Sept. 9 Webcast - Cancer in the Workplace: How Employers Can Help

On Wednesday, September 9 from 1-2 p.m. Eastern, NBCH is hosting a webcast for employers and coalitions addressing cancer in the workplace.

Two presenters will share real experience from worksites identifying evidence-based strategies to improve the benefits and resources for employees living with cancer.

Register here.

Over the last year Pfizer, in partnership with Cancer and Careers, has worked with a steering committee of experts to explore the topic of breast cancer and the workplace as part of the Breast Cancer: A Story Half Told program. The organizations recently commissioned a national survey examining the perspectives of working women with breast cancer, health care professionals and employers. This surfaced a number of important findings about how women living with breast cancer feel about working while undergoing treatment, and how employers can better support these women through improved communication.

As the challenges associated with working following a cancer diagnosis are not unique to breast cancer, Pfizer has also collaborated with several organizations to develop an additional resource, Workplace Transitions, This is a free program that provides information and tools to help support communication between employers and employees to ensure a healthy and productive workplace.

BenefitsPro: Businesses must be solution to health crisis

NBCH CEO Brian Klepper was a keynote at the recent Human Resource Executive Health and Benefits Leadership Conference.

Covering the conference for BenefitsPro, Kathryn Mayer wrote an article summarizing Klepper's comments which can be found here.

Brian Klepper doesn't just think the nation's health care system is flawed; he thinks it's broken.

But the good news, he said, is there is a solution: businesses. 

Klepper urged benefits managers to meet with their C-suite, talk about just how serious the health care problem is, and band together to take action to fight the health care industry and rein in exorbitant costs.

"The most important people in saving health care and saving America is businesses," he said.

Changing How We Pay for Health Care: Value-Based Reform

Dr. Jack Cochran and Charles Kenney wrote an article on The U.S. Department of Health and Human Services’ recent announcement to move the Medicare program toward value-based payments.

Posted today in The Health Care Blog and originating from a February post on the Kaiser Permanente blog, the authors noted that this effort "is among the most promising recent developments in health care. While changing the way we pay for care will not be easy, we believe that shifting away from fee-for-service to value-based payments could be a catalyst to a better, more affordable health care system in our country."

Also included was an excerpt from NBCH's Value-based Purchasing Guide.

According to the National Business Coalition on Health, a nonprofit organization of “purchaser-led health care coalitions … dedicated to value-based purchasing of health care services through the collective action of public and private purchasers,” the impact would be significant. The coalition takes this position:

 As the business community has learned over the past several decades, maintaining workforce health and preventing illness – particularly chronic conditions – improves productivity and competitiveness, and can lower health care costs over time.

Value-based purchasing can help shift the paradigm of why employers offer health benefits from seeing it as an employee recruitment and retention tool, to seeing it as a chance to improve population health and increase productivity, and ultimately the employer’s bottom line.

The authors concluded that this may be the tipping point in our nation’s complex, often difficult, health care journey. What do you think?

C-suite must band together to rein in health care costs

Steve Twedt's article today in the Pittsburgh Post-Gazette features comments from NBCH CEO Brian Klepper's keynote at the Pittsburgh Business Group on Health's annual symposium.

Dr. Klepper called on C-suite executives to band together if they are to overcome the power of the health care industry and to rein in health care costs.

"Business leaders need to develop a national health care data warehouse and analytics platform that will arm them with information showing which plans and providers produce the best value for the money as far as quality, safety and cost. They have to come together to work as one, to be a counterweight to the health care industry."

10 ACA Questions Small Employers Are Asking

According to Health Partners America the majority of Americans, including many small business owners, are still confused about health reform legislation.

Employee Benefit News recently covered the ten Affordable Care Act questions small employers are asking. The slide show can be found here.

Results of Deloitte's 2013 Survey of U.S. Employers

Forthcoming changes to the insurance market landscape in 2014 and 2015 will bring many employers to a crossroad. As health care reform unfolds, markets evolve, and costs continue to rise, employers will need to make important strategic decisions to actively manage their costs and figure out how best to respond to insurance-related provisions of the Affordable Care Act.

Deloitte’s 2013 survey of U.S. employers (50+ workers) offering health benefits shows their concern and uncertainty about ACA preparedness, health care system performance, cost-reduction strategies, and the quest to find value. Among key findings:

• U.S. health care system performance — Seeking better value and health outcomes for their investment, many employers are dissatisfied with the performance of the health care system, considering it to be costly, wasteful, underperforming, and lacking in transparency. 
• Affordable Care Act — Although familiar with many of the ACA’s insurance elements, three years into implementation and facing decisions around insurance exchanges and the employer mandate, the Act remains largely a mystery to many employers.
• Employer strategies and tactics — Employee cost-sharing tactics are in place but there is a gap between what employers are currently using and tactics they think could have high impact in managing costs.

