Energizing employees about their health benefits

Surveys show that health benefits selection is confusing and stressful for employees. Getting your employees more involved in open enrollment and other benefits administration activities can pay big dividends in reducing this negative experience, says Jo Hartoyo, CTO at eBenefits Solutions, an affiliate company of the UPMC Insurance Services Division. This division includes UPMC Health Plan, UPMC WorkPartners, LifeSolutions, UPMC for Life, UPMC for You, UPMC for Kids and Community Care Behavioral Health.

Smart Business spoke with Hartoyo about ways to engage employees through their benefits selections.

What are the benefits of increased employee engagement?

According to a recent survey, when employees are actively engaged in choosing their benefit options, they are three times more likely to be satisfied with their jobs than employees who are not actively engaged.

Those who are actively engaged in choosing their benefits are twice as likely to value those benefits their employer is offering.

The key takeaway is that a more engaged employee is going to make better-informed benefit choices. This helps both the employee and the employer. The employee can potentially save thousands of dollars by choosing the right plan and the employer is more likely to save on overall health care costs.

How can employers encourage more engagement?

1) Offer integrated tools. It’s best to integrate decision-making tools, cost calculators and other helpful information directly into the benefits enrollment process. These tools enhance the benefits enrollment experience and provide a more interactive, engaging experience. This makes it easier for employees to evaluate options and to make the right decisions. This enhanced level of self-service has the beneficial side effect of freeing up your HR business partners so they can tend to higher-level strategic programs aimed at achieving an organization’s goals.

2) Provide user-friendly, web-based technology. Better-designed technology with simpler, more intuitive interfaces is vital for increasing employee engagement. Employees are consumers and, as such, expect retail-like websites that are easy to use. It’s also vital to allow employees the ability to enroll in and manage all of their benefits seamlessly through a secure single-sign-on technology platform.

In addition, single-page applications allow employees to access their benefits, claims information and human resource updates all on the same screen, as opposed to skipping around from screen to screen where each page has a different look and feel. The one-screen approach makes navigation far simpler, more intuitive and more responsive for a better overall user experience.

3) Communicate with a multi-channeled approach. A recent workplace survey found that when employees received benefits communications through their preferred channels — via print, email, onsite meetings or a combination — 70 percent were very confident in their selections. When employees didn’t receive benefits communications through their preferred channels, less than 40 percent were very confident in their selections. Overall, the study showed that when employees both receive communications and enroll through their preferred channels, they are more likely to make better enrollment decisions. They are more informed about health benefit details such as deductibles, out of pocket maximums, and employer contributions.

At the end of the day, in order to energize and engage your employees with their benefits, you want to make things easy for them.

A basic example of this is to allow employees to enroll online. This means employees can sign up 24/7 from their home or office and can check their selections and benefits any time. It’s also much easier for employees to compare plan options and benefit details when everything is online.

These simple strategies will yield a huge payoff in terms of getting employees more engaged in the process and happier with their benefit selections. This translates to more satisfied employees and higher employee retention.

Insights Health Care is brought to you by UPMC Health Plan

How to help employees reduce the risk of health care fraud and identity theft

The health care system in the United States is complex and unwieldy, which unfortunately makes it susceptible to fraud. While only a small fraction of health insurance claims are fraudulent, they carry a hefty price tag. Some estimates put the total cost of health care fraud at more than $200 billion each year.

“Health care fraud costs everyone money — providers, health insurers, employers and consumers,” says Veronica Hawkins, Medical Mutual vice president of Statewide Accounts. “Additionally, it can result in a loss of benefits, higher out-of-pocket costs and inaccurate medical records.”

Smart Business spoke with Hawkins about health care fraud and identity theft, and the role employers can play in helping to decrease the risk.

What does health care fraud involve?

Health care fraud involves using the health care system for financial gain. It can be committed by dishonest providers, pharmacies, medical equipment companies and other related entities. There are even organized crime groups that run complicated scams. The most common types of fraud are misrepresentation of services, billing for services not performed, altering claim forms for higher payments and providing unnecessary medical services to patients.

