How new drug coverage programs can help control costs, keep employees safe

The concern over the cost and safety of compound drugs is growing. According to a report from Towers Watson, 39 percent of employers have already excluded certain compound drugs from their benefits, while another 24 percent expect to do so by 2018. Many pharmacy benefit managers, which work with insurance companies, have done the same.

“Despite not being approved by the Food and Drug Administration (FDA), many compound drugs are in high demand, and costs have skyrocketed in the last few years,” says Veronica Hawkins, Medical Mutual Vice President of Government Accounts. “Unfortunately, it is more difficult than ever for patients, and employers, to know which ones are safe and effective.”

Smart Business spoke with Hawkins about compound drugs, their financial impact and how to help employees avoid high-priced medications that are often unnecessary or dangerous — or both.

What are compound drugs?

To make a compound drug, a licensed pharmacist has to combine, mix or alter the ingredients of a medication. There are a variety of examples on the market today, but the most common are topical pain treatments, such as ointments, creams and powders.

Unfortunately, certain compound drugs are unproven, as well as overpriced. That’s why insurance companies and pharmacy benefit managers have stopped covering many of the ingredients used to make them.

Why is this issue important?

First, the FDA does not verify the quality, safety or effectiveness of any compound drugs. Many have been shown to be clinically unnecessary or even dangerous. Second, many employers have suffered financially from the excessive costs of some compound drugs. A gram of a bulk powder or cream, which hasn’t been proven to be safe or effective, can cost hundreds or even thousands of dollars.

Has the situation gotten worse?

Absolutely. According to Express Scripts, the pharmacy benefit manager for Medical Mutual, the average per patient cost for a compound drug increased from $90 to $1,100 between 2012 and 2014. And it’s gone up since then. As a result, most pharmacy benefit managers have eliminated or reduced coverage for many ingredients used to make compound drugs.

Are all compound drugs dangerous or ineffective?

No, certainly not. There are reputable pharmacies, which compound prescriptions that may be unavailable commercially. For example, employees might need a crushed or liquefied form of a drug if they have difficulty swallowing pills. It’s also common for many pediatric drugs.

However, other pharmacies charge inflated prices for compound drugs that don’t provide additional clinical value over more affordable and FDA-approved alternatives. Those are the ones that are currently creating problems for many employers.

What can organizations do?

One of the best ways organizations can avoid problems with compound drugs is to let their insurance company manage their coverage for them.

Many insurance carriers, including Medical Mutual, allow clients to participate in compound management programs. In these programs, the carrier excludes compound drugs or ingredients that have been determined to be unsafe or unnecessary. The compounds that are found to be reputable stay covered.

In these types of programs, many of the drugs that are excluded are also excessively overpriced. In most cases, organizations will see their compound drug claims dramatically reduced. Of course, employees need to know what’s going on, so the insurance company will notify its members before a claim is denied.

What else is important to keep in mind?

Education is important, too. Employees should know enough to question their doctor when they get a new prescription. They can also ask their doctor to send prior authorization to their insurance carrier to find out if the drug is covered ahead of time.

The most important thing is to keep employees safe from unproven medications that, in many cases, do more harm than good. And that, in turn, will help prevent excessive and unnecessary costs.

Insights Health Care is brought to you by Medical Mutual

How to help employees use their preventive health benefits correctly

Most organizations agree that preventive care is vital to help keep their employees healthy. And for those that follow the rules of health care reform, services that qualify as preventive are available to employees at no cost. However, there is still a lot of misunderstanding about what services are preventive.

“Doctors only bill visits as preventive if they meet certain criteria, but the average person doesn’t know what that involves,” says Amber Hulme, Medical Mutual Vice President, Central and Southern Ohio. “As a result, organizations might see employees skip preventive visits, not knowing they’re free, or get charged for a visit they thought was preventive.”

Smart Business spoke with Hulme about how to distinguish between preventive services and other medical care, why the difference is important, and how organizations can address misconceptions that might be preventing their employees from properly using the benefits available to them.

What services are considered preventive?

Essentially, preventive services are those performed for patients who don’t already have symptoms, injuries or other health problems. The physician decides what tests or screenings are right for the patient based on their age, gender, overall health status, personal health history, current health and other factors.

A visit can include a physical exam, immunizations, lab work and possibly X-rays. The goal is to keep patients healthy through early diagnosis.

How is diagnostic or medical care different?

Basically, if a patient goes to the doctor to diagnose, monitor or treat a specific illness, injury or a chronic health condition, it’s probably not going to qualify as a preventive visit.

Plus, any related services a patient might receive, including exams and blood tests, would likely be considered medical care, as opposed to preventive care.

Why does the difference matter?

Unless a plan was grandfathered under health care reform, many preventive services have to be available to employees at no cost. However, what is considered preventive isn’t always clear. Many lab tests and other procedures, for example, are only covered based on why and how frequently they are done.

Depending on the circumstances, the same test or service can be billed as preventive or diagnostic, or as routine care for a chronic condition. Even during a preventive visit, patients may have to pay a copay or coinsurance if the doctor ends up performing services that aren’t considered preventive.

It can definitely be confusing, but really it’s based on how providers submit the claims.

How would this actually work? Can you give an example?

Sure. Let’s say a person goes to the doctor to get a preventive colonoscopy. This person hasn’t had any problems in the past, but the doctor finds a polyp during the exam and proceeds to remove it. That’s still preventive. The follow-up colonoscopy, however, is going to be considered a medical procedure in terms of how the billing works. That’s because a problem has already been identified.

Another common example is a routine mammogram, which is preventive for women age 55 and older. But if a woman finds a lump in her breast and decides to get a mammogram, it would not be considered preventive because the symptom already existed. The same goes for women who have been diagnosed or received treatment in the past. Their mammograms would fall under routine chronic care.

What should employees be encouraged to do?

Organizations should make sure employees are familiar with how preventive care works under their benefits plan. Their insurance carriers can provide a list of all the preventive services available.

It’s also important to encourage employees to ask their questions when they go to the doctor, such as why a test or service is being ordered. That will help employees make sure they know how they will be charged and still get the care they need.

