The World Health Organization defines burnout as: a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed and recognizes three identifying characteristics of the phenomenon:
- Feelings of energy depletion or exhaustion
- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
- Reduced professional efficacy
Burnout has gained its status as a bona fide buzzword for good reason. A recent survey by Indeed found that 52% of workers were feeling burned out, up 9% from pre-COVID times; while a 2021 American Psychological Association study showed that 3 out of 5 employees reported negative impacts of work-related stress, such as lack of interest, motivation, and energy. The impacts of burnout go beyond an unhappy workforce. In fact, employees struggling with burnout are:
- 63% more likely to take a sick day1
- 23% more likely to visit the ER1
- 2.6 times as likely to look for a different job2
- Less likely to participate in meetings or projects, which can have a negative influence on company culture
All of these factors contribute to lost productivity, a drain on both financial and non-financial resources (e.g., other team members needing to take on more from a burned-out colleague, or resources spent on replacing employees that have resigned due to burnout), and overall a workplace environment that is far from ideal. Although every industry is struggling with burnout, healthcare and higher education are industries with unique challenges. Both require a higher onsite presence than other industries and have experienced a lot of change related to the pandemic.
At this point, you have likely heard the term burnout and understand its prevalence, but perhaps don’t have a clear path forward to prevent or mitigate the issue.
What to Do About Burnout
If you notice a team member seems less engaged or enthusiastic, tangibly overwhelmed, is declining in performance, or just less present – these are all flags for burnout. Often burnout can be nipped in the bud before getting to a more extreme state if you know the signs and have tactics in place toward resolution. Often supervisors will notice these signs early in the process, which means training related to burnout and compassion are imperative.
From a quantitative perspective, we’ve seen organizations successfully respond to employee burnout by implementing or boosting the following:
- Facilitation of work-life balance, by offering resources to help employees find that balance
- Regular monitoring of responsibilities and schedules
- Encouragement, or even a mandate, to use paid time off
- Flexibility regarding hours, place of work, etc.
- Management training including how to deal with burnout, and establishment of best practices
- Creation of clearly defined career paths and professional development opportunities
- Open, frequent, and honest communication
- Wellness programs and tools
- Protocols for recognizing accomplishments where the work matches the reward
On the more tangible side, wellness tools like Headspace, Calm, and Noisli have been developed to tackle stress, focus, and productivity. There is also a range of virtual counseling and mental health platforms available for employers to provide additional support to employees. At Spring Consulting Group, we have access to a platform called Spring Health, which offers counseling services, Employee Assistance Programs (EAPs) and more.
Burnout solutions must align with your organizational goals and demographics. I mentioned that industries like higher education and healthcare have different forces at play, which need to be accounted for in a burnout strategy. It can be a challenge to know where to begin but expanding on current offerings can be an easy first step as well as surveying employees to understand what services would be considered value-add to most participants. The key is to know burnout is negatively impacting your population and if unaddressed it will compound an already burdened attraction and retention strategy. The time is now to make it a priority and find solutions.
1https://thrivemyway.com/burnout-stats/
2https://www.gallup.com/workplace/237059/employee-burnout-part-main-causes.aspx
Executive Summary
Musculoskeletal (MSK) conditions are a driving force behind healthcare spending, representing an estimated 17% of all spending in the US healthcare market. In addition, MSK conditions are the leading contributor to disability worldwide.1 Some examples of MSK conditions include osteoarthritis, rheumatoid arthritis, osteoporosis, sarcopenia, back and neck pain, and fibromyalgia.2 MSK pain may be acute or chronic, localized or affecting the entire body.3 Additionally, conditions may or may not be related to work, creating an added layer of difficulty in understanding the condition and addressing individual patient needs.
Many models currently exist that attempt to control costs related to MSK conditions. While the vendors providing these programs are confident in their success, it can be difficult for employers to select a program that addresses the needs of all employees with relevant conditions. Therefore, a thorough and ongoing review of organizational health data is necessary. For example, what a hospital needs in an MSK program may vary greatly for an employer operating solely out of an office setting. When reviewing workers’ compensation claims, how many are MSK related? If there is a concern, employers may want to start by implementing ergonomic reviews where the employee works to ensure there is nothing at work that is negatively impacting the employee. Other attempts to address MSK costs focus on care and treatment after the injury or disorder exists such as overall wellness programs, one-on-one coaching, and digital physical therapy offered as an employee benefit.
What is the impact on healthcare spend?
– Musculoskeletal (MSK) conditions are the top cost driver of healthcare spending, followed by heart disease, cancer, and diabetes.
