1st Quarter 2017
As episodes of workplace-centered violence have increased in the United States, a focus on emotional and mental health matters is more essential than ever. This article addresses workplace violence, risk factors and the components of a violence prevention plan, as well as the importance of building a psychologically healthy workplace.
More and more employers recognize the business impact of behavioral health concerns in the workplace. This article provides insights into current innovations in behavioral health benefits. Areas of innovation include conceptual and delivery models, technological advancements, tools for engaging employees and ways of quantifying the business value of behavioral health benefits.
The barriers to achieving the mental health system we need are not just a chasm of a poorly organized system of care but a mountain range of issues that stop us from bringing mental health and well-being into the 21st century on a par with the rest of health care. This article reviews the progress that has been made, describes the continuing concerns and outlines a path forward toward holistic mental health and well-being in the workplace.
Although the Mental Health Parity and Addiction Equity Act (MHPAEA) and associated regulations have been around for a while, behavioral health advocacy groups have expressed significant concern about a lack of enforcement to ensure compliance among health plans and employers. This article presents recent developments in mental health parity, including a summary of the parity law requirements, new warning signs for nonquantitative treatment limitations and more.
Investing time and effort to uncover and mitigate today’s stressors for employees can help employers avoid tomorrow’s more damaging and expensive consequences. A comprehensive assessment of workplace stress can generate a substantial return on this investment, measured in enhanced individual well-being, reduced health care and disability costs and improved company performance.
The prevalence and destruction of opioid addiction have touched individuals and families across all social groups and geographies. Employers can contribute toward curbing the opioid addiction epidemic in a number of ways and should play an instrumental role in facilitating increased awareness of and access to needed programming. This article will explore the size and prevalence of the opioid epidemic, reflect on its implications for employers—including public policy initiatives—and suggest specific strategies for employer interventions.
Most Employee Assistance Program (EAP) utilization initiatives fail to address the impact of stigma, misunderstandings about mental illness and the reluctance of many employees to seek counseling as an option for better management of stress, work-life balance and overall mental wellness.
This article describes how methods of personalized medicine—specifically, pharmacogenetic (PGx) testing—can benefit private health plans, benefits managers, care providers and consumers alike. The authors cover pharmacogenomics as a science and also introduce an innovative way to optimize drug treatments. The article touches on some clinical outcomes drawn from a recent study in community pharmacy and reviews the application and return on investment of PGx testing in disability and medication management.
It is simply good business to protect the mental health and productivity of employees. This article describes existing challenges surrounding employees with mental disorders: the link between mental disorders, disability and an employee’s ability to return to work; best practices for employers, employees and health care providers; and the role of the insurance company.
The pressure on employers to justify providing health benefits or to prove the value of health investment has never been greater. This article provides a framework for employers to better understand the full impact of workforce health and well-being on bottom-line costs and the opportunities for connecting workforce health and well- being to top-line business performance metrics.
2nd Quarter 2017
Although determining the driving forces behind double-digit price inflation trends for pharmaceutical costs has proven increasingly difficult, one thing is clear: Drug trend rates are unsustainable for plan sponsors and will continue to be a top challenge in the coming years. This article discusses emerging strategies for dealing with prescription drug cost trends, best-in-class contracting, changing and affecting drug mix, the changing reimbursement model and what’s next in mitigating evolving pharmaceutical costs.
Specialty biotech drugs represent 1-2% of prescriptions yet 35% or more of overall pharmacy costs—and are projected to reach 50% of costs over the next three years. In the United States, the cost of these drugs is multiples more than in other countries, and their use presents global competitiveness and philosophical challenges for plan sponsors. This article examines specialty drug trends, discusses balancing access to them versus their impact and reviews the current state of specialty drug management. It provides plan sponsors with key considerations for the future. While specialty biotech management will remain an area of focus affecting benefits budgets for years to come, options are available to help manage their impact and improve outcomes.