Fraud can also be committed by regular people who steal medical identities so they can see a doctor, get prescription drugs, receive medical equipment or file false claims with insurance carriers. This can affect treatment, insurance and payment records, and credit reports. A 2015 study found that more than 2 million people are victims of health care fraud each year. These victims have to pay an average cost of $13,500 to fix their stolen or compromised identity.

How can fraud impact patient care?

Patients who are victims of fraud may not get the treatment they actually need. If a doctor falsifies or exaggerates a diagnosis, a condition that someone doesn’t have could be added to his or her medical record. Fraudulent providers may order inappropriate medical services or expensive and unnecessary diagnostic tests.

In cases of medical identity theft, patient medical records can be compromised or legitimate insurance information can be used to submit falsified claims. This could make a big difference in your future treatment if your medical records are inaccurate.

How does it affect health insurance?

Health care fraud can have a big effect on insurance by leading to higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits or coverage. For employers, health care fraud increases the cost of providing insurance benefits to employees and the overall cost of doing business.

What role can employers play in helping to lower the risk?

Employers can help educate their employees about how to better protect themselves. First, encourage them to pay attention to their explanations of benefits and billing statements to make sure the listed services are accurate. Too often, people don’t read these documents thoroughly.

Member ID cards, explanations of benefits and other health plan correspondence should be secured just like credit cards. These documents need to be kept in a safe place so that no unauthorized people can gain access to them. It’s also a good idea for employees to monitor their credit reports to identify any medical debts.

In addition, employees should only share their ID numbers and personal health information with trusted doctors and other providers. Check the network of providers available and make sure to view their ratings. Beware of ‘free’ medical services or treatments, as these offers are sometimes used as way to get information for filing false claims.

Insights Health Care is brought to you by Medical Mutual

How to combine programs to create a superior self-funded benefit solution

One of the biggest advantages of a self-funded arrangement is the ability to customize the health plan to fit the needs of a specific group of individuals. For example, if an employer group has a large number of women who may be at the age to start a family, a maternity management program could be a great tool for them. Or if an employer group is mainly located in a rural area, or is more tech-savvy in how they want to receive medical services, a telemedicine program might be a good fit.

Whichever programs and services meet the unique needs of a group, employers may have the opportunity to bundle those core programs together, lowering costs and reducing plan waste.

“By bundling core programs, employers can be confident that they are not paying for unnecessary extras and their employees will receive the care they deserve at a price the employer can afford,” says Erin Davidson, sales account executive at HealthLink.

Smart Business spoke with Davidson about putting together a custom health plan in a self-funded arrangement.

How does an employer know which programs are best for employees?

Employers can look at past years’ claim data and the demographics and common characteristics of their employee population as a basis for deciding which programs to implement. Employers should also rely on their network account manager to help them review data and draw conclusions.

After employers have a better understanding of which programs and services will be the most beneficial for the group, they can work with their network partner to bundle the selected programs together at a discounted rate, rather than paying for them on an a la carte basis. Plus, when certain programs are bundled and working together, they can help employers control the cost of their health plan and optimize outcomes for employees.

For example, when you bundle network access with a medical management program, you can have a collaborative team of health care professionals working together to better identify employees at risk and offer guidance toward appropriate care management. This integration of the provider network with cost containment services achieves the best possible outcomes for the employee and the benefit administrator.

Many networks already have ‘bundled’ options for some of their most popular programs that they offer at a discounted rate.

Once they have decided which programs they want to offer, what is the next step?

Many employers don’t realize that their network provider offers these supplementary programs and services and when they bundle them with their network access, it may be less expensive. Also, when programs are bundled with network access, employers can ensure that the doctors who are overseeing precertification or case management are in-network.

Employers should work with their network partner to bundle and implement a plan that is unique to their company and their employee group.

Are there programs that work well bundled together? What about any that don’t?

When building a comprehensive plan, employers should aim to have all bases covered. This means medical coverage, as well as some specialty (vision, dental, life and disability) and health and wellness programs. Selecting coverage from each of these components can make bundling the programs easier and more effective.

What else do employers need to know?

Just because your network partner offers a bundled solution, doesn’t mean it’s right for your company. It’s important to do the legwork to decide which programs and services make the most sense for your company, rather than simply assuming packages that have worked for other companies will work for you. Employers should rely heavily on their network partners to help them make these decisions.