Insights Health Care is brought to you by Medical Mutual

The appreciation is mutual: Building customer loyalty through a grass-roots customer loyalty campaign

 Just a few short years ago, while analyzing the highly competitive Ohio health insurance market, trying to find a game-changing way Medical Mutual could differentiate itself in the highly competitive and crowded marketplace, the light went on.

I knew that Medical Mutual had something none of our competitors had — a 2,400-person sales force, our entire employee-population, all living and working in Ohio.

So, I started thinking about a customer loyalty program. What if we could prove to companies doing business in Ohio that there was enormous added value to being a Medical Mutual customer?

And, what if, we could encourage employees to shop with those businesses that offered retail products?

I knew that if a program could be developed to answer those questions, then Medical Mutual would be unique in the health insurance market.

Building appreciation

Playing off the company name, the moniker Mutual Appreciation was born. Soon, the IT team was developing a database allowing employees to log their purchases and receipts on a website.

A mobile app soon followed, enabling employees to log a purchase and instantly locate a retail customer. The app also included a map showing them how to get there.

Employees were soon logging their purchases on home computers, as well as at the office or on the go.

One question remained: How would we encourage our 2,400 Ohio employees to participate? What if we offered them cash prizes and gift cards for attaining a certain dollar level? As a leader, I knew I had to build excitement, keep the momentum strong and identify other ways to encourage employees to participate.

Rewarding employees for their participation worked liked a charm. The buzz among Medical Mutual employees was huge. The competition became fierce.

Businesses have been quick to recognize the value and impact of Mutual Appreciation. Leadership recently led employees in a Mutual Appreciation cash mob at a Northeast Ohio restaurant chain and helped a local grocery store with a charity shopping spree, which benefitted its regional food bank partner.

Demonstrating loyalty

We are able to craft reports for our business customers to demonstrate loyalty, and being able to track employees’ buying power effectively communicates the results and benefits of Mutual Appreciation directly to those customers.

To date, Medical Mutual employees have spent $50 million doing business with our business customers. This year alone, nearly $13 million has been driven through the doors of Medical Mutual’s business and retail customers. During November’s Small Business Saturday, employees spent nearly $80,000 in one day with smaller business customers.

From the beginning, it was clear that as the number of purchases grew, so too would the impact on the customer’s bottom lines. That’s a powerful message.

The bottom line is everybody wins — local businesses, the local economy, Medical Mutual’s employees and our company. Now that’s mutual appreciation.

Rick Chiricosta is chairman, president and CEO of Medical Mutual of Ohio. Visit www.medmutual.com.

The 2016 Pillar Awards — A continuing community commitment 

Great companies serving great communities

The 2016 Greater Cincinnati Pillar Awards honor greatness in the name of outstanding community service.

On behalf of everyone at Medical Mutual of Ohio and our Pillar Award co-founding partner, Smart Business, we present these annual awards for Community Service for the 18th consecutive year.

At Medical Mutual, we have long understood the commitment to improve the communities we serve. We strive to live up to that responsibility in everything we do.

I personally want to congratulate this year’s recipients for their understanding of “commitment to community.” That is what the Pillar Awards are all about — leading by example and helping to improve the quality of life for Ohioans.

You will notice that one of the Pillar Awards is a special honor given to a company whose employees best exemplify the values of Medical Mutual’s volunteer employee SHARE Committee.

SHARE, which stands for serve, help, aid, reach and educate, is the heart and soul of Medical Mutual’s charitable giving effort. Each year, this committee helps coordinate more than two-dozen community events involving nearly half of the company’s 2,300 employees.

“Improving the communities we serve,” is a common theme for all of the Pillar Award recipients over the past 18 years and, once again, Medical Mutual of Ohio is honored to be in such outstanding company.

Rick-Chiricosta-New

Rick Chiricosta
chairman, president and CEO
Medical Mutual of Ohio

 

 

Quick Links:
KENT CLAPP CEO LEADERSHIP AWARD Mary Miller, JANCOA Janitorial Services
MEDICAL MUTUAL SHARE AWARD Bob Coughlin, Paycor
NONPROFIT EXECUTIVE DIRECTOR OF THE YEAR Jennifer Hauck, American Heart Assn. | Linda Holterhoff, Keep Cincinnati Beautiful | Kurt Reiber, Freestore Foodbank
NONPROFIT EXECUTIVE BOARD MEMBER Chris Bell, People Working Cooperatively | Joe Walter, Ohio Valley Goodwill
PILLAR AWARD FOR PHILANTHROPY Pete Effler, American Modern Insurance Group | Terri Huntington, Heimlich Heroes | Chad Barnhill, Horseshoe Casino Cincinnati | Mary Miller, JANCOA Janitorial Services | Jeff Rains, Breads of the World, dba Panera Bread | Sue McPartlin, PwC | William Rumpke Jr., Rumpke Waste & Recycling | John S. Domaschko, Paul Bromwell, Kevin Canafax, Greg Shumate Suits that Rock LLC | Edgar L. Smith, World Pac Paper LLC

The 2015 Pillar Awards for Community Service

 The Kent Clapp CEO Leadership Award

cin_pa_MaryMillerMary Miller
CEO
JANCOA Janitorial Services
www.jancoa.com

It was the mid-1990s and Mary Miller, CEO of JANCOA Janitorial Services, and her husband Tony Miller, president, wanted their company to be the best place to work and in turn become the premiere janitorial business in Cincinnati.

They created The Dream Manager as the vision for the corporate culture. Through one-on-one coaching sessions and group classes, employees are encouraged to identify their dreams and take real action steps to achieve them.

“The Dream Manager program is about inspiring our employees to really go after what they want in their lives,” Mary says. “There are not too many people who grow up and want to be a janitor.”

Some of the dreams employees have accomplished include earning a GED or college degree, purchasing a home or automobile, starting a small business, quitting smoking and adopting a child.

Mary is active throughout the community, including the Cincinnati Chamber of Commerce Leadership Class Alumni, WINGS group of United Way, city of Wyoming

the International Association of Administrative Professionals and ConSOARtium.

Not only employees benefit from the program. By taking an interest in their lives, JANCOA has improved employee retention. Since its inception, turnover has dropped from more than 100 to 65 percent.

