Your bad work environment may be raising your healthcare costs

Is your company’s culture leading to raised healthcare costs? More and more research is documenting a relationship between stressful work environments and a range of chronic conditions. Continue reading to learn more.


If you want to reduce the cost of healthcare for your employees — while simultaneously improving care — you may need to take a serious look at your work environment. When reviewing areas that could help reduce costs, a much overlooked aspect is a stressful work environment.

While employers have done a lot to reduce the risk of potential injuries in the workplace, they have done far less to reduce stress, which could also be harmful.

Research finds a link between employee health and job performance. There also is a growing body of research documenting the relationship between a stressful work environment and a range of chronic conditions — including depression, hypertension and sleeping problems. But employers often struggle to connect the dots between these health concerns and supporting a healthy environment for employees.

It’s difficult, if not impossible, to manage something that remains unmeasured. That’s why measuring outcomes beyond healthcare cost fluctuations, such as absence, periods of work disability and job performance, can help employers understand a broader range of outcomes important to the successful operation of their business.

When employers ask how they can affect the health of their employees, I ask what they know about the working conditions in their organization. Is there management trouble, high turnover, high illness-related absence or low job satisfaction? Some of this can be determined from employee satisfaction surveys, or analyses of sick leave data and work disability claims. Often, even more can be discovered by gathering employee feedback.

For example, listening to employees, equipping them with the knowledge to recognize safety issues and providing the tools or procedures to correct these issues, were key to improving workplace safety. A successful safety review can result in real change. Employees observe this change and a cycle is created where prevention becomes the focus because all are accountable and all have trust based on experience that their identification of potential or real safety issues will be dealt with effectively.

If employers are unaware of the factors in their own work environment that could be modified to lessen psychosocial stressors, a good place to start is by listening to employees. Many employers already conduct job satisfaction surveys or health risk appraisals that provide some information around work and health issues. These same tools could be used to identify and address psychosocial issues in the workplace.

Whatever the channel — a suggestion box, a designated HR representative, a focus group, a survey — it must provide employees with the opportunity to authentically and safely share their perspectives. And, finally, it must be demonstrably legitimate, resulting in employer actions that are clear and meaningful to all.

Typically employers use health and wellness programs in an attempt to remediate rather than prevent illness. Our interviews with medical directors of some of the leading U.S. corporations revealed a similar finding. Often, the medical director or chief health officer is charged with improving employee health, while the HR benefits manager is charged with reducing healthcare costs. Not surprisingly, these two goals can be at odds with each other. Imagine the company with a large percent of untreated depression.

So how can employers know what works or even what to try?

Evaluators often start their work by asking why particular activities, services or coverage types were chosen or implemented. This helps identify those areas more proximal to the employment setting (something about the job or in the work environment, for instance) and those areas more distal to the employment setting (such as medication formulary). To put a fine point on the problem, Pfeffer notes that “putting a nap pod into a workplace is not going to substitute for the fact that people aren’t getting enough sleep because they are working 24/7.”

Those looking to get started might begin by watching Working on Empty, an 11-minute documentary, which can provide solid direction for the type of information you’re seeking from your employees. Honor their voice and insight, and use it to implement real change. In doing so, you will build trust and a channel for contribution that improves outcomes for employees and employers.

SOURCE: Jinnett, K. (20 May 2019) "Your bad work environment may be raising your healthcare costs" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/workplace-stress-increasing-healthcare-costs


Status of Court Case Challenging ACA Constitutionality

Twenty states filed a lawsuit back in February of last year that asked the U.S. District Court for the Northern District of Texas to strike down the Patient Protection and Affordable Care Act. Continue reading this blog post for an update on the status of this court case.


As background, in February 2018, twenty states filed a lawsuit asking the U.S. District Court for the Northern District of Texas (Court) to strike down the Patient Protection and Affordable Care Act (ACA) entirely. The lawsuit came after the U.S. Congress passed the Tax Cuts and Jobs Act in December 2017 that reduced the individual mandate penalty to $0, starting in 2019.

