As U.S. business managers struggle to lead employees and deliver results in an uncertain economy, many are turning to experienced behavioral health professionals for guidance on how to lead employees through challenging times.
Businesses are wary about the economic recovery, and many are delaying serious hiring and reducing staffing levels. Managers don't always have the time to hunt down and then adopt best practices for their workplace.
The net effect is to further increase pressure on managing teams -- not just demanding more from stressed employees.
Mental health counselors hear about workplace stress every day from employees accessing their companies' Employee Assistance Program. These efforts may be enhanced with the help of professional coaches, who encourage managerial behavior that may help alleviate employees' job stress.
CIGNA Behavioral Health is one company that offers employers access to independent coaches for individual or group meetings with managers. The program includes periodic coach-manager meetings to review progress against specific goals. It's a tool for managers to anticipate and resolve employee productivity problems before they become a serious threat to business.
Through face-to-face or telephonic options, coaching programs assist managers and provide additional guidance and motivation to keep employees focused and productive. These types of programs focus on performance, not personnel issues; on action, not feelings; and on results, not excuses.
Coaches work with managers to help identify specific coaching goals and expected business results, then complete a thorough assessment. After that, active coaching includes problem solving, modeling, didactic instruction and goal setting. Ongoing maintenance and support is also offered.
Although coaching isn't the same as behavioral health counseling, coaches should have qualifications and credentials, which ensure that professionals with direct experience or specialized training in coaching deliver services, and that each coach has the skill set needed to provide real value, not just cheering from the sidelines.
Is the investment worth it? Consider the fact that 100 executives from companies which utilized professional coaching claimed an ROI of six times the cost of coaching. Most wanted help on how to better engage employees as team members, focusing employees on narrower, more achievable results. Others wanted to resolve unique workplace cultural conflicts and barriers to success.
In a world where it's more difficult and expensive than ever to recruit and keep the best employees, coaching programs can help ensure key personnel remain content, challenged and contributing members of the team. Gregory C. Donnelly (Gregory.Donnelly@cigna.com) is vice president, sales manager, sales division of Cigna HealthCare. CIGNA HealthCare is one of the nation's leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.
Companies report that 10 percent of employees drive as much as 75 percent of their health costs. To deal with the cost spiral, companies are working closely with their health care providers to find tools and programs to help employees better understand their health and take a more active role in managing it.
Here are some of the tools available to help your employees better manage their health.
* Health Risk Assessment is a high-tech tool that helps companies improve employee health by providing feedback and assistance based on responses to a voluntary health questionnaire.
In the past, HRA results included general statements like, "You should stop smoking" and ended there. Today's HRAs work off "smart software" that outlines an action plan and can link employees to other company-sponsored programs or outside support and self-help groups.
* Online support tools can join the HRA on a company- or health provider-sponsored Web site.
Created by medical experts, today's health decision support tools can help employees choose a hospital based on its reputation for a specific medical procedure, better understand the differences and similarities of specific generic and brand-name drugs, and give them instant access to valuable information to help them with important health care decisions.
* Chronic condition management programs help health care providers identify the chronic conditions with the highest impact on a company's health care costs, and work with their customers to introduce programs to help employees manage chronic illness without letting it get it the way of living their lives.
Programs provide personalized tools and support so employees can work with their own doctor to design a care plan focused on recognizing and managing symptoms, reducing the risk of illness and complications, and effectively dealing with illness.
Through these programs, not only are more employees are becoming better informed, but companies also like what they're seeing in the workplace. For example, when NCR introduced an HRA to its employees, 23 people were identified as high-risk and referred to chronic condition management programs.
In addition, 31 people used the HRA to refer themselves to the company's fitness center. NCR analysis shows a saving of $2 to $3 in the long run for every dollar it spends on HRAs. Gregory C. Donnelly (Gregory.Donnelly@cigna.com) is vice president, sales manager, sales division of Cigna HealthCare. CIGNA HealthCare is one of the nation's leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.
But the survey also indicates most people are unaware of the latest health services and resources available from many health plans. That knowledge gap is causing Americans to leave many of these services -- services that strong majorities, when polled, say they want -- unused.
"Closing the Knowledge Gap: American Health Consumers Speak Out," was commissioned by CIGNA HealthCare. It surveyed opinions from a random sample of 750 employees enrolled in employer-based health plans around the country.
