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Wellness Programs – New Study Confirms Cautioned Approach

During the past seven years, I have written a fair number of posts regarding wellness programs offered by employers. The core message of all blogs suggests that employers must have realistic expectations about what wellness initiatives will or will not do within the workplace.

A recent randomized clinical study published in JAMA is yet another reminder for employers to have tepid expectations when trying to keep their employees happy, healthy and less likely to incur more health costs. The study found that workplace wellness programs do not cut healthcare costs for employers, reduce absenteeism or improve the health of employees.

From the University of Chicago and Harvard, researchers used a large-scale approach that was peer-reviewed and included a more sophisticated design when analyzing BJ’s Wholesale Clubs. BJ’s has about 33,000 employees across 160 clubs. This analysis compared 20 randomly-assigned clubs that offered wellness programs with 140 BJ’s clubs that did not.

After 18 months of timeline analysis, this study revealed that wellness programs did not result in health measure differences, such as: improved blood sugar or glucose levels, reduced healthcare costs or absenteeism, or impacted job performance in a positive manner. In other words, employees with a wellness program did not experience reduced healthcare costs and other desired affects. I suppose one could argue that a year and one half was not enough comparison time to develop these conclusions.

One of the authors of this study, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago, put it quite succinctly in a Kaiser Health News article: “[But] if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause.”

What are your expectations about workplace wellness? Do you believe such programs, when appropriately and thoughtfully implemented, will greatly mitigate your healthcare costs, improve workforce productivity and reduce absenteeism? Maybe you feel these programs are a waste. From our 2012 Iowa Employer Benefits Study, employers shared their perceived ‘return on investment’ on the programs they currently had in place.

According to a 2013 “Workplace Wellness Programs Study” by researchers at the RAND Corporation, these programs only have a modest effect. This runs contrary to claims made by wellness firms that sell workplace wellness programs to employers. The report found that people who participate in wellness initiatives lose an average of only one pound a year for three years. Another finding is that employee participation in such plans “was not associated with significant reductions in total cholesterol level.” Smoking-cessation programs show some potential, but only “in the short term.”

Most likely, both skeptics and supporters of wellness initiatives will find ammunition to support their cause. Workplace wellness programs have grown to an $8 billion industry in the U.S., primarily as a direct result of rising employer health insurance costs.

This latest report may help stabilize any pre-conceived lofty expectations each of us may have about the benefits of workplace wellness programs. However, it must be noted that some employers have found value in these programs.

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Paid Family Leave – Its Time Has Come

Too many Americans experience a number of different hardships when taking parental leave for a newborn – or an aging parent. A 2017 Pew Research study found that Americans who received only some pay or no pay when they took family or medical leave:

  • Cut back on spending (78 percent)
  • Used savings set aside for something else (50 percent)
  • Used savings set aside for this situation (45 percent)
  • Cut short their leave time (41 percent)
  • Took on debt (37 percent)
  • Put off paying their bills (33 percent)
  • Borrowed money from family or friends (24 percent)
  • Received money from family or friends that they weren’t expected to pay back (23 percent)
  • Went on public assistance (17 percent)

As of 2016, the U.S. is the only developed country without government-mandated paid maternity leave. Additionally, according to research from the Organization for Economic Cooperation and Development (OECD), the U.S. is one of nine OECD countries that have no leave policies for new fathers. In total, there are 36 OECD countries.

Need for Parental Leave

According to research from the National Institute of Health, children have fewer mental health, developmental and other problems if they have full-time caregivers in the first few weeks and months of infancy. Other research also supports the need for promoting a healthy family environment within our country.

After World War II, with many women in the workforce, employers and lawmakers needed to address the issue of pregnancy on the job. In 1972, the Equal Employment Opportunity Commission drafted guidelines that basically labeled pregnancy as a disability. Six years later, the Pregnancy Discrimination Act of 1978 amended the Civil Rights Act that prohibited discrimination on the basis of pregnancy, childbirth or related medical conditions. However, this legislation did not provide time off – paid or unpaid – to care for a child.

Family and Medical Leave Act (FMLA)

The Family and Medical Leave Act of 1993 provides unpaid leave. But only about 60 percent of private-sector workers are eligible, as it provides 12 weeks of unpaid, job-protected leave with continued health insurance coverage to attend to a newborn or adopted child, a family member, or an employee’s own serious health condition. There are strict eligibility requirements for FMLA, such as needing to have worked at least 1,250 hours for an employer with 50 or more employees during the 12 months before the start of the leave.

Employer Role

Employers, for their part, have been adding parental-paid leave at their workplaces. According to a Society of Human Resource and Management (SHRM) survey in 2018, 27 percent of U.S. employers offered paid leave in 2018, a very slight increase from the prior year. A 2015 survey by Mercer reported about 25 percent of U.S. employers offered paid-parental leave for employees to bond with a new child, while in 2018, Mercer found this dramatically increased to 40 percent. Mercer also reported that the median number of weeks employers offer to birth parents in their paid leave policies was six weeks, a number similar to their 2015 findings. Most employers who do provide some type of paid maternity leave tend to be larger organizations and is dependent on their given industry.

As an example, according to the National Compensation Survey (BLS) in 2016, 37 percent of the finance and insurance sector employers offered paid-family leave, while 10 percent of manufacturing and six percent of leisure and hospitality offer such programs.