Employers should also remember that health and wellness and cost containment programs need engagement to be successful. It’s not enough that employers work to develop a comprehensive benefit plan; they need to be prepared to promote the plan to facilitate engagement.

Insights Health Care is brought to you by HealthLink

How EOBs help employees understand their health care costs

An explanation of benefits statement, or EOB, is a document that health insurance companies use to explain the costs of recent health care claims to their members. Making sure employees carefully review and understand their EOBs is an important part of managing health care costs.

“For many people, EOBs can be somewhat confusing and difficult to navigate,” says Amber Hulme, Medical Mutual regional vice president for Central Ohio. “But by helping employees understand what’s in their EOBs, organizations can avoid overspending on health care.”

Smart Business spoke with Hulme about what’s generally included in an EOB, key components to pay attention to and why it’s important for employees to review and understand every statement they receive.

What is an EOB statement?

Some people might not know what they are called, but anyone who has been to the doctor has probably seen an EOB. Any time an employee, or one of their dependents, gets care from a doctor, hospital or health care provider, their health insurance company generates an EOB. It documents the claim and explains how it was processed. Many insurance companies also allow members to review their EOBs online.

Each insurance company sets up its EOBs a little differently, but the basics are relatively similar. They include vital information for the policyholder, such as name, address and policy or group number. They also will have the provider’s name, date of service and a description of the care the patient received.

The key information, of course, is the details of how the claim is being paid, as well as current deductible and coinsurance balances.

How are claim details usually shown?

When employees receive an EOB, it’s important for them to look for a few key pieces of information. The amount billed, for example, is the full amount the provider charged for the services. The allowed amount, sometimes called the amount approved, is the portion of the claim covered by the health plan.

When employees review their EOBs, they can tell whether the health care provider accepted the allowed amount as payment in full. If they did, the employee is only responsible for the deductible, copays or any coinsurance amounts that apply. Otherwise, they might have to pay the difference between the allowed amount and the full charges.

How can EOBs help employees avoid overpaying?

For a variety of reasons, employees might find out that the services they received weren’t covered — or at least not at the level they expected. The EOB will include codes that explain why the insurance company didn’t approve some or all of a claim. For example, the plan may not cover a particular type of service, or the services were done at a non-network provider. This is coded and explained in the EOB.

By reviewing EOBs for these types of situations, employees can make better decisions about their health care in the future. For example, they might try taking advantage of urgent care facilities in non-emergency situations. Or, make a habit of checking the network status of their doctors and health care providers before they schedule each appointment.

What else should employees know about EOBs?

Most insurance companies have guides to help employees navigate their EOBs, and organizations should make those available to employees. Employees should be able to recognize, for example, if they’re being charged for services they didn’t receive.

Finally, it’s a good idea for employees to keep copies of their EOBs for their records. Insurance companies can usually retrieve paper copies for several years, but online copies are also available. Medical Mutual, for example, keeps electronic EOBs for two years. And employees should always call their insurance company if they have any other questions about their EOBs.

Insights Health Care is brought to you by Medical Mutual

Take two laps and call me in the morning

We have known for years that patients are more likely to start and maintain healthy behaviors and to better control their medical conditions when their doctor tells them to. We also know that people are more successful at making healthy changes when a health coach  motivates and guides them to stay on task.

So it’s no surprise that people are more successful when those two things are combined, as in when a doctor prescribes coaching to patients to help them follow through on their goals.

“Some health management programs are doing this now and employers are taking notice,” says Dr. Michael Parkinson, senior medical director of UPMC Health Plan and UPMC WorkPartners. “Physicians can now prescribe healthy behaviors, chronic disease management and better decision-making about surgery to employees. Of particular interest to employers, physicians are sending employees to coaching programs and online tools for such things as stress management, maternity support, weight loss, high blood pressure and chronic back pain.”

Smart Business spoke with Parkinson about the latest developments in this trend.

Why are so many employers offering health coaching to their employees?

It’s clear that changing unhealthy habits to healthier behaviors can head off chronic diseases, prevent them from getting worse and even reverse their effects.