Although they ranked decisions about their health care coverage as critical, well over one-third admitted they lack the information or understanding they need to make the best choice; 31 percent have doubts they would make the right choice; and 11 percent are convinced they would make a poor choice.
In addition, 80 percent said they would find the following services important in selecting a health plan, but more than half didn't know these services exist.
* 24-hour phone access to nurses to answer questions about everything from a child's persistent cough to a husband's mild chest pains
Nurse case managers to assist with post-operative care, claims filings, finding additional financial resources or support for people dealing with major illness
* Discounts on health, fitness and wellness services, such as smoking cessation, laser eye surgery, cosmetic dentistry and massage therapy
* Personalized online health resources to help people learn more about health issues or better handle claims and benefits management
* Disease management programs to help people better manage chronic conditions, including heart disease, asthma and lower back pain
Surprisingly, the need to close the knowledge gap is stronger among younger workers. For example:
* 32 percent of baby boomers consider themselves to be "very informed" health care consumers, compared to 16 percent of Generation Y workers.
* 74 percent of baby boomers say they are satisfied with their health care coverage, compared to 44 percent of Generation Y workers.
Workers want to become more informed and more engaged in decisions about their health care and coverage, and they are looking to their employers and health plans for assistance. Young people just entering the workplace are a particularly significant audience because the health decisions they make today may determine if they spend their later years healthy and fit or dealing with chronic illness. Gregory C. Donnelly (Gregory.Donnelly@cigna.com) is vice president, sales manager, sales division of Cigna HealthCare. CIGNA HealthCare is one of the nation's leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.
We are no longer confined to waiting days for valuable information to travel back and forth through the U.S. mail. We are able to do business with customers and service partners across the country just as easily as if they were across the hall. The 21st century is an amazing time to be in business.
However, the capabilities enabling us to instantaneously share information also enable others to access the same information. And that has many Americans wondering, "How safe is my personal information?" Information about confidential health information is of particular concern.
Protecting individuals' health information was one of the key drivers for the Health Insurance Portability and Accountability Act (HIPAA). Protected Health Information (PHI) is any information that:
* Relates to the past, present or future physical or mental health of a person
* Relates to the provision or payment for health care
* Identifies the individual
PHI includes more than health status or diagnosis information. It includes demographic information, information about relatives, contact information and most other information that could identify an individual.
So how do we protect this information? Privacy regulations that went into effect in April state that covered entities -- health care companies, providers and employers using PHI -- must:
* Keep individuals' PHI confidential.
* Obtain authorization for use and disclosure of PHI.
* Give individuals the right to access their PHI and certain other rights.
The HIPAA privacy regulations and protecting health information will have wide-ranging impact on the way health care companies do business with customers and service partners. Employers and their employees should feel reassured knowing that the mandates associated with HIPAA are top priorities for health care companies and providers.
The objectives of HIPAA are not new to health care companies. Many have had their own policies in place for years -- policies that include employee training and careful use of member data to improve health outcomes.
In addition, health care companies like CIGNA HealthCare strongly support the increased efficiency and reductions in administration costs we believe will result from the implementation of the regulations. In short, HIPAA regulations simply provide specific national standards designed to meet essentially the same objectives that many have had for years -- protecting our members' confidential information and simplifying health care administration.
It is an objective we continue to focus on as we work together to create benefits that meet the needs of the employer who offers the plans and the employee who accesses the care. Gregory C. Donnelly (Gregory.Donnelly@cigna.com) is vice president, sales manager, sales division of Cigna HealthCare, one of the nation's leading providers of health benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.
Employers make their company's health plan decisions based on factors, including the amount of premiums, benefits and the size of the network. Just as important, they make decisions based upon quality, although quality is intangible and sometimes difficult to evaluate.
For help, employers can turn to standards for evaluation such as those provided by the National Committee for Quality Assurance (NCQA), a private, not-for-profit organization dedicated to improving the quality of health care throughout the country.
NCQA evaluates health care quality through such things as accreditation, which involves a rigorous on-site review of a health plan's clinical and administrative processes. Another tool is the Health Plan Employer Data and Information Set (HEDIS), a means of measuring a plan's performance in areas such as immunization and mammography screening rates.