– The average health cost per member with MSK condition increased by 40% between 2010 and 2019.
– COVID-19 aggravated this trend as more workers shifted to remote work; 70% of employees with MSK conditions experienced new or increased pain.4
-The Department of Labor’s Bureau of Labor Statistics estimates that about 30% of workers’ compensation injuries fall under MSD.5
As costs have increased, traditional approaches to treating MSK conditions have not shown a corresponding improvement in patient outcomes. This may include surgery, advanced imaging, injections, and pain management.6 It may be time to consider alternative treatment options to appropriately address these rising costs and employee pain levels.
What alternative models exist?
As employers, employees and providers begin to understand that traditional treatment options may not be the best approach for specific cases, alternative approaches have grown in popularity. Workers’ compensation claimants receiving opioids dropped from 55% to 24% between 2012 and 2018, while there was a 131% increase in the use of massage to address chronic pain, a 26% increase in the use of orthotics, and a 15% increase in the use of physical therapy, according to the National Council on Compensation Insurance (NCCI).7
Employers who have identified a significant impact of MSK conditions on their claim costs should seek programs that can be added to their benefit offering. There is a large market for these alternative treatment options, some components of which are listed below:
- Digital physical therapy clinics using wearable technology
- Pain relief wearable technology
- Custom physical therapy programs and coaching, in person or remote
- Case review by leading medical providers
- Therapy addressing psychology and education of conditions and pain
- Remote work ergonomics
- Focus on chronic pain management
- Corporate wellbeing programs
Specialty MSK vendors track data that implies overall success including a 50% to 70% reduction in pain, 40% to 75% reduction in anxiety and depression, increased adherence and participation in programs, surgery avoidance, and return on investment for employers.
What should I do as an employer interested in an MSK program?
Employers must begin by understanding the cost associated with musculoskeletal conditions within their population, as well as the range of conditions employees may be experiencing. If costs (medical and pharmacy) are significant or increasing, employers should consider alternative programs that would benefit employees and the plan. Identifying a pattern may demonstrate the need for a specific approach like preventive programs or ergonomic assessments.
From there, market research will be necessary to understand pricing and select a vendor with the best program for your population. Spring’s consultants are here to help with market research, claims and data analysis, and/or a Request for Proposal (RFP) process so that you find a solution that best meets your organizational needs.
1https://www.businessinsurance.com/article/00010101/NEWS08/912336312/Musculoskeletal-disorders-in-comp-highlight-prescribing-changes, https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
2https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
3https://my.clevelandclinic.org/health/diseases/14526-musculoskeletal-pain
4https://healthactioncouncil.org/getmedia/a738c3c5-7c23-4739-bb8d-069dd5f7406b/Hinge-Health-State-of-MSK-Report-2021.pdf
5https://www.businessinsurance.com/article/00010101/NEWS08/912336312/Musculoskeletal-disorders-in-comp-highlight-prescribing-changes
6State of MSK Report 2021, Hinge Health
7https://www.businessinsurance.com/article/00010101/NEWS08/912336312/Musculoskeletal-disorders-in-comp-highlight-prescribing-changes
Coming out of our COVID haze, it can be difficult to remember a time when employers could be truly strategic and proactive without priorities evaporating due to lockdowns, staffing shortages, travel bans or taking a U-turn due to pressures in other areas of the business. The time is now to pivot back to your strategic plans related to employee benefits. We recommend the road to an optimal benefits program be lined with solutions to specific pain points and cultural considerations at your organization. However, I advise at least considering the following within your strategic roadmap to see if they are a fit and can close gaps within your current program.
1) Employee Surveys
Priorities within your workforce have likely changed considerably in the past two to three years. If you haven’t asked employees about their priorities related to employee benefits, it is time! Some of your more traditional benefits or office-affiliated perks that may have been linked to attraction and retention in the past are no longer a value add to employees. It is not enough to talk about perks and flexibility; needs must be better understood to ensure you are providing something that actually attracts and retains talent, instead of the
2) Lifestyle Accounts
Financial accounts within employee benefits are not new (e.g., a Flexible Spending Account), but recently employers have started using these account-based perks in different ways to fill a gap that exists in their offering while providing ultimate flexibility. These accounts are taxable but can be used within the parameters set by the employer. Organizations may use them to support just about anything, but common categories today include:
– Medical procedures that may not be covered within the medical plan (i.e., infertility services, elective procedures, etc.)
– Travel expenses for medical services
– Family-focused benefits (i.e., doula, etc.)
