Wellness Programs – Getting Started and Remaining Compliant

The overall health and wellness of your employees should be a top priority in your business. Why? Find out in this informative article from our UBA partner.


Where to Start?

First, expand the usual scope of wellness activity to well-BEING. Include initiatives that support more than just physical fitness, such as career growth, social needs, financial health, and community involvement. By doing this you increase your chances of seeing a return on investment (ROI) and a return on value (ROV). Qualitative results of a successful program are just as valuable as seeing a financial impact of a healthier population.

Wellness program ROI and ROV

Source: Katherine Baicker, David Cutler, and Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010, 29(2): pp 304-311

To create a corporate culture of well-being and ensure the success of your program, there are a few important steps.

  1. Leadership Support: Programs with leadership support have the highest level of participation. Gain leadership support by having them participate in the programs, give recognition to involved employees, support employee communication, allow use of on-site space, approve of employees spending time on coordinating and facilitating initiatives, and define the budget. Even though you do not need a budget to be successful.
  2. Create a Committee or Designate a Champion: Do not take this on by yourself. Create a well-being committee, or identify a champion, to share the responsibility and necessary actions of coordinating a program.
  3. Strategic Plan: Create a three-year strategic plan with a mission statement, budget, realistic goals, and measurement tools. Creating a plan like this takes some work and coordination, but the benefits are significant. You can create a successful well-being program with little to no budget, but you need to know what your realistic goals are and have a plan to make them a reality.
  4. Tools and Resources: Gather and take advantage of available resources. Tools and resources from your broker and/or carrier can help make managing a program much easier. Additionally, an employee survey will help you focus your efforts and accommodate your employees’ immediate needs.

How to Remain Compliant?

As always, remaining compliant can be an unplanned burden on employers. Whether you have a wellness or well-being program, each has their own compliance considerations and requirements to be aware of. However, don’t let that stop your organization from taking action.

There are two types of programs – Group Health Plans (GHP) and Non-Group Health Plans (Non-GHP). The wellness regulations vary depending on the type of employer and whether the program is considered a GHP or Non-GHP.

Group health plan compliance table

Employers looking to avoid some of the compliance burden should design their well-being program to be a Non-GHP. Generally, a well-being program is Non-GHP if it is offered to all employees regardless of their enrollment in the employer’s health plan and does not provide or pay for “medical care.” For example, employees receive $100 for attending a class on nutrition. Here are some other tips to keep your well-being program Non-GHP:

  • Financial: Do not pay for medical services (e.g., flu shots, biometric screenings, etc.) or provide medical care. Financial incentives or rewards must be taxed. Do not provide premium discounts or surcharges.
  • Voluntary Participation: Include all employees, but do not mandate participation. Make activities easily accessible to those with disabilities or provide a reasonable alternative. Make the program participatory (i.e., educational, seminars, newsletters) rather than health-contingent (i.e., require participants to get BMI below 30 or keep cholesterol below 200). Do not penalize individuals for not participating.
  • Health Information: Do not collect genetic data, including family medical history. Any medical records, or information obtained, must be kept confidential. Avoid Health Risk Assessments (i.e. health surveys) that provide advice and analysis with personalized coaching or ask questions about genetics/family medical history.

 

You can read the original article here.

Source:

DeRocha H. (15 August 2017). "Wellness Programs – Getting Started and Remaining Compliant" [web blog post]. Retrieved from address http://blog.ubabenefits.com/wellness-programs-getting-started-and-remaining-compliant


The Killjoy of Office Culture

Sometimes, negativity in the office is hard to avoid. Read this article for some helpful tips to take care of those who may be aiding in the negative atmosphere.


One of the latest things trending right now in business is the importance of office culture. When everyone in the office is working well together, productivity rises and efficiency increases. Naturally, the opposite is true when employees do not work well together and the corporate culture suffers. So, what are these barriers and what can you do to avoid them?

According to an article titled, “8 ways to ruin an office culture,” in Employee Benefit News, the ways to kill corporate culture may seem intuitive, but that doesn’t mean they still don’t happen. Here’s what organizations should do to improve their corporate culture.

Provide positive employee feedback. While it’s easy to criticize, and pointing out employees’ mistakes can often help them learn to not repeat them, it’s just as important to recognize success and praise an employee for a job well done. An “attaboy/attagirl” can really boost someone’s spirits and let them know their work is appreciated.

Give credit where credit is due. If an assistant had the bright idea, if a subordinate did all the work, or if a consultant discovered the solution to a problem, then he or she should be publicly acknowledged for it. It doesn’t matter who supervised these people, to the victor go the spoils. If someone had the guts to speak up, then he or she should get the glory. Theft is wrong, and it’s just as wrong when you take someone’s idea, or hard work, and claim it as your own.

Similarly, listen to all ideas from all levels within the company. Every employee, regardless of their position on the corporate ladder, likes to feel that their contributions matter. From the C-suite, all the way down to the interns, a genuinely good idea is always worth investigating regardless of whether the person who submitted the idea has an Ivy League degree or not. Furthermore, sometimes it takes a different perspective – like one from an employee on a different management/subordinate level – to see the best way to resolve an issue.

Foster teamwork because many hands make light work. Or, as I like to say, competition breeds contempt. You compete to get your job, you compete externally against other companies, and you may even compete against your peers for an award. You shouldn’t have to compete with your own co-workers. The winner of that competition may not necessarily be the best person and it will often have negative consequences in terms of trust.