While most health care providers would love to continually encourage patients to adopt healthy behaviors and get to the root of their patients’ health issues, most doctors simply lack the time or the expertise and resources needed to do the proper follow-up care. That’s where health management programs can help. They extend a doctor’s influence between office visits and help patients stay on their personalized care plans.

How do these doctor-prescribed health coaching programs work?

Let’s say a doctor prescribes a weight-loss program to help prevent a chronic disease such as diabetes. A trained health coach receives the physician’s prescription order at the same time that it is given to the patient. The coach then provides support and encouragement to help the patient become healthier, more engaged and more competent to manage his or her health. The health coach also provides the doctor feedback, which supports the doctor-patient relationship. Embedding the prescription for health coaching into the doctor’s electronic medical record represents a major breakthrough in increasing the ease and effectiveness of the process.

This arrangement produces better outcomes and usually lowers costs as well. It’s a win-win. The doctor gains additional support while the patient gets the health and medical assistance he or she needs.

Can you talk more about the doctor’s involvement in health coaching?

It’s important to note that these health management programs do not replace the doctor’s care. Rather, they support the doctor’s care. Most of these programs are facilitated by nurses, dietitians, exercise experts and other licensed and trained clinicians, often with medical director oversight. Also, these health coach professionals provide support based on the doctor’s specific recommendations. They will even help patients better prepare for their next office visit. Health coaches can evaluate treatment options and help people improve their skills in communicating their preferences to their doctors. Each patient is in expert hands throughout the process.

What types of health coaching are available?

There are health management programs in behavioral health, condition management, maternity and lifestyle improvement. These programs offer support for a range of needs, including depression and anxiety, substance abuse, diabetes, hypertension, high cholesterol, prenatal care, weight loss and nutrition, stress management and tobacco cessation.

Health coaches also provide support for people who need to make decisions about medical treatments or elective procedures. As an added bonus, most programs have no copays for employees. Better still, many employers incentivize their employees to enroll in and complete health-coaching programs. Finally, to accommodate busy employees, coaches are often available in person or via phone nights and weekends.

Insights Health Care is brought to you by UPMC Health Plan

How to help your employees stay healthy

Preventive care is all the rage in today’s health care world, and for good reason. Staving off chronic disease can not only save money for both employers and employees, it also creates a healthier and happier population.

“In-office fitness centers can contribute to that equation,” says Michael Boyle, manager of Healthy Connections Wellness Center, National Institute for Fitness and Sport, which manages 19 in-office fitness centers for Anthem, Inc. “It’s no secret that corporate fitness is a growing business, healthier employees take less sick time and have more energy, leading not only to more productivity but also to cost savings.”

Smart Business spoke with Boyle about some of the best strategies for engaging and motivating employees with health and wellness programs.

How can employers motivate their employees to stay healthy?

Employers can do several things to motivate employees to take part in health programs and stay healthy. Depending on time and resources, these strategies can be as elaborate as running a company-wide contest, or as simple as placing stickers on the stairs to show how many calories are burned with each step.

The key to successfully motivating employees is to keep participation easy and straightforward so as not to interfere with their already-busy work schedules.

What are some examples of the more complex programs employers can use to motivate employees?

One great program that can be really impactful for employees is a “Know Your Numbers” program in which employees receive incentives and/or discounts if they meet certain health requirements. These requirements can be customized by the employer and include things such as being a certified non-smoker, meeting body mass index, or BMI, requirements or receiving a flu shot.

Another example of a more involved program that employers can implement is participating in Global Employee Health and Fitness month (GEHFM). This international observance of health and wellness in the workplace, which takes place in May each year, was created by two nonprofits with the goal of promoting the benefits of a healthy lifestyle to employers and their employees.

Companies of all sizes are invited to participate in GEHFM by challenging their employees to create healthy habits. Employees can log, track and share their activities on the GEHFM website throughout the month.

While many employers use incentives to encourage employees to participate in programs, the incentives don’t have to be elaborate or cost a lot of money. The main goal for some employees may be to earn the prize, but the employer’s goal should be to promote a healthy lifestyle in efforts to help employees form healthy habits that they will be able to sustain for years to come. Learn more about GEHFM.

Are there programs that are a good fit for employers who are worried about the time and resources needed to engage employees?