The Dream Manager idea was popularized in The New York Times best-selling book, “The Dream Manager” by Matthew Kelly, and spread throughout the world.

The Medical Mutual Kent Clapp CEO Leadership Award recognizes the top executive for his or her passion toward philanthropy and honors the late Kent Clapp, CEO of Medical Mutual, who died in a 2008 plane crash.

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The Pillar SHARE award

cin_pillar_BobCoughlinBob Coughlin
CEO
Paycor
www.paycor.com

In 2010, a number of Paycor associates wanted to develop a way to express the guiding principles of the company that include, “Take care of each other” and “Do the right thing.”

They launched Community Partners, Paycor’s associate-led community service organization. Founded by the associates, the program has filled more than 9,847 volunteer opportunities to date. Some of the causes served range from

Accounting for Kids to the Down Syndrome Association of Cincinnati to Steps for Success at Oyler School and many others.

“There’s a real generosity here where associates want to be involved, to serve the communities in which we live and work,” says CEO Bob Coughlin.

Community Partners focuses on organizations, causes and issues of real meaning to associates, who in many cases have a personal connection with the cause.

For example, Paycor associates raised money and support for the Down Syndrome Association of Cincinnati Buddy Walk. A Paycor tax specialist’s grandson has Down syndrome as does a client service specialist’s daughter. Through the association, the grandson has taken horseback riding lessons, played baseball and soccer, and received assistance with his educational development.

Stories like this have inspired many Paycor associates, who bring their families and friends to participate in the Buddy Walk, a fun annual event that celebrates members’ achievements — just one of the many cases in which the company and the community both benefit.

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Honorees

cin_pa_PeteEfflerPete Effler
COO
American Modern Insurance Group
www.amig.com

American Modern Insurance Group, led by Pete Effler, COO, has a history of citizenship in the local community through both corporate philanthropy and employee involvement focusing on education, health care, youth and community well-being.

The company supports numerous area organizations, including the Cincinnati Museum Center, Boy Scouts of America and Insuring the Children, as well as local hospitals, schools and various community projects. Its employees volunteer for local social service agencies and in area schools through the American Modern Gives Back program.

In the month of December 2014 alone, 287 employees assisted with 53 local projects. The Clermont Chamber of Commerce Foundation named American Modern its 2015 Corporate Partner of the Year in recognition of this volunteer work.

The company’s Women’s Network and employee-led Community Involvement Team also engage in a variety of charitable activities, including a campaign that generated donations of about 2,100 school supplies for a local elementary school.

Among the most prominent examples of the company’s corporate citizenship are found in its work with the United Way of Greater Cincinnati and ArtsWave. American Modern is consistently one of the United Way of Greater Cincinnati’s top participating companies. It was named the Number One Pacesetter company of 2013 for making the largest dollar increase of the Pacesetter group.

American Modern has raised funds for ArtsWave for 20- plus years. In March, its employees surpassed the annual fundraising goal by nearly $3,000, pledging more than $62,000. Together with American Modern’s corporate contribution, the total raised was more than $102,000.

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cin_clm_TerriHuntingtonTerri Huntington
program manager
Heimlich Heroes
www.heimlichheroes.com

Since 2013, Heimlich Heroes has taught thousands of children how to recognize the signs of choking, understand how to properly administer the Heimlich maneuver and learn ways to help prevent or minimize the risk of choking.

Developed by experts at Cincinnati-based Deaconess Associations Inc. with support from the Heimlich Institute, Heimlich Heroes is empowering young people to save lives across the country.

Terri Huntington, program manager, leads the organization and can attest to the strong values and lessons of learning the Heimlich maneuver. She herself saved two children from choking by knowing how to administer the procedure.

In another case, an 11-year-old girl named Mariana — after completing the Heimlich Heroes training program — administered the Heimlich maneuver on her sister Gabriela who was choking on an ice cube, saving her life.

The virtual program has been taught in 31 states and has trained or registered 20,000 young people to date. Heimlich Heroes even exceeded its 2015 year-end goal of training 8,000 young people five months early.

Many youth organizations, schools, parents and teachers have been positively affected by Heimlich Heroes and show their gratitude by registering their classroom/ kids/schools multiple times.

Huntington maintains a high profile in the community, attending conventions, injury prevention and safety fairs, and community events. More than 100,000 lives have been saved using the technique established by Dr. Henry Heimlich in 1974.

Heimlich Heroes hopes to create more young heroes by educating, training and instilling confidence in young people around the world.

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cin_pa_ChadBarnhillChad Barnhill
General manager
Horseshoe Casino Cincinnati
www.caesars.com/horseshoe-cincinnati

Horseshoe Casino Cincinnati, led by General Manager Chad Barnhill, is proud to be the area’s hometown casino and is significantly invested in the community. Horseshoe empowers employees to reach out and is always looking for ways to impact the community.

From hosting the Hometown Market (a sustainability event which promotes purchasing from local businesses and a green lifestyle), to holding blood drives on the property and making care packages for those in the service, Horseshoe realizes it is important to not only provide a monetary contribution, but also to be a presence in the community.

More than 80 organizations have been impacted by Horseshoe Cincinnati through August of this year, ranging from ArtsWave to Give Back Cincinnati to the YWCA Battered Women’s Shelter.

Horseshoe Cincinnati and its team members have provided more than $63,000 in cash donations this year through August, including Cincinnati Recreation Foundation, $9,000; Alzheimer’s Association of Greater Cincinnati, $3,500; USO Tribute Cincinnati, $5,000; and The Brewery District Community Urban Redevelopment Corp., $15,652.

In addition to sponsorships and charitable contributions, Horseshoe Cincinnati encourages employees to engage with the community through the corporate volunteerism program Horseshoe Employees Reaching Out.

For this year through August, Horseshoe employees have spent more than 3,400 hours volunteering in the Tri-State area. Some examples include the YWCA of Greater Cincinnati, Honor Flight and Ronald McDonald House.

Internally, employees purchased “kiss grams” during Breast Cancer Awareness Month to kiss breast cancer goodbye, with all proceeds benefiting the American Cancer Society.