To view the Full Report or Executive Summary, click here.

Final Mental Health Parity Rules Published

The Obama administration has released final rules for the 2008 Mental Health Parity and Addiction Equity Act. The law requires most health plans to provide more generous mental health coverage, comparable what they cover for physical illnesses. Previously, insurers often charged higher co-pays or set stricter limits on mental health services.

The act doesn’t require employers to provide mental health coverage, but those that do must treat mental and physical health care equitably. Plans can’t charge higher co-pays, deductibles or out-of-pocket expenses for mental health services, nor can they apply separate treatment limitations. They must also offer equal out-of-network benefits. The administration released interim rules in January 2010, but the final rules had been delayed.

IRS Eases Restrictions on Flexible Spending Accounts

IRS has announced that employers can allow FSA participants to carry up to $500 of their  balances into the next year — and it can be effective in plan year 2013. Up until now, any money remaining in the account would have been forfeited. The added FSA flexibility is a response to comments from the public about the challenge of accurately predicting medical expenses, especially for certain income levels, and the unnecessary spending prompted by the use-or-lose rule.

Under current law, employers may allow a grace period of up to two and a half months, during which employees can spend funds remaining from the previous plan year. The grace period option will remain in place, but FSAs cannot have both the grace period and carry-over options. Under the Affordable Care Act, health care FSAs are capped at $2,500. Previously, employers often set it at $5,000, but there was no mandated cap.

Consensus Statement Offers Guidance on the Use of Biometric Screenings as a Workplace Wellness Tool

Three national health organizations have published new guidance intended to help employers create more successful programs for gathering health-screening information from employees. Known as “biometric screenings,” the gathering of such information — ranging from height and weight to blood pressure and cholesterol levels — can play a key role in an employer’s workplace wellness program.

The Health Enhancement Research Organization (HERO), the American College of Occupational and Environmental Medicine (ACOEM), and the Care Continuum Alliance (CCA) collaborated on a consensus statement titled “Biometric Screening for Employers,” which was published in the October issue of the Journal of Occupational and Environmental Medicine (JOEM), the official publication of ACOEM.

With the growth in the popularity of employer wellness programs, the inclusion of biometric screenings is on the rise. During a biometric screening, factors such as blood pressure, weight, and cholesterol are taken at the worksite and used as a part of a workplace health assessment to benchmark and evaluate changes in employee health status over time. These measurements are often used as an essential component in health management and wellness programs for employees.

But many variables must be taken into account in order for biometric screening programs to succeed, including data collection methods, selection of appropriate populations for screening, operational issues, privacy considerations, budget limitations and others. “Biometric Screening for Employers” offers detailed suggestions on all of these and other variables, organized into four major categories to assist employers when considering biometric screening as part of an overall employee health management approach.

Wellness Experts Caution Against Quick Move to Outcomes-Based Programs

In a new Employee Benefits News story, wellness consultant Dee Edington says companies seeking to make a business case for wellness are too quick to ditch participation-based programs for outcomes-based models and should wait until initiatives have a 70% participation rate and two to three years of data. Consultant Cortney Rowan of Altitude said employers should create wellness incentives with the intent of measuring outcomes to create an initial baseline from which to compare data in the future. Encouraged by the Affordable Care Act's increase in the allowed maximum of wellness incentives - from 20% to 30% of the cost of health coverage - may cause many employers to transition too quickly to outcomes-based wellness programs, before their program has sufficient engagement and maturity.

HHS Issues Final Rules on ACA Transitional Reinsurance Program

Final regulations issued recently by HHS have indicated the possibility of exempting “certain self-insured, self-administered” health plans from the ACA's transitional reinsurance program (TRP) fee.  Under Section 1341 of the ACA, during the first three years that state health insurance exchanges are operational (2014 through 2016), health insurance issuers and plan administrators (on behalf of self-insured group health plans) will be assessed a per-enrollee fee to finance a three-year transitional reinsurance program. The contribution rate for 2014 is $63 per covered life for the year.

These final regulations, which address a range of other issues including exchange eligibility verification, include two important items.  First,  HHS is contemplating an exemption that would only apply to self-insured plans that are “self-administered” – i.e., plans that do not use a third-party administrator (TPA).  Self-administered plans would not have to pay the fee.  However this is expected to be a very small number of self-insured plans since the majority of self-insured plans use TPAs.  Additionally, the preamble suggests that HHS will soon propose a rule to allow for the collection of the full fee for each year in two phases, under which the actual reinsurance component of the fee would be due at the beginning of the following calendar year (i.e., in early 2015 for the 2014 fee) and the component of the fee attributable to the recollection of Early Retiree Reinsurance Program expenditures would be due at the end of the following calendar year (i.e., in late 2015 for the 2014 fee).

