Worksite Health Promotion

Many EAPS fall into a common - and hazardous - category -  Management thinks the program is great, but employees think it’s a waste. But it doesn’t have to be that way if you have an employee assistance program or are considering one.

Seventy-three% of all firms (59% of small companys) have an EAP. But how well does the typical EAP work? Not as well as we’d hope. A Mid America Coalition on Healthcare study found -

• just 50% of 6,400 employees surveyed said they’d use the employee assistance program if they felt overwhelmed by personal issues, and

• one-third said they didn’t even know how to access its resources.

The good news -  Firms like yours have seen dramatic improvements in three relatively simple steps

1. Worker attitude surveys

The best starting place -  Take the pulse of your staff members with a short, confidential attitude survey.

Objectives -  Ask staff members when they know how to use the EAP’s resources. Then test workers’ knowledge and opinions of depression and other personal issues that might affect their workplace performance and/or safety. In the final section, find out how staff members would handle a serious personal issue.

In other words, find out where your individuals  would likely turn for help. Would staff members seek out the EAP? Would they prefer to discuss the issue with their family physician? A mental health specialist?

The Mid America Coalition’s survey remains an excellent design model from which to craft a recent survey for your own staff members.

2. Promote employee assistance program through education

Your survey data ought to help you pinpoint areas where staff members need more education about your EAP. Some awareness-improveing techniques that have gotten results -

• Lunch-and-learn sessions. Possible topics include dealing with personal-finance stress, caring for elderly parents, understanding depression or dealing with a dependent who’s potential mental health issues.

• Worker newsletter. If you have a benefits newsletter, spotlight the employee assistance program (EAP) from time to time. Some businesses without newsletters have done e-mail campaigns or targeted mailings instead.

• Workplace posters spotlighting EAP. the ones that work best are often posters designed around a specific theme (e.g., anxiety about personal debt) rather than a general “need help?” message. In addition to posters, you may want to distribute wallet cards with EAP contact info.

Need help locating educational material? There’s lots of free EAP-related  brochures and FAQs here. Remember -  When doing EAP education, constantly remind staff members that the program is strictly confidential.

3. Be sure to work with supervisors

For legal reasons, supervisors need to tread carefully when they suspect an employee has a mental health issue.

What you don’t want -  supervisors taking disciplinary actions without consulting HR or playing amateur psychologist and “diagnosing” the employee’s problems. Here is a PDF of some proven tips and talking points for doing supervisor-specific employee assistance program education.

HIPAA compliance -  Beware non-discrimination issues

HIPAA’s non-discrimination rules impact both mental health benefits and general health plans. Under current interpretations, health plans can no longer have benefits exclusions that deny benefits for injuries resulting directly or indirectly from pre-existing mental health issues.

That’s true even if the psychological condition wasn’t diagnosed until after the injury and even if the injury was self-inflicted. Example -  Suppose an employee gets hurt in a workplace accident he or she caused. After the fact, the employee is diagnosed with a mood disorder that previously escaped detection by the employee’s physician.

Under current regs, health insurance portability and accountability act (HIPAA)-covered plans can’t deny benefits. This puts companys in a bind. Mental health issues like depression, anxiety or bipolar disorder are one of the health conditions that’re most likely to go undiagnosed or underdiagnosed.

That’s why, in most organizations, having a strong EAP is one of your best compliance tools.

For many employees, telecommuting and flex-time are highly desired work-life benefits. But a growing number of organizations are reluctant to offer these programs.

Demand for these benefits remains high.  One study found that 87 percent of job applicants are familiar with the idea behind telecommuting and flex-time, and the majority express a desire to have at least periodic access to such programs.

Environmental interest groups have pushed the feds for years to develop incentives for companys to encourage telecommuting. the pressure has risen as gas prices have continued to soar.

However, flex-time programs have leveled off in some sectors, and there’s been a decrease in telecommuting.