Get rid of unproductive employees. One way to stifle innovation and hurt morale is by having an employee who doesn’t do any work while everyone else is either picking up the slack, or covering for that person’s duties. Sometimes it’s necessary to prune the branches.

Let employees have their privacy – especially on social media. As long as an employee isn’t conducting personal business on company time, there shouldn’t be anything wrong with an employee updating their social media accounts when they’re “off the clock.” In addition, as long as employees aren’t divulging company secrets, or providing other corporate commentary that runs afoul of local, state, or federal laws, then there’s no reason to monitor what they post.

Promote a healthy work-life balance. Yes, employees have families, they get sick, or they just need time away from the workplace to de-stress. And while there will always be times when extra hours are needed to finish a project, it shouldn’t be standard operating procedure at a company to insist that employees sacrifice their time.

 

You can read the original article here.

Source:

Mukhtar G. (14 September 2017). "The Killjoy of Office Culture" [web blog post]. Retrieved from address http://blog.ubabenefits.com/the-killjoy-of-office-culture


HRL - Woman - Frustrated

Are you addressing your employee’s financial health?

Do your employees find themselves bogged down with financial concerns? Maybe it's time to help them out. In this article, our partner, UBA, explores some of the ways your employees may be struggling with their financial health, and how you can help.


The importance of health and wellness in the workplace is more apparent than ever. It’s obvious why healthy individuals make better employees and the positive impact this has on your bottom line. When thinking about building a program to improve the well-being of your employees, don’t forget about the importance of their financial health.

In recent years, studies show that employees have a wide range of financial concerns that affect their work. Some financial issues are widespread, impacting a large number of employees, while others may be more unique based on an employee’s specific circumstances.

Financial stress in the workplace influences productivity, absenteeism, physical health, emotional well-being, and the overall happiness of employees. Nearly 25 percent of employees confirm personal finance issues are a distraction at work and 39 percent say they spend three hours or more each week at work dealing with personal financial issues.1

Some of the biggest financial stressors impacting employees today include:

  • Student loan debt – 2 million Americans collectively owe $1.3 trillion in student loans – that’s more than credit card and auto loan debt, and second only to mortgage debt 2
  • Retirement savings – 56 percent of Americans have less than $10,000 in retirement savings 3
  • Emergency funds – 46 percent are unable to cover a $400 emergency 4
  • Other debt – 48 percent of Americans have more credit card debt than savings 5

Unfortunately, financial stress can go unnoticed because it is usually not as openly discussed or addressed. Discussing personal finance with co-workers and even family members is still considered difficult for many. This makes it even more important to have a program in place to educate and empower your employees to make positive financial decisions.

There are a wide variety of financial wellness programs and services available. When developing a program, be sure that you include both educational resources and tools that support behavioral change.

  • Educational resources – Education is the backbone to any financial wellness program. Remember, financial issues can impact anyone in your company and not everyone learns the same way. Offer a variety of resources including workshops, seminars, books, online courses and access to financial consultations. It’s important to assure employees that they are in a safe environment where they can learn and feel comfortable asking questions and seeking more information.
  • Empowering behavioral change – Financial wellness doesn’t stop with education. Worksheets, budgeting tools, financial consultants, loan repayment plans and retirement savings plans are all tools that aid employees in making long-term behavioral changes that improve their financial health. Celebrating the small successes early on will help employees commit to making more long-term changes. Be sure to have programs in place that offer the tools and resources needed for employees to set goals, change their behavior and celebrate their success.

 

You can read the original article here.

Source:

Cannon N. (3 October 2017). "Are you addressing your employee’s financial health?" [web blog post]. Retrieved from address http://blog.ubabenefits.com/are-you-addressing-your-employees-financial-health


Data Note: Changes in 2017 Federal Navigator Funding

Are you looking for a run-down on Navigator programs and their funding? In this article from the Kaiser Family Foundation, we are offered an informative peak of the 2017 changes in federal Navigator funding within the Affordable Care Act (ACA).


Read the original article here.

Source:

Pollitz K., Tolbert J., Diaz M. (11 October 2017). "Data Note: Changes in 2017 Federal Navigator Funding" [Web Blog Post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/data-note-changes-in-2017-federal-navigator-funding/

 

The Affordable Care Act (ACA) created Navigator programs to provide outreach, education, and enrollment assistance to consumers eligible for coverage through the Marketplaces and through Medicaid and requires that they be funded by the marketplaces.  For the past two years, the Centers for Medicare and Medicaid Services (CMS) has funded Navigator programs in the 34 states that use the federal marketplace through a multi-year agreement that was expected to continue for the current budget year.  In August, CMS officials announced significant reductions to Navigator funding for the 2018 budget year.  These funding reductions coming so close to the start of the 2018 open enrollment period will affect the help many Navigators can provide to consumers seeking to enroll in coverage.

This data note analyzes funding changes and discusses the implications for Navigators and consumers.  It presents results of a Kaiser Family Foundation online survey of federal marketplace (FFM) Navigator programs conducted from September 22, 2017 – October 4, 2017 about 2017 funding awards (for the 2018 open enrollment period), the relationship between funding amounts and program performance, and the likely impact of funding changes on programs and the consumers they serve. It also includes insights from a roundtable meeting of more than 40 Navigators co-hosted by the Robert Wood Johnson Foundation and Kaiser Family Foundation held on September 15, 2017, as well as analysis of administrative data.