– Legacy wellness support (i.e., fitness equipment, fitness classes)
The beauty of these services is that they can be selected based on employee needs as well as organizational culture and budget.
3) Absence Policies and Processes
Diversity, equity, and inclusion (DEI) are at the top of the list of internal initiatives, and goals are uniquely defined based on how much progress has already been made. It goes without saying that DEI is critical to the success of all companies, but I think a key area of DEI that requires some additional attention is your corporate absence strategy. Over the past few years, organizations have developed additional absence policies around COVID-19 and Monkey Pox, but there has also been a large push toward more family-focused leave of absences surrounding bereavement, parental leave, and the like. It’s important that DEI initiatives within employee benefits focus not only on the services but also on the time off that may be required, and viewing this through the many lenses of your diverse workforce.
4) Oncology Support
As benefits professionals, we have worked diligently to identify point solutions for high-cost and highly disruptive conditions. While point solutions continue to be part of a strong strategy, most employers have or will see an increase in oncology prevalence and spend due, in part, to expensive treatments but primarily driven by disrupted or delayed care and screenings.
Initial concerns with COVID-19 not only decreased primary care visits but snowballed, as providers later had limited appointments available due to overwhelming demand, which has translated into undiagnosed cancers. Now as participants are getting back to their primary care physicians, many cancers have progressed further or upstaged, creating the need for more intense and complex treatment.

In addition to the direct cost of cancer care, employee productivity is significantly less after a cancer diagnosis, even if that diagnosis is within their extended family.
Spring encourages employers to seek a proactive and holistic approach to oncology support, including some or all the following:
– Monitor screening engagement
– Encourage prevention including reminders and other communications; consider incentives
– Educate and support initial and ongoing care decisions
– Concierge support
– Clinical support
Of paramount importance is to educate and engage employees before a diagnosis, so they know where to go for initial support. Those first few weeks after a diagnosis are critical to setting the stage for appropriate treatment and clinical review and/or second opinions. There are some free and buy-up options in the market provided by top-tier cancer care providers/facilities. Those have brand recognition and are designed to provide unbiased support but, in many cases, they also funnel patients to their service centers. Another consideration available is point solutions that are agnostic to cancer care providers/facilities and provide concierge support but do have an add-on charge, typically as a per employee per month (PEPM) or per referral model.
5) Healthcare Disparities
One of the most complex items that should be on your roadmap is to examine what healthcare disparities exist in your population. For starters, ensure multilingual communications are available to close healthcare gaps for those with language barriers. From there, it is important to begin to stratify your population – if your size warrants – and begin to examine if health outcomes are impacted by race, location, earnings, and/or other social determinants of health. This strategic initiative must be performed in collaboration with your insurers and third-party administrators and will take dedicated time to set a methodology and refine your findings over time. The key is to at least get started by looking at the data and talking about how you can improve your understanding of the current state to work toward better data in the future.

Setting the strategic plan for your employee benefit package should be customized to your organization’s priorities and complexities that are identified through claims experience and survey information. Given each organization has its own culture, demographics, and business priorities, it is impossible to set a perfectly standard list of considerations when it comes to your employee benefit strategy. But as you drive toward the best vision for your company – off in the horizon – be sure to stop along the way to check out these five hotspots of benefits planning.
Spring frequently helps employers assess different solutions, plans, and programs and build them into their roadmap. One client, edHEALTH, is currently organizing three solution committees to refine areas of opportunity and prioritize solutions based on demand and change readiness.
With healthcare costs skyrocketing and employee needs shifting, many employers are examining how they can save money while still providing strong benefits packages. Last week I spoke at the Vermont Captive Insurance Association (VCIA)’s 2022 Annual Conference on current medical stop-loss market trends and how captives can help cut costs. My fellow panelist, Tracy Hassett, President of edHEALTH, a collection of educational institutes and client of Spring’s spotlighted their captive which has seen significant savings.
Cost of Healthcare
Healthcare costs keep climbing for both employers and employees and our actuaries predict an increase in medical trends for 2022 between 4%-7%. Looking back further, within the past decade healthcare costs have risen roughly 80% for employees and 60% for employers while economic growth has been consistent at 2.5% annually. This increase in costs is coming from a range of factors including administrative expenses, prescription drug prices, increased utilization/deferred care, and risk-based capital of insurers.

We are also seeing a transition in what employees want out of their benefits packages. Our working population is changing; boomers are retiring and transitioning from employer health insurance to Medicare. Millennials have different needs and are looking for straightforward and convenient benefits without high costs. These shifts in healthcare priorities along with high costs have slowly made self-insurance the norm, with a Spring survey reporting 64% of all employers are now self-insured.
