Cancer / Oncology Benefits
In the past several years, cancer has become an important focus for employers, for a number of reasons. Perhaps most significant is the fact that an increasing number of cancers are being identified in the workforce.
Compliance / Reporting
As plan sponsors prepare for open enrollment, attention should be given to the Equal Employment Opportunity Commission’s (EEOC) new wellness regulations under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).
Many in the legal community warned of possible Employee Retirement Income Security Act of 1974 (“ERISA”) implications and litigation risk surrounding scheduling decisions made by employers in order to avoid being subjected to an Affordable Care Act (“ACA”) penalty for failure to offer coverage to full-time employees.
In a 2015 survey completed by Employers Health, 32 percent of employers reported their organizations were unprepared for the Sections 6055 and 6056 reporting requirements under the ACA.
Whether a plan sponsor has a robust or fledgling wellness program in place or has just begun considering one in light of the Cadillac Tax, recent litigation attacking wellness programs has given many plan sponsors pause. This article will provide a brief regulatory overview of HIPAA wellness program regulations, as amended and promulgated by the ACA; a summary of the recent Equal Employment Opportunity Commission (EEOC) litigation; and plan sponsor best practices.
Voluntary Means Voluntary? AARP Prevails in Challenge to EEOC’s Interpretation of Voluntary and How Plans Should Respond
A December 2018 court ruling dealt many incentivized wellness programs a serious blow. This comes as wellness programs continue to lose some of their luster for many plan sponsors. The ruling itself is generally summed up as a condemnation of the Equal Employment Opportunity Commission’s (EEOC’s) definition of voluntary resulting in a grey area around wellness incentives and penalties related to the collection of health and generic information. Certainly, a response depends on the plan’s philosophical stance on wellness. This article recaps the ruling, its background and rationale and briefly explores potential plan responses.
Applicable large employers (“ALE”) and employers who provide minimum essential coverage will have to file additional tax forms in 2016 for the 2015 plan year. Listed here is a brief overview of the information that employers and plan sponsors will be required to provide.
Employee Benefits & Strategies
It’s hard to believe that we’re almost through the first quarter of 2018. With the start of the new year, and the signing of the Tax Cuts and Jobs Act (TCJA) in December 2017, we have seen many changes regarding tax reform. I have been reading various articles and talking to other CPA’s on the topic to understand the impact of the new law on not only our team at Employers Health, but also our member organizations.
Benefits Accelerator® is a value-based strategy that harnesses a robust technology platform, preferred vendors with proven concepts and results that emphasize heightened health status and well-being. This collaborative approach can accelerate a plan sponsor’s objectives to control health care costs, improve health outcomes and streamline benefits administration.
Running a bid process can be expensive and difficult to manage. Therefore, plan sponsors tend to avoid the process all together. PBMs use this to their advantage, fueling one of the most fundamental ways in which they make money: multi-year static pricing agreements.
The “Cadillac Tax” is a 40 percent excise tax on the cost of employer-sponsored health coverage that exceeded certain cost thresholds. As originally enacted by the Affordable Care Act (“ACA”), the Cadillac Tax was non-deductible and scheduled to begin in 2018. Although the tax was intended to only impact “high-cost” plans, recent studies suggest that even plans with modest actuarial-values will eventually trigger the tax.
Implementing a private exchange benefits strategy affords the potential for more predictable health care costs, as well as relief from some administrative burden. But there are critical considerations for employers when evaluating private exchanges. In this article, Bruce Sherman, consulting medical director, discusses several of those considerations.
Employers Health News
(May 21, 2018) – Employers Health, a professional benefits organization, is announcing the 2018 recipient of its Excellence in Benefits Award. The award is intended to recognize annually,
an individual who has made meaningful impact in the field and/or delivery of employee benefits. This year’s winner is Violet Vernon, senior manager in human resources at Aerojet Rocketdyne Holding. An independent panel of human resources and benefits industry professionals unanimously selected Vernon. Nominees were scored on the impact made in the field of employee benefits, achieved outcomes and contributions to the betterment of the overall workplace and community.
Employers Health was certified as a great workplace by the independent analysts at Great Place to Work®. Employers Health earned this credential based on extensive ratings provided by its employees in anonymous surveys. Great Place to Work® is the global authority on high-trust, high-performance workplace cultures.
Surveys were completed by 29 employees ranking their trust, pride and confidence in the organization. Employees gave the organization a rating of 100 percent for offering great challenges, a great atmosphere and great pride in the organization. A summary of the ratings can be found at http://reviews.greatplacetowork.com/employers-health.
(May 25, 2017) – Employers Health, a professional benefits organization, is announcing the first-ever recipient of its Excellence in Benefits Award. The award is intended to recognize
annually, an individual who has made meaningful impact in the field and/or delivery of employee benefits.
This year’s winner is Jessica Ward, benefits manager at Columbus, Ohio-based DSW. Ward was unanimously selected by an independent panel of human resources and benefits industry professionals. Nominees were scored on the impact made in the field of employee benefits, achieved outcomes and contributions to the betterment of the overall workplace and community.
Employers Health, a professional benefits organization, is currently accepting nominations for the Excellence in Benefits Award. The award seeks to recognize an individual annually who has made meaningful impact in the field and/or delivery of employee benefits. The nomination deadline has been extended to February 15, 2017.
For 2015, clients in the Employers Health pharmacy benefit management (PBM) solution experienced an overall average per member per year (PMPY) cost trend of nine-tenths of one percent. While drug price inflation, utilization of expensive specialty medications to treat diseases such as hepatitis C and greater utilization increased trend, pricing improvements due to the Employers Health annual price negotiations and continued utilization of generic medications moderated trend to the nearly flat level.
