The modern employee assistance program (EAP) is an employer-sponsored benefit designed to support the achievement of employer health and productivity goals. EAPs also have evolved to become a strategic partner to maximize the human capital of an organization.

“An EAP’s main goal is to resolve problems before they interfere with work attendance or productivity. And, in performing that task, EAPs have a positive impact on a company’s bottom line,” says Sandra Caffo, a senior director at LifeSolutions, an affiliated company of UPMC WorkPartners.

Smart Business spoke with Caffo about how EAPs work and their ROI.

What is the potential payoff of using an EAP?

A study found that for every dollar spent in a typical EAP, there was a return of $5.17 to $6.47 in increased work productivity. The study also showed that 80 percent of costs from lost productivity were associated with presenteeism, which is when an employee is at work, but is not productive, largely because of personal problems.

EAPs employ behavioral health experts who can provide short-term coaching and counseling that focuses on problem resolution. The goal with all EAP services is to resolve problems before they interfere with work attendance or productivity. Because of that, EAPs can help supervisors understand how to manage those valued workers whose productivity suddenly and mysteriously plummets.

How do EAPs enhance value?

Supervisors may be able to spot a troubled employee and express concern, but typically they are not equipped to work out a plan of action to address the problem. Many supervisors would argue — correctly — that this isn’t part of their job description. That’s where an EAP can help. It can provide consultation to both the manager and the employee to develop a plan of action.

EAP consultants are able to guide leaders at all levels to shift their focus to management strategies that will make a difference in an employee’s job performance. With an EAP management consultant, leaders learn how to coach employees toward improved performance while holding them accountable for negative patterns of behavior.

Because EAPs are able to provide services that consider all of the occupational and non-occupational factors that affect job performance, they are able to increase the value of an organization’s investment in its workforce. They achieve this in several ways:

  • By increasing employee engagement and improving productivity, morale and workplace harmony.  
  • By focusing on building the capacity of employees and their dependents to successfully respond to life’s personal and work-related challenges.
  • Through EAP coaching and consultation, which helps leadership, managers and supervisors increase their skills to effectively address difficult employee situations. It can tailor programs and initiatives for key workforce groups to meet specific needs.

How does an EAP mitigate business risks?  

Supervisor consultation helps to build action plans and handle new or complicated employee situations, from incompatible employees to workforce reductions.

On-site trainings focus on staff development and skill building in areas such as stress management, customer service and multi-generational teams.

EAP intervention also can help when an organization has a traumatic incident like an accident or death to support those managing the situation and those affected by it.

A federal occupational health study of more than 60,000 workers using EAP services over a three-year period found statistically significant improvement from pre- to post-EAP intervention for six measures related to work productivity. These include: employees’ emotional problems, employees’ physical health, the interference of physical or emotional issues on work and social relationships, perceived health status, job attendance and/or tardiness, and global assessment of functioning. In short, the benefits of EAPs are measurable, and they can be used to select an effective EAP, gauge its performance and determine the ROI.

UPMC WorkPartners is part of the UPMC Insurance Services Division, which also includes: UPMC Health Plan, UPMC for Life, UPMC for You, UPMC for You Advantage, UPMC for Kids, Community Care Behavioral Health, EBenefit Solutions and Askesis Development Group.

Sandra Caffo is a senior director at LifeSolutions, an affiliated company of UPMC WorkPartners. Reach her at (412) 647-9480 or

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Published in Pittsburgh

On-site workplace centers have grown in recent years from being traditional in-house occupational health clinics where someone who was injured on the job could get basic care, to more extensive total health management centers that offer acute care treatment, health and wellness programs, health coaching, behavioral health assistance and chronic disease management.

Not all on-site facilities are right for all employers, but many different-sized companies are finding models that make sense for them.

“Studies have shown that only about 25 percent of large, self-insured firms offer some type of workplace center,” said Leonard Eisenbeis, director of Clinical Health Operations for UPMC WorkPartners, an affiliated company of UPMC Health Plan. “But, studies have also shown that the number of companies planning to open a worksite center doubled between 2007 and 2011 because employers are looking for a way to lower health care costs and support their bottom line.”

Smart Business talked with Eisenbeis about on-site services and why they can make sense for some employers.

What are some of the benefits that employees receive in on-site centers? 

