Do employees know where to go in a health crisis?

When talking to employers about their disability programs, I often ask, “Who do your employees go to first for assistance when they have a health condition?”

If I ask that question of a direct supervisor, it’s met with a quick response of “Me!”, which is quickly followed with the statement, “My employees know that my door is always open and I’m here to help them!”

Sadly, this is not true. The Standard recently surveyed employees who experienced a health condition in the workplace and asked that same question: Who did you go to for assistance? The responses varied.

For example, we found that at midsize companies with 100 to 499 employees, it varied:
· 44% went to their HR manager
· 33% went to their direct supervisor
· 18% went to their HR manager and direct supervisor
· 5% went elsewhere(204) 280-7195

What this shows is that many employers don’t have a consistent process in place for addressing employees with health conditions. This confusion or misunderstanding about whom to approach for assistance can create an inconsistent process for your clients and their workforce — potentially resulting in a negative experience for employees and lost productivity for employers.

Based on the survey findings, employees who worked with their HR manager tended to have a more positive experience and felt more valued and productive after speaking with them about their health condition.

For instance, 54% of employees felt uncomfortable discussing their health condition with their direct supervisor, versus only 37% of employees who went to their HR manager. In addition, 73% of employees who worked with their HR manager felt they knew how to provide the right support for their condition versus 61% of employees who worked with their direct supervisor.

There are several reasons why working with an HR manager can be more beneficial for employees, and ultimately, your clients. Typically, working with an HR manager can lead to more communication while an employee is on leave. Our research shows employees who worked with an HR manager were more likely to receive communication on leave and returned to work 44% faster than when they worked with their direct supervisor.

HR managers also are usually more aware of available resources and how to connect employees to necessary programs to help treat their condition. HR managers who engaged their disability carriers saw a 22% boost in employees’ use of workplace resources, such as an EAP, or disease management or wellness program, when involved in a return-to-work or stay-at-work plan.

This connection to additional resources is essential, as it can help employees receive holistic support to manage their health condition — whether it’s financial wellness support, connection to mental health resources through an EAP or one-on-one sessions with a health coach. HR managers also are usually able to better engage their disability carrier to provide tailored accommodations, which can help aid in stay-at-work or return-to-work plans.

Providing your client with these findings can help them understand the importance of creating a disability process that puts HR as the main point of contact. Not only does this create a consistent experience that helps provide employees with the support they need, it can improve employee morale and reduce turnover.

Jeffery D. Smith
Jeffery D. Smith is the Workplace Possibilities program practice consultant for Standard Insurance Company (The Standard), and has worked in the vocational rehabilitation field for more than 30 years.

How to help clients create association health plans



How to help clients create association health plans

New rules from President Trump and the Department of Labor expand the scope of (614) 338-0128, thereby creating a key opportunity for brokers to help clients who may benefit from the updated regulations.

The new rule expands who can participate in AHPs. This will allow more people to benefit from economies of scale in health insurance. Groups in the same metropolitan area no longer have to have a common business interest in order to form an association, and self-employed individuals will now also be able to participate in AHPs.

Offering coverage through an AHP can produce significant cost savings for your clients or prospects, but the group or sole proprietor will first have to join or form an association. It’s important that your groups get the regulatory and compliance aspects of AHPs right, which is why some of your current or prospective clients may already be asking you for advice on this.


To support these clients, partnering with an attorney will provide much-needed assistance.

Vetting a labor or ERISA attorney will allow you to provide another layer of support to clients interested in AHPs, but it will require some research. You will likely want to first interview at least two or three attorneys in your market, and ultimately form an alliance with one to assist clients who wish to create associations and ensure compliance.

Here’s how some brokerages are thinking about going about this, and a few steps to consider.

1. Identify relevant prospects

First, identify clients or prospects who may be interested in forming an AHP. You may want to start with franchising groups first. Traditionally, franchisees have had to pursue benefit plans for employees individually, and, as a result, many franchisors face a constant struggle to recruit new franchisees. Groups facing this dynamic may particularly benefit from the new AHP regulations allowing them to band together to offer health coverage.

Ask if these groups have thought about forming an AHP and if they would be interested in you doing some digging on it. If they would like more information, the next step is to engage an attorney.

2. Choose a lawyer to recommend

Call a few major law firms in your market and ask for attorney recommendations, as well as asking for referrals from any lawyers you already know or work with. Explain you are interviewing lawyers to find one who can assist clients with forming associations, and ask if they would be interested in that work.

During the consultation process, describe a situation one of your prospects is facing, and ask how the attorney would advise this client. To get the best information, ask if the attorney would be willing to write a one- or two-page memo as part of the evaluation process.

Last, and as with any external partnership, ask for the attorney’s references. Note that you should not need to pay the attorney for their time during this interview process — they should view it as business development time for them.