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cin_pa_MaryMillerMary Miller
CEO
JANCOA Janitorial Services
www.jancoa.com

The idea of giving to the community is important to JANCOA Janitorial Services owners Mary and Tony Miller. Cincinnati has been home to JANCOA for 43 years and is where the Millers have raised their children and grandchildren.

JANCOA contributes financially throughout the community, focusing on organizations that improve the quality of life for their employees, families and the community through education and economic initiatives. JANCOA supports 30 organizations every year, ranging from the American Heart Association to the United Way, the National Underground Freedom Center and Talbert House.

JANCOA’s corporate culture revolves around community involvement and paying it forward. Mary, CEO, has taught Dream Manager and Motivational Courses throughout Cincinnati to organizations including Talbert House, YWCA, Easter Seals and ReSource.  She speaks at local events about turning obstacles into opportunities, the importance of dreaming and a variety of other tailored messages.

Regarding volunteerism, JANCOA has a Dream Team of employees and their families who participate in the American Heart Association’s 5K Mini-Heart Walk. This year, more than 120 employees and their families walked to raise money and awareness to eliminate heart disease.

JANCOA hosts several events for employees throughout the year and at each event, employees are encouraged to support the program that assists teammates in need of a helping hand. Employees this year donated school supplies, and JANCOA hosted a Back to School Bash where employees’ school-age children could shop for supplies.

The company also strives to be a good neighbor by using environmentally friendly cleaning methods to help maintain a safe and healthy environment.

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cin_pa_JeffRainsJeff Rains
CEO
Breads of the World LLC, dba Panera Bread
www.panerabread.com

At the end of every day, the Panera Bread bakery-cafes donate all unsold bread and baked goods to local hunger relief agencies and charities, including churches and food pantries, Ronald McDonald House, Sisters of Charity, Salvation Army, Light of the World Charities, Matthew 29 Ministries and many others.

But that Day-End Dough-Nation program is not where the philanthropic efforts end for the cafes operated by Breads of the World LLC.

For the past 19 years, the Panera Bread franchisee, lead by CEO Jeff Rains, has worked hard to combat hunger and support various Cincinnati/Northern Kentucky charitable initiatives and donation programs.

Examples of some of the many initiatives include the Panera Cares Community Breadbox, in which customer cash donations go to area charities. In Hamilton and Clermont counties and Northern Kentucky bakery-cafes help fund the Freestore Foodbank’s PowerPack Program, while bakery-cafes in Warren and Butler counties donate to Shared Harvest Foodbank’s Back Pack program.

The bakery/cafes also play a major role in charitable events such as the Cincinnati Panerathon to Fight Hunger, a 5K/10K run to raise awareness and fight hunger in the community. The American Cancer Society of Southwest Ohio benefits from Panera Bread’s annual Pink Ribbon Bagel campaign — nearly $18,000 was donated in Cincinnati and Northern Kentucky in 2014.

Additionally, Breads of the World works locally with schools and nonprofits to help raise funds for their various initiatives through dine-to-donate fundraiser events within the local bakery-cafes.

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cin_cs_SueMcPartlinSue McPartlin
Market managing partner
PwC
www.pwc.com

Corporate responsibility is a key part of PwC’s overall strategy and is core to the company’s identity. It’s important to the clients and communities PwC serves to play a role in constructing and delivering solutions to the immense challenges faced by society. Whether through employee lifecycle, collaboration opportunities or thought leadership, PwC’s emphasis is on connecting employees to work that substantively helps solve important problems and builds trust in society.

Under the leadership of Sue McPartlin, market managing partner, the firm’s philanthropy focuses on youth education, inclusion and the environment. The goal is to deliver positive social impact, with measurable and long-lasting results.

In 2012, PwC launched Earn Your Future (EYF), a five-year, $160 million commitment to help students develop critical financial skills and provide educators with the resources and trainings to teach those skills.

In April, PwC extended EYF with an additional $30 million, increasing its overall commitment to $190 million. This increase supports new research and expanded professional development opportunities for educators.

McPartlin leads by example in being involved in a number of the EYF programs including various Junior Achievement events and Big Brothers Big Sisters. She also was the driver behind PwC’s affiliation with the Aspiring Stars Can Engage in New Directions program.

Since 2012, the Cincinnati office has donated more than 5,700 hours of employee time to advance financial capability in the community. The goal per year keeps growing substantially and the Cincinnati office donated more than 2,050 hours in PwC’s fiscal year 2015 alone.

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cin_pa_BillRumpkeJrWilliam Rumpke Jr.
CEO
Rumpke Waste & Recycling
www.rumpke.com

While Rumpke Waste & Recycling’s business is to accept a wide variety of things, it also gives back in a big way.

Rumpke donates hundreds of thousands of dollars annually to many charities, ranging from schools to churches to environmentally minded organizations.

In Colerain Township, where the company is headquartered, Rumpke has donated more than $750,000 in monetary and in-kind services to local organizations, schools and parks within the last 10 years. Rumpke also offers more than $25,000 annually in scholarships to graduating seniors throughout its service region.

Rumpke, founded in 1932, is one of the nation’s largest privately owned residential and commercial waste and recycling firms, providing service to areas of Ohio, Kentucky, Indiana and West Virginia.

The company, lead by CEO William Rumpke Jr., has partnered with Northwest Local School District through its Partners in Education program as well as the Cincinnati Public Schools Adopt-a-Class program. Rumpke employees dedicate time to local Chambers of Commerce and have become involved with the Dress for Success and Cincinnati Ballet charities.

Rumpke has also invested in new technologies to employ the best available waste and recycling technologies for the environment. In recent years, Rumpke has invested more than $32 million into its Cincinnati recycling facility, which has been lauded as one of the largest, fastest and most technologically advanced facilities in North America.

In total, Rumpke has invested more than $50 million in recent years to bring new technology to recycling and landfill operations.

Rumpke also has invested in new compressed natural gas equipment and new landfill gas-to-energy operations.