When looking at the healthcare market the vast majority of pharmacy spending is through pharmacy benefit managers (PBMs). Employers estimate outpatient pharmacy to be about 18% of health spending, with an additional estimated 10% within medical claims. Also in 2020, overall drug spending rose by almost 5%, with utilization and new drugs driving most of this increase.

Self-Insurance
We are seeing a fundamental change in the healthcare market, and all parties within the healthcare continuum are being asked to handle risk and chase healthcare dollars. This has pushed many employers to move towards self-funding plans which allow for greater customization, more control over risk, and potential cost savings. Many of these self-insured programs are looking at putting medical stop-loss into a captive, with a Spring survey reporting that although less than 50% of self-insured programs have stop-loss coverage, 42% of those that do have it within a captive.
Within the COVID era we have also seen many changes in the industry and numerous employers are reevaluating their healthcare packages. There has been a giant spike in mental health and COVID-19 resources like telehealth, and a decline in elective surgery. These trends have left hospitals and providers with the short end of the stick, leaving self-insured employers and health plans as the parties saving the most in the insurance landscape.
Case in Point: edHEALTH
Tracy Hassett led the case study portion of the presentation, with edHEALTH being a prime example to of a captive successfully yielding savings in healthcare costs as well as flexibility of options. edHEALTH is a consortium of 25 higher education institutions who came together (originally as a group of six schools) to bend the trend in rising healthcare costs. Today, edHEALTH covers almost 15,000 employees (~30,900 lives) and aim to better understand and control their healthcare costs and risk. Tracy explained edHEALTH’s captive structure and how the captive retained savings of $6.7M since inception through 2020, in addition to paying out $3.2M in dividends.
These universities all have similar risks when it comes to healthcare, so investing in a group captive was the ideal solution. Each member chooses their own level of risk and pays for their own claims (below the established self insured retention level [SIR]), but still has control of their program. Tracy continued to explain how prescription drug costs are one of their largest challenges when trying to save money in creating/reevaluating healthcare plans. However, with their captive in the past four years edHEALTH members have saved an estimated $50M on Rx costs.

All in all, I was honored to join in the thought-provoking discussions that took place at VCIA. Since medical stop-loss is one of the biggest areas of focus for our clients right now, it was a pertinent conversation and I was glad to have the opportunity to share my perspective, as well as the success of edHEALTH. Burlington remains as perfectly quaint as ever, and I look forward to next year’s event.
We are all feeling the impacts of inflation, and as the word “recession” continues to be a popular one among political, economic and social conversations, we thought we would sit down with our captive insurance experts (Karin Landry, Prabal Lakhanpal and Peter Johnson) to get their two cents on how a possible recession or economic downturn interplays with risk and financial management tactics, with a focus on captives. Here’s what they had to say.
1. What are some possible impacts of a recession on captive insurance companies?
Peter: Changes in risk profiles driven by economic changes (examples include commercial auto frequency moved down then up, cyber ransomware on the rise, healthcare workers’ compensation programs utilized, excess liability/umbrella rates increased substantially, etc.). This also impacted the commercial market and captives often stepped in to fill the gap.
Prabal: Changes in exposure units: a recession may lead to reduction in workforce and therefore a change in insurance spend. On the employee benefits side, during times of uncertainty we typically see an increase in disability claims as well as a spike in usage of health insurance. When taken together with the change in exposure units, benefits programs may see a reduction in performance.
Karin: A continued increase in captive interest. Clients are looking at different ways to save money during a recession. For those organizations that already have captives, risk managers will need to prove the value of the captive, as typically there are a lot of dollars funding reserves that management wants access to in order to improve cash flow during a period like a recession.
2. Are there steps captive owners can take to safeguard their captive against a recession? If so, at what point should they implement them?
Peter: We recommend having service provider and reinsurer relationships in place to be enable the ability to make quick changes and file a captive business plan change to adapt according to the market.
Prabal: For existing captives, we advise undertaking a captive optimization or “refeasibility study” every few years, and this will be especially important if we enter a recession. This process assesses captive performance against original goals, aims to realign the captive according to changes in corporate objectives or priorities, evaluates impacts from recent regulatory changes and/or market trends, considers additional lines, analyzes the domicile, and so forth. Captive optimization helps organizations understand the vulnerabilities of your captive and help you shore them up.