An on-site health management center is attractive to employees because it provides convenient and timely treatment for a set of acute conditions. It also replaces what, for the employee, would be a more costly visit to an emergency room or urgent care facility. Additionally, the center can monitor employees’ chronic conditions, which can easily be relayed to their primary care provider or medical home, improving overall total health management.

What are some of the benefits employers see with on-site centers?

Employers like the fact that on-site centers reduce employees’ lost time from work, which increases productivity. In addition, a good on-site center can help generate employee awareness through physician referrals by engaging at-risk employees in a comprehensive management of lifestyle behavior and disease management. Also, directly avoidable health care costs — such as physician visits, urgent care and emergency room use — can be diminished through on-site centers.

What are some features you can expect at an on-site center?

On-site center staff provide primary care support and on-site care for acute health care services, such as headaches, minor injuries, sore throats, sprains and strains.

You can expect the center to be a front door to occupational health services, where occupational injuries can be reviewed quickly and triaged, and occupational health exams, drug testing and OSHA reporting could take place. Good on-site total health management centers provide health and wellness education and referrals. Employers may include prescription medication services by providing a courier service to deliver prescriptions to employees.

Is there one model for on-site centers?

No. Employers can choose from several delivery methods to find the one that works best for their individual companies. For instance, they can have on-site health centers, or they can have a ‘near-site’ center within several miles of the employer’s campus to be used by employees who work at different sites. Another form of on-site services is mobile medical units, which are a cost-effective option for targeted medical services or testing.

Employers also may take advantage of telehealth technology within an on-site center to effectively service a number of worksite campuses. Telehealth is a remote health management application that links employees from an on-site health center to a physician or provider using interactive videoconferencing, voice and data systems, and embedded peripheral devices.

Telehealth is becoming more popular because this technology could allow an employer to install telehealth equipment with a nurse or medical assistant and transmit a patient encounter to a provider, greatly increasing the affordability of on-site care and financial return on investment. There are many options in the deployment of telehealth that make providing total health management care very scalable to companies of all sizes.

Leonard Eisenbeis is a director, Clinical Health Operations at UPMC WorkPartners. Reach him at (412) 454-4960 or


Save the date: Join UPMC WorkPartners for an upcoming webinar, “The Next Generation Worksite Health Center,” at 10 a.m. April 24. To register, contact Lauren Formato at (412) 454-8838 or


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Published in National

Returning injured workers to a healthy and productive lifestyle is the goal of any workers’ compensation program, but the cost can be high for all involved. For an injured worker, there is the recovery from the injury itself, anxiety regarding the workers’ compensation system and the potential loss of the identity that he or she enjoys through work. For the employer and insurer, there are the escalating costs and complexities connected with managing claims, as well as the temporary or permanent loss of valuable employees.

All could benefit from the expertise and oversight that can only be provided by a comprehensive managed care approach.

“With workers’ compensation claims, you need to have a beginning-to-end strategy,” says Deborah Mehalik, manager of Network Services for UPMC WorkPartners, which is part of the UPMC Insurance Services Division. “The traditional managed care approach needs to be expanded to specifically target extremely vulnerable points within the workers’ compensation system for all parties involved.”

Smart Business talked with Mehalik about the advantages of having a robust managed care approach to help employers handle workers’ compensation issues.

How can a managed care approach impact a company’s workers’ compensation program?

Managed care must be expanded to include concepts such as:

  • Accessing medical expertise throughout the life of the claim.

  • Identifying quality providers who have expertise in workers’ compensation.

  • Aggressively identifying early, safe return-to-work potential.

  • Developing an in-depth understanding of cost containment strategies.

  • Measuring programmatic cost drivers through the use of data analytics.

An important new concept in managed care is integrating health and wellness resources at the time of a work injury to improve the employee’s overall risk profile.

What is the key benefit that a managed care approach brings to workers’ compensation?

The primary benefit in a comprehensive managed care approach is that it is structured to produce a win-win for all stakeholders involved.

How does managed care contain costs?

Costs can be contained in several ways. This would include the identification of medical providers who understand the importance of safe, early return to work and how it directly impacts lost time days and indemnity costs. Medical expertise can assist with causality determinations and appropriateness of treatment, and also ensure correct acceptance and payment for both.

Having a clear understanding of injury drivers assists safety personnel in making the necessary changes to process and policy in an effort to avoid similar claims.