Today, about half of all organizations where telecommuting is feasible permit workers to work from home on a case-by-case basis. But the percentage of businesss offering full-time telecommuting has dropped in recent years.  Nowadays, only about 20 percent to 25 percent of businesss offer the benefit year-round.

Even some national businesss that are well-known for their telecommuting programs have scaled back. AT&T, for example, recently asked several thousand home-based employees to come back into the office.

Hewlett-Packard and Intel have done the same thing.  and the federal government lately noted a 7.3 percent drop in telecommuting employees. Why the cutbacks?

Staff Member Assistance Program - Pros and cons

Offering workers telecommuting or flex-time may be a good recruiting and morale-improveing tool, in addition to a way to retain workers who need to relocate, would otherwise have a need to quit or take leave or commute long distances to work.

But the programs aren’t without their drawbacks. Some of the main reasons companys give for scaling back or eliminating them -

• Company culture - It’s easier to build a sense of organizational stability and an individual connection between staff members, coworkers and supervisors when individuals  interact face-to-face on a daily basis.

• Security - Among the hidden costs of allowing staff members to telecommute (or else come in early or stay late) is keeping sensistive information safe. Some the cutbacks are being driven by companies’ IT departments.

Particularly, managers have raised concerns about stolen laptops, identity theft or other crimes driven by hackers gaining access to information via workers’ home Internet connections.

• Productivity - A lot of supervisors find it easier to ensure high productivity when everyone is working under one roof at the same time.  There’s also a widespread view that most workers get things done faster and more accurately when they’re not distracted by things at home.

The bottom line on the bottom line

Work-life programs like flex-time and telecommuting remain a useful benefit to offer employees, and a lot of businesses still provide these benefits for economic reasons.

But once the potential hidden costs are weighed, it’s often better for the bottom line to limit the scope of these programs.

Organizations that are thinking about starting a telecommuting program ought to look closely at job descriptions and telecommuting candidates. Some positions are poorly suited for remote work, and some staff members are more up to the challenge than others.

But unless the organization creates objective criteria for permitting or denying flex/telecommuting requests, such programs can actually damage morale.

The last thing any company wants is to open supervisors(and the company) up to accustations of favoritism or discrimination because of seemingly random decisions on which employees in their department can and can’t flex their schedules or work from home.

In the near future, the federal government may offer help to employers looking to start a wellness program. the help would take the form of tax breaks to offset program costs.

A current United States  Senate bill would give businesss a substantial tax break for starting wellness programs. Dubbed the Healthful Workforce Act, it calls for an business tax credit of up to $200 per employee enrolled in a newly created wellness program.

For larger firms, there’s the $200 credit for the first 200 employees and up to $100 per worker thereafter. to qualify for the full credit, your wellness program would’ve to feature -

• health risk (assessment|appraisal}s

• staff member education drives (e.g., targeted mailings, web-based tools)

• behavior change programs (e.g., tobacco use cessation, weight control, health coaches), and

• “meaningful” participation incentives (e.g., lower co-pays).

Licensed businesss would be able to claim the tax credit for up to 10 years after starting a wellness program.

The bill has enjoyed bipartisan support, but like many things in Washington, the parties disagree over how to fund the cost of the tax credit. as a result, it has been bogged down in committee.

If and when the bill is ratified, employers could claim the federal tax credit the following year.

In the meantime, whether or not your organization already has a formal wellness program, there are proven ways to make wellness part of the corporation culture. Best of all, they don’t have to cost an extra cent.

Wellness town meetings

It’s often said that successful wellness programs start at the top of the organization. Reason -  Workers choose up fast on whether management practices what it preaches when it comes to wellness.

If the people  in management are smokers, obese or simply reluctant to talk about health issues, it’s a tough sell to get employees engaged in taking control of their health.

That’s the idea behind the wellness town meeting.

Once a week (or once a month), everyone in the business attends a short meeting to discuss their own recent efforts to get healthier.

Managers generally go first, for break the ice about discussing some potentially sensitive issues like dieting or quitting use of tobacco.

In most organizations, the meetings are arranged to encourage casual, free-flowing conversation.