Further, have your actuaries undertake stress testing of the captive to ensure financial stability and consider getting rates as a captive, where appropriate. Then, implement a dividend return policy, which ensures that in the time of need, there is a clear outline of how the parent organization can access any surplus in the captive. Be careful here as you don’t want the parent entity drawing down the surplus so much that the captive loses financial strength.
Karin: Risk managers should determine whether or not their captives are optimally funded. They should calculate the value of the captive to the organization before it becomes a management issue. They should explore other lines of coverage to determine whether or not it will save money, improve investment income, and/or increase cash flow for the organization going forward.
3. How would a recession affect underwriting?
Prabal: Insurance companies have two main revenue streams: 1) underwriting income and 2) investment income. In a recession environment, investment income becomes less likely or harder to come by. Therefore, underwriters are laser-focused on ensuring underwriting income, resulting in tighter underwriting standards. For example:
Peter: Carriers often tighten underwriting standards and may refuse to underwrite certain risks and/or business types all together. We’ve seen this for certain casualty lines like cyber, GL, and excess liability. Carriers may also be forced to remove manual rate discounts and/or increase rates all together while narrowing coverage at the same time.
Karin: Because underwriting practices may tighten, risk managers must understand their organization’s risks better than the marketplace. You could find that your experience is better than the book of business at the carrier level. If this is the case, a captive may make sense.
4. What about reserving?
Peter: To the extent a carrier’s or a captive insurer’s reserves are in a strong position due to favorable experience, reserve releases can be expected and may offset some of the poor 2022 investment experience we’ve experienced. The opposite also holds for exposures with loss trend on the rise that are driving up overall loss costs.
Prabal: Actuarial stress testing of the captive also comes into play here to ensure stability and dividend return strategy so that there is a consistent approach.
Karin: For captives that book discounted reserves, changes in the discount rates will affect the level of reserves captives carry. For those lines of coverage that are sensitive to recessions like workers’ comp and disability, the impact of negative experience should be factored into the reserving process.
5. Could the economic environment cause changes in captive methodology or the lines placed within a captive?
Peter: We’ve seen captive owners become more interested in captive utilization particularly when they feel like carrier coverage and pricing is unjustified based on their own loss experience.
Prabal: Captive optimization helps with optimal capital utilization. In a recession where capital is scarce, companies benefit from being efficient with how they use it.
6. What sort of pressures might captives face during a recession in terms of loan backs or dividends to the parents, or any impacts on capitalization?
Peter: We’ve certainly seen dividend policies put into place for certain clients that have been hit harder during the recession than others. Some have looked to access their captive capital that was built up to significant levels over the years.
Karin: As noted earlier, management may see the reserves of the captives as a pot of money to access; proving the value of the captive negates that issue.
7. The Great Recession around 2008 caused a stall in captive formations. Do we think that could happen again?
Peter: It seems fairly unlikely to have a similar scenario to 2008 since a portion of the collapse was driven by extremely poor mortgage underwriting standards in place. But anything is possible.
Prabal: Further, unlike in 2008, the commercial markets are still in a hard market cycle. This will likely be accentuated in a recession and therefore yield an increase in captive formations.
Karin: Because capital is scarce during a recession, this may spur the use of cell captive programs as opposed to pure captives to meet the needs that risk managers have to control costs and minimize price increases.
8. Anything else related to economic volatility that captive owners and risk managers should keep in mind?
Prabal: One thing would be the potential to free up captive capital by using loss portfolio transfers. The current interest rate environment is likely to create a preferential market for these opportunities.
Karin: Organizations’ hurdle rate might change as a result of the recession. This would necessitate looking at the opportunity costs associated with captives and their reserving process. Additionally, organizations should evaluate their insurance partners to make sure they are sound as they will be grappling with some of the same recession issues noted here. I wouldn’t be surprised if some of the insurers experienced difficulties and either left the marketplace, contracted and changed the coverage levels that they offer, and/or focused in on certain risks while excluding other risks from their policies in accordance with market shifts.
Our Chief P&C Actuary, Peter Johnson participated in a panel discussion at the Vermont Captive Insurance Association (VCIA) Annual Conference on hard-hitting solutions to hard market concerns. Check out this article in Captive International which summarizes key points of the discussion.
The Challenge
A mid-sized (over $1B in annual revenue) architecture, engineering, construction and consulting firm was utilizing an industry group captive to underwrite their workers’ compensation, general liability, automobile coverages and subcontractor default risks. The organization requested Spring to help assess whether the group captive solution was still optimal and to help shape their risk management strategy. As part of this review, we assisted them in considering the pros and cons of exiting the group captive program to form their own single parent captive. To support this decision, we helped them understand both the financial implications and qualitative factors they should contemplate and the implications of this change.