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cin_pa_JohnDomaschkoJohn S. Domaschko
managing member and executive committee member

 

 

 

cin_pa_PaulBromwellPaul Bromwell
executive committee member

 

 

 


cin_pa_KevinCanafax
Kevin Canafax
executive committee member

 

 

 


cin_pa_GregShumate
Greg Shumate
executive committee member

Suits That Rock LLC
www.facebook.com/SuitsThatRock

Suits That Rock LLC began in 2007 as a fundraising idea during a brainstorming session between Kevin Canafax and John S. Domaschko and has grown to a yearly concert by more than 40 Greater Cincinnati business and professional leaders.

Each year, Suits That Rock raises more than $110,000 for arts education programming at The Carnegie. The Carnegie is a multidisciplinary arts venue for all ages which provides events, educational programs and art exhibitions to the Northern Kentucky and Greater Cincinnati community. Suits That Rock is an all-volunteer effort.

More than 1,000 city and state officials, corporate leaders, art supporters, music lovers and friends of The Carnegie attend the concerts every June.

Domaschko, who serves as managing member, also serves on the four-member executive committee. The other three executive committee members have day jobs outside of Suits That Rock — Paul Bromwell is CIO at Frost Brown Todd LLC, Canafax, is vice president of public affairs for Fidelity Investments – Midwest Region and Greg Shumate, is a corporate and commercial lawyer at Frost Brown Todd LLC.

Suits for 2015: Cliff Adams, Sheila Baker, Ramona Blaine, Bob Blanchard, Gary Bockelman, Tom Bosse, Paul Bromwell, Steve Brunner, Kevin Canafax, John Caulfield, Doug Chambers , Don Clare, Elaine Diehl, Jan Diehl, John Domaschko, David Ellis, Dick Felger, Larry Flemer, Mickey Foellger, Gregg Fusaro, Jim Gaines, Mike Glenn, Richard Goering, Ken Holliday, Ed Hughes, Melissa Lutz, Dave Miller, Susan Morgan, Graeme Murray, Len Murray, Ken Poleyeff, Chuck Reed, Scott Risner, Greg Shumate, Melissa Singer Reed, Ed Wilbers and Gary Wright.

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cin_pa_EdgarLSmithJrEdgar L. Smith
CEO
World Pac Paper LLC
www.worldpacpaper.com

Edgar L. Smith has always believed businesses and the people that own them must be socially aware and gain the trust and respect of the community in which they operate. They also must work to improve and enhance the quality of life in those communities.

Smith, CEO, leads World Pac Paper LLC in its support of many community service organizations and nonprofit organizations.

The company has introduced initiatives that include community involvement, educational and self-improvement programs.

Smith encourages the staff by setting an example through his actions and by motivating and inspiring the leadership team and employees to also engage in the community. Each week employees who volunteer give between two and 24 hours of their time to various efforts. Organizations receiving assistance range from the American Red Cross to Talbert House to You See Potential Leadership Organization.

In 2011, Smith was recruited to chair the ArtsWave Community Campaign, which was able to exceed its $11 million goal. His local involvement in the arts has gone national with previously being asked to join the Business Committee for the Arts executive board, a division of Americans for the Arts based in Washington, D.C. /New York City, which he now chairs.

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Executive director awards

cin_pa_JenniferHaukJennifer Hauck
executive director
American Heart Association
http://bit.ly/AHACincy

The American Heart Association, Cincinnati Division, has been breaking new fundraising ground under the leadership of Executive Director Jennifer Hauck. For the fourth year in a row, the Cincinnati Division has surpassed its annual campaign goal. The most recent campaign raised $5.6 million for the best showing ever. For two consecutive years, the campaign brought in $1 million in new dollars.

Hauck has created an environment in the Cincinnati office that people want to be a part of, not only the staff, but volunteers as well. Everyone’s opinion matters and there is an abundant amount of trust and respect for one another.

In addition to her AHA responsibilities, Hauck has become involved with Leadership Cincinnati, a high profile program of the Cincinnati Chamber of Commerce designed for established, senior leaders looking to make a difference in the community. She graduated from the program this year.

As she engages her team in almost everything that she does, Hauck also empowers her team to grow and “take a chance” on things. She is always looking for new ways to get the Cincinnati team motivated, whether it is a team-building activity or picking a theme for the year. Co-workers say she is tireless in her effort to make the office a productive, goal-oriented and fun environment.

Hauck lives the mission by setting an example for others by keeping fit and adhering to a healthy lifestyle. An avid exerciser and promoter of healthy eating, she keeps a stationary bike and healthy snacks in her office.

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cin_pa_LindaHolterhoffLinda Holterhoff
Executive director
Keep Cincinnati Beautiful
www.keepcincinnatibeautiful.org

Over the years, the name of Keep Cincinnati Beautiful has changed, first from The Cincinnati Clean Community Commission, to Clean Cincinnati Inc., then to Keep Cincinnati Beautiful Inc. to reflect its affiliation with Keep America Beautiful.

But its mission to decrease litter and blight, promote sustainability and cultivate community pride through education and beautification is still the same. And delivering that mission is the job of Linda Holterhoff, executive director, and her staff of 12.

Holterhoff began with Clean Cincinnati in 1982 as the education program manager. After a few years with a private company in the industry, she returned to Clean Cincinnati as the executive director and instituted its name change to Keep Cincinnati Beautiful.

The organization helps residents improve their neighborhoods and the environment by managing innovative programs and resources, leveraging partnerships and organizing volunteer events.

Keep Cincinnati Beautiful’s core programs include the Great American Cleanup, a community improvement program that enables residents to organize cleanup events in their neighborhoods. The organization supplies free cleanup supplies, tools and resources to more than 60 communities to help volunteers pick up litter, clean illegal dumpsites, remove graffiti, beautify community gateways and plant flowers.

More than 6,500 volunteers have participated at 138 cleanup events. Annually, up to 10,000 volunteers participate and collect more than 240 tons of litter, remove nearly 2,000 illegally dumped tires and plant thousands of flowers.

Other core programs include Urban Revitalization, Environmental Education and Daffodils & Daylilies, a program to beautify highway green space and deter litter.

