Benefits Buzz

Obama on BCBS of Alabama: Did He Mean It Was a Good or Bad Thing?

If you saw President Obama's speech on 9.9.09, you heard him reference the medical insurance situation in the state of Alabama.  Here's a rundown of what Obama said with a little analysis from WAAYtv.com:

"One paragraph in President Obama's health reform speech Wednesday night really perked up a lot of ears here in Alabama.

Here is the quote : "Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down." 

So what company was the president talking about? And is it true?

According to a report this year from the Government Accountability Office this year, 9 out of 10 insurance holders in Alabama use Blue Cross, Blue Shield. The same report shows less than 10 companies are legally allowed to sell health insurance in Alabama.

But is that a bad thing, as the President implies?

Alabama's Deputy Insurance Commissioner David Parsons doesn't think so. In an interview with insurance industry news site "InsuranceNewsNet.com" last month, Parsons compared BCBS to Wal-Mart, saying "Over time, it's kind of like the Wal-Mart syndrome," "They offer good products at lower prices, and people gravitate to it. They out-competed everybody."

I'm not a healthcare policy wonk.  I'm just a VP of HR trying to offer great benefits and keep costs in line.  But here are a couple of points for those not familiar with how healthcare works behind the scenes from providers like Blue Cross Blue Shield of Alabama:

-Because BCBS of Alabama owns the market, they are able to get huge price cuts from hospitals and doctors.  When I took my first company to self-insured status (for those of you unfamiliar, that means the company pays its own healthcare bills, dollar for dollar, with BCBS serving as the administrator and earning its money through an 8-10% administrative fee), I was shocked to see BCBS paying 40-50% of the retail sticker price for both office visits and procedures.  Hospitals and Doctors have to accept BCBS cutting costs in this fashion since they own the market. (Much like WalMart forcing vendors to cut costs that get passed along to consumers in some fashion).  If they don't agree, 90% of Alabama won't use them.

-The main grind in this situation is for fully-insured companies (meaning they pay set premiums on behalf of their employees, then face rate renewals annually), especially those with fewer than 500 employees.  BCBS uses a pool formula to determine increases, which means you could pay more in premiums than BCBS paid out in claims for your company and still get a hefty increase.  Like the doctors and hospitals, you have to take it because there's no one else in the market.

Again, I'm not a heathcare policy wonk, so I don't have the answer for you.  I know that those who advocate a single payer healthcare system dream, in part, of having the market power that BCBS enjoys.  The scary part?  When the system as a whole pays out more than it takes in, someone has to pay.  Can that be anyone other than the taxpayer, or the federal deficit if healthcare was nationalized?  My experience with BCBS of Alabama, both in a self-insured and a fully-insured environment, says "no".

The alternative is real competition.  I'd love to see some real research on what happens to pricing power related to hospital and doctor payment when 50 or more insurance companies are allowed to do business in a single state.

Editor's Note: By day, Kris Dunn is the VP of People at DAXKO, a cool software firm dedicated to providing solutions to the best membership-driven organizations in America. At night, he morphs into a blogger at The HR Capitalist and the Founder and Executive Editor of Fistful of Talent. That makes him a career VP of HR, a blogger, a dad and a hoops junkie, the order of which changes based on his mood. Tweet him @kris_dunn...

Open Enrollment IS Different This Year...

Open enrollment is just around the corner and many of you are already feeling like this year is going to be different. And, it will be. There’s a lot going on--the economy, the national debate on health care, the increased influence of social media. And, all of this is changing the way employees think about their benefits--and should be changing the way you think about enrollment.

Three big factors are shifting the employee mindset faster than you can say "default elections" and you need to know how to react:

1. Employees care about their benefits more than ever before. Survey after survey shows how much employees value their benefits–-both health care and financial. With salaries frozen, or decreasing, and the value of health care benefits always on the rise, benefits make up a larger part of total compensation than in years past--and, as a result, a larger part of your employment brand and value proposition.

2. At the same time, benefits are on the national stage--and you’re going to get more hard-to-answer questions. Health care reform has put health care benefits front-and-center in the national news. CEOs are getting in the debate. Employees and families will want to know how legislation may change their benefits and their health care.  As such, this is a prime opportunity for you to demonstrate and reinforce the value of your benefits offerings. 


3. And, if that wasn't enough, social media is changing (edit: has already completely changed) expectations for how, when, and why employees receive information. In an age of iPhones, Facebook, Twitter, and real-time access to any piece of information, the traditional methods of communicating benefits information are just not good enough. Employees want easier access to information and they want it to be easy to take action on the information they receive.  


So, great, but what do you do with that information? It is almost September, so a little late to overhaul your technology systems or completely change your communication strategy. But, there are simple ways you can improve your enrollment communication this year:

Connect benefits to the business. If you’ve never educated your employees about your benefits philosophy and how it is connected to your business, now is the perfect opportunity. Arm managers with information about total compensation and use them to help tell the whole story. Simple talking points or checklists will allow them to push your benefits message further.

Keep it simple. Employees' top concerns during enrollment always are: What's new? What will it cost me? This is no different than in years past, and you can spell out these answers (and why) in simple, easy-to-understand terms along with simple step-by-step instructions on how to enroll. If you haven’t already done so, create a one-page enrollment “Tip Sheet” that lists what’s changing in as simple a format as possible (perhaps just a list), gives brief enrollment instructions, and tells employees and families where to go for all the details. 

Focus on employee’s personal needs.  Resist the temptation to include figures about your total benefits spend or tell employees how many billion dollars per year bad health care decisions are costing the U.S. They are hearing this enough in the news and are already zoned out before you finish saying "billion." Your employees need to know how it impacts them, their lives and their families. If you talk about your overall health care costs, break it down into what the company spends per employee. When you talk about changes that could decrease costs, tell your employees what that will mean to their pocketbook. 

Promote missed or under-utilized benefits. Put together a list of the 5 to 10 benefit plans employees aren't using enough--health savings account, fitness benefits, voluntary insurance, hidden features of the EAP, preventive care benefits, commuter benefits, etc.--as a one-page tip sheet. Title it “The Top 10 Employee Benefits You’re Missing” or “10 Ways You’re Not Getting The Most From Your Benefit Plans."  Ask employees for their ideas. 

Start using social media. Now that 80 percent of Americans are using social media, do you think you can start integrating it into your benefits communication? It doesn't have to be intimidating. Start a benefits blog to focus on reminders and tips, and give employees a way to join the conversation. Use Twitter to post frequent updates and provide low-cost customer service. Social media is a perfect--and cost-effective--way to get employees engaged and to be responsive to their needs this year. This is especially important if enrollment meetings have been cut.

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 WWE has a Wellness Program?

I was as astounded as you were to learn last week that wrestler Oscar Gutierrez (Rey Mysterio) was suspended from wrestling for 30 days because he was in violation of the WWE’s Wellness Program.  I know!  Who knew the WWE had a wellness program?  When I read this, I wondered what their ROI is.  How are they keeping employees engaged?  What vendor have they partnered with to manage the program?  How exciting to have an organization so visible to the public out there championing the wellness effort!

So I Googled it.  “WWE Wellness Program.”  Sure enough, a press release for the WWE Wellness Program showed up at the top of the list.  From the program outline:

“NEWS ALERT -- Effective today, February 27, 2006, WWE is implementing a broad WWE Talent Wellness Program. The Program has two components: 1) an aggressive substance abuse and drug testing policy; and 2) a cardiovascular testing and monitoring program.”

As it turns out, the WWE “Wellness Program” is what the rest of us would call a drug policy.  But the press release is from 2006.  Let’s give WWE the benefit of the doubt.  Let’s check out the company’s official Talent Wellness Program Summary.  According to this website, key components of the program include:

• Comprehensive Medical and Wellness Staffing and Infrastructure
• Cardiovascular Testing and Monitoring Program
• Mandatory ImPACT™ Testing
• Substance Abuse and Drug Testing Policy
• Annual Physical Examinations and Blood Screening
• Referrals to Consulting Health Care Providers On An As Needed Basis

Maybe WWE deserves some credit.  While I suspect they aren’t aggressively managing health in the way a traditional wellness program might, one has to give them credit for implementing a program to monitor their talent’s cardiovascular, brain, and general overall health.  This would seem to be in line with how most professional sporting organizations would operate.  And it would appear that their drug policy makes up only a small portion of their overall wellness program (albeit a more visible portion of it).  But it doesn’t appear that the program focuses much on providing coaching or case management, perhaps because most of their wrestlers rely more heavily on their own personal trainers.

Food for thought: I wonder whether the WWE is tracking ROI the way the rest of us would to see whether they’re getting any bang for their buck from their wellness program.  I also wonder whether this program is specific to their wrestlers or if it applies to all employees.  If all employees, this would likely not fit the bill for an effective program. 

I suspect, like me, you think the WWE’s “Wellness Program” is more PR than effective health management.  But the next time you’re in a meeting with decision makers in your organization making the case for a company wide wellness program, be sure to point out that even the WWE has a wellness program.  Who knows?  Someone in your C-suite may be a closet wrestling fan.

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?

Who Would’ve Thought I’d Have Anything in Common With Whole Foods CEO John Mackey?

I have a confession to make.  I get my groceries at Wally-World.  There’s one near my house, their prices are lower than another nearby grocery store, and I don’t mind the inevitable overcrowding on Sunday afternoon.  Some of you will count this against me since, for years, this establishment was known to have had a less than stellar track record in the way it treated its workers, and it may be single-handedly responsible for ending the age of mom-and-pop stores of all varieties (grocery, specialty, you name it).  To the first issue, I would say that Wal-Mart heard your concerns and has made efforts to improve relations with its employees.  And to the second, if it hadn’t been Wal-Mart, it would’ve been someone else putting mom-and-pop out of business.  It’s called capitalism.