Understanding cost drivers such as pharmacy and physical therapy allows for an evaluation of the gap between current and best practices and gives valuable insight when determining which vendor to partner with. Having knowledge of bill repricing and the network(s) being utilized on the employer/insured’s behalf assists in managing costs by maximizing preferential pricing and allows for continued evaluation of provider performance.

What can employers gain from using a workers’ compensation plan with managed care?

An employer will gain enhancements in areas such as case closure rate, causality determination and utilization review. Employers also should experience reductions in areas such as DART rate (days away/restricted/transfer), and medical and indemnity costs. Accessing sophisticated data analytics allows benchmarking of current programmatic performance and, when well structured, shows value or areas of cost shifting when new strategies are introduced.

What do employees gain?

A managed care approach that focuses on quality care and outcomes benefits employees by utilizing a best-of-the-best approach, linking them to superior providers and treatment platforms. By identifying best practices in areas such as pharmacy management and physical therapy, the employee has seamless access to a prescribed regime that maximizes the recovery effort.

Click here to learn more about UPMC WorkPartners and its workers’ compensation program.


Deborah Mehalik is a manager of Network Services, UPMC WorkPartners, a segment of the UPMC Insurance Services Division. Reach her at (412) 454-7083 or

Insights Health Care is brought to you by UPMC Health Plan

Published in National

Managing the leave process has always been complex and it is becoming even more so with recent updates in federal regulations concerning leave and accommodations. In addition to the federal requirements, state and local governments also are enacting laws to further protect an employee’s time away from work.

“Employee absence puts a strain on your organization, and survival in today’s business climate demands high productivity and a lean and efficient staff,” says Edward Mashey, senior director for Absence Management Services at UPMC WorkPartners. “Every hour an employee is out on leave adds costs to your bottom line and what you don’t know can hurt you.

“Compliance concerns, administrative errors, inconsistent tracking, under reporting, lack of accountability, limited knowledge and costs — all are reasons for putting leave administration in the hands of a trusted partner with years of experience administering leaves of all types, including family medical leave, military and employer-sponsored leaves,” he says.

Smart Business spoke with Mashey about what an employer should know when outsourcing leave administration.

What is an employer’s obligation in this area? 

The Family and Medical Leave Act of 1993 (FMLA) requires covered employers to provide employees job-protected unpaid leave for certain medical and family reasons, including personal or family illness, military service, family military leave, pregnancy, and the adoption or foster care placement of a child. The law recognizes the growing needs of balancing work with family and medical issues.

What are some reasons employers should consider outsourcing?

Tracking and managing the paperwork associated with all leave requests creates additional administrative burdens for an employer. UPMC WorkPartners’ experience with employers has shown the average time needed to effectively process a leave is three to five hours per leave. For an employer of 1,000 employees averaging 120 leaves per year, this amounts to nine weeks per year of managing just the initial leave requests.

Why is compliance in this area so important? 

Compliance with federal, state and local leave requirements is a key component in a successful leave program. According to the U.S. Department of Labor, Wage and Hour Division, the average wrongful termination verdict for an FMLA case is $350,000, not including attorney fees. Employers should seek out leave specialists who have ongoing training and education related to federal, state and local regulation changes in order to keep an employer’s program in compliance.

It’s important for employers to know that a supervisor can be individually liable for violating an employee’s FMLA rights based on the FMLA’s statement of who can be liable and its definition of who is an employer. Having a partner that can train and communicate to a staff and effectively interact with them regarding leave and disability issues is extremely important.

What are some other issues that surround leave management?

Intermittent leave time needs to be fully reviewed to ensure the leave meets the requirements of a serious health condition and each increment of time away from work is appropriate and medically necessary. Each absence needs to be reviewed for medical necessity.

Currently, the federal government has proposed changes to the FMLA that include updates to the military exigency and injured service member leaves. An expert outsourced leave administrator’s dedicated staff keeps abreast of all leave law changes whether federal, state or local changes.

And remember, the end of an employee’s leave time is not necessarily the end of the employer’s obligation. Recent court cases have shown employers how important it is that they discuss with the employee their potential ability to return to work after leave time has expired. Working with a partner that has the knowledge and skills to help identify those cases that will need extra attention from an employer is an essential element of an intelligent leave management strategy.