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cin_pa_KurtReiberKurt Reiber
President and CEO
Freestore Foodbank
www.freestorefoodbank.org

With Kurt Reiber’s guidance as president and CEO, the Freestore Foodbank helps to support the needs of the 295,000 people struggling with hunger, including nearly 100,000 children in the 20 counties served in the Ohio-Indiana-Kentucky region.

A professional with 29 years of banking expertise with Key Bank, Reiber has had a significant impact on the organization’s high marks for operational and financial achievements each year.

The Freestore Foodbank distributed 20 million meals last fiscal year, started a new School Pantry program, initiated a five-year strategic planning process and continues to work toward improved efficiency and effectiveness in providing food and services to families in need.

Through the five-year strategic planning process, Reiber has helped introduce the idea of a continuum of services, particularly for children, ensuring that holistic services are provided from birth until adulthood. The School Pantry initiative is part of this program, offering on-site food assistance to middle and high school students and their families.

The Freestore Foodbank also initiated a summer feeding research project to ensure year-round assistance.

Reiber has been actively involved in fundraising activities and has supported the creation of donor engagement programs and events. He has been successful in expanding social enterprise activities, including Cincinnati Cooks Catering and FeedingWorks, a program for corporate supporters to improve communication and cooperation through volunteering.

Reiber is developing two new initiatives, Logistics 101 and a Mobile Market, to train unemployed adults in the warehousing industry and to offer purchased produce to areas that do not have access to traditional grocery stores.

Board executive awards

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cin_pa_ChrisBellChris Bell
Chairman of the board
People Working Cooperatively
www.pwchomerepairs.org

When low-income homeowners need critical home repairs and services so that they can remain in their homes People Working Cooperatively steps in.

A professionally trained staff, along with thousands of volunteers, helps Ohio residents with critical home repairs, energy conservation and weatherization, mobility modifications and maintenance services.

Chris Bell, chairman of the board, believes a strong volunteer program is key to the organization’s success. In 2014, PWC provided more than 8,601 services to 10,289 individuals in 5,901 households. A dedicated corps of 6,000-plus volunteers is a tremendous asset to the organization’s ability to maintain a strong presence in the community and complete thousands of home repair jobs a year.

Bell is also a member of the Leadership Board for the Newman Center at the University of Kentucky and a member of the Northern Kentuckian of the Year Selection Committee. He has served as president of the American Diabetes Association-Northern Kentucky Chapter; technology chair and education committee member and stewardship chair at St. Joseph School of Crescent Springs, Kentucky; and on the finance committee of the city of Crescent Springs, Kentucky.

Equally committed as his employer Fifth Third Bank, which for more than 25 years has financially supported the programs and clients of PWC, Bell first became involved with PWC in 2005.

His leadership of numerous Fifth Third volunteer teams participating in PWC’s Repair Affair or Prepare Affair events, Hometown Hollywood fundraiser, golf outing, veterans campaign and other events has been a great asset to the community.

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cin_pa_JoeWalterJoe Walter
board member
Ohio Valley Goodwill
www.cincinnatigoodwill.org

Joe Walter learned how to be tireless as an offensive lineman for the Cincinnati Bengals for 13 years. And as a board member and volunteer for the Ohio Valley Goodwill, he is indefatigable as well.

Walter has been on the board for 15 years, and his untiring support and dedication to the Goodwill mission have helped to grow the Auto Auction Donation program, a major source of funding for the organization’s programs and services, to become one of the leading nonprofit operations of its type nationally.

In addition, his guidance and commitment to the annual Goodwill Golf Outing has helped raise more than $390,000 in funds since its inception in 2001. The proceeds from these projects helped to support Goodwill’s skill training and employment programs for individuals with disabilities and veterans.

Walter regularly reaches out to his network, encouraging them to support Goodwill causes, including operating levies for a county board of developmental disabilities partner agency or special events that support the organization’s mission. His extensive network has introduced the Goodwill mission to a larger community of supporters which in turn helps the organization’s efforts to develop donation drives and other revenue generating community events.

Walter’s charm, engaging personality and humor have endeared him to the individuals the organization serves. He has partnered with individuals with disabilities served by the organization as “actors” in television commercials; he’s shared co-hosting responsibilities of the annual golf outing with an individual served by the organization; and regularly enjoys his contact with people enrolled in the programs and services.

How health benefits may soon change for many small businesses

In 2016, a key part of the Affordable Care Act (ACA) is scheduled to take effect for employers classified as small groups. Those organizations may have to start offering ACA plans later in the year or face a penalty.

Some reports say these changes could affect more than 150,000 businesses across the U.S.

“Back in 2013, small businesses got an extension on transitioning to the ACA, which let them keep the plans they had,” says Veronica Hawkins, Medical Mutual vice president, Government Accounts. “But the government says the extension will end in October 2016. That could mean a lot of employers will soon have to move to the ACA.”

Smart Business spoke with Hawkins about the changes scheduled for 2016, what they will mean for employers and how to make the best decisions in what is sure to be a very uncertain climate.

What is happening in 2016?

The big issue is the possible end of transitional relief, which has allowed many small businesses to delay the move to the ACA. The relief is scheduled to end with renewals after Oct. 1, 2016. Until then, nothing really needs to change.
When they renew after that point, they will have to move to ACA plans — unless transitional relief gets extended again.

Is the definition of a small group changing?

For a while it looked like it would. As part of the ACA, the threshold was scheduled to increase to 100 employees on Jan. 1, 2016. However, President Barack Obama recently signed a law that lets the states continue to define the size of a small group.

Ohio will keep the current definition, so groups with 51 to 99 employees won’t have to move to ACA plans next year, as many were thinking they would.

What is considered an ACA plan?

ACA plans are all plans that are not transitional or grandfathered. To meet ACA requirements, employers are required to offer plans that cover 10 essential health benefits, provide annual limits on maximum out-of-pocket expenses, use community ratings and include mandatory coverage for preventive benefits.

What is the difference between transitional and grandfathered?

While transitional plans were part of the government extension, grandfathered plans existed before the ACA was passed in 2010. Grandfathered plans are exempt from many ACA requirements. For some organizations, staying grandfathered makes sense because they avoid some of the extra costs of ACA requirements. If they have relatively healthy employees, however, they may see lower rates with ACA plans. It really depends from case to case.