My second confession is that I don’t eat anything organic (unless by accident).  Only God (and perhaps the FDA) knows what sorts of chemicals I’m ingesting when I eat the food purchased at my local Wally-World.  It hasn’t killed me, yet, so I’m not terribly worried.  So, who would’ve thought I’d come down on the side of Whole Foods CEO John Mackey in the debate over health reform.

In a recent op-ed in the Wall Street Journal, Mackey makes his proposals for health reform, and I agree with most of them.  What I admire about him is that he puts his money where his mouth is.  Whole Foods rolled out a Consumer Driven Health Plan (CDHP) with a Health Savings Account (HSA) several years back and has been serious about promoting it with employees and teaching them how to use it.  Employees are educating themselves about the plan and are, in fact, doing what CDHPs are designed to encourage them to do: shopping for health care services.

To be sure, I’m not certain CDHPs are going to save our health care industry.  But I do think they encourage people to think more carefully about their health care decisions.  I think that CDHPs should  be carefully designed to cover preventative things like regular checkups at low or no cost (i.e., not subject to the deductible).  Otherwise, some people will be inclined to avoid checkups in order to preserve their HSA balance.  That said, putting more responsibility on consumers seems like something else I remember that made this country great.  Oh yeah -- now I remember.  It’s called capitalism.

Mackey’s other proposals?

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.
• Repeal all state laws which prevent insurance companies from competing across state lines.
• Repeal government mandates regarding what insurance companies must cover.
• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.
• Make costs transparent so that consumers understand what health-care treatments cost.
• Enact Medicare reform.
• Revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

Enacting any one of these changes would be challenging (an understatement?) given the interests that would be affected.  Nevertheless, to me, these are reasonable proposals for health reform that would encourage market-based solutions and deserve as much discussion as the options currently being debated.

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?

Smoke 'em If You Got 'em - Unless We Have a Policy Against It....

A follow up to one of my first ever posts over at the HR Capitalist.  Scott Rodrigues had been working as a lawn-care employee for The Scotts Co. for only about two weeks when he was fired in 2006 after a drug test found nicotine in his urine, a violation of a company policy forbidding employees to smoke on or off the job. He promptly filed a lawsuit that argued, among other things, that the company violated his right to privacy.

As the Boston Globe reports, that case has made it through the courts, and the courts upheld the Ability of Scotts to terminate Rodriques for smoking:

"Now a federal judge has dismissed the Bourne man’s suit, ruling that Rodrigues’s smoking was not a protected privacy interest because he never kept his puffing a secret.

In granting Scotts’s motion for summary judgment, US District Court Judge George A. O’Toole Jr. said that Rodrigues admitted in a deposition that he smoked while walking down the street and in a restaurant parking lot and was caught by a Scotts supervisor with a pack of cigarettes on his dashboard.

“It is clear from those admissions that Rodrigues has not attempted to keep the fact of his smoking private,’’ O’Toole wrote.

The judge also rejected Rodrigues’s contention that his firing violated the 1974 federal law that protects employees’ rights to their benefits. O’Toole said that law did not protect Rodrigues because he was not yet a bona fide employee and was only working on the condition that he passed the urinalysis.

Jim King, a spokesman for Scotts, which is based in Marysville, Ohio, said the smoking ban has never been used to fire “an existing employee,’’ only to screen out applicants. Since the ban went into effect, he said, the percentage of smokers among the company’s roughly 7,000 employees has fallen from 28 percent to 7 percent.

“We’re obviously pleased with how [O’Toole] ruled,’’ he said. “We think the ruling speaks for itself.’’

Scotts’s smoking ban was announced in 2005 by chief executive Jim Hagedorn, a former two-pack-a-day smoker, and went into effect Oct. 1, 2006, giving the company’s employees nearly a year to prepare. Scotts has paid for employees and their families to take part in smoking cessation programs.

King told the Globe after Rodrigues filed his suit that the tobacco policy was intended to reduce medical costs for the self-insured company, which he described as deeply committed to promoting good health among employees. He pointed out that Scotts built a $5 million wellness center in Marysville and reimburses some workers for fitness club memberships."

Now for the big question based on the wording of the ruling.  What if the prospective employee had attempt to keep his smoking a secret?  Would the ruling have stood?

Interesting stuff.  I'm not sure we can get to wherever it is we are going in the healthcare debate (especially from a cost perspective) until employees have incentives or penalties to motivate them to live healthier.

Time Magazine - Exercise Doesn't Help You Lose Weight...

Weight Loss has long been thought to be a calories in, calories out type of thing that was aided by exercise.  Now, Time Magazine's throwing one of those cover articles out (titled, "Why Exercise Won't Make You Thin") that's sure to make a lot of people say "A-HA!!!"

More from the Time article:

"In general, for weight loss, exercise is pretty useless," says Eric Ravussin, chair in diabetes and metabolism at Louisiana State University and a prominent exercise researcher. Many recent studies have found that exercise isn't as important in helping people lose weight as you hear so regularly in gym advertisements or on shows like The Biggest Loser — or, for that matter, from magazines like this one.

The basic problem is that while it's true that exercise burns calories and that you must burn calories to lose weight, exercise has another effect: it can stimulate hunger. That causes us to eat more, which in turn can negate the weight-loss benefits we just accrued. Exercise, in other words, isn't necessarily helping us lose weight. It may even be making it harder.

Earlier this year, the peer-reviewed journal PLoS ONE — PLoS is the nonprofit Public Library of Science — published a remarkable study supervised by a colleague of Ravussin's, Dr. Timothy Church, who holds the rather grand title of chair in health wisdom at LSU. Church's team randomly assigned into four groups 464 overweight women who didn't regularly exercise. Women in three of the groups were asked to work out with a personal trainer for 72 min., 136 min., and 194 min. per week, respectively, for six months. Women in the fourth cluster, the control group, were told to maintain their usual physical-activity routines. All the women were asked not to change their dietary habits and to fill out monthly medical-symptom questionnaires.

The findings were surprising. On average, the women in all the groups, even the control group, lost weight, but the women who exercised — sweating it out with a trainer several days a week for six months — did not lose significantly more weight than the control subjects did. (The control-group women may have lost weight because they were filling out those regular health forms, which may have prompted them to consume fewer doughnuts.) Some of the women in each of the four groups actually gained weight, some more than 10 lb. each.

What's going on here? Church calls it compensation, but you and I might know it as the lip-licking anticipation of perfectly salted, golden-brown French fries after a hard trip to the gym. Whether because exercise made them hungry or because they wanted to reward themselves (or both), most of the women who exercised ate more than they did before they started the experiment. Or they compensated in another way, by moving around a lot less than usual after they got home."

The article's a good read, so give it a run.  The problem with mass media articles like this is that they tend to not change anything, with the exception of making those avoiding exercise feel emboldened like they are somehow doing the right thing.  I haven't been exercising, but guess what?  Time ran that big article that said exercise doesn't work - so there's no reason for me to start.

Meanwhile, regardless of the reality regarding exercise's impact on weight loss, that same group gets none of the other postive impacts of exercise in their daily lives.

Worse yet, their kids grow up with no exposure to exercise as a part of a healthy lifestyle.

Thanks Time...

Utah Plans a Marketplace/Exchange for Healthcare....

As the future of President Obama’s health care reform initiative and its ambitious timetable grow more uncertain, you may be interested in learning how some states are taking matters into their own hands with practical solutions that can be quickly implemented – rather than waiting around for a federal plan.
 
The State of Utah passed legislation in late 2008 that mandated the creation of a health insurance “marketplace” or “exchange” that connects consumers to a Website where they can evaluate insurance options and make informed purchasing decisions.  The first phase of the Utah Health Exchange, a “defined contribution” model for small employers (2 to 50 employees), is now underway and will be launched in November, 2009. 

In the first phase of the Exchange’s implementation, the plan will create the “defined contribution” model for small employers (2 to 50 employees).  In this model, employers define a specific dollar amount to contribute to their employees’ health insurance premiums and then employees can “shop” at the Exchange from a menu of plans offered by participating insurers.  This model enhances private competition and transparency in the health care system by giving employees the necessary information and purchasing power to make informed health insurance choices.  It also offers relief to employers who will no longer bear the full burden of administering a health plan for their employees.   

The technology behind the Utah plan is suited to the Exchange’s model because it can present consumers with side-by-side comparisons of plan options and costs with “drill down” details and links to forms and documents all in one location and at the “point of purchase.”  It can also handle the numerous administrative complexities raised by this approach, including the transmission of electronic feeds to multiple carriers and the funding of health insurance premiums from multiple sources such as the government or a spouse’s employer.  

Interesting times...

Economic Crack for Employees - The 401k Debit Card....

Gas prices are up, food prices are up.  The pressure is on from all corners...

Tough economic times mean that your employees will be looking for nickels and dimes in the sofa but also in the workplace - by looking to tweak their tax withholdings, opt out of medical employee contributions, and other extreme measures.

It's up to you to provide counsel to them.  One tool that some take advantage of, in times like these, is the 401k loan.  It's a bad idea from a retirement standpoint but part of the plan.  Most 401k loan programs have enough hoops and come with enough penalties and poison pills that employees look elsewhere for cash. 

A new kind of economic crack has hit the streets - the 401k Debit Card....From the Wall Street Journal:

"Debit cards are straightforward. You use them for purchases and money is deducted from your bank account. But when the debited account is your 401(k) retirement plan, critics angrily line up to take a swipe at that piece of plastic.