3. Circle back to clients and prospects

Once you’ve chosen a lawyer to recommend, circle back to the clients and prospects who expressed interest in forming an AHP. Explain what you learned, and share that you vetted multiple attorneys during your research. Offer to arrange a meeting with the attorney you felt was best suited to help them evaluate what would be necessary from a legal perspective to form an AHP.

This may seem like a lot of work on the front end, but the benefit is that you will have a significant competitive advantage in your market for all prospective AHP business.

With so many more businesses and self-employed workers now eligible to start or join an association and offer an AHP, this is an avenue of business growth worth considering.

Alex Tolbert
Tolbert is the founder and CEO of benefits administration platform & HR software company BerniePortal.

(740) 253-5663



How climate change is impacting mental health — and what employers can do

Driven by climate change, an increasing number of extreme weather events are making the news. All-time high-temperature records were set throughout much of the U.S. in July, four major winter storms buried the Northeast earlier this year, and much of south Texas is still rebuilding from the devastation of recent hurricanes.

Extreme weather damages more than buildings and forests, however. A recent analysis by the Centers for Disease Control and Prevention examined the effects of heat stress on outdoor workers, while a study published in Nature Climate Change found greater use of depressive language in social media when the temperature rises, as well as an increase in the number of suicides.

New research from the Integrated Benefits Institute goes even further, showing how often employers’ short-term disability insurance policies incur claims for several conditions impacted by climate change. These result in lost income for employees and lost productivity for employers and society-at-large — all of which may become more severe in the wake of extreme climate events. Our analysis found:

· Overall, about 1 in 20 U.S. employees with short-term, non-occupational disability insurance had a claim for leave in any given year.
· Collectively, anxiety disorders, acute stress reaction, adjustment reaction, depression, ischemic heart disease, heart failure, cerebrovascular disease, respiratory infections, upper respiratory disease, pneumonia and asthma/COPD comprised about 1 in 7 claims for short-term, non-occupational disability leaves.

All this considered, it’s vital employers take action as climate change impacts the health, productivity and well-being of their workforce. Our findings suggest that productivity losses due to absences may continue even after business operations have recovered from an extreme weather event. For that reason, the operational impact of extended absences should be incorporated into existing risk assessments and business continuity plans.

Including coordinated absence management policies and employee assistance programs as part of a company’s disaster recovery strategy can help mitigate some of these longer-term productivity losses — particularly if information about these services is shared with employees as part of a company’s emergency communications toolkit. Healthcare and disability carriers also can be important partners in business continuity plans by providing guidance on benefit and pharmacy-related questions and extending call center hours for members and providers.

It’s also important that employers develop a better understanding of their particular risks for conditions impacted by different types of extreme weather events.

While IBI’s analysis shows that some climate-impacted conditions are more common in some states than others, a closer analysis of changes in leave rates for specific diagnoses following localized extreme weather events — such as hurricanes, heatwaves, droughts, wildfires and flooding — is warranted.

Brian Gifford
Brian Gifford, Ph. D., is director of research and management with the Integrated Benefits Institute in San Francisco.




Lawmakers take aim to end taxing of benefits for nonprofits

Sen. James Lankford, R-Okla., and Sen. Ted Cruz, R-Texas, have introduced separate pieces of legislation set to eliminate tax burdens that many churches and nonprofits are subject to following the passing of the Tax Cuts and Jobs Act in December, 2017.

The Lessening Impediments from Taxes for Charities Act and the Protect Charities and Houses of Worship Act would repeal a provision that requires tax-exempt organizations to pay federal taxes on employee fringe benefits such as parking, meals and transportation.

This would require churches to fill out IRS Form 990 – the Return of Organization Exempt From Income Tax. This form provides the public with financial information about a nonprofit organization and would make the organization tax exempt from these fringe benefits.

St Patrick's Cathedral Manhattan, New York CitySt Patrick’s Cathedral Manhattan, New York CityGetty

This could also open up nonprofits to other government tax forms such as IRS Form 8868 — used by tax exempt organizations to request an automatic six month extension of time to file its returns — or Section 125 Premium-Only-Plans — a cafeteria plan that allows employees to pay their health insurance premiums with tax free dollars.

Benefit advisers are split in terms of whether or not these new pieces of legislation would help or hinder nonprofits and their benefits. Robson Baker, employee benefits and HR adviser for Clarus Benefits Group in Houston, Texas, says while he has not seen much action taking place in Congress regarding the legislation becoming law, he has begun to inform his clients of the bill and how they should start preparing themselves.