On December 14, 2018, the Court issued a declaratory order that the individual mandate is unconstitutional and that the rest of the ACA is unconstitutional. The Court granted a stay of its December 2018 order, which prohibits the order from taking effect while it is being appealed in the Fifth Circuit Court of Appeals (appeals court).

On March 25, 2019, the DOJ submitted a letter to the appeals court clerk stating the Court’s ruling should be affirmed and that the entire ACA should be struck down as unconstitutional. The DOJ intends to file an appellate brief to defend the Court’s ruling.

SOURCE: Olson, B. (16 April 2019) "Status of Court Case Challenging ACA Constitutionality" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/status-of-court-case-challenging-aca-constitutionality


What HR pros should know about clinical guidelines

Clinical guidelines are designed to optimize patient care in areas such as screening and testing, diagnosis and treatment. Read this blog post for what HR professionals should know about these guidelines.


Your employees and their family members frequently face tough questions about their healthcare: How do I know when it’s time to get a mammogram? When does my child need a vision screening? Should I get a thyroid screening? If I have high blood pressure or diabetes, what is the best treatment for me?

For the providers who care for them, the key question is: How do we implement appropriate, science-backed treatments for our patients, testing where needed, but avoiding potentially harmful or unnecessary (and expensive) care? The answer is to seek guidance from and use clinical guidelines —along with existing clinical skills — wisely.

Clinical guidelines are sets of science-based recommendations, designed to optimize care for patients in areas such as screening and testing, diagnosis and treatment. They are developed after a critical review by experts of current scientific data and additional evidence to help inform clinical decisions across a spectrum of specialties.

Based upon this process, guidelines are then released by a number of sources and collaborations, including academic and non-profit healthcare entities, government organizations and medical specialty organizations.

From preventive care to treatment protocols for chronic conditions, guidelines provide a framework healthcare providers use with patients to help guide care. However, it’s important to note that clinical guidelines are not rigid substitutes for professional judgment, and not all patient care can be encompassed within guidelines.

The impact on healthcare and benefits

Clinical guidelines are used in myriad ways across the healthcare spectrum, and providers are not the only ones who utilize them. Insurers also may use guidelines to develop coverage policies for specific procedures, services and treatment, which can affect the care your covered population receives.

To illustrate a key example of an intended impact of guidelines on health plan coverage, consider those issued by the U.S. Preventive Services Task Force, whose A and B level recommendations comprise the preventive services now covered at no cost under the mandate of the Affordable Care Act.

As another example, the National Committee for Quality Assurance, which accredits health plans and improves the quality of care through its evidence-based measures, uses the American Heart Association guidelines when creating its quality rules for treating high cholesterol with statin drugs.

Other examples exist among commercial coverage policies. For example, some cancer drug reimbursement policies use components from nationally recognized guidelines for cancer care.

Because science is rapidly changing, guidelines are often updated, leading insurers to revisit their policies to decide if they will change how services and medications are covered for their members. Providers and health systems may modify processes of patient care in response to major changes in guidelines and/or resultant changes in payer reimbursement.

Not all guidelines are updated on a set schedule, making it even more important for providers and organizations that rely on guidelines to stay on top of changing information, as it can have a direct impact on how they work. Attending conferences, visiting the recently established ECRI Guidelines Trust, and regularly reviewing relevant professional association websites and journals can help ensure needed guidelines are current. Lack of current information can affect care decisions and potential outcomes for patients. Those who have access to the most up-to-date, evidence-based information are able to work together to make well-informed healthcare decisions.

Why it matters for employers

As employers or benefits consultants, it’s critical to ensure that your health plan, advocacy or decision support providers, and other partners that depend on this information to guide their practices and decisions understand and follow current, relevant guidelines.

Further, by combining information from relevant guidelines and data from biometric screenings, health risk assessments, claims and other sources, it’s possible for clinical advocacy and other decision support providers to identify employees with gaps in care and generate targeted communications (through a member website and/or mobile app) to help them take action to improve their health.

Clinical guidelines are science distilled into practical recommendations meant to be applied to most patients for quality healthcare. By maintaining current, relevant guidelines, organizations and providers who work with your covered population can ensure that all parties have the key information they need to make the best decisions for their health.