One key -  Individuals  speak from where they’re seated, rather than standing up front, with all eyes staring at them.

Some organizations take a more formal approach, which can also work.  For  instance, at Old National Bank in Indiana, folks file into an auditorium to face their worst enemy, the scale.

Each week, everybody at the firm - from seasoned managers to the newest hires - comes in to get weighed. the only one who sees the number on the scale is the individuals getting weighed. Even so, the program has inspired a lot of folks to lose weight. for more on the firm’s program, click here.

Free tests and screenings

While there’s no substitute for having employees undergo comprehensive health risk (assessment|appraisal}s, it’s also wise to home in on screening for common conditions that aren’t necessarily lifestyle related.

Example -  skin cancer. It’s not just sun worshippers who are at risk of the most common (and in its early stages, treatable) form of cancer. Heredity plays a part. So does luck.

Fortunately, businesss can get their staff members screened for free. Through the American Academy of Dermatology’s National Melanoma and Skin Cancer Screening program, volunteer physicians perform skin cancer screenings at no cost.

In like manner, other medical associations and public health agencies offer free or nominal-cost screenings for a variety of other common conditions.

Indeed, it varies.  In some cases, an HSA-eligible plan may cost the same as a non-HSA high-deductible plan. In others, the premiums can actually be more expensive, a recent NHPI report finds.

As a matter of fact, a non-HSA plan offering similar coverage can carry a monthly per-employee premium that’s about $15 to $25 lower and a deductible that’s $500 to $1,000 lower than the HSA choice.

Sometimes the difference is due to price-jacking -  the HSA plans are the ones that’ve been hyped in radio commercials and mentioned in newspapers in recent years.

Nowadays, fewer individuals  exploring high-deductible plans ask first about the non-HSA, so insurance businesses sometimes slash prices to drum up interest in those options, too. Another factor -  Not all deductibles work the same.

Deductible cuts both ways

Two deductibles can look similar but work differently, and the cost scales can tilt for either an HSA or a non-HSA plan. Example -  HSAs by law can no longer allow first-dollar coverage of prescription drugs. But a non-HSA plan can.

On the flip side, HSAs often feature better preventive-care coverage. In some non-HSA plans, a individuals who’s yet to meet the deductible must pay out of pocket for standard tests (example -  cholesterol testing) that’re part of the routine physical. Only the office visit itself is covered.

Additionally, HSA-eligible plans have to follow rules that limit sum out-of-pocket costs. But this can push up the premiums paid on the front end.

Best bet -  Double-check with your broker to be sure you’re comparing apples to apples when assessing  the costs of HSA and non-HSA plans.

When your company has this common - and increasingly well-liked - fringe benefit you might be at legal risk without even knowing it.

Some businesses have an on-site employee fitness room as part of a formal wellness program. Others simply do it as a way for folks to get their juices flowing before work or blow off steam afterwards.

No matter the reason, companies with fitness rooms need to be aware that the benefit isn’t risk-free.

Over the last few years, several privately owned fitness clubs have been sued - and agreed to costly settlements - after exercisers suffered sudden cardiac arrest (SCA) and died before help arrived. In each case, the facility either did not have lifesaving equipment on the premises or didn’t have personnel properly trained to use it.

Some legal specialists have expressed concern that corporations could also be at risk when the unthinkable happened on company premises while an employee worked out.

SCA is of particular concern. Reason -  Even seemingly healthful, active adults are at risk of sudden cardiac arrest. It can’t be prevented. There’s no vaccine.

And few victims survive by the time an ambulance arrives. But there is a way to save the employee’s life and potentially save your firm from a lawsuit.

Learning about SCA

Sudden cardiac arrest (SCA) is a frequently misunderstood killer. It’s not the same thing as a heart attack. SCA can affect anyone, anywhere, anytime. It occurs more than 600 times every day in the U.S., killing at least 250,000 people  each year.

The only hope -  using a device called an automated external defibrillator (AED) within 10 minutes.

