivers to infants and health care personnel.

-- If you contract swine flu, talk to your doctor about antiviral medications Tamiflu and Relenza, which can lessen the duration and severity of the illness.

-- For more information visit flu.gov.

Source: Centers for Disease Control and Prevention

Pretty much all common sense, right? The first 5 tips especially are behaviors that make sense ALL the time--not just when there's a pandemic. But, no matter how much the CDC says it, and no matter how much we all know it makes sense, how many people actually stay home when they are sick? (Let alone for seven days!?!!?)

This isn't all about company policy (it is also a lot about individual choices) but, there are a ton of benefit programs and policy factors at play here--time off programs, sick leave, coverage for preventive care, short-term disability policies, family leave, access to child care, the list goes on and on. A company can't be successful with the message "please stay home when you're sick" if they don't have the policies, business process and culture that allow for that.

While many companies have moved from separate sick, holiday and vacation banks to one single "Paid time off" for flexibility, those policies may unintentionally encourage people to work when they are sick. Would you rather come into the office with the sniffles or take a day off of your upcoming vacation to Maui?

What if furloughs have drained people's vacation and PTO banks this year? How will you encourage workers to stay home when they're sick if they are going to have to take a pay cut to do it? Do your policies support parents who may need to stay home with sick kids?

And, what about hourly and low-wage workers? How do you encourage them to take time off if being sick for a week may mean not being able to make rent that month?

Think about the business culture too. Do the work requirements of a specific line of business set the expectation that no one can ever miss a day? How many knowledge workers still come into the office when they're sick even though they have laptops and cell phones, because they don't have a good relationship with their manager? How many managers don't really understand the time off and benefit policies in the first place?

Lots of questions and no easy answers. And, much at stake as we know the cost of lost productivity and absenteeism. As you plan for the flu season, look deeper--beyond common sense communication and business planning--are your benefits programs, policies and business culture truly supporting the health of your workforce this flu season? Or, are they discrediting your message and encouraging exactly the opposite behaviors you need?

Editor's Note - Jennifer Benz is founder and chief strategist at Benz Communications, a boutique consulting firm that focuses on employee benefits communication. You can reach her at jen@benzcommunications.com or via Twitter @jenbenz. 

Market-Based Health Reform: Good Thoughts, Not As Easy As It May Appear...

Shawn Tully provides some interesting proposals to reform health care in this country in an article published by Fortune Magazine on-line this week.  His proposals involve taking a market based approach to reform.  Here are some highlights:

• Eliminate the tax break provided to employees who get health care through their employer.
• Encourage employers to stop offering health coverage altogether and, instead, increase employee wages by an amount equal to what they pay on behalf of employees for that coverage.
• Give tax breaks directly to consumers to purchase health insurance on their own.
• Promote high deductible health plans (or other consumer focused coverage) for consumers on the open market so that consumers of health care begin acting just like that: consumers.
• Deregulate the “three big inflators” of health care costs: the standard benefits package, community rating, and guaranteed issue.
• Permit consumers to purchase health insurance across state lines.

In theory, I agree with Tully.  Take the money employers pay for health insurance and give it directly to employees.  Give tax breaks directly to consumers to purchase health insurance on their own.  Encourage (or incentivize) people to purchase only the health insurance they need and use the remainder of what they don’t spend on insurance itself to cover other health care expenses.  And implement reforms that encourage competition and innovation in a free market.

However, I see some issues with this approach.  First, I have little confidence that all employers will raise employees’ salaries by an amount equal to what they’re paying for health insurance.  Some employers will reduce total compensation to employees by raising salaries by an amount less than what they’re paying for health coverage hoping those employees will simply be appreciative for the nominal salary increase.  That said, one can argue that the labor market will correct this in the long term.  But there will be some period of time during which employees’ overall compensation may be materially reduced. 

Second, employees don’t know how to buy health insurance on their own.  For sixty years, employers in the US have spoon-fed health insurance to 170 million Americans, who very rarely read their Summary Plan Descriptions.  Pushing this responsibility to employees will, no doubt, result in analysis paralysis on the part of many consumers.  In a worst case scenario, consumers will purchase coverage that is far too rich or far too poor, simply because they don’t know what they’re buying.  And I don’t think that consumers will earmark what they don’t spend on a Cadillac health care policy for other health care expenses.  Prior to the current economic situation, Americans showed that, under normal circumstances, they will spend everything they bring in and then some.  The personal savings rate in the US was negative 1% in 2006 and negative 0.4% in 2005.

I am supportive of market based solutions to the health care dilemma this country is currently facing.  I worry that relying on employers to replace health care benefits with additional compensation will not work out in favor of employees (at least in the near term).  I’m not sure that consumers are ready for the responsibility involved in purchasing their own health insurance.  (Why do you think universal national health care has the support it does?)  I also think that Tully’s proposals work fine in a bubble.  But there are too many interests groups (including the insurance industry, unions, employers, local, state, and federal government, etc.) that will throw up innumerable roadblocks to any and all of these proposals.  The health care industry makes up one sixth of our national GDP.  Navigating the political landscape to implement such market based solutions would be almost as difficult as, well, navigating the political landscape to implement a public option to compete with private health insurers.

Editor's Note - Greg Dagley is a Benefits Consultant for a large multinational employer in Houston, TX. While his company has employees all over the globe, his job keeps him focused on US benefits and spending a lot of his time managing external vendors.  Is there any doubt his Excel skills are more advanced than yours?