SOURCE: Sivalingam, J. (18 March 2019) "What HR pros should know about clinical guidelines" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/what-hr-managers-should-know-about-clinical-guidelines?feed=00000152-a2fb-d118-ab57-b3ff6e310000


To check or not to check: Managing blood sugar in diabetic employees

Over the last 20 years, there has been a growing prevalence of Type 2 diabetes in the United States. An estimated that 75% of patients with Type 2 diabetes regularly test their blood sugar. Read on to learn more.


Over the last 20 years, there’s been a growing prevalence in the U.S. of Type 2 diabetes, a chronic condition that significantly impacts employers, their employees and family members clinically, financially and through quality of life. With that comes an increase in the use of insulin for people with Type 2 diabetes to better control blood sugar to reduce long-term complications, which includes eye, kidney and cardiac disease, as well as neuropathic complications.

Most of these patients manage their condition with oral medicines versus insulin, and it’s estimated that 75% of patients with Type 2 diabetes regularly test their blood sugar, even though doing so may not be needed. Blood sugar testing is an important tool in managing diabetes as it can help a patient be more aware of their disease and potentially control it better. But it also can be painful, inconvenient and costly.

Blood sugar testing can be an important tool in managing diabetes, and there are two types of tests. The first is a test conducted at home by the patient that shows the blood sugar at a specific point in time. The second type is called HA1c (a measure of long-term blood sugar control) that shows the average blood sugar over the last two to three months. The value of at-home testing is now thought to be questionable.

In 2012, the Patient-Centered Outcomes Research Institute began a study to evaluate the value of daily blood sugar testing for people with Type 2 diabetes not taking insulin. The endpoint for the study was whether there was a difference in HA1c levels for those who did daily testing and those that did not. The conclusion of the study found that there were no significant differences between those two populations.

In response to these findings, the institute developed an initiative called Rethink the Strip that involves stakeholders including primary care practices, healthcare providers, patients, health plans, coalitions and employers. Given the cost for test strips and monitors for patients with Type 2 diabetes who test their blood sugar daily, it’s important to adopt an evidence-based patient-centered approach around the need for and frequency of self-monitoring of blood glucose.

As employees and employers cope with the costs associated with blood sugar testing, there are several strategies that should be considered to better manage this issue. They include:

1. Support shared decision-making. Like all interventions within healthcare, it’s important to weigh both the benefits and the risks of daily blood sugar testing in a thoughtful manner between the patient and their provider.

2. Managed benefit design. Employers should pay for daily blood sugar test strips in cases where it brings value (e.g., Type 1 and Type 2 patients who are taking insulin as well as patients that are either newly diagnosed or are going through a transition period, for example, post hospitalization or beginning a new medication regimen).

3. Involve vendors. To ensure alignment in all messaging to plan members, ask health systems and/or health plans and third-party vendors to align their communication, measurement and provider feedback strategies on when it’s appropriate for daily blood sugar testing.

These strategies can help employees with diabetes understand how their daily activities (nutrition, exercise and stress) and medications impact their condition. This benefits the employee in reaching treatment goals and feeling their best, while also helping employers and employees reduce the need for unnecessary and costly test strips.

SOURCE: Berger, J. (14 March 2019) "To check or not to check: Managing blood sugar in diabetic employees" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/managing-blood-sugar-in-diabetic-employees?brief=00000152-146e-d1cc-a5fa-7cff8fee0000


Digital health revolution: What we’ve learned so far

The effectiveness of digital health devices is being called into question by recent studies. Digital health devices provide personalized feedback to users, helping improve their health. Read this blog post to learn more.


The promise of the digital health revolution is tantalizing: a multitude of connected devices providing personalized feedback to help people improve their health. Yet, some recent studies have called into question the effectiveness of these resources.

While still evolving, many compelling use-cases are starting to emerge for digital health, including a set of best practices that can help guide the maturation of this emerging field. In the near future, many people may gain access to individual health records, a modern medical record that curates information from multiple sources, including electronic health records, pharmacies and medical claims, to help support physicians in care delivery through data sharing and evidence-based guidelines.