Pharmacy and medical benefit integration’s most meaningful value lies in obtaining a comprehensive understanding of someone’s health journey. An effective way to control health care costs for all stakeholders and improve overall wellness is to understand and manage health conditions in their entirety, not just the prescriptions. This article highlights (1) how pharmacy and medical benefit integration provides a more holistic view of health, (2) how individuals inquiring about their pharmacy benefits can be successfully engaged to participate in health coaching and other programs available through their medical benefits, (3) how integrated data provides real-world insights for evaluating the value that drugs and health management programs deliver and (4) what plan sponsors might attain in cost savings through the use of integrated benefits.
The cost and complexity of specialty medications are keeping employers and plan administrators up at night. A 2016 survey found that large group employers (100+ full-time employees) struggle with specialty drug trend and cost management, using a variety of unconnected tools and techniques. This article outlines employer challenges and suggests a medical/pharmacy integration paradigm as a successful model for controlling costs and improving health outcomes.
The Affordable Care Act has magnified the problem of short-sighted human resource (HR) software purchases that reflect a siloed mindset about HR technology investment. This article outlines the problem with the siloed approach and the many advantages offered by an HR technology revolution. The author reviews best practices to consider, whether from the perspective of a consultant or that of an HR professional building a case internally for integration. When investment in HR technology is based on how the technology can help employees make better decisions because of greater access to accurate data, the ripple effects of improved decision making translate into real savings.
Roth is on the rise among defined contribution (DC) plans. Nearly three out of five DC plans surveyed now offer Roth contributions, and nearly one out of five offers in-plan Roth conversions. Roth contributions can offer tax advantages and permit tax-impact diversification to participants but also can add administrative complexities for the plan sponsor. There may also be confusion about Roth contributions relative to traditional after-tax contributions and Roth individual retirement accounts (IRAs). This article provides an overview of Roth contribution and in-plan conversion rules and contrasts Roth contributions with traditional after-tax contributions and Roth IRAs.
Plan liquidity provisions will impact retirement security—negatively for some (evil) but favorably for others (essential). Since the Great Recession, there have been dozens of articles in the benefits trade press about the (in)advisability of qualified plan loans. As debate continues, some service providers have pursued initiatives that encouraged plan sponsors to eliminate or restrict loans. Such restrictions may improve retirement security for some but would certainly reduce it for others. This article reviews the continuing debate over plan loans and offers recommendations.
3rd Quarter 2017
Far too many Americans are not saving enough—or at all—for retirement; workers routinely raid their retirement savings in times of financial emergency because they lack sufficient personal savings. Few of those with substantial savings have acted to address longevity risk and secure adequate retirement income that they cannot outlive. Home equity is typically underutilized as a resource in retirement. Americans often face these challenges with insufficient financial capability, and Social Security—the foundation of the national retirement system—is significantly underfinanced and leaves some with inadequate benefits. These problems may seem overwhelming, but they are solvable. Last year, a Bipartisan Policy Center commission proposed a comprehensive plan to address these challenges.
This article will focus on key issues surrounding economic security for older Americans. It will identify a number of issues where there are gaps and concerns, including coverage, level of savings for retirement, retirement ages, support for working in retirement, disability and retirement savings, lack of long-term care coverage, health benefits and the role of housing in supporting retirement. It will provide ideas for public policy directions and will consider the roles of Social Security and public programs, employee benefits and individual efforts.
The Forward Thinking Task Force of the American Academy of Actuaries developed the Retirement for the AGES framework to provide a straightforward and unbiased way to assess and compare different retirement security proposals. This article discusses factors impacting retirement security in the future, explains the Retirement for the AGES framework, and shows how AGES assessments have been applied to the traditional defined benefit system, safe harbor defined contribution plans, the South Dakota Retirement System, the New Brunswick Shared Risk Model, and the USA Retirement Funds proposal.
As our nation continues its transition away from defined benefit (DB) plans to a predominantly defined contribution (DC) retirement system, guaranteed lifetime income must be recognized as the crucial unfinished chapter in the 401(k) narrative. This article discusses policy makers’ growing sentiment for retirement income, why DC plans need a retirement income makeover and the reasons lifetime income provisions in the Lifetime Income Disclosure Act of 2017 (LIDA) and the Retirement Enhancement and Savings Act of 2016 (RESA) deserve public policy consideration.