It isn't hard to see why. The 401(k) debit card lets you borrow from retirement savings and pay yourself back with interest over time, much as you would with a typical 401(k) loan. Only the card makes it much easier to crack your retirement nest egg; all you do is shop, swipe and sign.

To the advisers, brokers and financial institutions pushing workers to save more for their futures and consider the 401(k) sacred, this debit card isn't just objectionable, it is blasphemous.

The rub is that employees evidently like the ability to borrow; studies show it actually makes them more likely to contribute to a retirement plan. Most 401(k) participants have access to loans and about 20% have gone through hoops and hassles to get one.

Yet employers seem to be drawing the line with the debit card. Although the product has been around for several years, few companies offer it. They are focused more on automatically enrolling U.S. workers in plans, not handing out quick and easy loans.

One advantage of a debit card is that if you are laid off or leave the company, there may be no pressure to reconcile the debt immediately. With a typical 401(k) loan, the outstanding amount must be repaid in full, usually within 90 days. Otherwise the loan amount is considered a taxable distribution."

I'm sympathetic to those who need cash, but the 401k Debit Card makes it too easy.  When a vendor comes around to sell you on these, do humanity a "solid" and just say no...

Reconsidering Giving Away Soda At Work

What are YOU spending on Wellness?

• $200 per participant in incentives?
• $40-50 per participant for biometrics screenings?
• $6 per participant for a health risk assessment?
• $4-15 pepm for health coaching?
• $2 pepm for incentive management?
• $200 per on site class?
• Goodness knows how much on staff time and consultants and the like, on program administration, and measuring of your butt kicking wellness program.

BUT does it every worry you that the $.75 peps (yes, that's per employee per soda) that you spend on providing free pop is corroding the value of what you have been spending on prevention?

Glucose, Fructose, or Sucrose?  Whoknose?
Does a sugar by any other name taste as sweet?

Most of us forgot the difference between glucose, fructose and sucrose long ago while starring wistfully at our high school heartthrob during chemistry. It wasn't something we needed to know and, I mean come on, who can tell the difference right? All of them taste sugary.

So, what's the difference? Well, according to a new study published in the Journal of Clinical Investigation, researchers from the University of California, Davis discovered that people consuming fructose-sweetened drinks showed an increase in a particular kind of fat that embeds itself between tissues in organs. They were also less sensitive to insulin, showed elevated blood levels of lipids, increased fat production in the liver, and elevated LDL (so-called 'bad' cholesterol) and larger increases in blood triglycerides. Yikes!

According to the study, those drinking glucose-sweetened beverages showed none of these changes. Unfortunately for us, most of the sugars that are readily available in the store come in the form of high fructose corn syrup or sucrose (table sugar).

So, uh, skip the soda and maybe provide a fruit bowl instead?

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.

Getting a Higer Rx Mail Order Rate Takes a PhD in Behavioral Science...

Well - not really, but it might help. 

If you've been responsible for oversight of the medical spend in your company, than you know two things are true related to your Rx plan saving you money:

1.  You need aggressive formularies

2.  You need to max your generic penetration rate

3.  You  need to max your mail order penetration rate (for scripts that are available for mail order).

Not a lot of surprise there, and you're probably familiar with the fact that you can usually get some movement with a little internal PR, then you get to a plateau and get stuck.  What do you do then?

Express Scripts, a St. Louis pharmacy benefit manager that handles drug coverage for large employers and health plans, is out to change that result. The company is applying the principles of behavioral economics to reduce waste, improve patient health, and boost its bottom line.

Here's an example of a behavioral program at Express Scripts via Business Week:

"One example: More than 70 Express clients, including uniform supplier Cintas (CTAS), have signed up for an initiative that focuses on getting employees to order drugs for chronic conditions, such as high blood pressure, through the mail. Home delivery is more efficient and thus a higher-margin business for Express than managing prescriptions filled at drug stores. That's because mail-order prescriptions get processed through its highly-automated pharmacies and come in 90-day packs instead of the usual 30-day supply. At the beginning of a three-month program that Express piloted with Lowe's (LOW), only 14% of the home improvement retailer's employees on so-called maintenance medications received their drugs by mail. When the pilot ended in March, 38% did."

How did they do that that? 

"Express and rivals such as Medco (MHS) typically try to persuade patients to switch by making mail-order drugs cheaper than store-bought ones. (Some employers require mail order for certain medications.) But incentives don't always work. The reason, says Express Chief Scientist Bob Nease, is a phenomenon known as "present bias," one of the principles of behavioral economics, which stresses that humans often act irrationally. People are more inclined to focus on the immediate hassle of changing a habit than the future benefit. So faced with the paperwork to initiate home delivery, most will keep driving to a pharmacy.

Express attacked such inertia by forcing Lowe's employees to make a conscious choice. The company contacted employees with letters and phone calls, asking them to choose between mail and retail. If employees didn't make a decision by their third refill, their drug costs would not be covered until they decided. That forced customers to weigh their options. 

Another theory Express is using is "loss aversion," which says people work harder to avoid losses than to pursue gains. That has led it to change its marketing pitch in other programs from "save money" to "stop wasting money".

Note - the program sounds innovative and it is in many regards, but the "nuclear option" of mail order - leaving employees at the retail pharmacy without having the ability to fill a prescription - is in play here, which always leads to a nice spike in the mail order penetration rate.

Would you take that nuclear option?  More and more companies will in today costs environment...

Can "Bonus Banks" Balance the Long-Term View with Short-Term Incentive Plans?

Hang around any business long enough, and eventually you'll run into circumstances where managers sacrifice the long-term view for short-term gain, usually the result of pressure felt from their boss, the board and/or shareholders in the company.  Here are two great examples:

--Subscriber-based businesses like Cell Phones - you're pinched on subscriber counts in a competitive environment, so you make the short-term decision to move your disconnect threshold, for customers who don't pay you timely, from 30 to 60 days.  In the short term, your subscriber numbers look great, but over time you train your customers that they don't have to pay you timely, and your bad debt goes through the roof.

--Any business where revenue is mined or expense avoided to improve the next quarterly report - We've all been around this one in our careers.  Is it good for the business long term to avoid R&D costs now?  Probably not, but we're doing it anyway...

So, there are levers to pull and decisions to make.  However, the bonuses that are traditionally paid out in a quarterly or annual fashion to managers in many companies are under more scrutiny than ever, based on what's occurred lately economically.  Enter the concept of the Bonus Bank, which defers managers receiving all of an annual bonus until time proves their management to be prudent.

More on Bonus Banks from BusinessWeek:

"Some companies, aware of the direction the regulatory winds are blowing in Washington and other capitals, are making preemptive moves to overhaul the schemes they use to reward top brass. One concept that's gaining traction is that of the "bonus bank." UBS (UBS) launched a bonus bank late last year after the Swiss government tossed the institution a $60 billion lifeline. Investors are pushing for E*Trade Financial (ETFC), Charles Schwab (SCHW), and JPMorgan Chase (JPM) to adopt similar plans.

Here's how the bonus bank works at UBS: One-third of a top manager's annual bonus will be paid out and the rest will be deposited into an account. The money can be drawn down over three years, provided the bank meets or exceeds predetermined operating targets and other benchmarks. If not, the manager stands to lose some or all of the funds in the account. The beauty of the idea, in the eyes of compensation specialists, is that it discourages employees from goosing results one year at the expense of the next. "For a bank, this is an opportunity to move to a system that's far more defensible," says University of Chicago's Booth School of Business Professor Raghuram G. Rajan.

While straightforward in principle, the bonus bank can be difficult to make work in practice. Briggs & Stratton (BGG) in Milwaukee, which has more than $2 billion in annual sales of engines for equipment such as lawn mowers, set up a bonus bank in the early 1990s. It worked pretty well, too, until 2005, when a spell of dry weather drove down demand for the company's products. So even as Briggs & Stratton outperformed rivals, it wasn't hitting return-on-capital targets, a key metric under its plan. By 2008, bonus accounts had moved into negative territory, meaning executives would have to relinquish a portion of their future payouts. The bonus plan had become a "disincentive" for managers to stick around, says CEO John S. Shiely. So the board decided to cap bonus bank losses, and put a temporary, supplemental bonus plan in place. Says William F. Achtmeyer, a member of Briggs & Stratton's compensation committee and CEO of strategy consultant Parthenon Group: "It's a model that is theoretically outstanding, but from an implementation perspective has its limits, too."

I'm a fan.  Of course, there is a lot to figure out in addition to what's mentioned above, such as the treatment of employees who exit the company before past years' bonuses have "vested".

Is IBM the Innovator in the 401(k) Business?

Let's face it - it's a bad time to talk 401k to employees.  With a market that topped at 14,000 in the dow and dropped all the way down in the 7,000 range, most employees who were fully invested in stocks took haircuts in the range of 30-40% of total assets.  That means when it comes time to pump up the old 401k, the audience isn't exactly receptive in most companies to benefit and HR pros - in fact, it can be hostile.

One of the areas I've struggled with in the past few years is running HR shops for companies that fall below the Fortune 500 space.  Buying power is a big deal in the 401k business, and if you are a venture capital-held firm with a couple of hundred employees, you've got limited power to minimize the things you might be able to control for employees - plan design, mutual fund fees, etc.  As an example, I was told last year that in order to enter the 401k space with Vanguard (a mutual fund company that believes in "indexing" and thus is among the best in the company at keeping fees low), you need at least 25 million in assets in your 401k.  Less than that?  You need not apply.