As these advances become a reality, here are several digital health strategies employers, employees and healthcare innovators should consider.

Micro-behavior change.

Part of the power of digital health is the ability to provide people with actionable information about their health status and behavior patterns. As part of that, some of the most successful digital health programs are demonstrating an ability to encourage daily “micro-behavior change” that, over time, may contribute to improved health outcomes and lower costs. For instance, wearable device walking programs can remind people to move consistently throughout the day, while offering objective metrics showcasing actual activity patterns and, ideally, reinforcing positive habits to support sustained change. Technology that encourages seemingly small healthy habits — each day — can eventually translate to meaningful improvements.

Clinical interventions.

Big data is a buzz word often associated with digital health, but the use of analytics and technology is only meaningful as part of a holistic approach to care. Through programs that incorporate clinical intervention and support by care providers, the true value of digital health can be unlocked to help make meaningful differences in people’s well-being. For instance, new programs are featuring connected asthma inhalers that use wirelessly enabled sensors to track adherence rates, including frequency and dosage, and relay that information to healthcare professionals. Armed with this tangible data, care providers can counsel patients more effectively on following recommended treatments. Rather than simply giving consumers the latest technologies and sending them along, these innovations can be most effective when integrated with a holistic care plan.

Real-time information.

One key advantage of digital resources, such as apps or websites, is the ability to provide real-time information, both to consumers and healthcare professionals. This can help improve how physicians treat people, enabling for more customized recommendations based on personal health histories and a patient’s specific health plan. For instance, new apps are enabling physicians to know which medications are covered by a person’s health plan and recommend lower-cost alternatives (if available) before the patient actually leaves the office. The ability to access real-time information — and act on it — can be crucial in the effort to use technology to empower healthcare providers and patients.

Financial incentives.

Nearly everyone wants to be healthy, but sometimes people need a nudge to take that first step toward wellness. To help drive that engagement, the use of financial incentives is becoming more widespread by employers and health plans, with targeted and structured rewards proving most effective. From using mobile apps and comparison shopping for healthcare services to encouraging expectant women to use a website to follow recommended prenatal and post-partum appointments, financial incentives can range from nominal amounts (such as gift cards) to hundreds of dollars per year. Coupling digital health resources with financial rewards can be an important step in getting — and keeping — people engaged.

The digital health market will continue to grow, with some studies estimating that the industry will exceed $379 billion by 2024. To make the most of these resources, healthcare innovators will be well served to take note of these initial concepts.

SOURCE: Madsen, R. (14 March 2019) "Digital health revolution: What we’ve learned so far" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/digital-health-revolution-what-weve-learned-so-far?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001


Dispelling the stigma around mental health disorders in the workplace

The Anxiety and Depression Association of America stated that nearly six in 10 U.S. workers reported that anxiety impacts their performance in the workplace. Read this blog post to learn more about the stigma associated with mental health disorders in the workplace.


It’s no secret that poor mental health impacts employee performance. Anxiety disorders, for example, affect 40 million adults in the U.S. each year, and nearly six in 10 American workers report that anxiety impacts their workplace performance, according to the Anxiety and Depression Association of America.

But because of the stigma often associated with mental health disorders, employees might not be using the benefits and programs clients have in place to help address the problem. That’s why just having programs in place isn’t enough, experts say. Instead, employers need to help remove the stigma of mental health conditions by creating a culture of inclusiveness in the workplace and forming employee resource groups.

Employers including Johnson & Johnson, Trulia and Verizon Media are doing just that, company executives said during a webinar last week hosted by the National Alliance of Healthcare Purchaser Coalitions.

When Margaux Joffe, associate director of accessibility and inclusion at Verizon Media, started working on a proposal to form a mental health-focused employee resource group (ERG), dispelling stigma and empowering workers was one of her first priorities.

“We wanted to create a paradigm shift,” she said, speaking as part of the webinar. “Growing up, you’re taught to think you’re ‘normal or not normal;’ you’re mentally ill or you’re not. We started with the idea there is no such thing as a ‘normal brain’ as we’re increasingly understanding neurodiversity in the human race.”