The Process
Spring began by undertaking a total cost of risk assessment at the line of business level for workers’ compensation, general liability, excess general liability, professional liability, subcontractor default, and medical stop-loss insurance lines. The purpose of the study was to explore the universe of options available to the client and included a high-level review of potential risk structures, retention levels, domicile options and reinsurance/fronting options. In addition, Spring commented on the competitiveness of the existing framework, generating a robust view of the advantages and disadvantages of the different solutions, and provided recommendations as to how best to move forward.
Spring’s Solutions
Spring implemented a multi-step approach that included the following:
- The Quantitative Analysis: Creating a total cost of risk comparison between the previous group captive and proposed single parent captive structures for each line to understand program cost savings. The key steps include:
- Analyzing loss and exposure data
- Developing expected claims at various retentions
- Defining operating cost assumptions (other than retained loss)
- Modeling captive company Proforma balance sheet and income statement
- Estimating captive capital requirements
- Obtaining brokerage quotes at the analyzed client retention levels to determine optimal retention level and the anticipated market savings that go with it
- The Qualitative Analysis: Evaluating non-financial factors such as risk distribution, domicile, regulations, administrative requirements and the positives and negatives for each captive solution. The key steps included:
- Evaluating the required structure to meet appropriate insurance tests, like risk shifting and risk distribution
- Evaluating differences between the home state and other potential domiciles
- Conducting a deep dive into the various service provider functions and requirements
- Completing a policy review to outline potential changes to coverage terms with a single parent captive
- Providing a pros and cons analysis for a single parent captive versus the current group captive structure. Some of the benefits of each are as follows:
- A single parent captive model allows additional flexibility in coverage option including medical stop-loss, more control over funding structure and selected services and risk control programs, and the ability to take full advantage of a favorable long-term loss profile
- The original group captive structure offers favorable pricing over commercial markets for certain lines in the near term due to large, self-insured retentions and economies of scale by mixing in the risk of other large insureds with similar risk profiles. It also allows access to certain safety management and other services (if desired)
- Reporting of Results: Preparing and presenting a report highlighting the financial and non-financial differences to enable the client to make a fully-informed decision to either move forward with implementation or stay with the existing captive.
- The Client Decision: After thorough fact finding, analysis and comparisons, and communication with the client, the decision was made to form a Vermont-based single parent captive. To move the process forward, we created an actuarial captive feasibility study, a captive business plan, policy forms and other documents to be submitted to the Vermont regulators. There was initial uncertainty over whether the client would still receive required risk distribution, as there was a change in the third-party risk profile with a single parent captive. However, the accounting and tax team concluded that the new entity, based on the selected coverage structure and underlying insured exposures, still qualifies for risk distribution and can be treated as an insurance company
- Next Steps: Spring began quarterbacking the client through the implementation process once they decided to form their Vermont single parent captive, which involved the following:
- Preparing an actuarial captive feasibility study and worked with the selected captive manager on the application material for submission to the Vermont department of insurance
- Assisting in the selection of service providers for the captive
- Providing ongoing actuarial and consulting services to the parent company and their captive to ensure that they are aware of all possible insurance solutions available and are informed in their insurance choices
Ongoing Success
In the current challenging market conditions, a captive solution is a powerful tool to have during renewal negotiations. Even if it isn’t implemented immediately, having the captive option available provides a competing solution to traditional carriers. Even for coverages not insured through the captive, the client will have increased bargaining power and may receive better offers from traditional insurers. Most importantly, moving from a group captive to a single parent captive has provided the organization the opportunity to use a captive solution to support other aspects of their business. For instance, by adding medical stop-loss to the captive, they will be able to generate additional savings for the HR teams, allowing increased support for employee wellbeing and resources to implement additional wellness initiatives.
In summary, the client chose the solution that provides them flexibility, over maintaining the status quo of their group captive, and enables the parent company a recoup of profits, particularly as it builds surplus over time, that would otherwise go to the group captive and excess carriers. As the captive matures, the client is also expected to receive captive profits back as dividends and be able to further increase self-insured retentions. We will continue to provide insurance consulting (both captive-related and beyond) to the parent company and lead them through the initial year of single parent captive strategies.