Also see: “How employers are responding to IRS Affordable Care Act penalty letters”

Because the legislation is still in its infancy, many of Baker’s nonprofit clients are unfamiliar with it and do not have a clear plan of action should it become law. Baker says this bill could lead his clients into unfamiliar territory when it comes to filing procedures with the IRS, causing smaller organizations to pay outside bookkeepers with money they may not have readily available.

“A lot of these nonprofits are going to be burdened with additional preparation and staff time,” Baker says. “Many operate off of volunteerism from bookkeepers because not all of these nonprofits are going to be large organizations that have a large staff of professionals who could handle the process.”

Baker refers to organizations such as nonprofit hospitals that have multiple sources of income including religious affiliation, charities and research or educational funds. These organizations receive the most scrutiny from policymakers, arguing whether they provide enough community benefits that justify forgone government tax revenues.

Other advisers, like Chris Corkran, national sales director at National Insurance Partners, says the tax filings could be the necessary sting nonprofits need to feel in order for them to reevaluate other benefits such as their health plan offerings, allowing their advisers to offer more innovative solutions.

“A lot of these smaller organizations are on ACA community rated plans and they simply cannot afford them any longer,” Corkran says. “A little pain allows us to come in and offer outside the box solutions to save them a fair amount of money off of their current plan design.”

These community ratings Corkran refers to requires health insurance providers to offer insurance policies within a given territory at the same price to all persons without medical underwriting, regardless of their health status.

A closer evaluation of the legislations, by The Christian Post, shows various repeals of paragraphs in the Internal Revenue Code that would affect nonprofit entities.

Cruz’s bill — Protect Charities and Houses of Worship Act — repeals paragraph six and seven of Section 512 of the IRC, while Lankford’s bill only repeals paragraph seven.

Paragraph six creates the special tax reporting rule for unrelated business taxable income and paragraph seven details what constitutes as unrelated business taxable that is disallowed fringe, such as parking and transportation.

Paragraph seven has specific language that states that, “unrelated business taxable income of an organization shall be increased by any amount for which a deduction is now allowable.”

Repealing paragraph seven could void paragraph six. However, House Ways and Means Chairman Kevin Brady, R-Texas, has defended the provision to tax fringe benefits, saying that it is a matter of fairness.

“It is about treating a nonprofit hospital the same as you treat a for-profit hospital,” Brady says. “We think the parity issue, the fairness issue is right.”

Bret Brummitt, senior consultant at AG Insurance Agencies and a former church pastor, says he ran his church as a 501(c)3 under the Internal Revenue Code allowing for federal tax exemption of his nonprofit as a public charity or private foundation.

As a small nonprofit, Brummitt says his church would not have been impacted by paying taxes because the amounts were not that hazardous to the community’s finances. “We didn’t have a huge amount of giving or expenses,” Brummitt says. “We also didn’t own property as we rented space from a museum and often relied on volunteers without paid staff.”

With little to no movement so far on either piece of legislation since their inception, Baker and Corkran agree that there is still a long way to go before either bill is suitable for law, should they even get that far.

Cort Olsen

What Atul Gawande can learn from the nation’s leading employers



What Atul Gawande can learn from the nation’s leading employers

As the new CEO for the BHA healthcare consortium, Atul Gawande, MD has just begun his national listening tour with employers and employees alike. In his new role, he is expected not only to encourage and shape new ways of thinking about healthcare delivery, payment and access, he’s expected to shift the lens onto the role of the consumer and the importance of the patient-physician relationship. One of Dr. Gawande’s key strategies to reduce healthcare costs is to reduce waste in the system — not on the supply side, but on the demand side. If he listens carefully to some of our nation’s leading employers, he’ll learn some have already figured out a way to do just that.

Eliminate unnecessary care
Today, nearly 15% of patients experience an incorrect medical diagnosis that subsequently leads to unnecessary care. A recent Mayo Clinic study found that among patients who come to the clinic for a second opinion, an astounding 88% leave with a new or refined diagnosis. Even when they get an accurate diagnosis, patients often experience ineffective and inefficient treatment regimens. This represents an incredible opportunity to eliminate waste in our healthcare system.

Several large employers have already realized that getting the diagnosis and treatment correct the first time is key to saving money, but more importantly, vital to getting their employees healthy and back to work. Our internal data shows that the majority of patients who seek an expert second opinion have a change in their initial diagnosis 25% of the time and a change in their treatment plan 65% of the time. This suggests their initial provider did not provide top quality care, with the potential for wrong tests and treatment. For this reason, more employers are now offering second opinion services as an additional employee benefit. Second opinion services are becoming mainstream: NBGH statistics show that 66% of employers now offer them, an increase of 47% over last year.