A lot of people with mental health issues don’t necessarily identify with the word disability, added Meredith Arthur, content marketing manager at Trulia.

“We struggled around removing the word disability because there was a desire to face the stigma and take it on,” she said of Trulia’s ERG. “Ultimately, we wanted to reach as many people as we could. We wanted to be sharper in our focus on mental health.”

Trulia expanded its ERG statement of purpose from just focusing on mental health education and awareness to advocating for the needs of different abilities.

Joffe said putting in place an ERG for mental health at Verizon was done with the support of senior leadership. “We’ve been lucky to get a lot of support from the company for ERG,” she said. “A common challenge that exists across the board is lack of organization readiness.”

Readiness is a huge component of success in mental health programs, added Kelly Greenwood, founder and CEO of Mind Share, a nonprofit organization addressing the culture of workplace mental health.

“It is so important to achieve true culture change,” she said. “Oftentimes we work with leadership first and do workshops for executive teams before rolling them out to the company to really get that buy-in and understanding from the top down to build a transparent culture.”

At Johnson & Johnson, it took the company about nine months to get its ERG program up and running. “There was a lot of conversation internally if it should be its own ERG for mental health or integrated into another employee resource group,” said Geralyn Giorgio, talent acquisition change management communications and training lead at the pharmaceutical and consumer packaged goods manufacturing company.

At that time, she said, the company had an ERG called the alliance for disability leadership. The decision was made to put mental health under that ERG umbrella. “Since than happened, there were a lot of [employees] not seeing themselves in this ERG. We felt strongly we had to rebrand the ERG, and we went live last year, using the name alliance for diverse abilities to make it more inclusive,” she said.

This year, Giorgio said, the company will work to empower managers to handle mental health conversations.

“If you have a manager open to the conversation, [employees] have a different experience than someone whose manager is ill-informed,” she said. “That’s something we need to focus on this year — helping our managers feel more comfortable with having the conversation.”

SOURCE: Otto, N. (12 March 2019) "Dispelling the stigma around mental health disorders in the workplace" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/dispelling-workplace-mental-health-stigma?brief=00000152-146e-d1cc-a5fa-7cff8fee0000


IRS Releases Information Letter on Returning HSA Contributions to an Employer

An informational letter was recently released by the Internal Revenue Service (IRS) clarifying that IRS Notice 2008-59 was not intended to provide an exclusive set of circumstances in which employers could recoup contributions made to employee HSAs. Continue reading this blog post from UBA to learn more.


Generally, a person’s interest in a Health Savings Account (HSA) is nonforfeitable. However, in the past, the Internal Revenue Service’s Notice 2008-59 described limited circumstances under which an employer may recoup contributions made to an employee’s HSA.

The Internal Revenue Service (IRS) recently released Information Letter 2019-0033 (Letter), clarifying that IRS Notice 2008-59 was not intended to provide an exclusive set of circumstances in which an employer can recoup contributions made to an HSA. If there is clear evidence of an administrative or process error, an employer may request that the contributions it made to an employee’s HSA be returned. This correction should put the employer and employee in the same position that they would have been in if the error had not occurred.

The Letter lists the following examples of when an employer may recoup HSA contributions:

  • An amount withheld and deposited in an employee’s HSA for a pay period is greater than the amount shown on the employee’s HSA salary reduction election.
  • An employee receives an employer contribution that the employer did not intend to contribute but the amount was transmitted because an incorrect spreadsheet is accessed or because employees with similar names are confused with each other.
  • An employee receives an incorrect HSA contribution because it is incorrectly entered by a payroll administrator (whether in-house or third-party) causing the incorrect amount to be withheld and contributed.
  • An employee receives a second HSA contribution because duplicate payroll files are transmitted.
  • An employee receives as an incorrect HSA contribution because a change in employee payroll elections is not processed timely so that amounts withheld and contributed are greater than (or less than) the employee elected.
  • An employee receives an incorrect HSA contribution because an HSA contribution amount is calculated incorrectly, such as a case in which an employee elects a total amount for the year that is allocated by the system over an incorrect number of pay periods.
  • An employee receives an incorrect HSA contribution because the decimal position is set incorrectly resulting in a contribution greater than intended.