As mentioned in an earlier blog, we are in the midst of randomly surveying Iowa organizations to learn about the prevalence of various ‘work-life’ benefits in the workplace – which includes paid leave, unpaid leave, and a host of other ‘convenience’ benefits that help assist employees and their family members.

Being able to pay for this benefit is a big hinderance for many employers, and yet, according to SHRM, not having these plans in place can cause skilled workers to leave for employers who do offer such plans. Additionally, SHRM estimates that every time an employer loses an employee, it will cost the equivalent of six-to-nine month’s salary to replace and retrain a replacement – and considerably higher for highly-skilled employees.

The moral of this story is that employers may be wise to pursue the costs up front by offering paid leave programs.

Federal Traction on Paid Family Leave

Despite the gridlock in Congress to pass meaningful legislation on basically anything of substance to Americans, there does appear to be some hope that there is bipartisan support for some type of paid-family leave. Iowa’s Senator Joni Ernst, along with Utah Senator Mile Lee (both Republicans), announced last month a bill that would allow new parents to take paid time off for their children. Known as the “Cradle Act,” the bill would allow Americans to draw from their Social Security funds to take time off from work.

Two other bills involving paid leave are currently being kicked around. The Working Parents Flexibility Act proposes to create tax-exempt savings accounts which can be used to pay for childcare. This appears to have bipartisan support in the House and is moving to the Senate. The problem with having accounts, similar to Health Savings Accounts (HSAs), is that not everyone can afford to set money aside to pay for this benefit. The other bill, FAMILY Act, proposes offering 12 weeks of partially-paid parental leave to all employees who fall under the protection of the FMLA. Funding would be provided through employer and employee payroll taxes. Five states already have a similar mandate in place: California, New Jersey, Rhode Island, New York and Washington. Again, employers with fewer than 50 employees are not impacted by the FMLA.

As employers continue to search for opportunities to obtain and retain a highly-valued workforce in the future, paid-family leave programs will be a large trend in the years to come.

Balancing competing demands of work and family are important reminders to having healthy and thriving families within our workplaces and communities.

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Electronic Health Records – The Bane of Medical Progress?

For years, indeed decades, Americans have reluctantly confronted the traditional ritual of having to manually complete paperwork before seeing a healthcare provider. Recollection of dates, medical conditions, and other important and critical medical details are challenging to put on paper prior to meeting with a new provider unfamiliar with our past medical history. Additionally, obtaining access to personal health records from one health provider to another has been a test of endurance for patients and caregivers alike.

With these and countless other challenges of providing accurate, up-to-date, and complete information about patients at the point of care, it is no wonder that a push to overlay medical records with sophisticated technology was long overdue. Electronic health record (EHR) goals are widely accepted to be the rocket fuel that helps ignite a very complex and grossly underperforming U.S. healthcare system:

  • Enable quick access to patient records for more coordinated, efficient care
  • Securely share electronic information with patients and other clinicians
  • Help providers to more effectively diagnose patients, reduce medical errors, and provider safer care
  • Improve patient and provider communication and enable health care ‘convenience’
  • Enable safer, more reliable prescribing
  • Promote legible, complete documentation and accurate coding and billing
  • Enhance privacy and security of patient data
  • Help providers improve productivity and work-life balance
  • Enable provider to improve efficiency and meet their business goals
  • Reduce costs by having decreased paperwork, improved safety, reduced duplication of testing and improved health

Yet, this belief that EHRs will enhance efficiency and promote safe and effective care may not be hitting its intended bull’s-eye – at least for the present time. A recent joint article, “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong,” researched and written by Kaiser Health News and Fortune Magazine reveals that EHRs have grossly underperformed on many key fronts.  In fact, EHRs are proving to have more unintentional consequences that cause patient harm and accentuate job burnout for many providers using them.

Applying shovel-ready financial stimulus money to jump start the economy during the Great Recession, which began in 2007, the federal government, thanks to legislators passing the HITECH Act in February of 2009, infused a huge chunk of change ($36+ billion) to incentivize hospitals and physicians to embrace health information technology into their practices.

How many other industries are given ‘free’ government money to motivate the use of information technology? Off the top of my head, very few – if any. Usually, due to market forces dictating improved efficiencies, most business sectors allocate their own financial resources to reinvest in information technologies. I realize there are tax incentives for doing this, but having manna fall from the sky – much like HITECH – is truly a gift that should have paid great dividends to all – including U.S. taxpayers.

In fairness to healthcare providers and software vendors, the HITECH approach was much too optimistic and ambitious to succeed during a relative short period of time. As this story indicates, there were too many cooks in the kitchen, in addition to the crazy requirements that software vendors required of their healthcare clients, including gag-clauses on flawed software.

Since implementation of the HITECH Act, there have been thousands of reports of deaths, injuries and near misses linked to the shortcomings of digital systems. Equally frustrating is that many patients continue to report difficulties on receiving copies of their complete electronic files. Take heart, however, proposed federal rules by the Department of Health and Human Service should, according to Sen. Lamar Alexander (R-Tenn.), “make it easier for patients to more quickly access, use and understand their personal medical information.”

Because the U.S. has many different software manufacturers in the healthcare space, each attempting to maintain their own ‘proprietary’ domain for exclusivity purposes, the EHRs are similar to the existence of diverse human languages that occurred in Genesis 11 when many different languages were spoken during the construction of the Tower of Babel.

With new scrutiny of the current EHRs, it is time to re-calibrate the existing cocktail of EHR-systems and determine what makes the most sense to patients, providers – and taxpayers. Singing from the same sheet of music would be a great start.

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