Spring Consultant Grace Giannattasio offers program highlights one year into eligible Massachusetts employees being able to apply for paid leave benefits under the Massachusetts Paid Family and Medical Leave policy. Check it out in this NEEBC blog post.

Karen English and Teri Weber explain how engagement is a key driver in absence management program success, and offer guidance on how to achieve that engagement in this article published in the Disability Management Employer Coalition (DMEC) Magazine.

In this BenefitsPRO piece, we offer our feedback on potential changes in the family and medical leave space based on Biden’s plans.

In this Boston Business Journal Q&A, Spring SVP Teri Weber shares her thoughts on how employers can meaningfully tackle mental health issues at the workplace.

Spring SVP Karen English and Alera Group’s Sally Prather are offering tips to enhance an absence management program in this BenefitsPRO article.

Dazed & Confused

Think about your last visit to the doctor. Did you know what questions to ask? Did you leave with a clear picture of the next steps or alternative options? Did you know the cost of your appointment and treatment path before starting it, or what would be covered by your health insurance? If you answered “no” to any of these questions, you are certainly not alone.

Bend Financial[i] recently conducted a survey that showed that only 29% of people were completely confident in their ability to navigate the healthcare system, whereas 56% were entirely confused when it comes to health insurance. Unfortunately, an alarming subset of consumers opt to avoid healthcare completely, too defeated by the complexity.

Beyond health insurance, employees must navigate the suite of benefits offered to them by their employer. While these are meant to provide support, they can cause more confusion when employees are looking for assistance. Employers must consider how introducing a new program or benefit will fit into their overall strategy and integrate the resources, without adding to the complexity employees face.

[i] https://www.bendhsa.com/newsroom/more-than-half-of-americans-confused-by-health-insurance-including-hsas

 

Breaking Through the Fog

Advocacy tools have popped up as a response to the confusing environment. These tools offer a wide variety of clinical, educational and administrative resources, such as:

The landscape for these platforms is robust and ever-changing. The spectrum of vendors include those that offer:

1. Holistic approach

Major players may provide all of the above features on a one-stop shop model for employees.

2. Preventive approach

Some vendors focus on prevention of common conditions, encouraging employees to get annual eye exams, diabetes screenings, cancer screenings, medication adherence, and more.

3. Targeted approach

This last category of vendors specialize in support for employees with common chronic conditions including diabetes, hypertension and high cholesterol. While likely not the most costly conditions, the potential for savings and member support is significant when factoring in the volume at play. These vendors aim for condition management by giving members the tools to monitor and manage their conditions better on their own, hopefully necessitating less emergency care in the future.

Comparatively, other tools focus only on the highest cost conditions and members, such as cancer diagnoses. Offering a specialized tool for members going through this difficult time enables them to procure the best and most cost-effective care, while also giving them access to resources related to nutrition, mental health, and more. While available on a standalone basis, advocacy solutions may also be accessible to employers through their insurance carriers, Third-Party Administrators (TPAs), or Employee Assistance Programs (EAPs). Programs embedded with a carrier or TPA tend to focus on overall health management programs, disease management and wellness, as well as resolving billing issues and comparing costs of providers. A commonality across platforms is the prioritization of the consumer experience – offering easy, self-service access in mobile apps or online portals. Members typically have a single point of contact at the advocacy company, so they know who to call and do not have to navigate being transferred or having an unfamiliar staff member pick up their case. Overall, for employees, health advocacy platforms may:

For employers, health advocacy tools can:

Advocacy Adoption: Is It Right For You?

Ultimately, it is up to the employer to determine what programs would best support their employees. Based on the 2020 Integrated Disability Management (IDM) Employer Survey conducted by Spring Consulting Group, 61% of employers offer a health advocacy solution today, compared to only 41% in 2018. Determining which model and which vendor to select can be difficult as there are many players in the market. In assessing whether an advocacy tool would be a good fit for your organization, any decision around advocacy solutions should be tied to program objectives.