BACKGROUND

In 2015, CMS signed three-year agreements with Navigator organizations to provide consumer assistance to residents of federal marketplace states.  The multi-year agreements promoted continuity and experience among Navigator professionals.  Multi-year agreement also spared CMS and Navigators the time and expense involved in reissuing grants during critical weeks leading up to open enrollment.  Under the agreements, Navigator programs in the FFM states are required to set goals and report performance data throughout the year relating to specific duties and activities.

Funding amounts under the multi-year agreements have been determined annually — $60 million for the first budget year (which runs September through August), and $63 million for the second budget year.  CMS notified continuing programs of the grant amount available to them for the coming year in late spring; programs then submitted work plans, budgets, and performance goals based on that amount.  Once CMS approved these plans, final awards were made in late August.

In May 2017, continuing Navigator programs were notified of available third-year funding amounts, which totaled $60 million, with grants for most programs similar to the year-two funding amount. In June, programs submitted their work plans and budgets corresponding to these amounts. The Navigator programs expected final Notice of Awards (NOA) by September 1, 2017.

On August 31, one day prior to the end of the second budget period of the grants, CMS announced it would reduce Navigator funding by more than 40%. CMS issued a bulletin stating that funding for the third year would be based on program performance on its enrollment goals for the second budget period.  On September 13, 2017, two weeks into the third budget year of the grant, FFM Navigator programs received preliminary NOAs for third-year funding, which totaled $36.8 million, or 58% of the year-two awards. (See Appendix A for funding awards by program.)

2017 NAVIGATOR FUNDING REDUCTIONS

CMS notified Navigator program of their preliminary 2017 grant awards on September 13, 2017.  The full list of preliminary awards was obtained and released by a third party (see Appendix A). This section summarizes funding changes based on information from that list.

Funding changes at the state level for 2017 were uneven across states.  Three FFM states (Delaware, Kansas, and West Virginia) received no net reduction in year-three Navigator funding.  Among the other 31 FFM states, the funding reductions ranged from 10% in North Carolina to 80% or more in Indiana, Nebraska, and Louisiana (Table 1).

Table 1: 2016 Federal Navigator Funding Awards  and Preliminary 2017 Awards as of  September 13, 2017, by State
State 2016 Funding Award 2017 Preliminary Funding Award Percent Change
Alabama $1,338,335 $1,036,859 -23%
Alaska $600,000 $446,805 -26%
Arizona $1,629,237 $1,167,592 -28%
Delaware $600,000 $600,000 0%
Florida $9,464,668 $6,625,807 -30%
Georgia $3,682,732 $1,433,936 -61%
Hawaii $334,510 $185,143 -45%
Illinois $2,581,477 $1,792,170 -31%
Indiana $1,635,961 $296,704 -82%
Iowa $603,895 $226,323 -63%
Kansas $731,532 $731,532 0%
Louisiana $1,535,332 $307,349 -80%
Maine $600,000 $551,750 -8%
Michigan $2,228,692 $627,958 -72%
Mississippi $907,579 $382,281 -58%
Missouri $1,815,514 $729,577 -60%
Montana $495,701 $374,750 -24%
Nebraska $600,000 $115,704 -81%
New Hampshire $600,000 $456,214 -24%
New Jersey $1,905,132 $720,545 -62%
North Carolina $3,405,954 $3,061,034 -10%
North Dakota $636,648 $208,524 -67%
Ohio $1,971,421 $568,327 -71%
Oklahoma $1,162,363 $798,000 -31%
Pennsylvania $3,073,116 $1,988,501 -35%
South Carolina $1,517,783 $511,048 -66%
South Dakota $600,000 $236,947 -61%
Tennessee $1,772,618 $1,497,410 -16%
Texas $9,217,235 $6,110,535 -34%
Utah $902,681 $394,862 -56%
Virginia $2,187,871 $1,108,189 -49%
West Virginia $600,000 $600,000 0%
Wisconsin $1,338,306 $749,215 -44%
Wyoming $605,847 $183,654 -70%
Total $62,882,140 $36,825,245 -41%
Source: List of preliminary grant awards was obtained and released by a third party, not by CMS.

When the multi-year agreement was established, federal funding was allocated across FFM states based on the state’s share of the number of uninsured people, with a minimum amount ($600,000) reserved for each of the smallest states.  This allocation formula no longer seems to apply.  For example, total funding for Navigators in Indiana ($290,000) was less than that for Navigators in Alaska ($447,000) despite the fact that there are four times as many uninsured residents in Indiana compared to Alaska (422,000 vs 95,600 in 2016).  Similarly, funding for Navigators in Ohio was less than that for Navigators in Oklahoma ($568,000 vs $798,000) though there are more uninsured residents in Ohio (631,000 vs 409,000).1

Overall, the funding reductions varied widely across individual Navigator programs. The vast majority (82%) of Navigator programs experienced reductions, while 18% of programs saw their funding stay the same or increase compared to funding levels in 2016. Forty-nine percent of programs had their funding reduced by more than half and more than one-quarter experienced funding reductions of over 75% (Figure 1).

Figure 1: Changes in Navigator Program Funding, 2016-2017

NAVIGATOR PROGRAM FUNDING VERSUS PERFORMANCE

This section summarizes findings from the KFF Survey of FFM Navigators about 2017 funding changes and program performance on certain metrics during the second year of the multi-year agreement.  All Navigator programs were contacted, and 51% participated in the survey.