Help employees find top quality providers
Workers need more than just access to a second doctor with another opinion. High quality, patient-centered care starts with having a high-quality physician, as physicians have significant influence over treatment options and clinical outcomes. Unfortunately, when left to their own devices, employees don’t have the tools and support to find high-quality providers. Transparency on physician performance data is sorely lacking, and while employers promote their health plan websites and premium designation provider listings, patients can’t comprehend what this data means.

This means patients often turn to Google, where they will stumble upon “doctor review” sites such as Yelp with ratings associated with the patient experience with that physician (i.e., personality, office wait times) versus meaningful health outcomes measures such as readmission rates, surgery infection rates, and health outcomes. Consumers also tend to believe that quality is related to the location of the physician’s practice and the prestige of the medical institution. Our research shows that googling leads them down the wrong path as the top doctors on Yelp are not actually high-quality physicians.

For this reason, best-in-class employers aren’t just offering second opinion services. Leading employers and 5048108302 are offering employees more help identifying and choosing the best physicians and hospitals.

Foster shared decision making
We can help employees get a second opinion and find an excellent doctor, but it is also critical to educate the patient about their diagnosis, condition, and care options so they can choose the treatment that is right for their needs and consistent with their values. This is a crucial piece of the puzzle sea ragwort that greater patient activation is related to better health outcomes.

For many conditions, multiple treatment options exist (including the possibility of doing nothing, when appropriate) and for some “high variation, high-cost conditions,” such as back pain and hip or knee osteoarthritis, surgery is an option but so are minimally invasive procedures, medications or physical therapy. Different options entail different risks, side effects, and benefits; incorporating patients’ preferences and values is critical.

The foundation for informed medical decision making is helping patients understand their evidence-based, relevant options unique to their individual preferences. As it turns out, when patients follow their needs, values, and preferences, there are often cost savings too.

Numerous studies show talking to consumers about their condition and the pros and cons of various treatment options can have a positive impact both on healthcare spending and on long-term health outcomes. For example, in 2008, the Lewin Group estimated that implementing shared decision making for just 11 procedures would yield more than $9 billion in savings over 10 years. In addition, 732-472-1176 by Group Health in Washington State showed that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over six months.

After going through a shared decision-making process, typically 40% of the employees we help guide either reduce the invasiveness of the pre-intended surgery or avoid unnecessary surgery altogether. This is good, high-quality, efficient healthcare.

One of our customers, a large manufacturing company, 306-341-0169 with only 251 employees by having them participate in the company’s Surgery Decision Support initiative for five surgical conditions that tend to have a considerable variation in cost and quality.

In an era of healthcare disruption, we expect to hear more from Gawande about fixes in the supply side of the system and on the demand side, as he and other leaders advocate for deep patient-doctor collaboration around shared medical decision-making. Benefit leaders, in partnership with their health plans and consultants, can have success improving the quality of care, avoiding unnecessary, wasteful care and improving health outcomes by helping employees with decisions involving both the quality and appropriate use of healthcare.

Sue Lewis
Sue Lewis is chief product and strategy manager for ConsumerMedical.

Frustrated with rising healthcare costs, employers get creative in care delivery



Frustrated with rising healthcare costs, employers get creative in care delivery

WASHINGTON, D.C. – Rising healthcare costs dovetailing alongside a tight labor market —which is upping the ante for recruiting and retaining talent — are pushing employers to take charge and offer new and better ways of delivering health and wellness solutions to employees.

More than a quarter of large employers are looking to circumvent the delivery system to help improve access, conveniences and the overall experience by developing virtual and digital care point solutions alongside concierge services as the role of employers in the healthcare system continues to change, according to the National Business Group on Health’s annual survey, released Tuesday. The nonprofit surveyed 170 large employers.

Per employee costs are projected to increase 5% to $14,800 in 2019, compared to this year’s estimated $14,099 per-employee, according to NBGH’s figures. Employers generally cover about 70% of the total employer-paid premium which means employees’ share will be 30%, or nearly $4,500 next year, NBGH’s 2019 large employer healthcare strategy and plan design survey indicates.

Brian Marcotte, president and CEO of NBGH presents findings of the group's Large Employers' 2019 Health Care Strategy and Plan Design Survey in Washington, D.C., on Aug. 7, 2018.Brian Marcotte, president and CEO of NBGH presents findings of the group’s Large Employers’ 2019 Health Care Strategy and Plan Design Survey in Washington, D.C., on Aug. 7, 2018.Nick Otto


These rising healthcare costs are pushing employers to come up with innovative approaches to provide better, and often cheaper, healthcare to workers, said Brian Marcotte, president and CEO of the National Business Group on Health, speaking Tuesday in Washington D.C.

“Healthcare cost increases continue to outpace workers’ earnings and increases in inflation, making this trend unaffordable and unsustainable over the long term,” Marcotte said. “No longer able to rely on traditional cost sharing techniques to manage costs, a growing number of employers are taking an activist role in shaking up how care is delivered and paid for.”