The best-interest contract exemption (BICE)—formally known as Prohibited Transaction Exemption (PTE) 2016-01—is part of a large regulatory package with quickly approaching deadlines for compliance. Issued by the U.S. Department of Labor (DOL), BICE is designed to (among other things) protect retirement investors from costly or conflicted investment advice. Under the rule, service providers that give investment advice to participants and plan sponsors now will have to follow the fiduciary standard of conduct under the Employee Retirement Income Security Act (ERISA).
Health insurance for a high-paid employee costs an employer the same amount as health insurance for a lowpaid employee. At the same time, health care costs and, therefore, health insurance premiums are growing much more rapidly than earnings. Therefore, it is reasonable to expect that—while earnings will indeed become more unequal over time—total compensation will not become more unequal or, when considered over the entire labor force, at least will not become as unequal. Direct empirical evidence supports this hypothesis, based on unique, unpublished survey data about employer compensation costs collected by the Bureau of Labor Statistics. The supporting results hold both for the period 1996–2008 and for the period 1992–2010. A regression estimated over the period 1990–2014 also bolsters the understanding that the rising cost of health care is a major cause of increasing earnings inequality. This finding suggests that the best policy to reduce inequality would be to effectively control the rate of growth in the cost of health care.
Thanks to funding from the Center for Medicare and Medicaid Innovation (CMMI), the state of Colorado soon will implement and test its proposed model for health care innovation, entitled “The Colorado Framework.” This article discusses how and why the model, integrating primary care and behavioral health as its cornerstone, creates a system of clinic-based and public health supports to spur innovation and health care cost savings. It also describes the current health care delivery challenges in Colorado and how payment model reforms—including capitation, risk adjustment and gain sharing—are necessary to achieve sustainability.
4th Quarter 2017
If we help our employees to be healthier, all sorts of good things can happen. Employers can see better productivity, reduced absenteeism, lower health care costs and even a more energized culture. At the same time, employees may suffer fewer health issues, better manage their health conditions and have greater quality of life. This article describes the effectiveness of smartphone apps to motivate behavior change across multiple dimensions of employee well-being. The authors provide case studies and explain what employers should consider when designing initiatives that use apps to improve employee well-being through employee benefit plans.
The Adventist HealthCare (ACH) mission led the organization to pioneer population health management, proving that sustaining a culture of well-being over the long term means healthier employees and costs that are consistently below the national average. This article describes how ACH’s integrated approach to building a culture of health involves many components, as well as support by top leadership. Key findings have emerged through ACH’s sustained and successful efforts to add new features and integrate components.
Chronic diseases are leading influencers of health care costs for employers. Employers may wrestle with whether it is their responsibility to educate employees about chronic disease prevention and support. The op- tion of maintaining the status quo, however, may result in a mounting financial burden. This article shows how adopting a proactive role as health educator may prove to be a critical business decision, allowing employers to positively influence the direc- tion of worker health, drive down claims expenses and reduce the demand on public health resources.
In the quest to control health insurance premium costs, companies have turned to wellness programs. These lifestyle-based programs have been proven ineffective from a cost-savings perspective. More effective are customized, data-driven solutions that focus on disease management. These programs focus on the prevention of chronic illness through highly targeted care management identified by in-depth data analysis. The result is a higher engagement rate than that of traditional lifestyle-based programs and, thus, lower employer health care insurance costs with a higher return on investment.
Lack of transparency in preferred provider organization (PPO) insurance claims processing can result in corporations paying hundreds of thousands of dollars in hidden fees and charges. This article explores how fees can be hidden within claims reports when plan participants receive services from providers that are not within the PPO network but claims are repriced and treated as in-network or are repriced by out-of-network providers. It also provides some insight on what plan sponsors should look for when reviewing claims reports and appendixes.
Despite relatively steady recent operating improvements, not-for-profit health care organizations face both cost challenges and significant potential changes if and when new legislation ultimately passes into law. This article provides ten considerations that should be the focus of not-for-profit health care organizations’ attention as they adopt an enterprisewide view of their investment programs to understand total system balance-sheet risk.