Does it make sense to move to the ACA early?

Keep in mind: transitional groups aren’t subject to ACA requirements. There’s also a chance the government will grant another extension. Or, another option might be introduced before they have to switch.

That’s why, if your plan is working, it may be best to sit tight for as long as you can.

What if you’ve already switched?

These changes don’t really affect organizations if they have already moved to an ACA plan. The only thing they really have to do in 2016 is recertify their status as a small group. All small groups have to certify their status to ensure they are placed in the correct market segment.

What else should organizations do?

Depending on the organization’s size and plan status, they may have a lot of questions. The landscape is still uncertain and things can certainly change.

The best thing organizations can do is work closely with their health insurance carrier to know where they stand — and what their options are.

Insights Health Care is brought to you by Medical Mutual

How a more attractive benefits package can help recruit and retain employees

Employers have found that a good health benefits package is essential to recruit and retain the best and brightest employees. A Harvard Business Review survey of human resources professionals showed 60 percent of them believe health benefits are more important than base salary in recruiting.

“Many employers are finding out the best way to make sure they have a highly motivated and satisfied workforce is through a solid health benefits package,” says Amber Hulme, Medical Mutual Vice President, Central and Southern Ohio. “Employers now have many creative options to ensure they can still offer benefits in an era of rising health care costs.”

Smart Business spoke with Hulme about why health benefits are so important to employers and employees, and how employers can mitigate the cost of providing their employees with excellent benefits.

How does a strong employee health benefit plan attract and retain good employees?

Today’s job market, particularly in Central and Southern Ohio, is very competitive. Employers want to find and hire the most skilled and motivated employees. Many surveys show the top two employee-valued benefits are health care and retirement funds, with health benefits often the most important.

With the costs of health care increasing, many job seekers look for those companies that provide health benefits. Additionally, other surveys clearly show the majority of a company’s existing employees say they would leave if their employer no longer offered health benefits. Health benefits today are an essential part of business strategy.

How can employers manage the cost of providing health benefits?

Employers can maintain and sometimes lower monthly health insurance premiums by increasing employee out-of-pocket costs. One way to do this is through a high-deductible health plan. These are plans with lower premiums and higher deductibles than a traditional health plan.

When coupled with a health savings account, a high-deductible health plan covers some costs upfront and then employees pay for other medical expenses using money that has been set aside before taxes. This encourages employees to manage and keep track of their own health care and take responsibility for how they spend those dollars.

Besides lowering the monthly premium for both employers and employees, high-deductible health plans empower employees to control their own costs.

Why is it important for employees to be responsible for their health care costs?

The idea is to make health care more consumer-driven. When employees have a greater financial stake in their own health care, they learn how to choose the most efficient doctors and hospitals in terms of cost and quality.

How do online tools help?

Online tools provide transparency in cost and quality, which are essential in giving health care consumers the information they need to make informed care decisions.

For example, Medical Mutual has an online tool called My Care Compare, which helps members find the best price, provider and location for health care services. With this tool, members can check cost estimates for more than 170 types of health care procedures and tests. Also, they are able to review satisfaction scores for physicians and quality ratings for health care facilities in their area.

Why does it make sense for organizations to invest in the health and well-being of their employees?

Wellness programs provide health information and engagement to help employees achieve healthy living goals. The programs also help employees understand their health, identify risk factors for disease and make positive changes. Wellness programs are good business, too, because they can help employers control health care costs, raise morale, improve productivity and reduce absenteeism.

Insights Health Care is brought to you by Medical Mutual

How to comply with new IRS reporting requirements

Starting next year, as part of health care reform, the IRS will require anyone who has health insurance to provide the Social Security numbers of any dependents covered on their plan. As a result, insurance companies and many employers have been tasked with collecting that information.

“Typically, insurance carriers only require employees’ Social Security numbers, not those of spouses or dependent children,” says Veronica Hawkins, Medical Mutual Vice President, Government Accounts. “However, the IRS will need that information to verify that everyone in the U.S. is covered.”

Smart Business spoke with Hawkins about what the IRS reporting requirements involve, how employers can make sure they comply with the new rules, and how to help their employees avoid costly fines for not supplying the required information in a timely manner.

What are the new reporting requirements?

As part of the Affordable Care Act (ACA), the IRS added Sections 6055 and 6056 to the Internal Revenue Code. In early 2016, employers or their insurance carrier will need to collect and report a wide range of employee information to the IRS. That includes Social Security numbers for dependents of all covered employees.

The purpose is to help the federal government enforce the ACA provision that says everyone in the U.S. has to have health insurance — or qualify for an exemption. In addition, it makes sure certain employers can prove they provide ‘minimum essential coverage’ for their employees and dependents.

What do organizations have to do?

It depends. The funding structure of the organization’s health plan — whether it’s fully insured or self-funded — is the first thing to consider. Self-funded employers, which pay their own claims, are responsible for reporting everything to the IRS.

The next thing to consider is pay or play. Pay or play is a rule under the ACA that applies to employers with 50 or more full-time employees, including equivalents. When the rule applies, there are reporting requirements for both employers and their carrier. When it doesn’t, employers can rely on their insurance carrier to handle everything if they are fully insured.

However, it’s important to know that insurance companies are required by law to reach out directly to any fully insured members who are missing Social Security numbers. So it’s in the employer’s best interest to work with the carrier ahead of time.

Are there penalties involved?

Self-funded employers are subject to penalties for not submitting forms correctly. The penalties range from $100 to $250 per instance, depending on whether the IRS believes a mistake or omission was intentional. However, for 2016, the IRS has said it will not penalize those employers if they can show they made a ‘good faith effort’ to comply with the rules.

Again, fully insured employers are different. The penalties are limited because the requirements can fall on them or their insurance company. But regardless of funding, there can be consequences for employees as well, if the IRS is missing a Social Security number for them or a dependent.

Instead of a fine, those employees could see money come out of their next year’s tax return. The actual amount would vary based on the type of information that’s missing, and the year in which the violation took place.

How can organizations prepare?