Nearly half of all companies polled said they are doubling down on driving delivery system changes. For example, 35% are implementing alternative payment and delivery models such as accountable care organizations and high performance networks either directly or through their health plan. More are embracing virtual care solutions, including coaching, condition management, remote monitoring, physical therapy and cognitive behavioral therapy, all which NBGH notes “shows the greatest potential for growth over the next several years.”

“The growth in virtual solutions largely reflects employer frustration with the pace of change in how healthcare is delivered,” Marcotte said. “If virtual care is not part of your healthcare strategy, your healthcare strategy is not complete.”

This year, 65% of employers will provide virtual mental/behavioral health services, 58% will offer virtual health and lifestyle coaching, and 42% will have virtual diabetes care management services in place.

Direct contracting with health systems and providers is also expanding, from 3% in 2018 to 11% in 2019, NBGH found. 2018934277 inked a deal with Detroit-based hospital system Henry Ford Health System to provide a new direct-to-employer healthcare option to 24,000 of its salaried employees and their dependents in Southeast Michigan.
In an unexpected shift from prior years, fewer employers plan to offer HDHP plans as the only option for their employees, dropping 9 percentage points from last year.

“The build-up of CDHPs has been driven primarily by the Affordable Care Act and the Cadillac tax, which was looming to go into effect in 2018,” Marcotte said. “You had a lot of companies rush to move to HDHPs to either minimize the impact of the Cadillac tax or delay it as far as they could.”

And, he added, there could be other factors involved in the decrease, such as a tight labor market and employers playing in the war for talent, but as the tax continues to be kicked down the road, employers are relaxing their move from that perspective, reflecting a move on their part to add more choice back into the healthcare mix.

Meanwhile, employers are very interested in adding more flexibility into their HSA plans, Marcotte added.

“There’s a lot of rigidity in what you can do and what you can’t do if you have a health savings account,” he said. “Building back in flexibility, employers would like to cover more value-based services and provide a higher level of coverage.”

Disruptors also are playing a major part in influencing decisions employers will make on getting employees access to healthcare, Marcotte said.

“Interestingly, seven in 10 employers believe new market entrants from outside the healthcare industry are needed to disrupt healthcare in a positive way,” he said. “These disruptors include innovators from Silicon Valley and elsewhere, and employer coalitions.”

The healthcare industry’s bombshell announcement came at the beginning of the year when Amazon, Berkshire Hathaway and JPMorgan Chase announced plans to collaborate on offering healthcare services to their U.S. employees.

“If you begin to leverage Amazon’s footprint within the home, their relationship with the consumer and their customer obsession, if you can incorporate healthcare into [employees’] routine and leverage [Amazon’s] platform, then you have an opportunity to reach [employees] in a way nobody has been able to,” Marcotte said.

(702) 733-9688

How many top 10 mutual funds are in your 401(k) plan?



How many top 10 mutual funds are in your 401(k) plan?

Do you ever wonder if the investment funds in your 401(k) plan are some of the very best? If employees are doing their part and saving as much as they can, shouldn’t they have access to above average investment funds to grow your savings as much as possible?

How can a plan sponsor or administrator tell which funds are the best?

Editors Lee Conrad and Andrew Shilling recently published their list of the top mutual funds in Financial Planning. Here’s how they determined which funds were the best.

Evaluation criteria

To develop their pool of candidates, Financial Planning began by looking at the 20 largest mutual funds as measured by assets. Many believe that asset size is an excellent indicator of fund quality. It takes consistently good performance over time to build the amount of assets that the 20 largest mutual funds have accumulated.

But other factors besides solid performance have drawn investors to these funds. Each fund offers an appealing combination of risk, stable management and reasonable cost. And because their performance is consistently good, few investors flee these funds when markets fall.

Bloomberg/file photo

After determining the 20 largest funds, Financial Planning ranked each fund based upon performance. They felt that longer-term performance was more meaningful than short-term. As a result, they used a five-year period to rank the mutual funds under consideration.

The top 10 funds

All of the top 10 mutual funds come from just three fund families: American Funds, Fidelity and Vanguard. Half of the top 10 are from American Funds. Six of the 10 and three of the top four are actively managed. This may surprise those who think that (805) 798-2321 are the only way to invest.