The good news is any person at your corporation could be quickly trained to use an AED - you don’t need any medical knowledge to use it. the training could be obtained for free through a local Red Cross or civic group. the devices themselves cost under $2,000.

Compare that to the financial risk of being sued for not having an AED near a workplace fitness room, and it’s a no-brainer that any company with on-site workout equipment should at least investigate an AED buy and training.

Workers, supervisors and upper managers alike will probably need education about SCA and AED use. A great teaching resource is available here.

Key talking points -  Without an AED, 90 percent of victims die. But when you have access to one, there’s a good chance to save an employee’s life. and it’s easy to teach supervisors and workers how to use the device when it’s ever needed.

The vast majority of facilities with AEDs never need to use them - and that includes medical facilities. But it only takes one tragic event, and subsequent lawsuit, to cause pain for both the business and an employee’s family.

Don’t forget -  Prevention and education are always your company’s best tools for avoiding liability. In this case, where human life is involved, the choice seems rather obvious.

For most firms, voluntary benefits are a win-win arrangement. But there can be hidden risks.

On the positive side, voluntary benefits cost companys next to nothing, yet increase employees’ morale and benefits satisfaction. an Aon survey found 77% of organizations offer at least one voluntary benefit.

But what happens if there’s a legal dispute between one or more of your workers and the provider?

In many cases, employers unwittingly get dragged into court. the provider may argue that the plan is covered by ERISA, and the employee’s lawsuit should instead be filed against his or her employer.

If the court agrees, the legal burden shifts.  Some courts have ruled that a voluntary benefits could  be covered under ERISA, even when it wasn’t an employer’s intention to formally “sponsor” the plan.

When push comes to shove, the providers will protect themselves. In truth, some attorneys warn that a voluntary plan insurer’s first move when sued by one of your employees will be to attempt to get the legal burden shifted from itself to you.

Two seemingly innocent things that may be turned against you in court -

• the written announcement to tell staff members about the new voluntary benefit, and

• getting involved if there’s a dispute between an worker and the plan provider.

Be careful with announcements When you offer a new voluntary benefit, the natural tendency is to attempt to get staff members pumped up to participate. But you can get in trouble when people  get the impression the firm endorses the plan. Helpful practices -

• Don’t put the announcement on organizational letterhead

• Put a disclaimer on the description

•  either exclude your voluntary offerings from employees’ benefits manuals or list them separately, and

• hold open enrollment at a different time than for ERISA plans (401(k), main health plan, etc.).

Also, when the vendor offering the voluntary plan has competitors, you may want to remind workers the vendor of the voluntary plan isn’t the only game in town. Some firms pass along lists of competing vendors.

Avoid involvement in disputes as with your ERISA plans, chances are workers will come to you when they have a problem with a voluntary plan. Your first inclination is to help.

But many specialists warn it’s better to stay out. Reason -  Courts see this as the action of a plan sponsor. But you are able to steer someone in the right direction (e.g., giving a contact name to call) while remaining neutral in the dispute.

Good intentions gone bad

From an ERISA standpoint, the most hazardous voluntary plan design is one that is partially paid by the company, even if employees pay the bulk of the cost.

In a major ruling a few years ago (Burgess v. Cigna Life Insurance), a USA  district court ruled against an business with a voluntary supplemental disability plan in which the firm compensated a portion of premiums for its lower-compensated employees.

While most workers compensated the entire premium - and firm made clear to  individuals  the plan was a voluntary benefit -the court said it didn’t matter. the act of contributing to some employees’ premiums made it an ERISA plan.

In the last few years, “presenteeism” has become an even bigger concern for a lot of corporations than absenteeism. Although many HR/benefits managers hate the admittedly overused term, presenteeism is notwithstanding a real issue in nearly every workplace.

Most widely,  presenteeism takes the form of workers coming to work sick. They’re  unproductive and endanger colleagues. Meanwhile, the staff member is not forced to use a sick day. A bad deal for businesss all the way around.