Navigators say the basis for 2017 funding decisions has not been clear.  Nearly half (49%) of respondents said that the rationale for the funding notice they received on September 13 was not provided at all, and another 40% said it was unclear (Figure 2).

Figure 2: Navigator Program Perception of Clarity of CMS Funding Rationale

The August 31 CMS bulletin indicated that funding for the Navigators would be based on performance against year-two “enrollment goals.” According to the bulletin, “a grantee that achieved 100 percent of its enrollment goal for plan year 2017 will receive the same level of funding as last year, while a grantee that enrolled only 70 percent of its enrollment goal would receive 70 percent of its previous year funding level, a reduction of 30 percent. The new funding formula will ensure accountability within the Navigator program.”

It is not clear what metric CMS used to determine funding levels since Navigators have been required to track a number of activities relative to goals, all of which could result in or contribute to enrollment in health coverage.  These include:

  • Number of consumers assisted with qualified health plan (QHP) selection/enrollment (including reenrollment);
  • Number of one-on-one interactions with consumers, including both general and specific inquiries; and
  • Number of consumers assisted with applying for Medicaid/CHIP, including referral of consumers in non-expansion states to the state Medicaid office;
  • Number of consumers reached through outreach and public education activities.2
NAVIGATOR-ASSISTED QUALIFIED HEALTH PLAN SELECTION METRIC

The number of consumers assisted with QHP selections is the most direct measure of marketplace enrollment tracked by Navigators, although as discussed below, it does not capture all marketplace enrollments that involved Navigator assistance.

There are two measures of Navigator-assisted QHP selections, one self-reported by the programs and one based on data collected by healthcare.gov – the Multidimensional Information and Data Analytics System, or MIDAS data.  The healthcare.gov online application includes a field where Navigator staff can enter their identification number for each consumer whom they assist. Navigators report that program staff have not been trained on this data entry and did not consistently enter it. Several weeks after the start of the fourth open enrollment period, some Navigator programs said they were encouraged by their CMS project officers to improve consistency of staff identification numbers on applications.  Some say they subsequently received reports from CMS staff during the project year comparing MIDAS and self-reported data on QHP selections that did not match – in some cases by a factor of two – and programs did not know why.  Other programs said they did not receive reports from CMS on their MIDAS data.  Navigators expressed concern about the accuracy of data counting QHP selections, especially if this will become the basis for future funding decisions.

The survey asked Navigators to provide both their goal and self-reported performance data for Navigator-assisted QHP selections as reported to CMS for the second budget period. Navigator performance relative to the goal was compared to the change in funding from 2016 to 2017.  Among programs that provided the performance data, findings include:

For 22.5% of programs, 2017 funding matches performance on the self-reported QHP selection metric (Figure 3).  Included in this group were:

  • 15.0% of programs that exceeded or met at least 95% of the goal and whose 2017 funds were not reduced; and
  • 7.5% of programs that did not meet the goal and had funding reduced by the same or similar percentage (+/- 5%).

For 77.5% of programs, 2017 funding does not reflect performance on the QHP selection metric.  Included in this group were:

  • 22.5% of programs that exceeded or met at least 95% of the goal and whose 2017 funds were reduced;
  • 27.5% of programs that did not meet the goal and had funding reduced by a greater percentage; and
  • 27.5% of programs that did not meet the goal and had funding changed by a smaller percentage.

Figure 3: Change in Navigator Funding Compared to Performance on QHP Selection Metric

The QHP selection metric tends to undercount enrollment that is connected to assistance provided by Navigators. Through the survey and at the roundtable, Navigators expressed concern that the QHP selection measure does not reflect the number of consumers whom they help and who ultimately enroll in marketplace health plans.  This metric, as defined by CMS, counts only those consumers who select a plan in the Navigator’s presence, a fraction of the total number of individuals who enroll in coverage and who were helped by Navigators.  For example, if a Navigator helped a consumer complete her application and reviewed plan choices, but the consumer went home to consider her options and made a final selection that evening, that visit could not be reported as a Navigator-assisted plan selection.3 According to the Kaiser Family Foundation 2016 Survey of Health Insurance Marketplace Assister Programs and Brokers, 18% of assister programs reported that nearly all consumers they helped who were determined eligible to enroll in a QHP made their plan selection during the initial visit. Thirty-five percent said they knew the final plan selection of all or nearly all such consumers whom they helped.

OTHER NAVIGATOR PERFORMANCE METRICS

Funding changes for 2017 also do not appear to align with performance on other metrics.  Navigators reported goals and performance data on other key metrics that relate to enrollment (Figure 4). Most programs met or exceeded these goals, so these metrics do not appear to be related to the funding reductions.  Among programs that answered these questions, Eight in ten programs (83%) met their goals for one-on-one consumers interactions, 71% met their goals for helping consumers enroll in Medicaid or CHIP, and three quarters met their outreach and education event goal.

Figure 4: Most Navigators Met Other Enrollment-Related Goals

One-on-one assistance: The most comprehensive measurement required by CMS is the number of consumers provided one-on-one assistance.  A one-on-one encounter can involve helping a consumer with any step along the process that ends with enrollment:  educating consumers about the availability of plans and assistance, completing a marketplace application for financial assistance, appealing a marketplace decision, reviewing and understanding plan options, or selecting a QHP.  Navigators also provide one-on-one assistance to consumers after they enroll so that they can remain covered.  Such help includes answering tax reconciliation questions, resolving premium payment disputes, and referring consumers for help with denied claims.  Once they have resolved the problem they came in with, many consumers leave and complete the enrollment process on their own.  The one-on-one assistance metric would also count consumers who are helped but who do not enroll in coverage.  On average, the number one-on-one encounters Navigators reported was 15 times higher than the number of QHP selections.