Here is Financial Planning’s top 10 list, in reverse order, with the associated five-year returns:

10. American Funds Capital World Growth & Income Fund: 10.80%

9. Vanguard Small Cap Index Fund: 12.92%

8. American Funds Washington Mutual Investors Fund: 14.36%

7. Vanguard Total Stock Market Index Fund: 14.67%

6. American Funds Investment Company of America Fund: 14.71%

5. Vanguard 500 Index Fund: 15.01%

4. American Funds Fundamental Investors Fund: 15.03%

3. Fidelity 500 Index Fund: 15.07%

2. American Funds Growth Fund of America: 16.15%

1. Fidelity Contrafund: 16.85%

It is hard to imagine that a plan sponsor or administrator wouldn’t have a number of these funds in their 401(k) plan. If you don’t have any, e-mail the link to this piece to the human resources and employee benefits person in charge of your plan. Your fund lineup needs to be improved.

Robert C. Lawton

Everything small employers need to know about association health plans



Everything small employers need to know about association health plans

The Department of Labor in June loosened association health plan regulations, aiming to make it easier for employers to form AHPs and, in turn, make it easier for employers and self-employed individuals to join the resulting AHPs.

Before finalizing the AHP regulations, the DOL reports that it received approximately 900 public comments on its initially proposed regulations. Many comments were submitted by the American Society of Association Executives, which represents 7,400 organizations and more than 39,000 individual members. We spoke to Robert Skelton, ASAE’s chief administrative officer, about the changing AHP landscape and the opportunities and challenges it can bring to small employers and self-employed individuals.

Employee Benefit News: Historically, why has AHP creation and adoption been relatively limited?

Robert Skelton: In the 1980s and ’90s, there were association health plans. However, there were some bad actors who formed associations solely for the purposes of offering health plans. These plans were underfunded and failed, leaving a mess of unpaid claims and uncovered individuals. Since then, the states have tightly regulated or banned such plans.

EBN: How do the new regulations attempt to expand the creation and adoption of AHPs?

Skelton: The expansion of the definition of an employer under the DOL’s new rule, plus some restrictions on the type of an association that can offer an AHP, addresses the bad actors and creates a mechanism under federal law for an AHP to exist. If an association established an AHP for its members, the AHP would be considered the employer for the purposes of the health plan. This revised definition would allow the AHP to be considered a large health plan, which can achieve more economies of scale than a single association member could achieve on its own.

[Image credit: Bloomberg][Image credit: Bloomberg]

EBN: In a nutshell, what opportunities and challenges do these new regulations offer to small employers and self-employed individuals?

Skelton: AHPs could provide more affordable healthcare plan options for small employers and for self-employed individuals than are currently available under the state or federal exchanges. I think most people would recognize that a large group of individuals is much cheaper to insure since expensive claims can be balanced out over the larger group. The challenge for AHPs will be to enroll a sufficient number of people to be able to enjoy this advantage.

EBN: What type of feedback are you hearing from your members in response to the loosening of these regulations?

Skelton: Many trade associations, which are groups of employers, are very interested in pursuing an AHP to benefit their members. A good example is the National Restaurant Association, which recently announced that is was rolling out an AHP. Restaurants are generally small business with less than 50 employees, which means they do not have to offer health insurance at all and often can’t afford the small business insurance options offered on the exchanges. The AHP potentially gives them an affordable option. One criticism has been that associations would only offer cheap plans with few benefits; there has been no interest in that. Associations realize that they have to provide a quality product, otherwise they will risk alienating their members completely.

Professional membership associations, though, are disappointed with the final regulations. Those associations are usually individual membership societies and are not able to offer an AHP under the new regulations.

EBN: An ironic aspect of these regulations is that it seems to promote the idea that small employers can escape the headwinds of state and federal small employer health plan regulations by joining an AHP. It seems odd to me that the federal government is issuing new regulations designed to help employers escape existing federal regulations. What are some advantages small employers might see by joining an AHP that is exempt from small group/small employer rules?

Skelton: Does it surprise you that politics might be involved with this? That is actually a pretty significant concern with establishing an AHP. What is done by one administration by regulation can be undone by the next administration. ASAE is part of a coalition that will be pushing for a legislative answer that would be more likely to survive a change in administration.

EBN: One aspect that caught my eye is that AHPs will continue to be considered multiple employer welfare arrangements (MEWAs). Thus, in effect, an AHP is simply a type of MEWA, it seems. Meanwhile, certain states, such as DC and Maryland, severely restrict or prohibit the formation of a self-funded MEWA, meaning that an AHP formed in that state would need to be fully insured. What headwinds or even opportunities does a fully insured AHP offer?

Skelton: Having to comply with the rules of each state, and DC, insurance commissions is certainly going to make forming an AHP more difficult. One of our comments highlighted our concern with this issue. I believe large employers generally only have to comply with the rules of their home state even if they have operations in many jurisdictions. AHPs will be at a disadvantage as compared to these plans. A fully insured AHP would avoid the MEWA rules but may not be as competitively priced.