I give you that intro as a backdrop to a recent BusinessWeek article on 401ks at IBM, which recently dropped its pension line to create a supercharged 401k for its employees:

"Back in January 2008, IBM (IBM) replaced the last of its pensions with a new-and-improved 401(k). The plan came with plenty of enticements, befitting a company that earned more than $10 billion on $99 billion in revenue the previous year. There were generous matching contributions, super-low fees, custom-designed portfolios, free access to financial coaches, and more. Even so, critics hammered IBM's move as one more sign of retreat from the secure retirement benefits of the past.

Today, hardly anyone is complaining about IBM's 401(k), least of all the participants. The plan is sumptuous compared with offerings from most companies. Across the U.S., 401(k)s have been bludgeoned by the financial crisis. Balances have shrunk to a fraction of their former value, and many companies have slashed matching contributions. Yet IBM is sticking with its plan—one of the largest in the U.S., with $27 billion in assets. "In my job, I often hear horror stories," says J. Randall MacDonald, senior vice-president for human resources, who led the shift from pension to 401(k). "I don't hear horror stories about the 401(k)."

IBM's creation isn't revolutionary in design or implementation. But it combines most of the best features of 401(k) plans at other companies, then leverages IBM's size to wrangle cut-rate fees from investment firms that want to manage its retirement assets. With 94% participation among more than 100,000 active U.S. employees, the plan boasts an average employee balance of $127,000, more than double the national average. Fees, which have a bigger impact on long-term results than most people realize, typically are just 10 basis points, or 0.10%. "IBM takes a very paternalistic and serious attitude in terms of the quality and the cost to participants," says Ted Benna, chief operating officer of pension consultant Malvern Benefits and the man considered to be the father of the 401(k).

Having weathered the recession, at least so far, IBM is now toying with some truly radical ideas. MacDonald hopes someday to meld retirement and health benefits into compensation, leading to a performance-based 401(k) through which top performers could be rewarded with better benefits. Given IBM's size and clout, any trail it blazes in this area could alter the retirement landscape dramatically.

 

Is there any doubt that size matters?  One example - fees in the IBM plan are .10% on average?  That's clearly related to the purchasing power of the small nation that is IBM.  A small company is lucky to have one or two funds out of 15 that have fees of .30%, with the rest of them moving toward 1.00% in a pretty quick fashion...

So, the IBM plan is great, but the biggest benefits are a reflection of the size of the company...

Paying for Health Care By Eliminating Pre-Tax Treatment of Healthcare Premiums...

In an interview on June 28, David Axlerod, political advisor to President Obama, commented on ABC’s “This Week” that the President would not “…rule out the possibility that the White House might agree to a tax hike on health insurance plans that would hit middle-income Americans.”  This follows a campaign during which then candidate Obama promised not to raise taxes for American’s making more than $250,000 (a threshold that was subsequently lowered to $200,000).  Furthermore, he ridiculed John McCain for making just such a proposal:  "For the first time in American history, he wants to tax your health benefits.  Apparently, Senator McCain doesn't think it's enough that your health premiums have doubled. He thinks you should have to pay taxes on them, too."  I’m reminded of a former president whose hopes for a second term came to an end when he reneged on a promise made during his first run for office: “Read my lips -- no new taxes.”

It continues to be a busy year on the health care front.  The President has made no secret of his intention to make significant changes to the way health care is delivered and paid for in this country.  At the forefront of the argument is whether or not a public insurance option should be established to “compete” with private insurers.  As expected, private insurers are up in arms about this.  President Obama has said that private insurers have nothing to worry about, claiming, “If private insurers say that the marketplace provides the best quality health care, if they tell us that they're offering a good deal, then why is it that the government -- which they say can't run anything -- suddenly is going to drive them out of business? That's not logical.”  What hasn’t been said is that, while private insurers have to turn a profit to stay in business, the federal government does not -- at least not in the near term.

The latest estimates from the Congressional Budget Office and Max Baucus, Chairman of the Senate Finance Committee, put the expense for a public insurance option somewhere between $1 trillion and $1.6 trillion over 10 years.  So the trillion dollar question left unanswered is where to find the funding to pay for this public option.  If the federal government is looking for a stash of cash that hasn’t been tapped, employees’ pre-tax contributions for health care coverage is a logical place to look.  Estimates are that these tax savings to Americans cost the federal government nearly $200 billion per year in tax revenue.

The dot that most Americans haven’t yet connected is that this loss of tax savings will result in an increase in their personal tax burden.  A change of this nature will hit 170 million Americans like a ton of bricks when they see their tax liability increase the year after the tax savings is eliminated.  I’m no accountant, so I’ll use simple math.  An employee paying $250/month in health care coverage through his/her employer will see an increase in taxable earnings of $3,000/year.  Assuming a 28% tax bracket, that’s an additional $840/year s/he will owe Uncle Sam.  This doesn’t include imputed income that could be added for employees covered by employer sponsored health plans that provide coverage over and above some actuarial threshold defined by the government, nor the potential loss of tax exempt status for flexible spending accounts.

The next few months will be interesting.  Opposition has been building and will continue to build against the public option being proposed.  There are more than a few lobbyists with their hands full in Washington these days.  But the President wants to sign something by the end of this year, even if that “something” lacks detail.  Whether he’ll be able to garner enough support from both sides of the aisle is yet to be seen.  Failure to do so could spell political suicide (if taxing employee benefits alone doesn’t do it).  Keep your eyes peeled -- things will be moving fast this summer.

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?

Pfizer Program Helps Unemployed Maintain Access to Rx

There's no shortage of discussion about the risk of rising health care costs and tightening budgets discouraging people from taking important prescription drugs. It is a problem for both those with insurance (but high copays for brand name drugs) and those without insurance who can't fork out the cash for pricey prescriptions every month. And, it is a short-term personal budget fix that has awful long-term health implications (which, of course, means long-term health expenses too -- for the individual, their employer, really all of us).

So, this Pfizer program caught my eye. MAINTAIN is a program that lets unemployed individuals (and their families) who are in financial need and lack prescription coverage continue to get their Pfizer medicines free-of-charge for up to one year (or until they become insured, whichever comes first).

This is right from the official Pfizer info: 

Through MAINTAIN, more than 70 Pfizer medicines are offered that treat a range of chronic health conditions. It is easy to learn if you may be eligible, by visiting www.PfizerHelpfulAnswers.com or calling 866-706-2400. The program is user-friendly, with a one-page application that Pfizer will typically process within two to three weeks. The program is expected to accept applications through December 31, 2009.

There are four eligibility requirements for MAINTAIN:

• Applicants must be able to demonstrate loss of employment since January 1, 2009;
• Lack prescription coverage;
• Attest to financial need; and,
• Be on their Pfizer medicine for at least three months prior to unemployment and enrolling in the program.

Uninsured patients who need a Pfizer medicine but who do not qualify for MAINTAIN may qualify for Pfizer’s other Patient Assistance Programs.

No matter what you think of big pharma, you can't complain about this program. And, what I like even more is this nifty little tool on their website to help you find Assistance Programs that are right for you (available in Spanish too). Medical plans can be super confusing, and prescription drug programs are notorious for being anything but user friendly (my favorite being the all-too-common labels "preferred" and "non-preferred" for brand name drugs--usually the "non-preferred" is the higher copay, meaning "not preferred by your PBM--we don't really care about your perspective.")  So, it is really nice to see the extra step taken to make these programs accessible, not just out there for the good-guy status.

Also, I'm often asked what employers can do to "soften the blow" of layoffs. There's not really any way to make getting laid off seem like good news, but employers can provide departing employees with helpful resources like this program and other assistance programs. That's a simple step that shows real concern for your workforce--even after they leave. 

Editor's Note - Jennifer Benz is founder and chief strategist at Benz Communications, a boutique consulting firm that focuses on employee benefits communication.

Do the Rich Get Special Treatment in the Organ Transplant Biz?

When it comes to organ transplants, you probably know that it's illegal in America to buy/sell organs from donors.  If you need an organ, you have to get on the transplant list regardless of your socioeconomic status.  Most people stop there with the thought process and assume that everyone's created equal.

Of course, money matters in the USA, and even if you can't buy an organ, the fact you can travel and pay your own frieght at several different "centers of excellence" across the company can dramatically increase your chances of getting the transplant you need.

Case in point, Apple CEO Steve Jobs, who is reported to have recently received a liver transplant in Tennessee.  More for ABC News:

"Reports that Apple CEO Steve Jobs traveled to an unidentified hospital in Tennessee for a liver transplant this March have sparked a debate over whether the wealthy are able to use their resources to game the national organ donation system.

Jobs couldn't pay for an organ. Nor could he pay to cut the queue. But what someone with Jobs' resources could do, according to liver transplant surgeons and ethicists, is to use money and mobility to improve the odds either by going to an area of the country where there are more organ donors, or by signing up at multiple transplant centers.

"It's not for anybody but the rich. It's called multiple-listing, a practice some would say is unethical," said Arthur Caplan, co-chair of the United Nations Task Force on organ trafficking and chair of the department of medical ethics at University of Pennsylvania.

When a person needs a liver in the United States, the patient must go to a hospital with a transplant center for an extensive medical, mental and financial consultation. Then if he or she is determined a good candidate, the patient will be put on that transplant center's waiting list.

When a liver becomes available, the nearest of the 49 national Organ Procurement Organizations (OPO) will run a database search and algorithm to match the liver to people on all the transplant centers within that OPO's designated local and regional area.

"The local area is not a state, it's that donor service area of that OPO," explained Anne Paschke, spokesperson for the United Network of Organ Sharing (UNOS). "For a liver they're going to look in the local and regional areas before they look nationally."

According to the Organ Procurement and Transplantation Network, 15,771 people are currently waiting for a liver in the United States. Last year, 1,481 people died waiting for a donor liver, almost all of which come from the recently deceased. The national average waiting time for a transplant is about a year, but it can average as little as a few months at some centers, organ experts said.