Medicaid/CHIP enrollment assistance or referrals: The ACA requires a “no wrong door” application process through which consumers can apply through the marketplace, using a single streamlined application, for either private health insurance subsidies or Medicaid/CHIP.  Navigators are required to help all consumers with the application.  Navigators from Medicaid expansion states noted that most consumers who sought help were ultimately determined Medicaid eligible.  At the roundtable, some commented that, when the August 31 bulletin was released, they assumed CMS would base funding on enrollment under both types of coverage.

Outreach and public education: Four years after implementation, the public’s understanding of ACA benefits and requirements remains limited.  For example, many consumers continue to be unaware that signups for private non-group health insurance, generally, must take place during open enrollment.4  Turnover in marketplace plans is high, as most participants need non-group coverage only while they are between jobs or other types of coverage.  Navigators report that consumers are less likely to seek, or be receptive to, information about the marketplace until they actually need it.

IMPACT OF NAVIGATOR FUNDING REDUCTIONS

This section summarizes findings from the KFF Navigator survey as well as insights from the Navigator Roundtable meeting on program changes that may result from the funding reductions.

Most Navigator programs say they will continue to operate in 2018 despite the funding reductions.However, three programs said they will terminate work for year-three.  These include two programs – one statewide and one nearly statewide5 – that had been the only Navigator service providers for consumers in most areas of their respective states.  Their decision to withdraw was based on the level and timing of funding reductions.  The September 13 NOA directed that no more than 10% of the grantee’s award could be spent by programs pending CMS review and approval of the final budget and work plan.  Because the preliminary award was announced two weeks into the plan year with final awards scheduled to be made as late as October 28, grantees were faced with maintaining staff payroll and other expenses for as long as two months without assurances they would be reimbursed. The terminating programs, both operated by nonprofits, determined this was not feasible.

Most programs report they will likely reduce their geographic service area and limit help to rural residents. Among programs whose funding was reduced, 45% of statewide programs and two-thirds of regional programs said it is somewhat or very likely they will have to limit the territory their program will serve in year three. Programs emphasized their inability to afford the same level of travel expenses and/or the cost of satellite offices that they had previously incurred in order to offer in-person help to consumers living farther away.  Consumers living in rural communities may be the most affected.  Most (55%) statewide Navigator programs and 72% of regional programs expect to limit services to rural residents this year (Figure 5).

Figure 5: Navigator Programs Reducing Geographic Service Area and Services in Rural Areas

Nearly all programs (89%) expect to lay off staff as a result of funding reductions (Figure 6).  Some programs expect to cut Navigator staff by 75% or more.  The KFF 2016 Assister Survey found that continuity among staff has been high to date.  One advantage of the multi-year agreement was to allow staff experience to grow over time.  To fill in the gaps left by staff lay-offs, some programs plan to rely more heavily on less experienced volunteers.

Figure 6: Navigator Program Response to Funding Reductions

Most Navigator programs expect to reduce services in other ways, as well.  Nearly all programs (81%) say they will likely reduce outreach and public education activities as a result of budget reductions.  In addition, 89% of programs say they will likely reduce spending on marketing and advertising. Nearly six in ten programs (57%) said they will likely reduce the number of months in which they offer Navigator assistance.  Some programs expect to close following open enrollment, others will cut back to a skeletal staff.  As a result, consumers who need assistance at tax time, or help with special enrollments or post-enrollment problems during the year, may have difficulty finding it.

Over four in ten programs say it is likely they will curtail help to consumers related to Medicaid.  At the roundtable, some discussed a strategy of pre-screening consumers during open enrollment to identify those likely eligible for Medicaid/CHIP.  These consumers might be asked to come back at a later date, if they do not have an immediate medical or coverage need, because Medicaid and CHIP enrollment is year round.  Other expressed concern that, if CMS bases future funding on QHP plan selections, Navigators in Medicaid expansion states could be disadvantaged.

In addition, 57% of programs say they will likely limit time staff can devote to helping consumers with complex cases.  These cases include consumers experiencing identity proofing problems (for example, faced by young adults who have not previously filed income tax returns or established credit ratings).6  They also include consumers with income data-matching problems (for example, self-employed individuals who have difficulty estimating income for the coming year).  People who cannot resolve identity or other data verification problems within 90 days risk losing their marketplace coverage or subsidies.

Another 54% of programs say they will likely limit the number of limited English proficiency (LEP) consumers they can serve.  Programs often pay a premium for bi-lingual staff, an expense they may no longer be able to afford with reduced funding.

Consumers who need these kinds of assistance may have difficulty finding it elsewhere.  Many consumers seek help from other types of marketplace assister programs.  Federally qualified health centers (FQHCs) also receive funding from the federal government to provide in-person enrollment assistance, although the authorization for most federal funding expired September 30 and has yet to be extended.  In addition, Certified Application Counselor (CAC) programs provide in-person help in the marketplace, though are not paid by the marketplace.  The KFF 2016 Assister Survey found that all three types of programs play an important role in helping consumers.  They also tend to differ from Navigator programs in some key respects.  In particular, Navigator programs typically undergo a higher level of training; they are more likely to operate statewide, sponsor outreach and enrollment events, handle complex cases, and provide help throughout the year.