EBN: Regardless if the AHP is self-funded or fully insured, it seems that the regulations prohibit the AHP from screening applicants based upon claims experience or health risks and further prohibit the AHP from varying premiums and premium equivalents upon the same. If so, the AHP, over time, will naturally house employers and individual members who are lower than average health plan utilizers, with these employers and individuals subsidizing the higher utilizers. This subsidization could lead these low utilizers to gradually leave the AHP, potentially creating a text book “death spiral” effect. How might newly formed AHPs prevent this death spiral from occurring?

Skelton: I think this is exactly the issue that the state exchanges are experiencing — the less healthy individuals with higher claims are using the insurance and driving up costs, while healthy individuals find cheaper alternatives or forego insurance. The key for avoiding the death spiral is adequate capital, stop loss insurance and a large participant base. This will not be a good venture for the risk-adverse.

EBN: What other advice might you have for associations contemplating sponsoring an AHP and for small employers and self-employed individuals thinking about joining an AHP?

kelton: For associations, do the research and determine if they have the knowledge and the resources to support offering an AHP. There are many organizations that are also looking to partner with associations, which could be a way to manage the risk. Then, talk to your members, and try to determine if an AHP will be a useful benefit for them.

For individuals, do the research and be sure that the plan is well-funded and well-run, and compare costs.

Zack Pace
Zack Pace is senior vice president, benefits consulting at CBIZ, Inc.




Looking to drive out hiring biases? There’s an app for that

Technology and society are changing so fast that it’s hard to imagine what the world might look like in 10 or 20 years. In the midst of the doom-and-gloom predictions about workplace disruption and jobs lost to automation, there is solid research that predicts AI will actually create more jobs than it eliminates — including some that don’t exist today.

To prepare for the new opportunities, we need to ask: Who will be the worker of tomorrow? Will the future workplace reflect the rich diversity of the world? As some jobs are eliminated and others are created, how can we bring everyone along on our journey to the future? And what role will technology play?

It’s no secret that several high-profile companies have struggled with inclusion and diversity. Uber and Google are the most high-profile tech examples from the last year, but these companies are certainly not alone. Even with the best of intentions, companies continue to perpetuate conscious and unconscious biases based on age, gender, race, religion, nationality and ability.

[Image credit: Bloomberg]
[Image credit: Bloomberg]

In looking at new technologies that will help us shape the future of work, a theme that has come up again and again: How disruptive will these innovations be in helping to solve the problem of diversity and inclusion? Here are some starting points for combining technology innovation with work-practices innovation.

Eliminate bias in screening, hiring and promotion. In a Yale University study, participants evaluating scientists for research positions consistently rated male candidates as more qualified than female applicants. But what happens if gender or race or age are removed from the screening process? A Stanford study showed that the percentage of women musicians in symphony orchestras rose from 5% to 25% when they started auditioning behind privacy screens.

Of course, you can’t always conduct a job interview from behind a visual barrier. But there are many things you can do to eliminate unconscious bias from the screening process. Talent Sonar, for example, offers a cloud-based platform that embeds AI, machine learning and analytics directly into a company’s hiring workflow to assess characteristics of potential candidates. The program separates out non-relevant resume information such as a candidate’s name, educational background, and hobbies — all of which can contribute to unconscious bias.

When considering automating the hiring process, however, we need to be aware that the programmer’s unconscious bias can be built right into the algorithms. So, it’s important to start with a diverse programming team, as well as consciously correcting for bias.

Open up the pipeline. Tech leaders have said they would like to hire a more diverse workforce, but felt hindered by a lack of qualified candidates. Perhaps they aren’t looking in the right places. Many of the workers who will fill the jobs of the future won’t come through the traditional route of four-year colleges and universities. To widen the talent pool and seek out diverse voices, forward-thinking companies are broadening their search for qualified workers, and finding them in community colleges, apprenticeships and other non-traditional training programs. Some tech companies are now partnering with community colleges to combine classroom learning with real-world experience in areas where the companies need more skilled workers.

Organizations are looking to broaden the pool of qualified workers by broadening the ways young people engage in education. LRNG connects community organizations, public institutions, and businesses with programming that turns entire cities into learning landscapes for underserved youth. Using a computer, smartphone, or tablet, young people can access both online and real-world learning experiences, connect with mentors and peers, build new skills — and prepare for 21st century jobs.

We must remember that a huge pool of potential workers is coming online as ubiquitous broadband and assistive technology provide opportunities for disabled workers who could not have participated before.

The pipeline of qualified candidates is there. You just have to be creative to find them.

Believe it and act on it. Integrate diversity and inclusion into your corporate values and culture, from top to bottom. As a leader of “extreme innovation,” I’ve seen first-hand how creativity thrives in the presence of different perspectives, talents, and points of view.