Paschke said UNOS requires transplant centers to encourage patients to do "multiple listings" at transplant centers in multiple geographic areas to increase the odds of being matched to a liver. The only catch, Paschke said, is that health insurance policies often cover only one medical evaluation to get on one transplant center list. Most people simply don't have the money to pay for multiple extensive evaluations at far-flung locations.

Unfair advantage or necessary evil in our system so organs don't go wasted?  I'm not judging Jobs, but it's an interesting question.

Is Coffee the Wonder Drug to Prevent and Treat Alzheimer's?

Sure I've got stained teeth and I'm more than a little hyper.  The good news about my fondness for coffee ALL DAY LONG?  It might help me prevent Alzheimer's disease has received an extra boost from two new studies.

From the Atlanta Journal Constitution:

"Florida researchers report that a daily dose of 500 milligrams of caffeine -- the equivalent   found in five 8-ounce cups of coffee -- reversed memory issues in mice bred to develop Alzheimer-like symptoms. After two months on the stimulant, the mice rebounded to score just as well on memory tests as normal mice of the same age that had never exhibited signs of dementia.

The studies, published in the July 5 online edition of the Journal of Alzheimer's Disease, also found that caffeine cut by half the mice's excessive blood and brain levels of beta amyloid, the protein linked to characteristic plaque found in human Alzheimer's disease.

"The new findings provide evidence that caffeine could be a viable 'treatment' for established Alzheimer's disease, and not simply a protective strategy," lead author Gary Arendash, a University of South Florida neuroscientist, said in a news release. "That's important because caffeine is a safe drug for most people, it easily enters the brain, and it appears to directly affect the disease process."

Studies to test whether caffeine can help people with mild cognitive impairment or early Alzheimer's disease are likely to follow, investigator Huntington Potter, director of the Florida Alzheimer's Disease Research Center, said in the news release."  In the most recent experiments, the researchers also found that caffeine did not improve the memory of normal mice as it did for the Alzheimer's mice."

Coffee (and other forms of caffeine) is looking more and more like a good thing.  Have a cup today.  Make it three, maybe five.

Not a problem for me...

Was Denis Leary Right About Preventative Care?

Denis Leary had a great line from his Broadway show/CD "No Cure for Cancer".  It goes a little something like this:

"I love these little facts. "Well you know. Smoking takes ten years off your life." Well it's the ten worst years, isn't it folks? It's the ones at the end! It's the wheelchair, kidney dialysis years. You can have those years! We don't want 'em, alright!?

The Leary premise is quality over quantity.  If the late years aren't good ones, the theory goes that you may as well do what you want.  No mention of the cost of health care during the late years.  That doesn't translate too well into comedy, especially the Leary version of comedy.

Not to worry.  Arthur Garson's got you covered in this column from Governing Magazine, where he and Carolyn Englehard argue that preventative care just doesn't pay out:

"If you're among those who think prevention saves money, and will help reduce the overall cost of medical care, you're not alone. But while an apple a day might keep the doctor away, at least for awhile, it also might cost more than you think. Preventive medicine can help avoid costly illnesses earlier in life, only to increase the population of elderly and infirmed people who will most likely require expensive treatments for other illnesses later.

Even worse, unhealthy habits such as tobacco smoking may actually save money in the long run as people who smoke die earlier and use fewer health care dollars. "This doesn't make sense," you say, "Smokers are less healthy than nonsmokers." That may be true, and smokers do use up to 40 percent more medical care while they are alive. A recent study from Holland showed that, on average, smokers die at age 77 and save $100,000 in lifetime medical care costs compared with non-smokers who die at 83.

The same is true for people who are obese. While obesity-related conditions such as Type-2 diabetes, high blood pressure and heart disease are associated with high medical expenditures, the costs that are saved by preventing obesity will only be offset later in life by diseases unrelated to obesity that accompany living a longer life. In the Dutch study, obese people die at 80 and save $50,000 compared with non-obese people who die at 83."

Wow, there it is.  It's cheaper to allow people to make their own decisions about lifestyles because we don't have to spend money on them once they're gone - it's cheaper overall to let them do what they want. 

What the column doesn't explore is ramifications of preventative care for employers.  The ten years at the end are largely funded by the government.  What about the 5/10 year ROI scenario for employers that invest in programs that get people to stop smoking or drop their blood pressure.  Is the ROI there for the companies that choose to do that?

That's the million dollar question (literally) for employers in America.

Focusing on Surgery - Part of the Reason Effectiveness Trails Cost in the USA?

I've always been amazed that the USA always shows up in the mid-teens regarding outcomes/effectiveness of care when compared to other industrialized nations.  All the money we spend, and we trail Europe? 

One reason might be a over-reliance on surgery, which we've been trained is the path to take when you're serious about getting healthy.  A recent BusinessWeek article focuses on this tendency in the USA using heart disease and prostate cancer as examples:

"Each year, more than 1.3 million Americans have their clogged arteries widened with a tiny balloon and then kept open with slender mesh tubes called stents, made by companies like Johnson & Johnson (JNJ) and Boston Scientific (BSX). The total bill for these angioplasties is more than $21 billion a year. But while many patients and doctors firmly believe that angioplasties prevent heart attacks, the data say otherwise. A series of studies—the newest published in the June 11 issue of The New England Journal of Medicine—finds that stable patients with chronic heart disease who have the procedure get little benefit compared with similar patients treated just with drugs, such as Pfizer's (PFE) cholesterol-lowering Lipitor and other statins, and aspirin. "There are still many patients who undergo angioplasty without really understanding that it will not reduce chances of heart attacks or death—though it will reduce symptoms," says Dr. Judith S. Hochman, director of the Cardiovascular Clinical Research Center at the New York University School of Medicine.

That's why there's a growing effort, led by physicians, health insurers, and even state legislatures, to make sure patients truly understand the medical evidence about angioplasty and other treatments and procedures. Once informed, the patients are encouraged to make their own choices. This idea goes by the somewhat clunky name of shared, or informed, decision-making. Instead of being routinely whisked in for a prostate screening PSA test, for instance, men would first be told that major studies have failed to show the test saves lives. What's more, the test increases the chances a patient will undergo surgery or treatments that cause incontinence, impotence, and other problems. "The fact that PSA screening is more likely to cause mischief than save a life is not intuitive to patients or even physicians," says Dr. Paul J. Wallace, medical director for health and productivity management programs at health-care provider Kaiser Permanente, which is testing this approach.

Studies show this process, using comprehensive videos and other materials prepared by groups such as the nonprofit Foundation for Informed Medical Decision Making (FIMDM), leads patients to choose conservative options more often. It reduces rates of angioplasty or prostate surgery, for instance, by 15% to 30%. Put into widespread use, the approach has the potential to trim hundreds of billions of dollars from the nation's $2.4 trillion health-care bill. Yet patients do as well or better than if they had opted for the procedures. Surveys done after the decision also show patients to be more satisfied, no matter which choice they made. "That's the kind of win that doesn't fall into your lap very often," says Washington State Senator Cheryl Pflug, a Republican.

Hundreds of Billions.  Kinda catches your eye, although the specter of making decisions in terms of who gets surgery and who doesn't would be a rallying cry for those who claim nationalized health care will take the decision out of the hands of the patient/doctor.

It'll be interesting to see this play out in the scope of nationalizing health care...

There's No Such Thing As Private Health Information in the Big Time....

Most of us get to control access to our private healthcare information.  If we're on blood thinners and we want to keep that confidential from future employers, we control it - we just don't say anything.

Not so in some professions, especially where public safety is involved.  Still, in professions with public safety at issue, your employer would put safeguards in place to ensure the disclosure of your medical issues through questionaires and full-blown physicals, but your medical conditions aren't widely known by the public.

Not so in professional sports.  Consider the case of DeMarre Carroll, as reported by SI.com:

"Former Missouri forward DeMarre Carroll earned the nickname "Junkyard Dog" for his blue-collar approach and relentless work ethic. Now he must convince NBA teams that a previously undisclosed liver disease won't keep him from being a pro.

Agent Mark Bartelstein confirmed Wednesday that Carroll, a first-team All-Big 12 pick and potential first-round draft selection, was diagnosed with a liver ailment "a couple of years ago." He downplayed the possibility that Carroll might eventually require a liver transplant.

"It's jumping the gun," said Bartelstein, a Chicago agent whose NBA clients include former Kansas star Brandon Rush and Eddie House of the Boston Celtics. "There's a possibility (of a transplant) way in the future, maybe 20 or 25 years down the road."

Carroll has been treated by Dr. Jeffrey Crippin of Washington University in St. Louis, a specialist in gastroenterology, liver disease and transplants. Crippin declined comment, referring questions to Carroll's agent.

Bartelstein said that Crippin is preparing a letter for NBA coaches, general managers and team doctors outlining Carroll's health before the June 25 draft."

In your workplace, such public disclosure would be the cause for a lawsuit.  In professonal sports, it's given that everyone has the info and the info becomes public.  Strange contrast...

Discounted Health Care for Buying Local Veggies? Is this Heaven?

I live in the mecca of local and organic produce. There are so many farmer's markets to choose from on a given week that you could eat like royalty nearly year-round and hardly step foot in a grocery store. The daddy of them all, the Ferry Plaza Farmers Market, and my favorite low-key version, The Alemany Market, are bustling year round and have arguably some of the best coffee, specialty food, gourmet treats and, of course, produce in the country. (Not that I'm biased or anything.) 