Edward Mashey is senior director, Absence Management Services at UPMC WorkPartners. Reach him at (412) 667-7117 or

SAVE THE DATE Wednesday, Jan. 16 , 11 a.m. to noon, UPMC WorkPartners webinar: Best Practices in Leave Administration. To register, contact Lauren Formato at or (412) 454-8838.

Insights Health Care is brought to you by UPMC Health Plan

Published in National

As employee wellness and health assume increasing importance in the workplace, the need for more qualified wellness leaders is growing. Employers need to know their investment in wellness is producing leaders who are current with the latest advances and emerging trends. They need to know their investment is being used efficiently and effectively to design comprehensive integrated programs, effective incentive plans and measurable results.

As a result, there has been an increase in the number of workplace wellness certification programs and the emergence of certified wellness leaders.

“Successful wellness programs need to have holistic health champions in the workplace,” says Rose Gantner, Ed.D., senior director, Consumer Education, Training and Innovation for UPMC WorkPartners. “And it is only through wellness certification programs that we can develop these champions who can make the business case for wellness and create a culture of health in the workplace.”

Smart Business spoke with Gantner about workplace wellness certification programs and why they make sense for employers and companies. Gantner is the author of a new book, “Workplace Wellness: Performance with a Purpose,” due out in March.

Why is there a need for wellness certification programs?

Corporate wellness programs are needed because of an increased focus by employers on employee health, recognition of the link between physical health and the psychosocial aspects of the environment, and the need for increased productivity and decreased health care costs. Certified professionals help create the mission, drive engagement in an organization and work to improve the health and well being of all employees and their families.

A healthy work force has numerous benefits for employers, and wellness certification programs are designed to help capture those benefits. A wellness culture is fundamental. It is based on trust, psychological safety in the environment, shared norms and a genuine feeling that employers care about employees. You can’t change behaviors without this positive culture of health, supported by committed senior leadership willing to serve as role models.

Changing the culture isn’t just holding a weight race; it’s making the race the thing to do to reach a healthy weight. It’s not just encouraging healthy eating; it’s making healthy choices the easiest ones in lunch rooms. It’s making taking the stairs, versus the elevator, ‘just what we do.’ The most important ingredient is having people who understand the importance of having the peer and social support necessary to effect meaningful changes in behavior in the workplace. Employees who value their health and the health of others can best gain this knowledge and skill through wellness certification programs.

What are the advantages of a wellness certification program for an employer?

When a company has a wellness program that offers certification, an employer can feel confident of the professionalism of those involved in running the company’s wellness program, and consequently, in the effectiveness of the program. Certification is one way an employer can identify a true expert in the field of workplace wellness. Certification programs provide employers with the metrics that are essential to support wellness and health productivity programs. Studies have shown that when companies support wellness with measurable outcomes, they have greater financial success. Through these programs, participants can learn about return-on-investment calculations that can provide employers with the best information and the application of the right interventions at the right time.

Are all wellness certification programs the same?

No. Some focus on the clinical aspects of wellness, on specific health conditions. Others put more attention on one-on-one services such as personal training, health coaching, or nutrition, while still others require a participation fee. But some are offered free to commercial employer groups as part of a total benefits package.  What is important is finding the right program to fit a company’s needs and demographics. Successful corporate wellness programs must engage employees from the top-down and bottom-up. The strategy should be multidimensional and use tools that leverage technology and the power of social support.

What elements should a wellness certification program include?

Participants should come away with a full understanding of the latest industry standards and best practices. This knowledge component is invaluable. Second, they should learn about a wide variety of programs and services critical for sustaining engagement long term and about how to increase high performance while decreasing health care cost trends.

Employers should expect a competency-based program that provides the most recent and relevant resources. Good programs should include pre- and post-training exams, instruction in how to strengthen and expand programs, and sharing of real testimonials and lessons learned about how such programs make a difference in people’s lives.

What are some skills that can be acquired in a wellness certificate program?

You can learn fundamentals necessary to build sustainable cultures of health and new research on positive psychology components to maximize engagement strategies. You can become confident in your knowledge and ability to implement self-care programs, design and manage program calendars, integrate chronic disease management programs and employee assistance, and evaluate and provide reports to stakeholders. There is a difference between having employees participate in wellness programs, and being engaged and actively involved in long-term, meaningful changes in behavior. When that happens, it’s a win-win for employees and for employers.