Absolutely. Lunch and Learns are very easy to implement with minimal time and resources. Simply invite employees to spend their lunch hour learning about healthy living topics such as how to prevent neck and back injury, or the importance of taking breaks and staying active during the workday.

Starting a walking club is another great use of a lunch hour or an afternoon break and takes little time or effort to get started.

Is there anything else employers should consider?

Being healthy is not just about physical health, it includes mental health as well. With volunteer opportunities including gardening at local schools, working in the food pantry and volunteering with Special Olympics, giving back is a great way to keep people positive and encourage healthy living.

Employers should consider community service and team building activities when appropriate.

HealthLink is a fully owned subsidiary of Anthem, Inc., one of the nation’s leading health benefits companies.

 

Insights Health Care is brought to you by HealthLink

How healthy eating can increase employee productivity

In any business, the productivity of employees is critical to its success.

That’s why many organizations look for ways to keep their employees working at maximum efficiency. From the work environment to managerial support to quality work/life balance, many dynamics contribute — and workplace nutrition is another important factor.

“Many workplace wellness programs focus on fitness and health screenings,” says Veronica Hawkins, Medical Mutual vice president of Statewide Accounts. “Encouraging employees to eat healthy should also play a key role.”

Smart Business spoke with Hawkins about why organizations should promote healthy eating and how they can do it effectively.

How does diet correlate with productivity?

Plenty of studies link good nutrition with better overall health. It makes sense. People who eat well often feel better and have more energy.

Employees who try to follow guidelines of good nutrition also reduce their risk of obesity, heart disease, stroke, diabetes and some types of cancer.

Are there simple things leaders can do to promote healthy eating?

Leaders can set a positive example. If employees see their managers drinking water throughout the day and making good decisions about foods they eat, employees may be more apt to follow suit.

Another way is to implement an awareness campaign that encourages healthy lifestyle choices and includes tips on how to do so. This can include bulletin boards, posters or emails that focus on the benefits of nutrition, offer meal strategies and promote local farmers’ markets or restaurants with healthy menus.

Hosting healthy department potluck lunches also can get employees engaged as they try new foods and share recipes.

These are good ways to start making nutrition part of the workplace culture.

How can organizations create a culture of nutrition?

Any food ordered for meetings should include fruits, salads and other low fat items instead of donuts and pizza. Most organizations provide refrigerators and microwaves, but toasters and blenders can make it even easier for employees to bring food from home that can be prepared.

If your organization has a cafeteria and/or vending machines, make sure plenty of nutritious options are available.

At Medical Mutual, we often work with employer groups to design and implement nutrition programs that focus on healthy eating. This can also include online virtual coaching or a personal health coach through a lifestyle-coaching program.

Offering nutrition classes is another cost-effective way to reach a large number of employees and address multiple topics. These could be one-hour ‘lunch and learns’ that address specific issues, like understanding food label information, or longer seminars that delve into a variety of subjects, like stress, weight loss, etc.

Classes are a good way to bring employees together and help them support each other in making healthier choices.

Are there other resources available for organizations to use?

The Centers for Disease Control and Prevention’s website offers a plethora of nutrition information. There are multiple links to fact sheets, an interactive website about improving fruit and vegetable consumption, downloadable brochures, and links to additional useful sites such as the U.S. Department of Agriculture. These can all be made available to employees.

If your organization makes healthy eating part of the workplace culture, it can go a long way toward keeping employees happy, healthy and productive.

Insights Health Care is brought to you by Medical Mutual

How to support employees with alcohol challenges

Though sometimes hard to detect, alcohol abuse and alcoholism can impact the workplace — from absenteeism and lost productivity to missed deadlines, strained relations with co-workers and outright dismissals from work.

It is important for employers to have policies and plans in place, including support for employees who struggle with these challenges, says James Kinville, senior director of LifeSolutions, an employee assistance program (EAP) and part of UPMC WorkPartners’ suite of services.

Smart Business spoke with Kinville, in recognition of Alcohol Awareness Month, about what employers can do to help.

What can employers do about this problem?

Employers have an obligation to support their employees, but should not base that solely on lost productivity or the company’s bottom line. Rather, employers have a moral obligation to help their employees live healthier, happier, more sober lives. The same goes for employees dealing with family, financial, legal or health problems.