There are a few things organizations should do. Those with fully insured plans should work with their insurance carrier and prepare to file their own pay-or-play reporting. Medical Mutual, for example, is reaching out to employers to collect information and minimize impact on employees.

Organizations with self-funded plans should be familiarizing themselves with the IRS forms and instructions. They need to understand what information they are missing and make sure it’s collected and submitted correctly.

It may also be a good idea to consult with a tax adviser or legal counsel.

Insights Health Care is brought to you by Medical Mutual

How to help employees get the most out of their health benefits

When employees understand their health costs, it can save your organization money. Studies suggest, however, that most consumers with health coverage don’t fully understand their health plans.

“Employees need to understand what their insurance plan covers and what it doesn’t,” says Amber Hulme, Medical Mutual Vice President, Central and Southern Ohio. “With the right information, they can reduce health care costs for themselves, as well as their employer.”

Smart Business spoke with Hulme about what employees must understand about their health care coverage, how common misconceptions can affect medical costs and what simple steps can make the most difference.

What resources can help employees better understand their benefits?

There are two key documents your employees should know. First, all employees get a benefit book or certificate of coverage, which explain what medical services are covered — and not covered — under the plan. Employees should look up every service or supply that might apply to their needs. It’s important for employees to be familiar with this document so they aren’t surprised if a particular service is not covered.

The second document is called an Explanation of Benefits (EOB). After employees receive services, they should read their EOB to make sure they understand what they’re paying for. Organizations can encourage employees to call their insurance company’s customer service department with questions.

Why is checking the network so important?

Doctors and hospitals work with insurance carriers to negotiate rates, which is a big factor in how much members have to pay for care. Employees receiving services outside the network often have to pay any balance beyond what the insurance carrier pays. But by staying in network, they only pay their copay and any deductible or coinsurance that applies.

Many people don’t realize, however, that a provider’s network status can change. Health insurance members can make sure their doctor is in network by calling a customer hotline or going online and searching an easy-to-use provider directory.

What should employees know about their options for care?

First, employees need to know their options in non-emergency situations. When employees get injured or feel ill, their first instinct is often to visit the emergency room. But it’s not always the best choice. When it’s not an emergency, a visit to a primary care doctor could cost half as much as a trip to the ER — or less.

Urgent care facilities and convenience clinics are also great options for common illnesses such as a cold or flu, as well as infections, allergic reactions, minor cuts, burns and sprained muscles. Employees can get prescriptions filled and vaccinations.

Another important consideration is when employees need to get a blood test or have other lab work done. In many cases, they will automatically go to the lab that’s inside the hospital or affiliated with their doctor’s office. But there are options. Independent labs, for example, can often provide the same tests and the same level of service at a lower cost. Your insurance carrier should have tools that can help employees find other options that may be better for them and help them save money.

How can you effectively present benefits to your employees?

Communicating benefits clearly to employees is crucial in their understanding of health coverage. Benefit presentations are one of the best ways to educate employees.

To maximize interest, organizations need to make their presentations interactive and use visuals. Be open to any questions and present information in short segments to avoid confusion. After the presentation, refresh the topic by regularly emailing your employees with benefit reminders and updates.

The key is to give employees the resources they need — how to reach their insurance carrier, useful websites and where to look for their certificate of coverage or EOB.

Be open to communication and always encourage employees to ask questions.

Insights Health Care is brought to you by Medical Mutual

How to empower employees to manage their health care spending

With the move toward consumer-driven health care, organizations are seeing their employees become more aware of the cost of medical care. While the approach has proven effective in reducing spending for some, others are still leery of changing their benefit structure.

“Normally, people will pay a set amount in annual premiums,” says Veronica Hawkins, Medical Mutual vice president of Government Accounts. “But when your employees spend more on premiums each year than they do on medical care, consumer-driven health care may be something to consider.”

Smart Business spoke with Hawkins about what defines consumer-driven health care, how the options generally work and under what circumstances it might be right for your organization.

What is consumer-driven health care?

It refers to health plans that give employees greater control over their health care spending and helps them be better consumers.

Typically, consumer-driven health care involves a combination of a tax-free savings account, such as a health savings account (HSA) or a health reimbursement arrangement (HRA), and a high-deductible health plan. Flexible spending accounts (FSAs) are another option, which employees can use along with an HSA or HRA as an added benefit.

The high-deductible plan covers some costs upfront. Employees pay for other medical expenses using money that’s been set aside before taxes. This encourages them to manage and keep track of their own health care — and take responsibility for how those dollars are spent.

How does an HSA generally work?

With a compatible high-deductible health plan, eligible employees can open and start funding an HSA. These accounts are usually funded through payroll deductions and employees and employers can both contribute. With an HSA, there are no taxes on deposits or interest, or on withdrawals employees make for approved medical expenses.

Employees just have to make sure they use the money in their account to pay their portion of the costs. Any remaining balance at the end of the year rolls over automatically, with no penalty.

How does an HRA work?

An HRA is a tax-free arrangement that is owned and funded by the employer. HRAs are classified as ‘notional’ accounts, meaning the organization only contributes money to the account when they receive claims for approved medical expenses. The most popular HRAs are the ones that fund a portion of an employee’s deductible, but employers also have a say on which medical expenses they will reimburse.

Generally speaking, any money that’s left at the end of the benefit year won’t roll over to be used in later years.

What about FSAs?

There are several different types of FSAs. There is a health FSA, limited-purpose FSA that is usually for dental or vision care, one for dependent care expenses, one for adoption assistance, and one for parking and transit expenses. Similar to HSAs, employees fund FSAs through pre-tax payroll deductions.

While any money left in the account at the end of the year is forfeited, organizations have the option to offer a grace period of 2½ months or let employees carry over up to $500 into the following year.

What else should organizations know?

There are a lot of variables involved in consumer-driven health care, but it all boils down to empowering employees. When employees understand the cost of an office visit, a lab test or a monthly prescription, they are able to become better consumers of health care and are more likely to engage in healthy behaviors.

But just like any change in your organization, education is critical. Because once employees are responsible for funding their own health care, they need to feel confident that they can pay for what they need.

Insights Health Care is brought to you by Medical Mutual