Health Care Reform
The Trump Administration and Republican controlled Congress have begun an attempt to advance certain objectives that have become dogmas during the election. One such objective is to repeal and/or replace the Affordable Care Act (ACA).
Mental Health / Depression
As a first-of-its-kind initiative, Right Direction has received national attention for its leadership in addressing depression in the workplace. To validate the societal and economic burden of how depression impacts employers, Employers Health launched the results of The Impact of Depression at Work Audit (IDeA)* survey (Ipsos, 2014).
Research in abundance demonstrates not only does employee health affect direct health care costs, but impacts performance and productivity as well. Unlike absenteeism which is marked by employees deliberately or habitually not showing up to work, with presenteeism, employees clock in, they just may be checked out from the events of the day. Presenteeism is defined as “being at work but having impaired functioning due to mental or physical symptoms.”
In June 2013, the AMA officially declared obesity a disease by that definition. While this was supported and debated by various constituents, the fact remains the implications of obesity on a workforce continue to mount. More than 72 million U.S. adults are obese, and persons who are obese have medical costs that are $1,429 higher than those of normal weight (CDC, 2010). How many of them work for your organization?
To date, many corporate wellness programs have been created with the Biomedical Model at their foundation. The focus needs to move beyond biometrics and shift from being only on the disease to addressing the factors that influence people’s behaviors.
Pharmacy Benefits / Specialty Pharmacy
In the era of high deductibles and co-insurance, what plan sponsors do with rebate dollars generated from brand drug utilization has come under more intense focus. Today, many plan sponsors utilize rebate dollars received from the Pharmacy Benefit Manager (PBM) to offset total plan costs, thereby factoring into the rate-setting methodology and/or offsetting contributions made by employees towards the total cost of care.
The pharmacy benefit marketplace has been at the center of attention lately due to a combination of factors, including the growing list price of brand medications and the impact their prices have on the participant, particularly those enrolled in high deductible health plans. The outrage over Mylan’s price inflation of its EpiPen® product fostered an array of news articles, television interviews, congressional hearings, campaign promises and finger-pointing among pharmacy supply chain stakeholders.
A new age of medicine is upon us, and it comes in the form of personalized gene therapy. Recent developments have pushed the single-dose, potentially curative treatments with high projected price tags closer to launch. Thus, the bene t design and coverage for engineered genes to treat, prevent and cure diseases are a rapidly growing concern for plan sponsors preparing for the pharmaceutical pipeline.
Providing affordable and sustainable benefits is a primary goal for employers that offer prescription drug coverage. Recent press and public scrutiny over rapidly rising drug prices has revealed the struggle many plan sponsors experience in their efforts to achieve that goal.
The rise of specialty pharmacy spend and trend can be traced back to the work of pharmaceutical manufacturers determined to provide targeted biological treatment for complex medical conditions. We must now count on these same manufacturers to create the competition necessary to provide these innovative treatments in an affordable manner https://www.facebook.com/Phoenix-Direct-Management-921753441258891/.
Car crashes are no longer the leading cause of injury death in the United States. That morbidly-esteemed title now belongs to overdose deaths due to opioids either by prescription or heroin that claims the lives of seventy-eight Americans daily. The abuse and overprescribing of opioid analgesics is an epidemic that requires all health care stakeholders to take action.
Written in fall 2015, this piece includes important pharmaceutical industry news relevant to employers, while providing analyses and strategies to best manage prescription drug trends.
Member organizations that participate in an Employers Health PBM program enjoy an uncommon feature known as an annual “Market Check.” What is the Market Check and what role does it play in delivering value to plan sponsors?
Specialty drugs do not have a consensus definition across all stakeholders in the specialty space, but they can generally be thought of as high-cost medications used to treat complex conditions. Often, these medications are biologically developed from a living organism into products such as hormones, proteins and vaccines.
With the recent approval of Addyi (flibanserin) for the sudden and unexplained loss of libido for premenopausal women, plan sponsors must weigh clinical and legal considerations. There are very important questions over Addyi’s low efficacy, concerning side effects, and the potential for gender discrimination.
Making it the most common chronic bloodborne infection in the US, an estimated 3.2 million people are impacted by the Hepatitis C virus (HCV). Many are concerned about the approved HCV medications and high-cost therapies. To better understand the benefit implications of HCV, it is important to grasp the risk factors and clinical course of this infection.
Wellness / Employee Wellbeing
From both the overall organizational and individual member perspectives, tailored and uniquely personal well-being plans are the key to realizing positive change.
The link between workforce health and a healthy organizational bottom line has been repeatedly made through research. According to one study, companies with high employee engagement had a 19 percent increase in operating income and nearly a 28 percent growth in earnings per share.
Organizations commit millions of dollars each year to designing the optimal compensation and benefits packages for their workforces. Yet, organizational goals can fall short if the company culture fails to engage employees and provide an environment where they can thrive and want to come to work. How important is it to build cultures of well-being and engagement, and what might that look like?
Researchers have been studying the effect of workplace culture on workforce health for years. Effective and sustainable behavior change efforts must encompass the overall culture of the workplace. So, where is the disconnect for employers in developing workplace health management strategies, and how can they create a culture fostering employee well-being?
Historically, many employers have offered vaccination as a covered health benefit due to the perceived importance of immunization for their employees and their families. But not everyone wants to get vaccinated for a multitude of reasons. The purpose of this article is to address some of these misconceptions and provide an update on 3 viral infections (influenza, shingles, and pneumonia) that have safe and effective vaccines to prevent them.