The best way to address these issues is through an EAP. This benefit offering, which is often separate from health insurance, helps employees with personal or work-related problems that impact their job performance. EAPs typically offer short-term counseling, referrals, employer/employee training and education.

How specifically can an EAP help employees with alcohol problems?

Most EAPs offer awareness training so managers can recognize the signs of a problem and know what to do about it. Once a policy is in place, a manager knows that he or she can refer an employee to the program. That’s incredibly helpful and gives a manager peace of mind.

It’s not a supervisor’s job to diagnose alcohol abuse or alcoholism. Even if a manager suspects that alcohol is involved, it’s better to focus on how the suspected alcohol problem is manifesting itself through increased absences, frequent tardiness or a dramatic falloff in work quality. Stick to tangible behaviors, not the alcohol part.

Accusing the employee of having an alcohol problem rarely goes well and it can be very stressful. It’s better to say you have noticed certain ongoing problems, provide the employee with the EAP number and insist that he or she make contact right away.

What about confidentiality? Are some people hesitant to seek help because it could hurt their career if the word gets out?

Whether the employee seeks help on his or her own volition or is referred by a manager, EAPs are extremely confidential. The EAP only divulges to the employer that the employee made contact with the EAP and that there’s a plan in place. No other health or confidential information is shared.

What is the process once the employee makes contact with an EAP?

Most EAPs offer six sessions with a counselor who conducts a comprehensive review and assessment and works with the employee to develop a plan of action. Sometimes, that’s all that’s needed. Other times, the counselor may refer the employee to a therapist or other behavioral health professional covered under the health plan.

What would you tell employers that don’t have an EAP?

Partner with one. EAPs tend to be low cost and even small companies can afford them. It’s a high-value service that employers tend to not need often, but when they do, it makes all the difference.

It’s also important to promote the EAP. Employees need to know about the service and that their organization supports it. EAPs work best when they are promoted internally in a consistent, customized manner, through mailers, lunch and learns, promotional campaigns and worksite presentations.

Any final thoughts on helping employees with alcohol challenges?

You often hear with alcohol or drug addiction that the person with the disease — and these are diseases, not moral weaknesses — has to hit bottom before realizing he or she has to take steps to get better. By utilizing EAPs and other support services, we can raise that bottom so the afflicted person doesn’t have to fall as far. With an EAP, the employee can take action sooner, before a potential crisis hits.

Insights Health Care is brought to you by UPMC Health Plan

The importance of industry experts in a time of health care reform

As the new presidential administration approaches 100 days in office, upcoming health care reform continues to develop.

“The House recently shared its preliminary plan to repeal and replace major components of the Affordable Care Act (ACA), but there will likely be many changes to the bill, titled the American Health Care Act, before it is passed,” says Erin C. Davidson, sales account executive II at HealthLink, Inc. “Once finalized, the new bill will likely have a direct impact on employers who recently transitioned to an ACA-compliant plan, or who were planning to do so in the near future.”

Smart Business spoke with Davidson about what to expect and what employers should know about the future health care reform.

What changes to health care reform can employers expect in the upcoming year?

One significant change is that employers who have ‘legacy plans’ that were supposed to transition to ACA-complaint plans by Jan. 1, 2018, may be able to keep their current plans through December 2018. The Centers for Medicare & Medicaid Services recently announced another one-year extension for transitional (grandmothered) policies. As details of the American Health Care Act are finalized, we should learn more about what changes, if any, may directly affect employers in the next year.

One thing is certain, self-funded plans are not regulated as heavily as fully insured plans, so they are not subject to certain reform regulations and mandates. In addition, employers who self-fund their health plans have been able to minimize the impact of the ACA and eliminate some premium taxes. Therefore, the current uncertainty surrounding future health care reform may have less of a direct impact on employers who self-fund their employee health plans.

With this uncertainty, where can employers get reliable information and advice?

No matter the state of the industry, it is very important that employers have a partner they can rely on for reliable, unbiased information. This could be their insurance broker, or their insurance carrier account manager or representative. For employers who self-fund their health plans, it might be their third party administrator (TPA) or network partner.