But, one of my favorite treats of the summer is my Community Supported Agriculture (CSA) veggie box. Once a week I pick up a box of the tastiest just-picked fruits and veggies. I read the info sheet on all the obscure or not-so-obscure items inside and plot out what to cook, freeze or eat on the spot (the strawberries don't always make it all the way home). I'll be the first to admit I'm a bit of a geek about this but it is so much fun--kind of like Christmas morning once a week (plus supporting the community and all that good stuff too). Unless you threw in a chef to cook the veggies for me, I would never have thought a CSA could get better. Until now.

In Madison, people are getting rebates on their health care for joining a CSA! The Madison Area Community Supported Agriculture Coalition (that is a mouthful!) has a program called Eat Healthy Rebate where their CSA members get rebates on their health plans--up to $200 bucks! This info from the Minneapolis Star Tribune:

CSAs are particularly popular around Madison, Wis. There, Physicians Plus Insurance Corp. in 2005 began offering $200 premium rebates to member families who joined CSAs. The program appears to have been the first of its kind in the country. In 2006, the first full year of the program, 972 members got the CSA rebate; heading into this season, 1,460 will qualify, said Physicians Plus marketing manager Scott Shoemaker.

If people are motivated to eat "healthier foods, exercise and practice preventive health measures, they're going to be healthier in the long run and need less health management down the road," Shoemaker said. "They'll go in to the doctor less. And costs will go down."

This is pure brilliance in my opinion. Why not pair eating healthy with lowering your health care costs -- and supporting the local community all at the same time?

This could be a great fit for employer wellness incentives too. Employees are often offered reimbursements for gym memberships that go unused--maybe for some employees those incentive dollars could be better spent on healthy eating? 

Are there other examples of pairing local agriculture with health incentives? Please leave examples--or your ideas!--in the comments below. 

Jack of All Trades & Master of None

Poor focus hampers wellness implementation.

Are you updating your facebook status via Twitter from your iPhone as you apply your make-up or eat your burger on the driveto your next open enrollment meeting?  Many Americans feel as though they are good at multitasking and engaging in multiple activities simultaneously leads them to believe they are accomplishing more. 

In her book, Distracted: The Erosion of Attention And The Coming Dark Age, author Maggie Jackson points to a growing body of research studies that seem to suggest the opposite.  A flood of stimulation, interruption and fleeting human contact have created a culture of "diffusion, fragmentation."

She points out the consequencesof what most of us consider par for the course in our lives and working environments:

Interruption and the knowledge worker:

• Knowledge workers switch tasks every three minutes. And once interrupted, a worker takes an average 25 minutes to return to their original task, according to informatics scientist Gloria Mark.
• How often are we interrupted?  The average worker gets 156 emails a day, according to the Radicati research group. And that's just the beginning; instant-messages, phone calls, faxes and snail mail add to the influx.

Making a national habit of multitasking:

• Sixty-five percent of people eat while they drive.
• Sixty percent of kids age eight to 18 multitask some or most of the time they're doing homework.
• Twenty-five percent of restaurant meals are ordered from the car, up from 15 percent from 1988.
• American kids are exposed on average to nearly six hours a day of non-print media.
• Two-thirds of children under six live in homes that keep the tv on half or more of the time, an environment linked to attention-deficiencies.

Time and time again in the world of wellness we see this habitual tendency toward mindless overcommitment, interruption, and multitasking lead to programs that are too diffuse to do much good if the desired outcome is a healthier workforce and reduced health care costs.

Why wellness fragmentation does not equal results

How does ROI for wellness work?  It is more of a cost avoidance than an actual savings in most cases.  Here is a simple (and maybe a little too simplistic) example to help walk you through the "savings." 



Half of your workforce participates in a risk based population health strategy (wellness program) and the other half does not.

For the participating half of the population, whose risk is known, you are able to offer outbound (active) and passive programs that directly impact and address the risks you've identified as prevalent to this group. 

Let's say the programs you've implemented are effective, engagement in them is high, and you retain these employees.  Over a series of years you should see something happen that is counter to what will have happened with no intervention. 

That is to say, this group will not get sick as often as non-participants because your interventions were effective and employees stuck around long enough for you to see results.

The non-participants at your company, as an aggregate, are an unknown entity to you.  You have very little data on their risks and, as a group, they will most likely continue to use health care at the same rate as before. 

Yet, if your company-wide wellness communications are effective and appealing, your participant group is vocal and influential, and your non-participants stay at your company without developing any major illness then some studies indicate that your wellness program might actually have a halo effect. 

That is to say, even non-participants will learn a little more about self care whether they participate or not.  Sure, that could slow the rate of health care cost growth in that group, though probably not by a lot.

Both groups' cost trends together is your overall trend.  Both may continue to rise, but your participant group's trend over several years will rise more slowly - making your overall costs appear to grow more slowly. 

UNLESS.  Yes, there is an unless.  Unless, your participant group is so small and the growth in the cost of health care is so large that your non-participants' health care usage effectively nullifies any impact you had on participants.    

Wellness is not Wii Fit.  You need to focus.

As much as we know that on an individual level good health is as simple as: sleep well, eat right, and move more, achieving a successful organizational wellness strategy is as much an art as it is a science.  It takes focus, discipline and rigorous measurement to impact behavior, motivate and sustain participation, and to quantify results.

If your program is to be successful then you will need to engage a large chunk of your workforce, stratify their risks, and follow a disciplined series of stepsover several years in order to see return on investment.  Oh, and do all of this while simultaneously carrying out the core work of your company.

Fight the urge to multi-task

While multi-tasking may be transitioning out of vogue when it comes to work effectiveness, its cousin  - work sequencing - can help break large and complex tasks into more manageable pieces. 

Plan to succeed by drafting a multi-year strategy with a realistic timeline.  Schedule monthly (core team), quarterly (key shareholders and decision makers) and annual reviews (company wide) of a the wellness program before you even begin work.  This will hold you accountable for reporting progress toward implementing your strategy and plan. 

Build up to maximum efficiency by starting with only a few key program components that will get you the most bang for your buck.  Gradually add complexity as your initial program begins to show results. 

More often than not, companies initially underestimate how much time it takes to implement a strategic wellness program.  They allocate too few resources and take on too many program components to ever really get much traction.  As a result, their programs suffer from poor participation due to fragmented management and the overall program shows high attrition.  Plan intelligently and sidestep this common trap.

Editor's Note: By day, Kris Dunn is the VP of People at DAXKO, a cool software firm dedicated to providing solutions to the best membership-driven organizations in America. At night, he morphs into a blogger at The HR Capitalist and the Founder and Executive Editor of Fistful of Talent. That makes him a career VP of HR, a blogger, a dad and a hoops junkie, the order of which changes based on his mood. Tweet him @kris_dunn...

Sunscreen Arms Race - How About a 500 SPF Product?

For those of you who haven't met me, to classify me as pasty is fair.  Irish blood has made me that way, which means I need some sunscreen protection when it's beach or pool time.  I've long since given up on the bronze tan, I'll settle now for people not squinting if they look my way, as the sun deflects off of my skin like it was aluminum foil.

Given my history as pasty-man, I've grown skeptical of the need for even 50 SPF sunscreen.  After all, if I burn in 20 minutes without sunscreen, 50 SPF means I have the ability to stay out in the sun (properly applied with no water erosion) for 1,000 minutes, right? 

As it turns out, there's a SPF marketing arms race that's going on right now.  More from the New York Times:

"LAST year, Coppertone rolled out two easy-to-use sprays with its highest-ever sun protection factor: SPF 70+. Not to be outdone, Neutrogena offered its Ultra Sheer Dry-Touch lotion in SPF 85 strength, that year’s big gun.   This sun season, Banana Boat is retaliating with a pair of SPF 85 sprays, which it trumpets on its Web site as “our highest SPF level in a continuous spray formula.” 

But now, SPF creep has hit the triple digits with Neutrogena’s SPF 100+ sunblock, leading some dermatologists to complain that this is merely a numbers game that confuses consumers.  The parade of stratospheric SPFs is “crazy,” said Dr. Barbara A. Gilchrest, a dermatology professor at Boston University School of Medicine. “For a normal person who is fair-skinned and concerned about skin damage and photoaging,” Dr. Gilchrest said, “it’s really in my opinion tremendous overkill.”

But that’s not necessarily the case. No SPF, not even 100+, offers 100 percent protection. What’s more, both UVA and UVB radiation can lead to skin cancer, which is why dermatologists now advise using sunscreens with an SPF of at least 15 and UVA-fighting ingredients like an avobenzone that doesn’t degrade in light or Mexoryl SX.

The difference in UVB protection between an SPF 100 and SPF 50 is marginal. Far from offering double the blockage, SPF 100 blocks 99 percent of UVB rays, while SPF 50 blocks 98 percent. (SPF 30, that old-timer, holds its own, deflecting 96.7 percent)."

Good to know.  Remember, when you see me on the beach, be sure your sunglasses are on.  The glare can be blinding...

Editor's Note: By day, Kris Dunn is the VP of People at DAXKO, a cool software firm dedicated to providing solutions to the best membership-driven organizations in America. At night, he morphs into a blogger at The HR Capitalist and the Founder and Executive Editor of Fistful of Talent. That makes him a career VP of HR, a blogger, a dad and a hoops junkie, the order of which changes based on his mood. Tweet him @kris_dunn...

Fat Is the New Skinny - Trends in Classifying Yourself As Overweight...