Premium amounts alone may not always reflect the true costs -- or benefits -- of quality. Indirect costs, such as productivity, sick days and related wages also must be considered, as many illnesses cost a tremendous amount of money in lost work time.
The NCQA reports that:
* Estimated indirect costs in the United States for asthma total roughly $3.8 billion.
* Major depression costs about $23 billion in lost workdays.
* People with heart disease lose an average of 12 extra days of work and 17.3 bed-disability days each year.
* Smokers are out between two and 5.5 more days each year than are nonsmokers.
Such numbers illustrate why a health plan's commitment to preventive care services can also serve as an important indicator of quality. Effective health plans offer preventive health care initiatives such as:
* Outreach programs to encourage women to have a mammogram screening
* Disease management programs for people with chronic conditions like asthma, diabetes, heart disease and lower back pain
* Beta-blocker initiatives for people who've had an acute myocardial infarction, when deemed medically appropriate for preventing a second heart attack
* Prenatal education programs designed to help women have healthy pregnancies and healthy babies
* Preventive care reminders sent out yearly reminding health plan participants about preventive care services recommended for people in their age and gender group
* Newsletters sent to members with practical information on preventive care
Employers should pay attention to quality, because high-quality plans tend to result in healthier employees. And, as a recent Watson Wyatt report shows, employees place a high priority on quality, too.
Almost 90 percent of consumers surveyed feel that access to quality care is one of the most important factors to consider when choosing a health plan, an increase from a similar report five years earlier.
According to the report, consumers are now more likely to recognize that there are differences in the quality of local health plans, hospitals and specialists.
Fortunately for employers and employees alike, there are solid tools available for judging that quality.
Gregory C. Donnelly is vice president, sales manager, sales division of Cigna HealthCare. Reach him at (216) 642-2573 or at Gregdonnelly@cigna.com.
In last month's Smart Business, we examined the growing trend toward consumer-directed health plans.
In such plans, employees, armed with more information, are given more control over the allocation of their health care dollars. Such plans typically feature an employer-funded health savings account combined with a high-deductible traditional health plan.
With health care costs on the rise, some employers are moving toward these consumer-directed health plans in an effort to balance costs and promote consumer engagement in their health care decisions.
Things to consider
When evaluating consumer-directed plans, considerations for both employers and employees include:
* Depth and breadth of information available to the consumer. With decision-making shifting to the employee in these plans, the need for comprehensive, consumer-friendly information to help them make good choices becomes critical.
In a 2002 Watson Wyatt survey, 37 percent of businesses surveyed were looking for ways to give employees more information about their health care benefits. Plans that offer personalized, Web-based information, especially data about prescription drugs and hospital options, will be of greater interest to companies as they seek to arm employees with the facts they need to make appropriate health care choices.
* Availability of value-added programs. Programs such as 24-hour nurse phone lines, disease management support and nurse case managers can provide critical information and should be considered when selecting a consumer-directed plan. These programs can also provide further savings to employers.
* Choice and flexibility in the plan. Plans that cover preventive care services without a deduction from a health savings account or without being subject to the deductible can improve employees' satisfaction with their health benefits. Some plans may also tier hospital or provider networks as a means to control employer costs while giving consumers the option of getting care from a more costly provider.
* Deductible limits. While there are no limits on employer contributions, companies typically fund 50 percent to 75 percent of the deductible amount. Look for plans that offer a wide range of deductible levels when considering consumer-directed plans.
As more companies explore the use of consumer-directed health plans, it is important to recognize how such a plan might benefit your employees. Businesses whose overall benefit strategy focuses on reining in health care costs while providing more employee choice are often more open to plans with a health savings account.
For others, a plan that gives employees a set amount of funds from which to purchase health care coverage in the open market might be the preferred product.
Although more businesses are exploring the use of consumer-directed health plans to help empower consumers and control costs, they are generally not yet replacing traditional coverage options. Instead, they should be viewed as another opportunity for employers looking for creative benefit solutions. Gregory C. Donnelly (Gregory.Donnelly@cigna.com) is vice president, sales manager, sales division of Cigna HealthCare. CIGNA HealthCare is one of the nation's leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.
Benefits integration can provide a more complete picture of a member's health situation and more personalized care for employees and families. Physicians often see only a portion of their patients' health profiles, and integrated information can be a valuable tool in managing a patient's condition.