SOURCE: Hsu, K. (14 March 2019) "IRS Releases Information Letter on Returning HSA Contributions to an Employer" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/irs-releases-information-letter-on-returning-hsa-contributions-to-an-employer


Workout - Girl - Stretching - Pixabay

How employers can take advantage of the best-kept wellness secret

Did you know: Some insurance carries pay wellness dollars to companies who implement wellness programs. Continue reading this blog post to learn how companies can take advantage of insurance companies’ best-kept secret.


Did you know some insurance carriers pay companies to implement wellness programs? It’s called wellness dollars, and it is insurance companies’ best-kept secret.

Wellness dollars are a percentage of a company’s premiums that can be used to cover wellness-related purchases. The healthier employees are, the fewer dollars insurance carriers need to pay out for a policy. Many insurers have incentives like wellness dollars for employers to improve the well-being of their workers.

The benefits of adding a wellness program are plenty. These programs typically generate a positive return on investment for companies. Research done by three Harvard professors found that overall medical costs decline $3.27 for every dollar spent on wellness programs. Costs from absenteeism fall about $2.73 for each dollar. Well-designed programs can improve employees’ overall wellbeing and life satisfaction, according to a report from the U.S. Chamber of Commerce.

It’s a new year, and group health insurance plans are starting fresh. Here’s how employers can take advantage of wellness dollars.

Get in touch with your carrier. The first step is to get in touch with your insurance carrier to find out if your self-insured or fully-insured plan covers participatory or health-contingent programs. If you don’t have wellness dollars, it’s still early in the year, and it’s worth negotiating to see if you can include them in your company’s current package.

You will work with your insurance carrier to determine how your wellness dollars can be spent, based on an agreed-upon contract. The amount of wellness dollars that you receive depends on the number of employees and profitability.

Every company is different, so the range of services varies and could include wellness programs, gym memberships, nutrition programs, massages and more. Sometimes incentives for wellness activities can be used; sometimes it can’t. Ask your carrier for a complete list of covered expenses. This will help you as you shop around to find the right offerings. Save receipts and records for reimbursements.

Determine the best use. There are a few ways to determine what offerings you should use for your company. Before making any decisions, ask your employees and the leadership team what type of program they would be most likely to engage in. Gallup named the five elements that affect business outcomes: purpose, social, community, physical and financial. Look for a comprehensive program that includes these five elements, instead of coordinating with multiple vendors. If only a portion of your expenses will be reimbursed, it’s still worth getting a wellness program. They have cost-savings on an individual and team level.

Wellness programs are all about building culture, and with unemployment at a record low, it’s a sticking point to keep employees invested in your company. A few examples of wellness offerings include fitness classes, preventive screenings, on-site yoga, financial wellness workshops, healthy living educational workshops, and health tracking apps.

Once you’ve implemented wellness offerings in your workplace, keep track of your company’s progress. Create a wellness task force, a healthy workplace social group, or conduct monthly survey check-ins to make sure employees are staying engaged. Some wellness programs utilize technology to track participation, integrate with wearables, and report other analytics. Ask your insurance carrier if wellness dollars have flexibility in adding or changing the services throughout the year, based on engagement.

SOURCE: Cohn, J. (14 February 2019) "How employers can take advantage of the best-kept wellness secret" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/how-employers-can-take-advantage-of-the-best-kept-wellness-secret


Employee wellness programs and compliance: What to know right now

Do you know whether your wellness plan is “purely participatory” or “health-contingent?” Under the Health Insurance Portability & Accountability Act (HIPAA) current guidance, employers need to assess whether the plan is “purely participatory” or “health-contingent.” Read on for more.


Defining “wellness” for any one person is no simple task, and neither is deciphering a given wellness program’s compliance under the law.