The KFF 2016 Assister Survey also found that agents and brokers are less likely than marketplace assister programs to serve consumers who need translation services, help with complex cases, and help with Medicaid applications. Brokers and agents are also less likely to help uninsured consumers, immigrants, and consumers who lack internet at home.

DISCUSSION

The Administration’s decision to reduce funding for Navigator programs comes at a challenging time for consumers who rely on coverage through the marketplaces. High-profile insurer exits from the marketplaces, rising premiums, and uncertainty over the federal commitment to funding the cost sharing subsidies are likely sowing confusion among consumers about whether coverage and financial assistance remain available. This confusion, coupled with a shortened open enrollment period, increases demand for the consumer education and in-person enrollment assistance Navigators provide. At a time when more help may be needed, the funding reductions are likely to reduce the level of in-person help available to consumers during this fall’s open enrollment and throughout the 2018 coverage year.

Navigator programs generally report that they do not understand the basis for the funding decisions, and our survey results suggest that there is not a clear link between funding and performance of programs relative to goals on the measures they are required to track and self-report. This ambiguity makes it difficult for programs to plan for the future.

Both the magnitude of the reductions and the timing has caused disruption to Navigator program planning and operations.  Programs plan to adopt various strategies in response to the reductions, including reducing their geographic service area and cutting services, such as outreach and assisting with complex cases. Three programs report they will terminate operations, leaving consumers in their states with very limited access to in-person help. While consumers may be able to turn to other assister programs or brokers, less in-person assistance will be available in some areas, especially for people with complex situations or who live in remote or rural communities.

 

Read the original article here.

Source:

Pollitz K., Tolbert J., Diaz M. (11 October 2017). "Data Note: Changes in 2017 Federal Navigator Funding" [Web Blog Post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/data-note-changes-in-2017-federal-navigator-funding/


Employer Premiums Rise Nearly 7% in 2017; Employees Absorb More of the Health Insurance Cost

On October 26th, UBA released the following press release on the UBA Health Plan Survey:


Increased prescription drug costs for employees with 5- and 6-tier plans; increased out-of-network deductibles and out-of-pocket maximums, especially for singles; self-funding on the rise

Premium renewal rates (the comparison of similar plan rates year over year) for employer sponsored health insurance rose an average of 6.6%—a significant increase from the five-year average increase of 5.6%, according to the 2017 United Benefit Advisors (UBA) Health Plan Survey, released today. Two states saw record premium increases: Connecticut saw a 24% increase in premiums in 2017, up to $655 from $530; New York also saw a large increase of 14%, up to $712 in 2017 over $624 in 2016.

On the other side, some states saw decreases in premiums, such as Arizona and Washington which saw 2% and 10% decreases, respectively.

Percent Premium Increase Over Time

Average employee premiums for all employer-sponsored plans rose from $509 in 2016 for single coverage to $532 in 2017 and from $1,236 to $1,272 for family coverage (a 4.5% and 3% increase respectively). Average annual total costs per employee increased from $9,727 to $9,935. However, the employee share of total costs rose 5% from $3,378 to $3,550, while the employer’s share rose less than 1%, from $6,350 to $6,401.

“Premiums have been holding relatively steady the last few years. And while this year’s increases are not astronomical, their departure from the trend does warrant attention. To mitigate these rising costs, employers are shifting more premium onto employees, offering more lower-cost consumer directed health plans (CDHPs) and health maintenance organization (HMO) plans, increasing out-of-network deductibles and out-of-pocket maximums, and leveraging continued extensions on the ability to “grandmother,” says Peter Weber, President of UBA. “We’ve also seen reductions in prescription drug coverage to defray increasing costs even further.”

Prescription Drug Plans—For a second year, prescription drug plans with four or more tiers are exceeding the number of plans with one to three tiers. Almost three-quarters (72.6%) of prescription drug plans have four or more tiers, while 27.4% have three or fewer tiers. Even more surprising is that the number of six-tier plans has surged, accounting for 32% of all plans, when only 2% of plans were using this design only a year ago.

“While employers chose to hold contributions, copays and in-network benefits steady, they dramatically shifted prescription drug costs to employees. By increasing tiering and adding coinsurance (vs. copays), employers were able to contain costs,” says Weber.

Out-of-Pocket Costs—Median in-network deductibles for singles and families across all plans remain steady at $2,000 and $4,000, respectively. Single out-of-network median deductibles saw a 13% increase in 2016, and a 17.6% increase in 2017, from $3,400 to $4,000. Both singles and families are facing continued increases in median in-network out-of-pocket maximums (up by $560 and $1,000, respectively, to $5,000 and $10,000).

Self-Funding—The number of employers using self-funding grew 48% for employers with 25 to 49 employees in 2017 (5.8% of plans), and 13.4% for employers with 50 to 99 employees (9.3% of plans).

Overall, 12.8% of all plans are self-funded, up from 12.5% in 2016, while almost two-thirds (60.9%) of all large employer (1,000+ employees) plans are self-funded.

“Self-funding has always been an attractive option for large groups, but we see self-funding becoming increasingly desirable to all employers as a way to avoid various cost and compliance aspects of health care reform,” says Weber. “For small employers with healthy populations, self-funding may be particularly attractive since fully insured community-rated plans under the ACA don’t give them any credit for a healthy group.”

