Debra Horn

Friday, 29 July 2005 11:28

Weighty matters

On the door leading to the main stairwell at a local company, there’s a colorful poster that reads, “Small Steps Can Make a Big Difference.” The small steps mentioned are those that employees take if they opt to use the stairs rather than the elevator to travel from floor to floor.

Because this company has offices on the third, fourth, fifth, sixth, eighth and ninth floors, walking instead of riding is not always an easy alternative. But it’s an option an increasing number of employees are choosing. And the company is encouraging them every small step of the way.

Encouraging employees to be more active is one of the many ways employers are dealing with what some call an obesity epidemic. The number of Americans considered obese by the Centers for Disease Control (CDC) was reported as 44 million in 2001, a 74 percent increase in 10 years. And, according to the CDC, 300,000 Americans die each year of causes related to obesity and physical inactivity.

The cost of obesity to American businesses is also bad news. The American Journal of Health Promotion estimates the cost at $13 billion a year, broken down this way.

  • $8 billion in health insurance costs

  • $2.4 billion in paid sick leave

  • $1.8 billion in life insurance costs

  • $1 billion in disability insurance costs

Obesity costs businesses in terms of lost work days and restricted-activity days. A study in the American Journal of Health Behavior showed that annual medical expenses for Dallas city employees increased from $114 for normal-weight individuals to $573 for the overweight to $620 for the obese. Eight percent of all private employer medical claims are due to employees who are overweight or obese.

Because most adults spend half their waking hours at work, finding ways to include physical activity during the work day is the most practical way for many adults to become active and combat obesity. Here are some tactics companies can try.

  • Offer a menu of voluntary, fun exercise programs loaded with incentives.

  • Make effective weight-loss programs, such as Weight Watchers, available on-site at a reduced rate.

  • Sponsor or subsidize fitness center membership.

  • Implement a healthy eating campaign, including offering healthy options in cafeterias and vending machines.

  • Encourage walking during lunch hours or breaks.

  • Work with group health vendors to develop programs that target overweight employees.

  • Talk with health plan providers about specially designed employee education material and disease management programs that target obesity.

  • Provide employee assistance programs for private counseling or community-based weight management programs.
  • Establish a health promotion committee to promote healthy lifestyles at work.
  • Bring in physicians, nutritionists and fitness experts to provide inspiration, information and motivation.
  • Changing health behaviors is hard work, and it takes time. Progress can be slow even for the most dedicated participants. That’s why an important part of making such a program work is to keep things light and to encourage supportive, healthy work environments.

    Plan events that are not just good exercise but fun. Encourage people to use the stairs by sprucing up the stairs with a fresh paint job, artwork or piped-in music. Encourage lunchtime walks by setting up friendly competitions with fun prizes for extra motivation.

    Effective at-work physical activity programs do require an investment on the employer’s part. But work site programs can help overweight employees find a pathway to successful weight loss and weight management, as well as create an environment that supports healthy behaviors for all employees.

    Debra Horn is vice president of clinical and network services for UPMC Health Plan. The Health Plan, with 440,000 members, is part of the University of Pittsburgh Medical Center’s integrated medical delivery system and is the only provider-led health plan in Western Pennsylvania. Reach Horn at (412 )454-5210.

Thursday, 30 June 2005 06:47

Present and accounted for

You probably know the feeling -- you're physically present, but you're not all there. You may be distracted by something, you may be in pain, but you're simply unable to focus on what you're supposed to do.

If that happens once in a while at a party or during an after-dinner conversation, it's usually no big deal. But if it happens to frequently at work, it may be a very big deal.

"Even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality -- a concept known as 'presenteeism,'" writes Dr. Cheryl Koopman, lead author of a health-related productivity study conducted by a Stanford University research team.

Historically, presenteeism has been overlooked by employers who generally focus on absenteeism when evaluating health-related losses in productivity. One reason for that has been the difficulty in developing reliable data and/or measuring standards.

"Although productivity gains attributable to decreased presenteeism may be substantial, appropriate measurement tools are still in their infancy," Koopman's study reported.

According to Ron Goetzel, director of the Cornell Institute for Health and Productivity Studies (IHPS), losses related to presenteeism have "not been adequately considered by employers." In fact, these productivity losses could possibly exceed the costs of both absenteeism and medical and disability benefits.