Employers Bear the Weight of Obese Workers

A new story in Benefits Pro describes the challenges employers face when employees are overweight or obese. Studies estimate compensating for obesity costs employers upward of $70 billion a year. Possibly further upping those costs and complicating the issue is a decision this summer by the American Medical Association to classify obesity as a disease, elevating it from a condition.

The Equal Employment Opportunity Commission has also considered obesity brought on by medical conditions, such as an underactive thyroid, to be an impairment under the Americans with Disabilities Act. The EEOC looks similarly at morbid obesity, which is defined as 100 percent more body weight over normal. To help combat obesity and improve the overall health of their workers, more and more employers offer wellness programs as part of their health care plans and benefits programs. They typically view them as ways to contain health care costs and retain their workforce.

How do Small Employers View the SHOP Exchanges?

A new study, being released today as a Web First by Health Affairs, surveyed 604 randomly selected firms--including both firms that currently offer insurance and those that do not. One clear message was that health insurance cost was by far the most important factor in purchasing decisions. Some of the study's findings:

• Employers liked features of the SHOP exchanges, including getting one bill; writing one monthly insurance check; and the ability to compare costs, benefits, and physicians in networks among plan offerings. 
• The proportion of employers willing to shift to narrow-network plans that contract with no more than 25 percent of the providers in a community rose to 82 percent with a cost savings of 20 percent. 
• Eighty percent of small-group employers offering insurance said they used brokers to perform various tasks, including selecting and managing their health insurance plans. 

The authors found two challenges to the SHOP exchanges: the need for a strong buy-in from brokers and an expected increase in the number of self-insured small employers. Under the ACA, self-insured plans do not have to provide essential health benefits or pay premium taxes. "This survey quantified a much-discussed unintended consequence of the Affordable Care Act: a movement to self-insurance, which poses a threat not just to SHOP exchanges but to the entire small-group market," the authors conclude. They recommend an amendment to the ACA: prohibiting the sale of stop-loss coverage (against catastrophic events) to small firms. This would avoid undermining many benefits of small market reforms and SHOP exchanges.

NIHCM Data Brief on Trends in Employer-Sponsored Insurance

Recent accounts of employers dropping health coverage, restricting eligibility for spouses, turning to plans with narrower networks and greater cost sharing, and restructuring workforces are often framed as side effects of the ACA. But many of these cost-cutting trends began long before health reform. This data brief from the National Institute of Health Care Management offers a comprehensive look at how employer-sponsored insurance has been changing and how provisions of the ACA and other dynamics might affect this market. Topics include:

• the decline in rates of employers offering health insurance, particularly for smaller firms with lower-wage workers
• projections of the ACA’s impact on employer-sponsored coverage and part-time workers
• the ongoing movement to greater employee cost sharing and shift into high deductible plans
• growing employer reliance on workforce wellness programs and interest in defined contributions and private exchanges
• the emerging focus on promoting value through reference pricing, high performance networks and transparency
• the trend toward self-insurance among smaller firms

Best Practices for Transition to Value-Based Purchasing

A recent Robert Wood Johnson Foundation report authored by consulting firm Bailit Health Purchasing identified numerous challenges organizations can face during the transition to value-based payments. Some of these challenges include a lack of affiliations with payers and other providers, a state government apathetic about payment reform, selecting the wrong population to conduct a pilot test of the reform program, and inadequate organizational size and resources.

The research is based on interviews conducted with nine RWJF grantees that received financial support to implement payment reform within their communities. These projects were funded through two competitive calls for proposals, released in 2010 and 2011, that aimed to identify and support innovative payment models. The grantees were diverse, including, for example, quality improvement organizations, provider groups, and a state government body. In addition to the interviews, the authors drew upon their experiences with the RWJF Aligning Forces for Quality alliances, the experiences of other RWJF payment reform technical assistance providers, and the authors’ independent work in payment reform.

Alliance for Health Reform Employer Toolkit

The Alliance for Health Reform has published a new employer toolkit explaining all of the implications of the ACA on employers. The toolkit - a collection of published news stories and other documents - also includes information about the delay in the mandate to 2015, and analysis about its impact on employer-based coverage.