The 2017 UBA Health Plan Survey Executive Summary is available now at http://bit.ly/2017UBASurvey. For interviews, contact Carina Sammartino, Media Relations, csammartino (at) hrmarketer.com or 760-331-3547.

About the 2017 UBA Health Plan Survey
The 2017 UBA Health Plan Survey contains the validated responses of 20,099 health plans and 11,221 employers, who cumulatively employ over two and a half million employees and insure more than five million total lives. While other surveys primarily target large employers, the focus of the UBA survey is to report results that are applicable to the small and mid-size companies that represent the overwhelming majority of the nation’s employers, while also including a mix of large companies in rough proportion to their actual prevalence, nationally. This is an important distinction compared to other national surveys.

You can read the original article here.

Source:

Mukhtar G. (26 October 2017). "Employer Premiums Rise Nearly 7% in 2017; Employees Absorb More of the Health Insurance Cost" [Web Blog Post]. Retrieved from address http://blog.ubabenefits.com/news/employer-premiums-rise-nearly-7-in-2017-employees-absorb-more-of-the-health-insurance-cost


HRL - Office - Collaboration - Write - Paper

Better risk management means balancing old, new skills

What changes are happening within the P&C industry? Read this informative article written by  STEVEN R. CULP  and DUNCAN BARNARD of Property Casualty 360 degrees to find out!

You can read the original article here.


The P&C industry is undergoing fundamental change, with significant consequences for the risk function. New approaches to data, the workforce, partners and customers are changing the way insurers operate.

The stakes are high, and with interest rates low, revenue streams are under threat while new competitors are entering from all sides.

At the same time, insurers are encountering new obstacles — from regulatory uncertainty to reduced demand among millennials.  The Internet of Things, autonomous vehicles and other major shifts present major challenges along with large opportunities.

P&C insurers and insurance professionals can use these AI tools right now to run smarter, faster — and ahead of...

To survive — let alone thrive — insurers need to evolve. The scale of the evolution could be challenging, but many of the changes that are needed should add significant long-term value. For example, the availability of real-time data allows P&C insurers to think about new products and propositions to unlock predictive and opportunistic strategies.

 

Insurers are also rethinking their relationships with all stakeholders, becoming a "partner" to customers, brokers and other intermediaries while establishing deeper ties in adjacent industries such as automotive and home security. An openness to new technologies also demands a broader ecosystem of supply partners, including technology companies, insurtech firms, venture capitalists and digital specialists.

As we have done in alternate years since 2009, Accenture conducted extensive research in 2017 among nearly 500 global risk management executives in the financial services industry, including 190 in insurance.

We wanted, in part, to understand how insurers view the challenges facing the risk management function. We found that P&C insurers are facing the world with a bit more confidence than their life insurance counterparts. For example, only 61 percent of P&C respondents saw balancing the responsibilities for control and compliance with the need for effective customer service as a major impediment to effectiveness, versus 84 percent of insurers. And only 65 percent of P&C respondents reported being hampered by shortages of skills in new and emerging technologies, versus 71 percent of life insurers.

However, while there were some differences from sector to sector, we found that both P&C and life insurers are taking a more progressive approach to risk management when compared to our earlier research. They are investing to develop their risk functions in three key areas

Innovation is everywhere in insurance.

Innovation is everywhere in insurance. (Photo: iStock)

Harnessing digital innovation

Advances in big data and analytics are helping insurers better understand risk, build stronger predictive models and tailor customer relationships to suit personal preferences and risk attitudes.  At the same time, robot brokers are on the rise, new platforms are providing micro-pooling “social insurance” models, and sensors allow insured cargo to report every bump, scrape and drop impact it endures in transit. In parallel, some of the most transformative technologies are being implemented deep in the back offices of the world’s leading insurers.

P&C insurers and insurance professionals can use these AI tools right now to run smarter, faster — and ahead of...

The cloud is a great example. Our 2017 Global Risk Management Study finds that cloud technology is virtually ubiquitous—91 percent of insurers are using it — but just 26 percent are highly proficient in using cloud within their organization, 36 percent are not using it to its full potential, and 29 percent are only just introducing it. Respondents want to improve efficiency in response to cost pressures, and cloud is the top choice in this regard, with 77 percent indicating their risk function uses it to reduce costs.

Balancing old and new skills

New tools and processes change how risk teams interact with the business, alliances, regulators, customers and other external stakeholders, requiring new skills and a better balance of attributes across teams. Beyond quantitative skills, the risk management function needs to be able to deliver value by providing economic insights, generating new ideas and building strong relationships throughout the organization in pursuit of the overall strategic objectives.

To support these goals, some insurers are bringing staff into the risk function from other areas of the business to enhance credibility and facilitate relationships. Others are hiring from diverse disciplines, including economics, the law and engineering. There are few professionals who possess every skill the risk function needs. From general quantitative competencies to technology acumen, industry knowledge, niche risk specialties, communication skills, creativity and management experience, candidates with the whole package are extremely rare.

Integrating across the business

Currently, 54 percent of insurance respondents say there is limited coordination between risk management activities at the local level and the group level. While some aspects of centralization are desirable to enable a more aggregated and consistent picture for analysis and evaluation, the reality is that risk exists everywhere in the business and risk professionals need to be engaged throughout the business — not only at an aggregate level.