Health advocacy solutions can provide cost savings to employers or health plans, as they direct employees to access only necessary healthcare services, perhaps at a lower cost facility than they otherwise would have used. A tool like this should, in theory, help avoid bigger, high-cost problems down the road by assisting the employee with addressing issues early. Certain vendors may even offer a cost savings guarantee. However, it will take time to see a possible Return on Investment (ROI). On the flip side, an advocacy solution can encourage greater utilization, such as for behavioral health services. While a higher utilization rate may mean increased claims, giving employees tools to access the services they need can lead to less emergent or high-cost care down the road. As such, you should determine if you are looking for immediate or long-term results.

There is a lot of logic behind the argument that an advocacy tool will increase engagement. However, if an employer has had trouble engaging employees in the past, such as in wellness challenges, incentives, education, etc., nothing is guaranteed. Vendors claim that anywhere from 30% to 80% of employees will participate in their program, but this is highly variable based on different aspects of the program and the employer, such as program features or employer incentives. 

By equipping members with the necessary tools to make health care decisions based on value and outcomes, better outcomes are achieved. The plan data will guide your decision related to population health management. For example if you are struggling with diabetes specifically, you may want to consider a targeted point solution focused on diabetes management before committing to a more comprehensive program that tends to be more expensive.

With an advocacy tool, members have support to mitigate confusion around healthcare services, surprise billing, complex diagnoses…but it only works if members leverage the support. Programs should be communicated often and where possible linked to activity within the plan. We always recommend eliciting employee feedback before launching a program such as this, to ensure you are solving for problems that really exist for employees, instead of problems you think exist for employees. Sometimes our clients even roll out a smaller pilot program as a test before implementing the wider solution for the whole organization.

Most organizations will have a few different goals at play, which are not limited to those listed above, but typically there is a hierarchy to consider. Working with a trusted advisor can help to understand key differences and ensure programs are designed to work for the employer and their employees. At Spring, we routinely help employers vet solutions to find the one that is optimal for their goals and population.

Conclusion

Overall, health advocacy tools have risen in popularity for a reason. They address critical problems in our healthcare system – confusion, expenses, access, lack of trust – and serve as a different avenue for employers to limit the rising costs associated with healthcare. Advocacy helps ensure employees are understanding the care they receive and have greater visibility into actual costs. While results will vary by platform and organization, vendors are confident in their results; they report significantly lower healthcare trend for clients, compared to previous years when there was no advocacy program in place. With an ever-changing landscape, it is possible that health advocacy programs can bridge the gap between consumers and care, but only time will tell if they can make a long-term impact on the market.

Employees bring their whole selves to work each day which allows for the highly efficient, effective, and creative workforce we enjoy. As Human Resource professionals we appreciate the diversity of our workforce and continue to adjust within our employee benefit programs to meet the changing needs of our employees and their families. Top employers know that thinking more strategically about caregiving will help them fight for top talent and provide the corporate culture employees are seeking especially in this more complicated caregiving landscape brought on by COVID-19. 

The concept of caregiving is not new but as our workforce evolves it is becoming more critical to consider caregiving as an area of opportunity within employee benefits. This shift, further amplified by the pandemic, highlights a cavern between top tier employers who appreciate the multitude of responsibilities employees must navigate versus those that hire people despite them.

The Rosalynn Carter Institute for Caregiving recently released Caregivers in Crisis: Caregiving in the Time of COVID-19. This thoughtful piece attaches hard data to the burden we have all experienced over the last 6 weeks. The data indicates that 83% of caregivers have increased stress since the start of the pandemic, and 42% have indicated that the number of other caregivers available to help them has declined. Caregivers themselves – in addition to those requiring care – are experiencing an increased burden from isolation, stress, financial concerns, and general instability.

Employers that are new to the concept can consider caregiving solutions as a continuum or suite of solutions; not a one size fits all approach or something that has to be implemented all at one time. A core offering typically includes:

Enhancements allow for 24/7 live support and paid time off when necessary to address caregiving emergencies.

Defining Caregivers

AARP estimates that each year approximately 40 million American adults provide support to others with basic functions (i.e. activities of daily living).  Many of those, including 75% of millennial caregivers are working. 
 