An IHPS study indicates that employees who go to work when they are not feeling well and are less productive as a result may cost companies more in terms of lost productivity than what the companies actually pay in dollars for sick days and other medical and disability benefits.

The role of a company's health plan and the effectiveness of the health plan's health management programs are essential to limiting the production losses that result from presenteeism. Effective treatment of recurring minor ailments can keep employees healthy and reduce presenteeism.

Benefit plans including health management programs that monitor employees with chronic conditions and encourage them to seek appropriate care and take the appropriate medications can result in savings for an employer both in terms of long-term health care costs and improved productivity.

"If a company's health plan is poor, for example, disorders may not be well-managed," says Goetzel. "Workers will continue to work and not be as productive. Employers need to weigh the cost of good medical care against the potential for on-the-job productivity losses, which we see are substantial in many areas."

Employers who are sensitive to bottom-line concerns may notice increased utilization costs that often accompany effective health management programs. But companies should not overlook the resulting improvement in their employees' overall health and the increased productivity that results from health management programs.

Indirect costs triggered by presenteeism can be as costly as any other business expense -- the IHPS study estimated that presenteeism costs businesses an average of $255 per employee per year.

Controlling the financial impact of presenteeism means putting an emphasis on specific ailments, many of which are not normally considered expensive to treat. A major industry study found five top causes of presenteeism.

* Headache

* Cold/flu

* Fatigue/depression

* Digestive problems

* Arthritis

Clearly, one way to decrease absenteeism and presenteeism is through a comprehensive employer-focused health management system that integrates all aspects of health care, including traditional health care management services for chronic conditions and catastrophic illnesses, disability services, employee assistance programs and corporate health promotion programs. Finding a health insurance carrier that brings together these components into an integrated model means that employers have a one-stop shop that can deliver the key components that help keep employees at work and focused on their tasks.

Debra Horn is vice president of clinical and network services for UPMC Health Plan. The Health Plan, with 440,000 members, is part of the University of Pittsburgh Medical Center's integrated medical delivery system and is the only provider-led health plan in Western Pennsylvania. Reach Horn at (412) 454-5210.

Monday, 25 April 2005 10:21

A healthy choice

Less than three weeks before he left office, President Clinton issued a memorandum to the heads of all federal departments and agencies. He called on all department executives to "review their policies" and "leave flexibilities to allow Federal employees to take advantage of screening programs and other effective preventive health measures."

In recent years, many employers have followed suit by offering workplace screenings for their employees, albeit without the prompting of a presidential directive. Workplace screenings make too much sense for employers to ignore the concept. As Clinton pointed out, "The workplace is a logical place to provide employees with health information and services to help them learn about preventive health."

In recent years, employers have found that work place screenings come with a number of benefits.

* Early detection of potential health problems

* The encouragement of healthier lifestyles

* Reduction of absenteeism

* Increased productivity

* Improved morale

Workplace screenings -- which are conducted in such away as to keep personally identifiable information secure from both the employer and the health plan -- can be designed to measure height and weight, blood pressure, waist/hip ratio, cardiovascular endurance, body composition and cholesterol and glucose levels. The results provide essential information to employees about low-level chronic disease or other conditions that may require immediate attention. It can also alert employees to behaviors that could potentially create costly health problems in the future.

The screening can motivate employees to make improvements in their behavior for their health and to institute lifestyle changes. Studies have shown that many employees understand that workplace screenings benefit them and their families first and foremost, and not the employer or the insurance company that may sponsor it. And screenings get results. A national survey by the Principal Financial Group showed that 47 percent of employees who participated in health screenings eat healthier, 45 percent exercise more and 42 percent think about healthier options more often.

"It's not just the right thing to do from an altruistic standpoint," says Jerry Ripperger, director of consumer health for the Principal Financial Group. "It's a good business decision. The result is improved employee attendance, productivity and morale."

The workplace is an ideal place for such screenings for several reasons.

1. You can reach a high number of people at low cost, including those who would not otherwise seek professional help.

2. It provides easy access for a majority of employees.

3. The involvement and support of colleagues maximizes participation.

4. It allows for a better chance of long-term follow-up measures.

One Pittsburgh-area business instituted a workplace screening program in fall 2004. A recent survey regarding the screening program got encouraging results.