Also, integrated benefits administration helps facilitate outreach and support to physicians and coordination with other medical management strategies, such as disease management.
Integrated programs take shape
One example of integrated benefits administration is CIGNA Pharmacy Management, which has implemented coordinated programs that help alert physicians to opportunities to improve care for patients and support them in addressing patient issues.
As a result of integrated benefits data and claims analysis, physicians are notified of patients identified as potentially being in high-risk categories. In a survey conducted during pilots of these programs, 64 percent of physicians said program outreach and support were helpful in improving care.
Benefits integration in action
An asthma program, introduced nationwide in February 2003, identifies members who demonstrate increased use of reliever medications (used to treat asthma attacks) without controller medications (used to prevent attacks).
Clinical studies indicate an increased risk of hospitalization when large amounts of reliever therapy are used without controller therapy. The objective is to reduce asthma-related emergency treatment situations by encouraging physicians to prescribe controller therapy as they deem medically appropriate.
Programs like this work the following way:
* A monthly claims analysis, incorporating integrated medical and medication history and claims data, is used to identify members who demonstrate increased use of reliever therapy without controller therapy.
* Program management provides the member's physicians with the pharmacy and medical claims history that indicates the member may be at increased risk of hospitalization.
* For members with a history of asthma-related hospitalization, emergency room visits or previous identification by the program in the last three months, a clinical pharmacist will contact the physician to review the member's clinical information.
As a result of the pilot program conducted in 2002, 48 percent of identified members with asthma added controller therapy, helping to improve treatment. Many physicians indicated the additional information about their patients' medical and prescription history was helpful in providing care.
Does your company's health plan use integrated benefits administration to identify specific opportunities for improved health outcomes? Helping to improve the health of employees should be a priority for both the health plan and employer, and benefits integration helps make it possible. Gregory C. Donnelly (Gregory.Donnelly@cigna.com) is vice president, sales manager, sales division of Cigna HealthCare. CIGNA HealthCare is one of the nation's leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.
The challenge is making sure that employees have the tools to make informed decisions.
The good news is that employee benefits providers are attempting to make better use of the Internet to meet this need. The bad news is that access to brochureware, generic calculators and some back office applications doesn't seem to resonate with consumers.
CIGNA recently conducted a national survey of businesses and workers and found that while 80 percent of employers offer benefits information or tools online, just one in five employees has made use of them.
That's a pretty big disconnect, considering that all the parties -- benefits providers, employers and employees-- have the same goal: to improve the individual's opportunity for successful health care and financial outcomes.
In many cases, the portal is the leading edge approach. But while many portals fall short of meeting consumer needs and expectations, they can serve as an excellent foundation on which to create a more personalized and integrated environment to deliver better benefits experiences for consumers.
At CIGNA, we've launched the myCIGNA.com benefits portal to provide plan participants with detailed information about their health care and retirement accounts. It also lets them set preferences so that continually updated Web resources are aligned with their stage of life or health care information needs.
For retirement plan participants, personalization means they are no longer inundated with courseware that covers "Finances 101" and "Choosing a Retirement Home," but instead categorizes information that is useful and appropriate to preferences and interests. Similarly, health plan members can access information and tools specific to their concerns, such as a healthy baby immunization chart or a disease management program.
The portal offers an integration point for accessing information and receiving service. MyCIGNA.com provides information all in one place for health care plan participants (medical, dental and pharmacy) and retirement program customers (pension, 401(k), nonqualified plans and online brokerage services). Transactional tools and updated account information are being integrated with other forms of customer care, from service rep calls to phoning a registered nurse through a 24-hour health information line.
Web technology also offers increased opportunities for flexibility. Health plan applications can be recast as Web services that plug in all the authorized constituencies -- the employee, the doctor or hospital and the service provider -- thereby enabling delivery of a seamless, coordinated 360-degree view of the individual's health care information. From this vantage point, participants have a sense of greater control over their benefits and their health.
Investment in technology is critical because people must become more involved and make more decisions for themselves about the management of their health and financial well-being.
To do so, they have no choice but to be more informed and more engaged and, as an industry, we can no longer be passive in our efforts to help them. Gregory C. Donnelly (Gregory.Donnelly@cigna.com) is vice president, sales manager, sales division of Cigna HealthCare. CIGNA HealthCare is one of the nation's leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.