A recent survey by LifeCare revealed that 93% of workers (polled from 1,500 organizations) admit that they at least ocassionally come to work when they’re sick enough to stay home. More important, the published study  looked at the reasons why folks do it.

Troubling rationales

The No. 1 reason workers cited for coming to work sick was a belief that they’d be “letting other individuals  down” when they call out. Almost 30 percent of respondents cited this as their main reason. Beyond that, the top responses were -

• It’s too risky, due to office politics or culture, to take time off (26%)

• the worker is too busy at work to be able to stay home a day (15%)

• the staff member saves up sick days for childcare/eldercare emergencies (12%), and

• the staff member saves up sick days to use as additional vacation time (8%).

A lot of of these rationales are troubling to HR/benefits managers.

In the first place, supervisors who hassle staff members about taking legitimate sick time are, at best, being pennywise and poundfoolish.  Presenteeism costs more than absenteeism, once you figure in the uncharged sick days, lack of productivity and risk of other staff members getting sick.

You’ve more power than you think to change your corporation culture when the “tough it out” mentality still applies to individuals  who come in sick. When  executive management is confronted with the real dollars and cents of presenteeism, lowering the problem generally becomes a priority. at the very least, firms shouldn’t invite it.

In terms of supervisor- and employee-education, repetition of the “stay home when you’re sick” message is the key. Eventually, it’ll sink in.

Of course, there’s still the problem - as evidenced by the survey - of staff members who misuse their sick days by trying to hoard them for other purposes.  

Adopting PTO, no-fault absence policies or use-it-lose-it sick leave are the three most common ways of decreasing the risk, but be aware that each of these policies have risks of their own.

At the end of the day, the more open the lines of communication are between management and employees, the less prevalent the presenteeism problem becomes.

In many segments of society, we  hear about racial and ethnic profiling in negative ways. But what about when it comes to wellness programs?  

When used for the specific purpose of  beginning - or reviewing  - a wellness or disease management (DM) program, profiling isn’t just legal. It’s also encouraged.

Affects health risks

Different ethnic and racial groups tend to be more at risk - for genetic and/or cultural reasons - of certain medical problems. Examples -

• African-American, Latino, Native American and Pacific Islanders are  at higher risk of diabetes than Caucasian employees

• Chinese women are statistically twice as likely to get cervical cancer

• Caucasians have disproportionately high rates of obesity and high blood pressure, and

• Latinos have higher rates of asthma and chronic obstructive pulmonary disease than other groups. the HIV/AIDS population is also disproportionately Hispanic.

Bottom line -  By analyzing  the ethnic breakdown of your worker population, you are able to set disease management (DM) program priorities with greater confidence and accuracy.

Health Care quality an issue

Several studies also show there’s an unfortunate relationship between ethnicity and quality of healthcare. A lot of times, minority staff members receive inferior treatment and health education at the same facilities where others receive top-notch care.

This ordinarily happens for innocent reasons. A common scenario -  a lack  of Spanish-speaking physicians in the network for your Latino staff members. But the result is ordinarily higher health costs for you and, often,  greater reluctance among minority staff members to seek needed treatments.

By profiling workers against the doctors in the network, you ultimately help workers get the care they need and the business to better control long-term costs.

Almost two-thirds of organizations with wellness programs offer staff members incentives - financial or otherwise - to participate.

But only one firm in five has seen major betterment in employees’ health status (and lower costs) within two years of launching the incentive. Here are three keys to getting good results - and a red flag for failure.

Cancer screenings pay off big

Most wellness programs feature health-risk assessments for things like high cholesterol and diabetes. But many overlook the need for early detection of cancer, which may affect any employee, regardless of his or her age or general health.

In many cases, you can line up certain screenings, such as skin cancer detection (the most common kind of cancer and, in its early stages, the most easily treated) for free or at a nominal cost.

These resources are often available through community agencies or the American Cancer Society. More involved and costly screenings - such as mammograms - are well worth the cost.