In 2016, when the Equal Employment Opportunity Commission (EEOC) released its final regulations defining a “voluntary” program under the Americans with Disabilities Act (ADA), the entire landscape — at least what can be seen on a hazy day — appeared defined. But thanks to AARP’s successful challenge to these regulations and the EEOC’s recent acknowledgment of the demise of its incentive limitations, employers find themselves back in the “Wild West” of sorts for wellness compliance.

That being said, the uncertainty is not new for employers with wellness programs, and there is now more guidance than before, so let’s take a moment to take in the current view.

The current guidance under the Health Insurance Portability & Accountability Act (HIPAA) remains unchanged, so any wellness program integrated with a health plan or otherwise constituting a health plan itself, employers need to assess whether the plan is “purely participatory” or “health-contingent.” The health-contingent plans (which condition the award of incentives on accomplishing a health goal) will require additional compliance considerations, including—but not limited to—incentive limitations, reasonable alternative standards (RAS), and notice requirements.

The RAS should be of particular importance because they can be missed most out of the compliance parameters. Often there is an “accidental” program such as a tobacco surcharge, and the employer does not even realize the wellness rules are implicated, or the employer’s RAS is another health-contingent parameter that actually necessitates another RAS.

The Department of Labor is actively enforcing compliance in this area, so employers will want to take care.

Additionally, the EEOC’s ADA (and Genetic Information Nondiscrimination Act) regulations are still largely in force. This seems to be a common misconception—ranging from a celebration of no rules to a lament for the end of incentivized wellness programs that include disability-related questionnaires (like an average health risk assessment) or medical examinations (including biometric screenings).

The truth is somewhere in the middle.

The ADA’s own RAS and notice concepts still apply, along with confidentiality requirements. All that has changed is that the EEOC has declined (again) to tell us at what point an incentive turns a program compulsory. So employers sponsoring wellness programs subject to the ADA have three choices, based on risk tolerance (In truth, there are four options, but charging above the ADA’s previous incentive limitations would be excessively risky):

  • Run incentives for ADA plans up to the 30 percent cap that existed before. This is the riskiest approach. To take this route, an employer must rely upon HIPAA’s similar (though not exactly the same) incentive limitations as indicative of non-compulsory levels. The fact that Judge Bates did not accept this argument in the AARP case advises against this approach, but this case does not have global application. If this path is chosen, it will be imperative to document analysis as to why this incentive preserves voluntariness for your participants.
  • Keep the incentives below the previous 30 percent cap but incentivize the program. This approach does have risk because no one knows at what point an incentive takes choice away from participants. However, the incentive is a useful tool to motivate and reward health-conscientious behavior. The wellness incentive limitations stood at 20 percent under the HIPAA regulations for quite some time without much concern, so this could be a relatively safe target. But the most important thing is to carefully assess the overall structure of the program(s) offered, consider the culture and demographics of the employees who may participate, and balance the desire to motivate against the particular tensions of the program to decide on a reasonable incentive. Make sure to document this analysis and reconsider it every time a program changes.
  • Not incentivize the program at all. This is the most conservative approach from a compliance perspective but ultimately not required. Before the EEOC’s 2016 regulations, employers were incentivizing programs subject to the ADA, and nothing about the AARP case or the EEOC’s response to it prohibits incentives.

There’s no doubt the wellness compliance landscape has changed a little over this last year, but this is also just the tip of the iceberg. With enforcement heating up, it is imperative for employers to carefully consider compliance, document the reasonableness of incentive choices and lean on trusted counsel when necessary to avoid potentially costly and time-consuming issues.

SOURCE: Davenport, B. (13 February 2019) "Employee wellness programs and compliance: What to know right now" (Web Blog Post). Retrieved from https://www.benefitspro.com/2019/02/13/employee-wellness-programs-and-compliance-what-to-know-right-now/


Hospital pricing transparency: More information, more confusion?

A new ruling on hospital pricing transparency now requires that hospitals provide a list of their prices for all of the services and medications they provide. Continue reading this blog post to learn more about this ruling.