In times of change, an established relationship with an industry expert becomes even more valuable as employers have to decide the best option for offering health care benefits to employees. The wisest employers rely on multiple resources to gather information and make decisions. This means self-educating themselves about changes in the industry, gathering input from a variety of industry experts and examining options, such as self-funding, that safe guard their health plan from industry shifts.

However employers choose to make important policy decisions, they should have an industry expert they can rely on for information and advice.

Has the importance of relying on industry experts changed over the past five years?

Since self-funded arrangements come with the ability to customize nearly every aspect of the plan, it has always been important for employers to rely on industry experts to ensure they select the best network and programs for their employees.

In regards to fully insured health plans, health care reform has perhaps deepened the way employers rely on experts. Previously, employers depended on experts, such as insurance brokers, to shop around for them and ensure they were receiving the best coverage and the best rates. Once the ACA took effect, employers began relying on these experts more heavily to not only ensure they receive the best coverage and the best rates, but also to determine which mandates applied to their company and ensure they met requirements.

What else should employers know?

Many network providers and insurance carriers already have established relationships with industry experts that employers can take advantage of when searching for a partner to meet their needs.

Whether it is a broker, TPA or network provider, employers should talk to experts about the state of the industry, upcoming reforms and how their health plan may be affected by changes.

Insights Health Care is brought to you by HealthLink

More employers look to outsource leave management services

Managing employee leaves of absence is becoming more complex for employers of all sizes. Nearly every day, there are updated interpretations and applications of the Family and Medical Leave Act (FMLA) and Americans with Disabilities Act and Amendments (ADA/ADAAA). Plus, the increasing number of states and regions passing additional leave laws, paid and unpaid, make this complicated for all employers.

That’s why more employers, large and small, are looking to outsource leave management services.

Smart Business spoke with Linda Croushore, senior director of Disability Services for UPMC WorkPartners, about how to navigate the challenging proposition of managing absence.

How many companies are currently outsourcing leave management services?

The Disability Management Employer Coalition (DMEC) and Spring Consulting Group found in its 2016 Employer Leave Survey that 34 percent of all employers with 50 or more employees are now outsourcing FMLA management. Employer groups with more than 1,000 employees are outsourcing their programs at a rate of 45 percent, while also looking for help in managing the ADA leave accommodation process.

In general, what are the pitfalls that make employers seek help?

The DMEC study confirmed that one of the most difficult things that managers and supervisors face is accurately tracking intermittent leaves. Employees may also have difficulty accurately accounting for their time away from work. It is frequently a manual process and the timeliness of the reporting becomes an issue.

Failure to accurately account for missed time leads to missed opportunities for the employer to evaluate the validity of the time being requested against the FMLA. Accurate and timely completion of the medical certification needed to support the intermittent leave can also be a stumbling block.

What did the study find to be the major leave management challenges for most organizations?

According to the DMEC study, the top challenges facing organizations are:

  • Managing intermittent leave.
  • Training and education about roles and responsibilities of managers.
  • Integrating with ADA/ADAAA.
  • Managing workers’ compensation leaves in conjunction with the FMLA.
  • Managing short-term disability with the FMLA.
  • Coordinating leaves with attendance policies.
  • Relying on managers for leave enforcement.
  • Keeping up with new federal, state and/or municipal/county laws.
  • Controlling employee abuse.

How can employers streamline the process?

An area of increasing litigation is the end of leave process used by employers in relation to ADAAA. In many cases, employers do not offer an extension of the federally mandated FMLA time as an ADAAA accommodation. In addition to time away from work, other situations may arise where an employee asks for accommodation for a protected disability.

While some requests are straightforward and require little interaction, many of the disabilities for which an employee may request accommodation are not clearly recognized and could easily be ignored. These situations require discussion with the employee and the health care provider to determine functional abilities and possible accommodations. The employer is obligated to provide a reasonable accommodation that allows the employee to function in the workplace. However, the requested accommodation may or may not align with that definition.

What should employers that are considering outsourcing look for?

In seeking a third party administrator, look for one that can provide a streamlined process that centralizes intake, and integrates management of leave and short-term disability claims. Look for one that can act as a single point of contact for employees, their health care providers and front line managers.

Insights Health Care is brought to you by UPMC Health Plan