Central frameworks and tools help to provide a more standardized and coordinated response to regulation, a consistent set of rules for managing the portfolio of risks and the capability to perform complex and high-value calculations to measure risk exposure, liquidity and solvency. But decentralization is also valuable because local or specialized teams can focus on local regulatory requirements and market-specific topics. Any effective risk management function must be able to exist locally and centrally, being close to the business and connected across the organizational structure to manage the overall portfolio, including strategic and emerging risks.

As the study results indicate, the nature of risk is changing. It is up to P&C firms and their risk management functions to create and continually develop a dedicated emerging-risk working group that can identify and evaluate the nature of emerging risks and their potential impacts. That may be the best way to address the constant and disruptive change confronting the industry.

 

You can read the original article here.

Source:

Culp S., Barnard D. (6 October 2017). "Better risk management means balancing old, new skills" [Web Blog Post]. Retrieved from address http://www.propertycasualty360.com/2017/10/06/better-risk-management-means-balancing-old-new-ski?t=commercial-business%3Fref%3Dchannel-feature&page=2


SHRM Connect: Mental Health Issues in the Workplace - What Would You Do?

Are you a SHRM member and/or HR professional? In this article from SHRM by Mary Kaylor, she dives into what SHRM Connect is and how you can get involved!

You can read the original article here.


SHRM Connect is an online community where SHRM members can ask questions and get answers on a variety of HR topics. It’s a great place to network with other HR professionals and share solutions.

The conversation topics range from “HR Department of One” to Employment Law, are always insightful, and deal with some of the most pressing issues that HR professionals face in the workplace today.

While some of the conversations take on a more serious tone, others will deliver a bit of comic relief -- and on Fridays, I’ll be highlighting a conversation or two in hopes that you’ll take some time to visit. You may want to "lurk"… perhaps respond, but you’ll always learn something.

It’s a great community and I highly recommend checking it out.

While May is officially Mental Health Awareness month, HR must deal with employee mental health issues, and their effects on the workplace, all year long. This week’s highlighted conversations involve a few different scenarios. What would you do?

Subject: Self Harming

In the General HR area, a poster asks for advice on how to handle about a perceived case of self harming:

We have a new(er) employee that was observed by another employee to have cuts up and down her arm. The employee brought it to our attention out of concern. We thanked the employee and asked that she keep it confidential. We do not offer an EAP.

My thought is to speak with the employee that is self harming and let her know what was observed and just check in and see if she is ok. If she says everything is good, just leave it at that. If she mentions something is going on...or if she needs to seek treatment etc, go down that road.

For those of you who have experience with this, is this an ok approach? Is it best to not address it with the employee? Any other resources, since an EAP is not an option?

Thanks!

To read/respond to this conversation, please click here.

* * * * *

Subject: Alcohol and Discussion of Suicide

In the General HR area, another poster asks for advice on monitoring an employee:

Know of an employee with an alcohol problem who has gone through treatment and released to return to work by the treating facility. Prior to admittance, she talked about suicide. What follow-ups by the employer would you suggest, other than a monitoring agreement for a period of time?

To read/respond to this conversation, please click here.

* * * * *

Subject: WWYD

In the General HR area, yet another poster is wondering how others would handle a case of an employee with anxiety – and lots of absences:

I was hoping to get opinions on this situation, and I believe I know the correct way to follow up but I was interested to see what others would say.

We hired a non-exempt employee in July of this year. Since that time, this employee had 6 unexcused absences, and two preplanned days off. We accrue and allow employees to use their vacation leave from day one, and this employee essentially used all the time throughout the end of the year. Sick time is not available for employees until they've been employed for 90 days. This employee stated about a month ago after one of their absences that they has very bad anxiety, but does not have insurance they are unable to get medication or see a doctor. This employee never asked for any type of accommodation, and we actually even provided resources to assist with their anxiety. All of the times they called out after that conversation were simply because "i feel bad and can't come in". I received copies of the texts and they're pretty vague. They called out again on Tuesday after having a pre-planned half day off on Friday, and we decided to give the employee a final written warning with a 60 day timeframe to improve their attendance. Unfortunately the employee called out again yesterday with a very vague explanation and stated that 'I still feel pretty bad'.

After speaking with the managers over this department, we decided to terminate employment due to excessive absences. I explained that to the employee in the phone call and gave them an opportunity to explain themselves. I tried to create a dialogue in the event that we were missing something, but I just got 'heh. oh okay.'

Now this morning, I received a page long email stating this employee has rights under HIPAA that they didn't have to disclose the anxiety disorders that they have (we never asked, they disclosed it voluntarily). Also stated that they would have expected a written warning for their excessive absenteeism but not the fact we separated employment. They go on to blame us for other areas of lacking (training, etc) but said we amplified the anxiety problem because of the amount of training we were giving them.

I feel like this employee is looking for anyone to blame. It's an unfortunate situation but as an employer, we cannot read employees minds. If an employee needs an accommodation due to a medical condition, aren't they supposed to request it? How are we supposed to help with vague callouts?

Thoughts?

You can read the original article here.

Source:

Taylor M. (22 September 2017). "SHRM Connect: Mental Health Issues in the Workplace - What Would You Do?" [Web Blog Post]. Retrieved from address https://blog.shrm.org/blog/shrm-connect-mental-health-issues-in-the-workplace-what-would-you-do