Whether or not we have seen the worst of The Great Resignation, savvy employers are not new to adjusting their benefits and “perks” programs to better align with workforce desires. At the Disability Management Employer Coalition (DMEC) Annual Conference last week in Denver, I spoke specifically on whether Flexible Time Off (FTO) has taken over as the frontrunner, versus the more traditional Paid Time Off (PTO) approach. I thought you might be curious to know the answer, at least in my opinion, so I’m jotting down the key points from my presentation here.
Background
As with so many things in business and in life, in order to clearly understand the current state of PTO, it’s critical to look back at the history of the concept. In 1910, President Taft proposed 2-3 months of required vacation, “in order to continue his work next year with the energy and effectiveness which it ought to have.” Countries like Germany, Sweden, and others were no strangers to this idea, and set forth on setting global standards regarding minimum levels of vacation. Today, the U.S. is one of only six countries in the world – and the only industrialized nation – without a national paid leave policy. So, what gives?
At least on paper, Americans seem to prefer work over vacation. You may be laughing or rolling your eyes, but it is a fact that significant time off goes unused at the end of the year (people choose to lose it rather than use it). In some cases, this may be the result of a corporate culture that, while they may document PTO programs, do not actually encourage the use of that time. If you’re expected to work while on vacation, you may not feel it worthwhile to take said vacation.
PTO
Over the years additional policies popped up to fill some of these gaps, such as leave related to COVID-19, sick leave, disability, parental leave, and family leave. Many organizations arrived at a PTO program in which an allocated number of days account for different types of leave which vary by employer, but might include vacation, bereavement, sick and personal leave. While this creates efficiency and reduces unscheduled absences, this design (perhaps inadvertently) encourages working while sick, as employees do not want to use days within their bucket when they have a cold, since those same days could be used on a tropical vacation or, on a less happy note, in the case of a personal or family emergency. This flaw went from acceptable to unacceptable in light of the pandemic, and turned some organizations off of PTO and on to FTO.
FTO
Flexible Time Off (FTO) allows for ultimate flexibility in the volume of “vacation” time taken. With the expectation that employees do their jobs, meet deadlines and achieve their individual and corporate goals, time for rest is scheduled at the discretion of managers. FTO however is not to be confused with unlimited vacation days. While a nice idea, some challenges exist around FTO, including:
- FTO plans are unlikely to meet the needs for vacation plans and sick/safe plans, and are not recommended to fulfill all of these requirements given federal and state law complexities
- Performance management and manager training is critical with this design
- Be careful about creating guidelines around the number of acceptable days off, because it can quickly morph into a PTO plan with wage liability
- Participation in FTO plans for non-exempt employees is not recommended as it will result in payroll obstacles and litigation susceptibility
Given these factors, however, FTO plans can be a powerful organizational tool. If you’re considering FTO, I recommend first answering the following questions:
- Which population should be considered for FTO?
- What approach will ensure managers are managing workload instead of time off?
- What scheduling and approval processes will be implemented?
- How will you ensure employees have the opportunity to leverage their FTO?
- Are you accounting for sick/safe requirements through another policy/program?
- How will you answer to the stigma that FTO is designed to decrease utilization and save you (the employer) from PTO liability?

The Big Reveal
FTO can bring a lot to the table for an organization: it is unlikely to result in more time off (than before), it is financially savvy, a good recruiting tool, and relatively easy to implement. On the flip side, however, I noted some real challenges. In the end, and if you read this article for the clickbait title, my investigative answer is no: FTO is not the new PTO. It should however be considered as one tool within the absence management toolbox, and assessed according to your individual employer needs and priorities.
After a short hiatus, The Disability Management Employer Coalition (DMEC) was able to host their 2022 Annual Conference in-person for the first time since the pandemic started. DMEC is one of the leading organizations in the paid leave industry and their annual conference brings together employers, vendors, government officials, lawyers and more to network and discuss leading trends in the business. This year also marked the 30th anniversary of the creation of DMEC, furthermore solidifying itself as a staple in the world of disability management. It was great seeing so many familiar faces from the industry and learning more about what’s keeping industry professionals up at night. This year’s conference took place in Denver, CO and Spring had the pleasure of both exhibiting and presenting.
Although this year’s conference covered a wide range of topics, I noticed the following three key themes.

1) FMLA & ADA Challenges
Although compliance is often a hot button topic at DMEC, this year there was a specific emphasis on maneuvering around FMLA & ADA challenges. Presenters tackled FMLA & ADA challenges from a range of angles including changes in guidance, a Q&A with federal agency leaders, and a mock trial where the attendees acted as the jury. Some of the of the FMLA & ADA related presentations this year included:
- Helen Applewhaite, Director of the FMLA Division at the Department of Labor (DOL) was interviewed on employer challenges under these laws and key DOL and EEOC priorities in a session titled “A View from the Top: Current FMLA and ADA Challenges”.