As of the first of this year, a new rule is in effect that requires hospitals to list the price for all the services they provide and medications they prescribe for patients while they’re in the hospital. In theory, this should give patients more information that can help them decide where it makes the most economic sense to receive hospital care. In actuality, while there’s a wealth of new data available, it can be difficult to find — and nearly impossible for people outside the healthcare industry to understand.

The document that aggregates the price information is called a chargemaster, and it can contain tens of thousands of entries. The new rule doesn’t require that the information be written in plain language, only that it be machine readable, so much of the data reads like it’s in a yet-to-be-discovered language. For example, if you download Memorial Sloan Kettering’s chargemaster, you’ll find an Excel spreadsheet that contains 13,088 entries such as “CAP MALE/FEMALE RAIL, $765” and “BX SUBCUT SKIN/INC, $1,771.” Even if a patient puzzles out the meaning of these abbreviations, the prices listed are different from the lower fees that insurers negotiate, so estimating how much you would pay for care is complicated at best and impossible at worst.

The goal of the hospital pricing transparency rule is to help patients understand the cost of their care and choose more wisely when deciding where to receive that care. Unfortunately, the information that is now available adds to the confusion and doesn’t help patients make one-to-one price comparisons when choosing where to receive care. In addition, the rule only covers care delivered by a hospital, so patients don’t have the information they need to make price comparisons for services performed in doctor’s offices, urgent care facilities, diagnostic test sites and outpatient surgical centers.

Though the new rule generally doesn’t help employees, employers can.

Even if price transparency doesn’t help workers better understand the cost of care and choose where to receive that care, there are strategies and resources that employers can provide to help their employees make more informed decisions about healthcare. Here are some of them.

Second opinions. Wrong diagnoses, inappropriate treatments (treatments that don’t meet the evidenced-based standard of care) and medical errors all drive up healthcare costs for both employers and employees and can lead to poorer health outcomes. One strategy to lower the risk of these types of problems is providing employees with streamlined access to second opinions from experienced physicians.

A second opinion can confirm or change an employee’s diagnosis, suggest other treatment options and pinpoint misdiagnoses, especially in the case of serious and complex conditions like cancer, autoimmune disease and back and joint problems. In fact, a Mayo Clinic study found that 88% of people who sought a second opinion from the hospital’s physicians for a complex medical condition received a new or refined diagnosis. Employers can make second opinions available to employees through several channels, including a health insurance plan or as a standalone benefit.

Care coordination. Duplicate testing and medical care is another source of wasted healthcare dollars. When communication between healthcare providers is inconsistent or medical records aren’t updated and shared among all treating physicians, employees may undergo repeat testing — for example, when a primary care physician and a cardiologist both order a cardiac stress test for a patient with shortness of breath. Employers can offer care coordination through a case manager for employees who are living with multiple health conditions.

This support can lower the risk of duplicative testing as well as duplicate prescriptions or medications that can result in interactions, which can put an employee’s health needlessly at risk. Another piece of this equation is the review and coordination of medical records, which is especially important when employees see multiple physicians. A medical records management service should include a review of the employee’s records by an RN or physician, consolidation of a comprehensive medical record, and the creation of a secure electronic medical record that can be shared with the employee’s permission with all treating physicians.

Guidance on where to receive care. While you can undergo a colonoscopy, medication infusion or a range of common surgical procedures at a hospital, that may not always be the most appropriate or cost-effective place to receive care. By offering employees the ability to talk with a care manager or adviser about the procedure they need and the options for where they can receive that care (a hospital, outpatient surgery center or doctor’s office), employers can help them receive the care they need and lower both claims costs and employee out-of-pocket costs.

Medical bill review. Another resource employers can offer to make sure healthcare costs are carefully managed is a medical bill review. Experts estimate that between 30% and 80% of medical bills contain errors that increase costs. There are many different causes of these errors, including the use of the incorrect billing codes and use of out-of-network healthcare providers. In addition to offering employees the services of a medical billing review and negotiation firm, they can provide education that lets employees know what types of errors are commonly made and how to spot them on their own bills.

SOURCE: Varn, M. (13 February 2019) "Hospital pricing transparency: More information, more confusion?" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/hospital-pricing-transparency-more-information-more-confusion?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001