For millennials in particular the stress of caregiving can be more challenging since they are typically providing care for more hours in a week, making less money and having less support from other family members (i.e. reduced family size).  Also of note, millennials are the most diverse caregiving community to date (i.e., racially, ethnically and more likely to identify as LGBTQ+) which can be important to consider related to diversity and inclusion.

It is important to think broadly about caregiving solutions. In addition to introducing separate solutions, it is equally important to shift our mindset and expand common employer benefits that could be leveraged for extended family members (i.e. second opinions, medical guidance with challenging health diagnoses, etc.). The term caregiving must also extend beyond elder care of medical conditions but include children struggling with online school or developmental disabilities or Medicare eligibility and financial planning when moving into retirement. The goal of caregiving solutions is to support your employees as both caregivers and those needing care. 

We have all heard the announcement on the airplane about putting on your own mask before helping others; employer sponsored caregiving is building on that logic and allowing your employees to more efficiently:

Caregiving support as an employee benefit is still in its infancy. Unfortunately, many employers do not realize the need, the impact on employee performance and the demand that exists at the employee level. A 2019 Harvard Business School Study, The Caring Company, indicates that while only 24% of employers surveyed believed employee caregiving influenced their employees’ performance at work, 80% of employees surveyed admitted that caregiving had an effect on their productivity. In addition, 32% of employees surveyed indicated that they left a job because of their caregiving responsibilities. 

Employers who take a proactive position on caregiving support – along with the tools needed for successful roll out and measurement – will see a direct impact on attraction, retention, productivity, and corporate morale. 

If your organization is interested in exploring caregiving support as an employee benefit, or is ready to identify partners for a best practice roll out, please reach out to our team.   

Our Managing Partner and Senior Vice President, Karin Landry and Karen English laid out some of their predictions of what businesses can expect to see in 2021. Check out the HR Teach Outlook piece here.

According to SHRM, paid leave may have been 2020’s biggest workplace news.  A number of U.S. companies (between 27% and 52% depending on the study) expanded their paid leave benefits, with paid parental leave growing at a faster pace than paid family care leave. The states and jurisdictions of California, Colorado, Connecticut, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Washington, and Washington DC have passed paid family and medical leave (PFML) laws to date and at least another ten states are considering them. In addition, numerous localities have passed paid sick and safe leave laws. These can vary across cities and counties, even within a given state.

On a federal level, laws exist such as the Family and Medical Leave Act (FMLA), enacted in 1993, which affords unpaid job-protection, and programs such as the Fischer Tax Credit, the Federal Employee Paid Leave Act (FEPLA), and the Families First Coronavirus Response Act (FFCRA). Federal programs offer limited coverage as wage replacement and job protection may or may not be included in each law. A federal paid leave program is now seemingly supported by both democratic and republican parties, with the biggest difficulty being how to pay for it. 

In addition, and to complement paid leave policies, more companies are offering and triggering EAP and wellness programs than they have in the past. About a fourth of companies say they provide a caregiver benefit, separate from EAP, that might include flexible work hours, personal time, counseling services, free programs for finding and managing care, employer subsidized online resources, child, or eldercare. You can read more about the landscape for caregiver benefits here.

Taking these factors into account gives benefit professionals the opportunity to heighten the discussion with senior management, consider plan and policy design more holistically and determine administration that will minimize employee confusion, position managers for stronger engagement, and lead the organization towards better outcomes. 

Sources:

Leave and Flexible Working Survey, SHRM Employee Benefits, 2019.  Paid Time Off Survey, WorldatWork and PTO Inc., 2019. Integrated Disability, Absence and Health Management Survey, Spring Consulting Group, 2020.

Integrated Disability, Absence and Health Management Survey, Spring Consulting Group, 2020.

Data compiled by the Organization for Economic Cooperation and Development (OECD), 2018. 

Paying the Way, Large Employers and the State Paid Leave Patchwork, The ERISA Industry Committee, 2020.

Paid Leave: Exploring the Impacts to Other Benefits Programs, Spring Consulting Group and ClaimVantage, 2020