That's right.  Our kids have been fat so long that our expectation of what fat is has started to shift.  See this research abstract from Burke, Heiland and Nadler and exhale:

"We test for differences across the two most recent NHANES survey periods (1988–1994 and 1999–2004) in self-perception of weight status. We find that the probability of self-classifying as overweight is significantly lower on average in the more recent survey, for both men and women, controlling for objective weight status and other factors. Among women, the decline in the tendency to self-classify as overweight is concentrated in the 17–35 age range, and, within this range, is more pronounced among women with normal BMI than among those with overweight BMI. Among men, the shift away from feeling overweight is roughly equal across age groups, except that the oldest group (56–74) exhibits no difference between surveys. In addition, overweight men exhibit a sharper decline in feeling overweight than normal-weight men.

Despite the declines in feeling overweight between surveys, weight misperception did not increase significantly for men and decreased by a sizable margin among women. The shifts in selfclassification are not explained by differences between surveys in body fatness or waist circumference, nor by shifting demographics. We interpret the findings as evidence of a generational shift in social norms related to body weight, and propose various mechanisms to explain such a shift, including: (1) higher average adult BMI and adult obesity rates in the later survey cohort, (2) higher childhood obesity rates in the later survey cohort, and (3) public education campaigns promoting healthy body image. The welfare implications of the observed trends in self-classification are mixed.

Hat tip to Marginal Revolution...

The Bun In The Oven & The State of Preventative Health Care...

Here are some snippets from an email I received from the US Department of Health and Human Services today:

"We know that the health care crisis impacts every American, but our mothers, daughters and sisters are paying a particularly heavy price. Today, 21 million women and girls are uninsured. Women who try to purchase insurance find that the private market is often stacked against them. Premiums in the private market for young women are often higher than they are for men. In some states, insurance companies can legally discriminate against women, and leave them with higher health care bills or inadequate coverage.

We know America's women can't afford to wait for comprehensive health reform. Roadblocks to Health Care reports:

• In the individual insurance market, women are often charged higher premiums than men during their reproductive years. Holding other factors constant, a 22 year old woman can be charged one and a half times the premium of a 22 year old man.
• In a recent national survey, more than half of women (52%) reported delaying or avoiding needed care because of cost, compared with 39% of men."

Why are women charged more?
Among other things, because we can get pregnant and pregnancy in the US is very expensive. We therefore use more health care and are charged more or denied insurance coverage. But here is the crazy part, folks: women cannot self-impregnate!

Not long ago, I received a very personal lesson on the wacky state of preventative health care for maternity. As an otherwise extremely healthy person with a good track record for taking care of myself and little in the way of worrisome health risks, I'd gone the way of financial prudence. I purchased a health plan with a high deductible, but with inexpensive co-pays on doctor's visits and alternative medicine as well as discounts on pharmaceuticals, should I need them.

This was all working out very well. I continued to do my part for the team by taking good care of myself, paying my insurance company dutifully and not using any medical care! I was mentally prepared should a catastrophe befall me. I figured, should that happen, my piddly $5k deductible would seem like chump change in comparison to what I would otherwise have had to spend out of pocket for catastrophic care. All those years of paying unused premiums to my carrier would have been put to good use!

Then, about 6 months ago I developed a small "medical" problem. That's right. I got pregnant. Ok, so this is no catastrophic illness or disease condition, right? I mean, there are more than 6 billion people on earth and, unless I am mistaken, pregnancy is the way we all got here. As a scientist, I will grudgingly agree that pregnancy looks suspiciously like a highly evolved parasitic infection. Yet, unlike malaria - for instance - my health plan wasn't ponying up any cash for pregnancy vaccines or other preventative measures against this "disease."

So, it was one $20 co pay with my primary care doc, the cost of a pregnancy confirmation test, and then I was on my own. At that point my options were to start clocking maternity care against my catastrophic deductible. After meeting that limit I'd pay 30-70%. After doing the math, I realized that if I ended up in a hospital for a routine, healthy birth, with no serious complications, that I would most likely end up paying $7,500+ out of pocket for my "disease."

Compare this to a $2000-2500 bill if I pay cash for a home birth with a certified nurse/midwife, including all prenatal scans and labs and two months of well baby care, and it left me scratching my head. Now if there were complications (need for surgery, premature birth, gestational diabetes, preclampsia, etc.) that led to a need for emergency medical intervention then, as I said, there is not much room to gripe over the deductible when so many dollars and someone's life are on the line. Yet when all signs in my case (and in the case of nearly 75% of pregnancies that come full term) point to a completely normal, healthy pregnancy and birth, I am perplexed about how this situation serves any sort of greater good.

In my case, I simply opted to pay the midwife out of pocket and should an emergency arise, well, it's an emergency - deductible be damned. Yet I think about all of the women whose partners may have left them; women whose partners lost their jobs; women who have lost their own job and are not sure how to afford COBRA, but would be denied individual coverage due to their "pre-existing condition"; women who are short on the cash to be able to afford the relatively less expensive but still cost prohibitive bill for good prenatal care and who end up with very costly bills later on down the line due to having delayed or avoided care.

And these mothers who were impregnated by partners who - in most cases - will not be denied coverage or see rate increases due to their partners' "disease," are left unable to pay and to pass on the costs to the remaining payers in the current insurance system - thus becoming contributors to the astronomical rise is insurance rates. These are not some handful of bad people "out there." If you are reading this blog, breathing and have a pulse right now then you have a pregnant woman to thank.

People are not going to stop making more people, people. It just isn't going to happen. So what are our options when it comes to taking pregnant women off of the bad apple list with regards to health care costs?

1. Provide safe, effective and affordable contraception and family planning services to women of reproductive age (yes, this means after menarche) .
2. Ensure that pre-natal care is covered as preventative care under health plans.
3. Stratify pregnancies by risk and ensure that health plans cover lower cost but safe and effective birth options such as licensed birthing centers and midwife assisted home births for low risk pregnancies.
4. Ensure that health plans rapidly identify and direct high risk pregnancies to maternity care and coaching programs that help manage behavioral risk factors and more closely monitor pregnancy through birth.
5. If you are an employer providing maternity benefits and health insurance for your employees and spouses, make sure you emphasize prental care and maternity benefits offered by your health plan. Consider setting aside lactation rooms to encourage breastfeeding mothers to pump so that they can continue to feed their babies breastmilk (which has health benefits for the mother and child).
6. Support legislation that accomplishes all of the above and funds community health education centers that provide outreach, education and services to uninsured populations - eliminating a cost barrier which might keep pregnant women from seeking care until it is too late.

If altruism isn't your bag, then consider that early prenatal care helps all payers in the health insurance game by lowering costs shared by the pool. And if you are still feeling the glow from that gift that had your mom in tears last weekend, then - hey - do it for the lady who loved you enough to endure nausea, swollen feet, ill-fitting clothes and a whole lot more to bring you into this world.

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.

Alabama Teachers - Wellness is Gone, and Don't Smoke 'em If You Got 'em...

When push comes to shove on the benefits front, what's the first thing to go?  Select from:

1.  No price increases;

2.  Nice to have things like wellness programs; or

3.  Allowing people to smoke without charging them more for benefits...

If you're the group that administers benefits to Educators in Alabama, you dump wellness and start charging the smokers more.  From the Montgomery Advertiser:

"The board of the Public Education Employees Health Insurance Plan de�cided Friday to maintain the same basic rates for active employees: $2 per month for individual coverage, $132 for dependent coverage and $134 for family coverage. The rates for retired education employees will also stay the same.

The board unanimously raised the surcharge for smokers by $2 per month to a total of $25 starting Oct. 1. That affects about 20,000 people.

As a cost-saving measure, the board voted to eliminate all of its wellness program except flu shots. Deputy Director Marc Reynolds said eliminating health screenings, osteoporosis screenings, Weight Watchers and other features of the wellness program should save $3.5 million in the new fiscal year. But he said it could be more costly in the long run if illnesses are detected later and the treatment is more expensive.

The board had to look for cost savings and revenue generators because the education budget passed by the Legislature on Thursday provided for no increase in funding for health insurance for the 284,655 active and retired employees and dependents who have coverage. The Legislature did that, at the request of the Alabama Education, to put as much money as possible toward maintaining school jobs during the recession."

Interesting to see if wellness comes back to this group or if it's gone forever.  Still pretty good monthly rates for gold plated coverage though...

What Would You Do If Your CEO Got Swine Flu?

Get Well Soon, CEO!

Finding an executive manager is never easy. And once you do find a fearless leader, myriad cultural, economic and - yes - even personal health issues can threaten to throw the whole situation off the rails.

"The impact of replacing senior managers, especially due to sudden health issues, is even more acute than normal turnover. A study by Deloitte shows that 47% of companies cite their biggest people-related challenge as leadership development and succession planning," says Candie Fisher,Director of Client Development for Generator Group, a talent management firm based in Portland, OR

Steve Jobs' much publicized cancer struggle sent off a flurry of speculation about Apple's readiness to replace him.  Last year,CFOs at nCipher and Servocell resigned due to ill health. In 2004 McDonald's CEO, Jim Cantalupo died at age 60 of a heart attack. Charles Bell, who replaced Cantalupo, was diagnosed with colorectal cancer only a month after being named chief executive. 

And while the press might not have noticed that your company's top brass was 'not strong enough' to attend a meeting, that's just the kind of news that makes fine grist for the company rumor mill.  If people are worried about your firm's financial performance, an ailing leader's plight isn't exactly the kind of news that will boost productivity. 

Executives Are People, Too!

Despite their strategic importance to an organization, executive leaders are in many other ways just like everyone else. They have bad hair days (case in point, get a load of Bill Gates and the Microsoft crew in this photo)!

They get sick - often due to preventable causes - just like the rest of us.

Sharon McDowell is an exercise physiologist for the Center for Creative Leadership's Leadership At The Peak Program. The program has looked at the overall health of senior executives and leaders with more than 15 years of management experience, in the top three tiers of the organization, with leadership responsibility for 500 or more people and/or executive staff functions. McDowell says that of the nearly 3,000 program participants screened 58% had high cholesterol; 60% are overweight or obese; and about 50% don't exercise regularly.