A single case of cancer identified early normally saves thousands of dollars in medical claims and disability costs - not to mention trauma for the employee.

Smart worker wellness incentives

Health Insurance Portability and Accountability Act (HIPAA) has tricky non-discrimination rules for offering staff members a break on premiums or copays. You needn’t worry about HIPAA if you -

1. Structure the program as a cost-break for employees who embrace wellness. on the flip side, imposing surcharges for uncooperative employees can force you to jump through health insurance portability and accountability act (HIPAA) hoops.

2. Make the incentive available to all staff members. for  instance, when you offer a discount to non-smokers, an worker who lately quit smoking must also be eligible.

3. Allow employees who fail to earn the incentive to have another shot at it next plan year.

Bottom line -  Make the financial incentive a reward, not a punishment. Do the incentives work? When they’re done right, yes.

Firms offering monetary rewards for wellness generally save about $20 to $50 a month, according to some estimates.

Making wellness programs simple

Many firms require employees to work with an individual “health coach” for earn premium discounts or other incentives. Normally, the worker sets up appointments and reports to the health coach on a regular basis, either by phone or in person.

The good news -  the early results are often encouraging.

The bad news -  Once staff members realize there’s ongoing effort involved, many lose interest. But many firms have found a simple alternative. Rather than having participants contact the health coach, the health coach calls them.

In many cases, this minor program tweak keep folks on the right track and cuts dropout rates.

Wellness begins upstairs

No matter how much money your business spends on wellness, the odds of success depend largely on the example set by top management.

Example -  If your CEO is a smoker, chances are few staff members will purchase into a tobacco use cessation program.

Likewise, it’s hard to sell staff members on subsidized gym memberships when your organization culture is sedentary. for wellness to work, the top brass must practice what the firm preaches.

Are your health care programs delivering on your providers’ promises?

Just as importantly, how can you hold vendors accountable when you’re not getting what you compensated for?

Here’s one proven way -  Develop a provider scorecard. Scorecards alone won’t bring down your healthcare costs. But they’ll at least help be sure your company - and workers - get everything you’re compensating for.

The tool can help you measure plan performance with greater precision - and identify specific areas that need improvement. Best of all, any company can adopt the technique to fit their needs. Here’s how it works.

1. Select specific rating areas

Benefit pros who’ve successfully adopted the scorecard system recommend grading vendors on five to 10 measurable areas, like -

• Claims processing. Are employees’ medical claims turned around in a timely fashion? Are you hearing complaints that the explanations of benefits (EOBs) are slow to arrive or hard to understand?

• Disputed and resolved claims. Do employee questions and complaints about denied or still-pending claims get answered quickly and thoroughly? How often are you forced to go to bat for employees?

• Accessibility. Are plan reps quick to answer phone calls? Do they attend regularly scheduled meetings?

• Reports. Do you receive timely compensated claim and utilization reports?

• Open enrollment. Did you receive effective support preparing for and conducting open enrollment events?

• Staff Member education. Do your staff members find the written and/or one-on-one services provided through the plan helpful in answering questions about managing specific chronic diseases (like diabetes or depression)? Do you receive support in educating your staff members to make healthy lifestyle choices, like smoking cessation?

2. Choose a workable rating scale

There are two schools of thought when it comes to picking  a rating method -  subjective or objective. A lot of benefit pros - especially those from smaller firms - use a simple pass/fail or 1 to 5 score to rate their satisfaction.

Others develop more elaborate, statistic-based ratings. One method -  take the provider’s guarantees (e.g., addressing disputed claims within 3-5 business days) and then measure by percentage how often these goals are met.

These rating data could be obtained through quarterly performance reports, employee surveys, issue and complaint files and, for bigger plans, external audits.

3. Feedback triggers improvement

It’s good practice to share your scorecard system with the provider before meeting to review the results. Reason -  This lets you iron out any provider questions about the review categories and scoring system.

Once that’s settled, you are able to meet to go over the numbers and prioritize the areas that need improvement. Many firms then add a new scorecard category - providers’ followup.