* 85.2 percent to 92.3 percent of respondents strongly agreed or somewhat agreed that the screenings were helpful in understanding their personal health status

* 99.3 percent plan to discuss screening results with their physicians

* 50.9 percent plan to participate in other health promotion events and activities

* 19.6 percent uncovered a new medical condition at their screening

Workplace screenings can be expensive for companies to arrange, but there is a bottom-line benefit. According to a study by the University of Michigan, overweight employees had $186 more in health claims each year than normal-weight employees. Obese employees cost $488 more per year, according to the same study.

Employees with chronic diseases had annual claims of $760 more than those without such diseases. Learning about health risks early and addressing them before they develop into full-blown chronic diseases could save countless dollars.

To encourage participation, some companies provide prize giveaways or run contests. But contests are designed to produce only a few winners. With work place screenings, everyone wins.

Debra Horn is acting vice president of clinical services and network performance for UPMC Health Plan. The Health Plan, with 440,000 members, is part of the University of Pittsburgh Medical Center's integrated medical delivery system and is the only provider-led health plan in western Pennsylvania. Reach her at (412) 454-5210.

Thursday, 29 September 2005 07:24

Summary plan description

If an employee came into your office and demanded to see the SPDs for your long term disability and medicals plans, would you know what he was talking about?

Title I of the Employee Retirement Income Security Act (ERISA) requires administrators of covered employee benefits plans to disclose certain material to participants and beneficiaries. ERISA disclosure takes on three forms regarding material such as reports, statements and documents.

First, direct operation of law requires disclosure at a certain time or occurrence of an event, such as when a new plan takes effect. Next, disclosure can be requested from a participant or beneficiary. Finally, ERISA requires reports, statements and documents be made available for inspection by participants and beneficiaries at a reasonable time and place.

A summary plan description (SPD) is one of the documents ERISA requires be provided to plan participants. More than a mere compliance document, the Department of Labor describes the SPD as “the primary vehicle for informing participants and beneficiaries about their rights and benefits under the employee benefit plan in which they participate.”

Although ERISA does not specifically define an SPD, it does enumerate the information that must be contained in an SPD — the plan name, sponsor, administrator, address for service of legal process, funding mechanisms, requirements for participation and benefits, circumstances that result in ineligibility or a denial of benefits, and a statement of participants’ rights under ERISA. Often plan administrators take the benefit book supplied by an insurance carrier as an SPD, but even though these books may describe the benefits to participants, they usually do not meet other statutory requirements.

ERISA requires that the plan administrator furnish participants of welfare benefit plans a copy of the SPD and any modifications. Normally this distribution is required within 120 days of the plan becoming subject to ERISA or within 90 days after a participant first becomes covered under a plan. Then, an updated SPD must be provided every five years, if changes are made within the five-year period. Otherwise, barring any amendments or modifications, the original SPD must be distributed every ten years.

SPDs must be distributed in a manner “reasonably calculated to ensure actual receipt” of the material. Thus, first class mailing is acceptable, as well as personally handing the document to a participant. However, just posting or leaving a supply in a common work area would not be acceptable. In 2003 the DOL expanded the circumstances in which electronic mailing may be used to furnish SPDs. However, the general requirements for distribution of an SPD must be met and there are other disclosure requirements for electronic transmission.

There are several types of ERISA plans which are exempt from the SPD requirement. Two are employer-provided daycare and welfare plans for select employees, namely management and highly compensated employees. However, there is no exemption for small plans, those with fewer than 100 covered participants. Thus, a company with only five employees that sponsors an ERISA-covered welfare plan must comply with the SPD requirements.

No specific civil penalties exist for failing to prepare or provide an SPD. However, a participant, pursuant to ERISA, may bring suit to enforce the requirement, which may mean attorney and litigation fees. Additionally, if a participant makes a written request for an SPD, and it is not provided within 30 days of the request, the plan sponsor may be charged $110 per day.

An employer sponsoring an ERISA-covered benefit plan is responsible for knowing the ERISA disclosure obligations. Thus, an employer as a plan administrator must know what language is to be present in the SPD, when and how it must be distributed, and whether the regulations require that it be modified.

The contents of this article are intended as general information only. It is intended to alert the reader to issues in employee benefits. It does not constitute legal advice or a legal opinion on any specific facts or circumstances. You should consult your own lawyer or employee benefits consultant with any specific questions concerning your situation.

Frances K. Horn, Esq., PHR can be reached at (412) 456-7000 or