Executive managers lead high stress lifestyles and often lack the time for structured exercise. The World Heart Federation and the US Federal Centers for Disease Control say failure to exercise is as bad as smoking a pack of cigarettes every day.

Unexpected leadership transitions are costly, says Fisher, "At the top levels, many companies do not have a strong program in place to fill senior leadership positions from within. As a result, fully-loaded recruiting costs of 1.5 times the annual salary are commonplace."

Fisher recommends companies implement a two-pronged strategy of keeping their senior managers focused on both wellness and succession planning. "Executive level jobs can be stressful, reducing executives health risk through wellness programs can increase leadership productivity thus improving their ability to mentor, groom, and retain high potential talent," she states.

Increasing executives' personal well-being might also improve their effectiveness. McDowell's research has shown that executives that exercise are more likely to be perceived as more energetic and effective than their non-exercising peers in 360 degree management surveys.

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.

Alabama - Now Charging Obese Workers More For Benefits....

I've written a lot in the past about the continuing escalation of healthcare costs in the U.S. forcing companies into a corner, a corner which will force them to either penalize unheathly employees or reward healthy employees for their health metrics.

Whether you use the carrot or the stick will be up to you.  But employers are increasing their moves to link employee heathcare premiums to metrics like blood pressure, cholesterol, blood glucose, obesity, etc.

The state of Alabama recently annouced some changes that suggest you'll have your BMI memorized in 5 years.  From MSNBC....

"Alabama, pushed to second in national obesity rankings by deep-fried Southern favorites, is cracking down on state workers who are too fat. The state has given its 37,527 employees a year to start getting fit — or they’ll pay $25 a month for insurance that otherwise is free.

Alabama will be the first state to charge overweight state workers who don’t work on slimming down, while a handful of other states reward employees who adopt healthy behaviors. Alabama already charges workers who smoke — and has seen some success in getting them to quit — but now has turned its attention to a problem that plagues many in the Deep South: obesity.

The State Employees’ Insurance Board this week approved a plan to charge state workers starting in January 2010 if they don’t have free health screenings. If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enroll in a wellness program, or take steps on their own to improve their health. If they show progress in a follow-up screening, they won’t be charged. But if they don’t, they must pay starting in January 2011.

“It’s terrible,” said health department employee Chequla Motley. “Some people come into this world big.”  Computer technician Tim Colley already pays $24 a month for being a smoker and doesn’t like the idea of another charge.  “It’s too Big Brotherish,” he said.

The board will apply the obesity charge to anyone with a body mass index of 35 or higher who is not making progress. A person 5 feet 6 inches tall weighing 220 pounds, for example, would have a BMI of 35.5. A BMI of 30 is considered the threshold for obesity.  The board has not yet determined how much progress a person would have to show and is uncertain how many people might be affected because everyone could avoid the charge by working to lose weight."

Welcome to the brave new world.  I'm a proponent of rewarding employees who live healthy lifestyles that result in reduced risk.  Still, I wonder if $25 per month ($300 per year?) makes enough of a dent.  My take is that the psychological threshold for action is triple digits - $100 per month. 

Put the doughnut down.  Doughnuts are for closers people who exercise... Not for those who think the Wii Fit is a good exercise tool...

How Are Benefits Managers Responding to Tough Economic Times?

Chances are, given current economic conditions, you aren’t rolling out many new benefits this year.  In fact, you’ve probably received direction from your e-suite to “cut costs” without much direction regarding where those savings should come from.  There’s a fine line that folks who work in benefits are walking these days.  On one hand, we’re looking for opportunities to control or cut costs.  On the other, we want to continue offering benefits programs that help attract and retain talent.  The challenge is finding ways to balance these competing interests.
 
If you believe the media, the easy cut for many employers is the employer match on 401k contributions.  Others are making changes to what they contribute toward medical coverage or changing medical plan design.  Still, others are moving away from traditional health coverage altogether toward consumer driven health plans (CDHP).  In a recent survey, Watson Wyatt found that 51% of employers responding currently have a CDHP in place -- up 9% from the prior year.

While it may feel like every employer is reducing benefits, the results of a recent Tower Perrin survey seem to indicate otherwise.  The survey found that few respondents were planning to make dramatic changes to their benefits during the next year.  Many employers are taking this opportunity to communicate with employees about their concerns and take a harder look at their benefits strategies.  Here’s an excerpt from their press release:

“Amid worries about their 2009 performance (56% of respondents expect to see revenues decline, in some cases by as much as 20% or more), a fair number of respondents see the economic crisis as a catalyst for constructive action.  For instance:

• 70% are increasing communication to address employee concerns, and more than 57% said they were not cutting back on investments in benefit communication or education.
• 53% are trying or considering new benefit strategies they would not have considered otherwise.
• 47% reported they are taking a more holistic approach to reward management.”

The argument against making drastic cuts today is that employees tend to have long memories.  While they may not walk out your door in the current economic environment, they’ll remember how you treat them today when the environment improves.  There are certainly employers making changes to their benefits programs just to survive.  If a choice has to be made between reducing benefits and closing your doors, obviously a reduction in benefits makes more sense. 

Let’s face it -- benefits are offered as part of a total compensation package to attract and retain talented employees.  Benefits managers around the country will be faced with tough decisions this year.  Over the next 6-18 months, they’ll need to be strategic about decisions they make.  Looking for opportunities to control or cut costs will be imperative.  But employers should think twice before taking an axe to their benefits programs at will.  If they do, their employees will remember it when times aren’t quite so tough.

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?

Digital Medical Records - Not A Clear Winner?

Much has been said recently about the promise of portable, digital medical records, but there are two sides to the story.  For every authority that touts the efficiency, safety and cost benefits of an electronic medical record, there are others who say it's not as simple as the current administration and IT vendors would have you believe.

From BusinessWeek:

"Under the federal stimulus program enacted in February, hospitals can seek several million dollars apiece for tech purchases over the next five years. Individual physicians can receive up to $44,000. These carrots should encourage the proliferation of technology that will computerize physician orders, automate dispensing of drugs, and digitally store patient records. If providers participate broadly, those files are supposed to be accessible no matter where a consumer goes for treatment. President Barack Obama says the changes will improve care, eliminate errors, and eventually save billions of dollars a year. There's also a stick: The federal government will cut Medicare reimbursement for hospitals and medical practices that don't go electronic by 2015.

The incentives are working. R. Andrew Eckert, CEO of tech provider Eclipsys, says one client, a 250-bed hospital that shelved a software order in the fall after losing $50 million in the stock market, has reinstated the order. The move is "100% due to the stimulus," says Eckert (who won't name the hospital). Brandon Savage, chief medical officer at GE's health unit, says his company's technology will leapfrog the competition by not just replacing paper but also guiding doctors to the best, least-costly treatments."

But not everyone is sold.  It's Amercia - we like it that way: 

"That rare agreement, however, is obscuring the checkered history of computerized medical files and drowning out legitimate questions about their effectiveness. Cerner, based in Kansas City, Mo., and other industry leaders are pushing expensive systems with serious shortcomings, some doctors say. The high cost and questionable quality of products currently on the market are important reasons why barely 1 in 50 hospitals has a comprehensive electronic records system, according to a study published in March in the New England Journal of Medicine. Only 17% of physicians use any type of electronic records.

But so far there's little conclusive evidence that computerizing all of medicine will yield significant savings. And improvements to patient care may be modest. An analysis of four years of Medicare data published in March in the scholarly journal Health Affairs found only marginal improvement in patient safety due to electronic records—specifically, the avoidance of two infections a year at the average U.S. hospital. "Health IT's true value remains uncertain," wrote Stephen Parente and Jeffrey McCullough, researchers at the University of Minnesota.

Part of the problem stems from a fundamental tension. Info tech companies want to sell mass-produced software. But officials at large hospitals say such systems, once installed, require time-consuming and costly customization. The alterations often make it difficult for different hospitals and medical offices to share data—a key goal. Meantime, the health IT industry has successfully lobbied against government oversight.

"Most big health IT projects have been clear disasters," says Dr. David Kibbe, senior technology adviser to the American Academy of Family Physicians. "This [digital push] is a microcosm for health-care reform....Will the narrow special interests win out over the public good?"

What special interests you ask?  When in doubt, the cynics follow the money in D.C.  For my money, as a software firm employee, it's almost impossible to serve a market this big without some significant level of customization on a big customer basis, and as the article points out, that makes sharing data difficult.

And if we can't get a portable medical record, and it really doesn't drive safety, why would we do it?  Got to get to one standard and force it on people for the economies of scale to work.

An Apple A Day or A Bad Apple? Where Health and Productivity Meet.

An Apple A Day or A Bad Apple?

I was recently listening to an episode of This American Life entitled, "Ruining It For The Rest of Us" where they featured stories about how easily one person's behavior can have a contaminating effect on others. One particularly haunting story covered the research of Will Felps, a professor at Rotterdam School of Management in the Netherlands, who placed a confederate in a group and observed the impact that this "bad apple" had on the rest of the group. In nearly every case, the influence of even one spoiler tarnished the productivity and the morale of the group.
One thing that the researchers in Felp's study didn't look at, however, is that poor health can impact mood. Could an apple a day and a brief jaunt outdoors help the bad apple get his mood back on track? Or could workplace health and wellness be a protective means of coping for those who might otherwise be affected by a bad apple?

How do health and mood interact in your workplace? Have you seen an instance where a bad apple lowered the productivity of a work group and subsequently led to more sick days or a reluctance of team members to show up for work?

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.