- In a session titled “Recent ADA and FMLA Trials: Employer Wins and Losses,” experts included interactive polls where attendees could predict jury outcomes from previous FMLA & ADA trials.
- Lastly, compliance experts from ReedGroup and an Absence Management expert from The Guardian conducted a mock trial titled “Law & Order: DMEC Edition,” where presenters took roles of the judge, plaintiff, defense and plaintiff’s attorneys, and the attendees acted as the jury responding to employers breaking FMLA & ADA regulations.
2) Support for Caregivers and Healthcare Workers
Although COVID has settled a bit in severity, caregivers and healthcare workers are still facing high rates of burnout and overworking, without receiving much federal support. Also, in the past 50 years we have seen the highest rates of children and elderly parents in the home, often requiring some type of care, most often unpaid care by a family member. During this year’s conference, presenters tackled the issue of mental health for employees assuming the role of a caregiver and how employers can offer needed support. Below are some of the groundbreaking presentations tackling this issue.
- Experts from the Lincoln Financial Group explored solutions employers can adopt to support employees who act as caregivers in their “Caring for the Caregivers: A Key to Employee Retention” session.
- The Standard’s Dan Jolivet looked at common stressors healthcare workers face that lead to fatigue and turnover in the healthcare industry and brainstormed possible solutions in his “Costs of Care: The Impact of Stress and Compassion Fatigue on Healthcare Workers” presentation.
3) The Future of Leave
As we tentatively look beyond the COVID-19 era, there was a huge emphasis this year on what we can expect from the disability and leave management industry moving forward. During the pandemic many employers adjusted to remote/hybrid leave policies, introduced new mental health resources and navigated changing COVID regulations. But as we slowly move into a post-COVID world, many speakers, such as those noted below, looked at new-age alternative leave policies and what we can expect for the future of leave.
- Representatives from Unum explained how previous leave programs are not working for today’s workforce and a one-size fits all approach is not suitable for most employees in their “Leave Is Changing: Are You Changing With It?” presentation.
- Spring’s SVP, Teri Weber evaluated whether flexible time off policies could be a viable replacement for traditional PTO policies in her “Is FTO the New PTO?” session.
- Leave specialists from Brown & Brown, FINEOS, New York Life Group Benefit Solutions and Spring looked at “How [Employers Can] Harness Market Forces to Meet Future Absence Management Challenges.” Some of these market forces discussed included Instagram, the gig economy and federal paid leave policies.
a) Utilizing Tech & Data
When looking at the future of leave management, we are seeing a giant increase in leave related tech and software, which allows employers to better understand leave trends and preferences within their workforce. Although tech and data collection software are not new in the industry, we are seeing constant updates and an influx of new software that help measure different facets of absence management policies. Below are a few tech & data related sessions we wanted to spotlight.
- AbsenceSoft’s CSO and CCO showcased how data is key in managing eligibility, entitlement, workflow process and more, as well as common mistakes to avoid when designing a data strategy.
- One panel presented on “Improving the Employee Leave Experience through Technology”, in which they reviewed how tech can expedite the collection of medical documents, identify opportunities for wellness programs and more.
- When it comes to implementing Absence Software, it can be tricky selecting the right program. A discussion including CVS Health and CommonSpirit Health spoke on best practices when selecting and implementing a software-based solution.
b) Moving Past COVID-19
As many organizations slowly move back into the office, employers have been developing and reassessing return-to-work programs and reevaluating leave policies to keep their workforce happy. On a national level, we are seeing changes in COVID-related compliance and a big push to retain talented employees through enhanced benefits packages. Here are some noteworthy sessions related to adjusting to a post-COVID world.
- In a presentation titled “Life Beyond COVID: New Focuses for Absence & Disability Compliance”, representatives from Jackson Lewis review the long-lasting effects of new leave legislation.
- Experts from Voya Financial and FullscopeRMS’s Claims Director, Katie Hunt shared recent research to help enhance leave management and return-to-work programs.
- Another panel including DMEC’s CEO, Terri Rhodes tackled feedback and questions from the audience on challenges for absence management teams, return-to-work programs and ADA accommodation processes.

All in all, being back at the DMEC Annual Conference in-person was a powerful experience! This year I saw so many young and enthusiastic faces which is a good sign for the future of the industry. DMEC never fails to provide innovative insights into the absence and disability management landscape while providing a fun and interactive experience, and I am already looking forward to their next event.