ROSE GANTNER, Ed.D., is senior director, Consumer Education, Training and Innovation for UPMC WorkPartners. Reach her at (412) 454-8571 or

Published in Pittsburgh

Today’s leading companies are developing business strategies to address rising medical costs and improve the health and productivity of their work force.

An overarching health and productivity strategy breaks down traditional silo benefits programs, which allows for a more comprehensive management of an employee’s health. Companies benefit from healthy and productive employees, while providing employees with the services necessary to take control and impact their quality of life.

“Very few companies have an effective strategy to comprehensively manage health and wellness across all benefit lines,” says Melissa Dunn, senior director, sales and marketing at UPMC WorkPartners. “When comprehensively managed, today’s business leaders can address and impact rising medical costs and unscheduled time away in the workplace.”

Smart Business spoke with Dunn about the need for a comprehensive health and productivity strategy and why it makes sense for employers.

What is a health and productivity strategy?

It is a holistic and integrated approach to addressing health and productivity issues that impact an organization’s performance. It’s a strategy that achieves cost savings for employers, and not by rationing care or reducing benefits. Rather, savings are achieved by looking across all care provided to an employee and then coordinating that care to identify health trends and create programs to positively impact these trends. This not only benefits the employer, it also improves the overall health of employees.

Studies have shown that unhealthy lifestyle behaviors drive 50 to 75 percent of poor health and the associated costs. In turn, those lifestyle behaviors drive 41 percent of short-term disability costs, 24 percent of workers’ compensation costs, 29 percent of the cost of absences and 38 percent of medical and pharmacy costs. But all too often, an employer wrestles with those costs in silos, resulting in excess expenditures and underwhelming results.

An integrated, total health management strategy links the resources a company offers to employees, which are often already in place — including leave management, short-term disability, employee assistance programs, wellness, health coaching and more — to take a proactive approach to addressing health and productivity issues.

How can an employer bring this all together?

Seeing the connections between programs and how each program can impact an employee at a time when assistance is needed most is critical to a successful health and productivity strategy. Employers that provide employees with a 360-degree view of all the benefits and resources available empower employees to access the necessary care and assistance. Employers that have successfully provided an integrated health and productivity solution to employees have engaged with service providers and vendors to not only provide the services but to automatically facilitate the linkage between the services. This approach identifies, engages and impacts more employees and results in improved health and productivity.

Here is a real-life example of how it can work. An employee filed a leave claim to care for her mother. Once the claim was submitted, the employee assistance program contacted her to see if she needed assistance in finding daily care for her mother.

During the conversation with the EAP counselor, the employee acknowledged that she was feeling severely overwhelmed by the burden of her job and her additional family responsibilities. After further discussion, she was referred to a behavioral health counselor to be evaluated. The counselor then referred her to a partnering physician for evaluation and treatment. Through the process, the employee received assistance for her family situation and the right care for her personal health situation. This resulted in the employee returning to work with limited distractions.

Where should employers start to implement an integrated health and productivity strategy?

Many companies offer programs that are critical to a successful health and productivity strategy. However, the problem is that these programs are typically provided in silos, and the siloed approach does not provide the opportunity to connect the programs on behalf of an employee and the issues they face.

An integrated approach breaks down silos and creates crosswalks to receive the services of multiple programs through one source.

How can employers break down program silos?

You can break down these silos by providing an integrated technology platform and service processes that look at individual employees and connect them to the various services available. In-depth data analysis enables collaboration among leave management, employee assistance, employee benefits, workers’ compensation, disease management and other programs to best serve employees.  Collectively, these programs offer employees a wealth of education and services to address issues such as stress, depression, weight management, etc., creating a positive impact on health and productivity for employers.

And when employees are more knowledgeable about their own health, they are more motivated to follow prescribed treatments and better able to achieve goals for a healthier life. An integrated health and productivity strategy provides solutions intended to empower people with the information, tools and support needed to take charge of their health.

To reduce medical trend or disability costs, employers should identify ways to provide these crosswalks, connect people to the services they need and positively impact the health of more people. Through the use of a total health management strategy, you have the ability to identify, find, engage and impact more people than before.