The toolkit includes: 

• Key facts about the employer mandate 
• Data about trends in employment-based health coverage 
• Links to news articles and reports explaining and analyzing the issue 
• Health care experts who understand the issue and its implications, along with contact info 

In 2011, more than 170 million individuals had employment-based health benefits (55.1 percent of the population), but that is down 11.8 million from 2000, when employers covered 65.1 percent of the population. The ACA contains an incentive for employers to offer affordable health benefits. Starting in 2015, employers with more than 50 full-time employees are required to offer health coverage or pay a $2,000 fee per full-time employee, if any employee receives a subsidy through the state insurance exchange. Critics of the employer mandate say that, rather than being an incentive to keep coverage, the policy will instead drive employers to drop coverage and demote full-time workers to part-time. Proponents of the ACA disagree.  

Aon Hewitt Survey: More Employers Will Offer High-Deductible Health Plans

The Washington Post reports on an Aon Hewitt survey that indicates high-deductible (or consumer-directed) health plans could become the most common form of coverage offered by companies with 500 or more workers in the next three to five years, as companies continue trying to cut health-care costs. Aon Hewitt said its annual survey of more than 800 large and mid-size U.S. employers found that 56 percent are offering CDHPs as a plan choice and another 30 percent are considering offering one in the next three to five years.

Employers are considering these plans because they make workers aware of how much their care costs, which could help slow growth in health care expenses for companies. Patients tend to think more about what they need and how to get a better deal for it. That means the employee may fill a prescription with a generic drug instead of the pricier brand-name medicine. They also may look for a better deal on an MRI exam instead of heading to the nearest hospital.

Health care expenses and administrative costs for the coverage grew about 4 percent last year for employers with CDHP plans, according to Aon Hewitt. That compares with growth of 6 percent and 7 percent for more traditional health insurance plans with lower deductibles: HMOs and PPOs.

Employers Preparing Now for Cadillac Tax in 2018

The Commonwealth Fund reports on recent trends among employers to start trimming back benefits now in preparation for the Cadillac Tax hitting "high cost plans" in 2018. As employees at many private companies prepare for the open enrollment season, some will find out soon about decisions their employers have made about benefits in order to escape a tax on expensive health care coverage that hits in 2018.

The tax imposes a 40 percent excise tax beginning in 2018 on the cost of coverage for health plans that goes above limits of $10,200 for individual coverage and $27,500 for self and spouse or family coverage that year.  Nearly a third of all big employers say they are taking steps in 2014 to avoid the tax in 2018, according to a survey released earlier this week by the Mercer consulting firm.

Mercer estimates that about 40 percent of companies would have to pay the tax on at least one plan if they did not change the current benefit design. Mercer's figures are the partial findings of a survey of 2,800 large employers across the nation, with about 2,000 responses so far. The full survey will be released later.

NBCH member coalition, The Alliance in Madison, Wisconsin, has developed a Cadillac tax estimate calculator for employers.  You can find the calculator on the newly-launched NBCH ACA Calculators and Resources webpage.

Lawmaker Asks for Rules on Employers' Use of Health Risk Assessments

The New York Times reports that a federal lawmaker is asking the Equal Employment Opportunity Commission to investigate employer wellness programs that seek detailed health information from employees, and to issue guidelines preventing employers from using such programs to discriminate against workers. The request, by Representative Louise M. Slaughter, Democrat of New York and a staunch advocate for health privacy rights, came a few days after Pennsylvania State University suspended part of its new employee wellness program that had drawn objections from faculty members.

Ms. Slaughter, who made her request in a letter to the commission, is the author of the Genetic Information Nondiscrimination Act, a federal law that protects Americans against discrimination in employment or health insurance based on their genetic information. It is legal for employers to use financial incentives to encourage workers to fill out health risk assessment forms as long as that reward is based on completion of a wellness form and not tied to specific questions related to an employee’s health status.

Policy Brief on ACA's Cadillac Tax

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation explains one of the most controversial provisions of the Affordable Care Act: the so-called Cadillac tax on generous employer-sponsored health insurance plans. Beginning in 2018 a 40 percent excise tax will be assessed on the cost of any of these plans exceeding $10,200 for individual coverage and $27,500 for family coverage. Employers, who would be responsible for paying the tax, are preparing for it by scaling back health benefit offerings or increasing workers' deductibles or co-pays to avoid paying the tax. Although critics of the tax say it unfairly reduces health benefits for subscribers to these plans, particularly those with expensive chronic illnesses, proponents maintain that when consumers pay a larger share of the costs, they will be less likely to overuse care.

Since the excise tax will not take effect until 2018, it will be some time before policy makers determine whether it will work as intended to achieve its dual goals of both raising revenue to fund health coverage expansion nationwide and lowering health care costs. Still, lawmakers from both parties and many policy makers agree that the excise tax should make employers and employees pay much closer attention to their medical spending over the long run.