“Massive inclusion” is one of the principles we use in Cisco CHILL — a radical innovation model that condenses a several-months-long innovation cycle down to a few days. It simply means that we bring together into the same room at the same time everyone who would need to love an idea in order to take it to market.

Last year, for example, we conducted a Living Lab on Transforming the Patient Experience of Cancer Care. We assumed the solutions we developed would be for patients. But because of the principle of massive inclusion, caregivers were also in the room — and the result was the birth of CircleOf, a startup focused on help and support for the caregiver as well as the patient.

The principle of massive inclusion holds true across industries and at every organizational level — if we don’t include everyone, we’re likely to miss valuable opportunities.

Why should people be working so hard to create diverse workplaces? It’s the right thing to do but it’s also profitable. We’ve all seen statistics showing how diversity coincides with better financial performance. With new research from Cloverpop, we’re beginning to understand why: decision-making drives 95% of business performance, and diverse teams make better, faster decisions. In fact, teams that are age, gender and geographically diverse make better decisions 87% of the time.

Simply by broadening inclusion, we spur innovation, make better decisions, and drive financial performance. We create a future where everyone is invited to participate in shared success. No one expects the culture in tech to change overnight. But the quicker we get on with it, the better off we’ll all be.

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Kate O’Keeffe is an innovation leader and founder of Cisco CHILL.

Benefits in the bathroom stall: Outside-the-box tips for getting employees engaged during enrollment



Benefits in the bathroom stall: Outside-the-box tips for getting employees engaged during enrollment

Tired of not getting employees engaged during open enrollment? You might want to try spreading the word on the sleeve of a coffee cup or on the door of the office restroom.

Those were among the suggestions from Chad Schneider, director of channel sales at software firm Jellyvision, who spoke Tuesday at Employee Benefit Adviser’s Workplace Benefits Mania in Phoenix about the need for “innovative and personalized” benefits education.

“[The benefits industry] is growing, and it’s the most complex it’s ever been,” he said. “So how do you break it down and actually get employees to understand it?”

It’s an area that needs attention: According to Aflac data, 92% of employees aren’t moved to try anything new during open enrollment and simply sign up for the same benefits year after year. And, citing data from his firm, Schneider said 55% of employees say they want help with choosing their health plan.

“We are communicating in a foreign language,” he said. “There’s a better playbook and there’s a better way to do this. Our communication is boring and confusing and we are mostly communicating just once a year.”

The future of (407) 922-6333 is less about the jargon and boring benefits booklets and more about entertainment, ease and personalization, Schneider says. So where should employers start? Here are six ideas to consider.

Send an email or video from a prominent company leader. An email from the company’s CEO or other important C-suite member telling employees about the importance of benefit offerings and sharing information about upcoming enrollment is hugely important — and a surprisingly uncommon practice, Schneider said. “If the CEO is spending all this money on their company’s benefits — their second largest expenditure besides 469-305-2993 — why wouldn’t they want to promote it? Send a letter from a CEO, or better yet, send a video,” he said. “You don’t need expensive equipment; you can use your phone. It’s easy to leverage the technology that’s in your pocket.”

Offer incentives or giveaways. Don’t just rely on doughnuts during the morning of open enrollment. Employers should spice things up and offer some incentives or giveaways, Schneider said. Some companies have games or raffles attached to enrolling in certain benefits. “The more you get your employees engaged and excited, the better,” he said.

Send text messages. Time to throw the old benefits booklet away? Perhaps, Schneider suggested. “Nobody reads the booklets; they are a waste of time and energy and money for both [brokers and employers],” he explained. “Employees love text messages — and they can be an easy and quick way to send repeated information on open enrollment information.” Plus, there are a number of text message platforms that can help employers manage the communications, he said, including SlickText, SumoText and EZTexting.

Embrace social media. Most companies have Facebook, Twitter and LinkedIn — so why not use them to engage with employees about benefits? “A lot of employees actually go on [their company’s platforms] and look at posts; they share things, like things,” Schneider said. “Think outside the box and post on social media about open enrollment — post hyperlinks and give communication about what’s happening. It’s worked really well with some company clients for us.”

Be a guerilla marketer. Employers should be innovative when it comes to getting the message out. A good place to start? Think about what is important to your company and employees. One employer Schneider worked with said their employees drank a lot of coffee — so they printed out special coffee sleeves that had information about the company’s upcoming open enrollment. “It was inexpensive, it was super smart, and we got unbelievable engagement,” he said.

Think outside the breakroom. “Everyone posts things in the breakroom, but is that where all your employees are going?” Schneider said. Where does every employee go every day? The restroom. “We had a company that put [benefits] information on bathroom stalls — the results were unbelievable; it worked really well,” he said. Another good spot to leave information? The cars of each employee. “It’s all super simple, but smart. These are things that can encourage employees to dig in.”

Kathryn Mayer