MELISSA DUNN is senior director, sales and marketing for UPMC WorkPartners, which is part of the UPMC Insurance Services Division. Reach her at (412) 454-8380 or

Published in Pittsburgh

Bullying has long been considered a concern mainly of parents, teachers and principals, not office managers or CEOs. But in recent years, employers have faced the problem of diminishing civility in the workplace, and that often manifests itself in bullying and other similar kinds of behavior.

“Workplace bullying is basically symptomatic of underlying issues in the culture — uncivil ways of being, behaving and managing people,” says Debra Messer, account manager for LifeSolutions, a UPMC WorkPartners affiliate. “The bullying may not always be intentional, but it is always harmful and must be addressed.”

Smart Business spoke with Messer about bullying and civility in the workplace, how it impacts employers and employees, and what you can do about it.

What is workplace bullying?

Whether it’s referred to as disrespect, rudeness, bad manners or a lack of interpersonal skills, bullying always comes down to unacceptable behavior in the workplace. This behavior causes distress for the targeted employee, for the co-workers who witness it and for any clients who may be affected by it. It impacts the overall morale of an organization.

Bullying is more than an occasional rude remark or thoughtless gesture. It is repetitive over time, and tends to escalate or worsen if left unchecked. It involves a power disparity. It is a pattern of behavior that serves to put down, embarrass or disempower another person.

How is a company affected by bullying in the workplace?

An organization in which bullying occurs stands to lose, any way you look at it. Some of the effects of bullying include retention problems and absenteeism, decreased engagement, and a climate of fear and mistrust. Fearful employees hide mistakes to the detriment of customer needs. New ideas are not shared and creativity and innovation can be affected. Also, a company’s public reputation and image can be damaged. Everyone loses when bullying is allowed to continue.

How common is workplace bullying?

The Workplace Bullying Institute and Zogby International have conducted multiple surveys of adult American workers and made several key findings, including that 37 percent of American workers reported being the target of bullying, and 12 percent of employees reported witnessing bullying. That means that nearly half of all workers have had direct or indirect exposure to it.

The survey also found that 72 percent of the bullies were identified as bosses and that more men are perpetrators than women. However, the majority — 57 percent — of bullying targets are women. The study showed that 40 percent of bullied employees do not tell their employer about the bullying and that 62 percent of employers either ignore reported bullying or take action that makes the situation worse.

Why is bullying coming to light as an issue now?

Bullying has always been present whenever people have worked together. It is only in recent years that it has been identified as a critical issue or a sentinel event and formalized efforts been made to study and address it.

In 2008, the Indiana Supreme Court ruled that workplace bullying is a form of intentional infliction of emotional distress. The court awarded $325,000 to a plaintiff bullied by a supervisor. This high-profile case helped to propel workplace bullying into the spotlight. In response, many companies have begun instating anti-bullying policies, and a number of state legislatures have been considering ‘healthy workplace’ legislation that would offer employees means to address these issues.

What is the impact of bullying on the person targeted?

The impact can be considered ‘health harming’ to the employee. It can be emotional, psychological, physical, or social injury, and it may result in a loss of production. Moreover, employees who witness other employees being bullied can exhibit reactions and symptoms similar to those of the targeted employee.

How can workplace bullying problems be solved?

An organization’s leaders need to recognize the more subtle signs of bullying, including those entrenched in the system. Leaders must know how to convey expectations for civil behavior to their employees and commit to consistently and fairly responding to incidents of disrespect or bullying when they occur.

Creating a culture of civility in which disrespect and bullying rarely occur often requires major shifts in thinking, perspective, management styles and behaviors. It will take time, commitment and the willingness to honestly assess the environment and long-held patterns of behavior. It is not for the faint of heart, and one cannot wait until the ‘other side starts to behave better.’ As Gandhi said, ‘You have to be the change you want to see.’

What are some options for management to deal with this problem?

Workplace bullying does not occur in a culture that does not allow it. Leaders need to ask themselves, ‘Do I send the message that each employee is valued, respected and appreciated, or do employees feel dismissed, expendable, or unheard? Do employees feel they can come to me when they are overloaded or stressed?’

The reality is that a company cannot promote a culture of civility or respect unless leadership exemplifies those qualities.

DEBRA MESSER is an account manager for LifeSolutions, an employee assistance program that is part of UPMC WorkPartners. Reach her at or (412) 647-9064.

Published in Pittsburgh