Wednesday, April 19, 2017

Mom's Keys to Super-Aging


My mom practicing her balance
after completing 40 squats.
Meet my mom. Mom is 73 and she can out walk most of my friends. I'm always sharing exercise tips with her and Mom actually does the things I recommend. It started years ago when I suggested she stand on one foot like a stork when brushing her teeth. When that got easy, I sent her a half foam roller to challenge her balance. Balance is a key to preventing falls and broken bones according to the National Osteoporosis Foundation. Here's a simple routine anyone can follow

Mom will be adding interval training to her routine. My friend, Carol Harnett, recently shared this NYTimes article on the best exercise for aging muscles. It describes a study that looked at the types of exercise that have the most positive impact at the cellular level. As we age, the cells in our muscles do not regenerate as quickly. Exercise can help us combat this, but interval training has the greatest positive impact. 

What's this mean in practice? Mom is going to work hard on a stationary bike, elliptical or treadmill for four minutes, rest and go easy for three, and repeat three more times for a 28 minute work out. She'll throw in a few minutes to warm-up and set a goal to do this three times per week. And, because I want to be able to hike up a volcano in Iceland when I'm 72 like my mom did last year, I'll be doing the same thing. 

Mom and I plan to be "super-agers" just like these women on The Today Show who defy the effects of old age. In addition to being physically active, these folks are learning new things. They routinely push through the feeling of discomfort we all feel when we're exercising or struggling to learn something new. I'm taking a Health Economics class at George Mason University this semester. Mom's looking into taking one of The Great Courses online. (Following that link will get you a free month trial thanks to Ezra Klein at Vox.) 

Wednesday, April 5, 2017

A Day Late and 17 Cents Short

10 Steps to Addressing Pay Inequities


Pew Research Center
http://www.pewresearch.org/fact-tank/2017/04/03/gender-pay-gap-facts/
Yesterday was Equal Pay Day. It symbolizes the date when working women’s wages catch up to what men were paid the previous year or how far into 2017 women have to work (on average) to earn what men earned in the 2016 calendar year. Pew Research Center reported that in 2015, women earned 83% of what men earned. So, the gap is narrowing (you've probably seen the often sited 79 cents on the dollar statistic), but still persistent. 

I've spent a lot of time thinking about pay equity and making sure the compensation program we have at ASHA works equally well for everyone. In 2015, I was asked to help facilitate a workshop at ASAE on Negotiation Success in Your Association Management Career and one of the things that was discussed was how to negotiate a job offer. There are plenty of studies that show women don't negotiate as aggressively and; therefore, wind up with lower starting salaries than men. Salary increases in future years compound the problem. 

Since women and other people in minority groups tend to be paid less than men, basing an offer upon a candidates salary at a previous job perpetuates past discrimination. Massachusettes decided to deal with this problem by prohibiting employers from inquiring about a candidates salary history during the hiring process. The law is the first of its kind. 

Addressing this problem one woman and one job offer at a time seems like a highly inefficient way to fix the problem. I think HR folks need to fix the system--the underlying policies, procedures and practices. 

It is not the candidates responsibility to tell an employer what a job is worth. HR folks have plenty of survey resources available to determine what other employers pay for similar work. At ASHA, we benchmark (market price) every job based on a carefully written position description and determine a competitive salary. When we post a job, we post a starting salary range that's from 90% to 100% of this number. It's non-negotiable and if you take a look at one of our postings, you'll see we clearly state that along with the FLSA exemption status and other facts about the job. 

The pressure to eliminate the wage gap is ratcheting up. The Obama administration encouraged companies to sign an "Equal Pay Pledge." If employers don't fix the problem, individual states will continue to create their own pay equity laws like California, New York, Massachusetts and Maryland have. I understand New Jersey, Pennsylvania and Washington D.C. are currently working on revisions to their equal pay statutes. 

Until recently, state laws typically followed the Federal Equal Pay Act of 1963. These new laws radically alter how pay equity will be determined in these states and will most certainly complicate administration for employers with employees in these states. Before other states take action or employers find themselves facing expensive and time consuming litigation, maybe HR folks should act and find out what's driving pay in their organizations. 

10 steps to conducting a compensation audit:
  1. Assure you have up-to-date position descriptions for each job
  2. Decide what components of pay you need to review e.g.,  base pay, bonuses, commissions, overtime
  3. Determine the factors you will examine e.g., gender, race/ethnicity, gender identity 
  4. If you have people working in multiple locations, decide which locations you'll start with. Obviously, you want to prioritize people working in states with pay equity laws like California, New York, Massachusetts and Maryland.
  5. Determine what information you have that might explain differences in pay e.g., education, years of experience, special certifications
  6. Make sure the data you are going to use is clean. If your HRIS has people in the wrong jobs, or inaccurate education information, you're going to be facing the old GIGO (garbage, in garbage out) problem. 
  7. Decide which jobs have multiple incumbents or which employees to include in comparative groups (This is where the rubber really meets the road. I suspect this is why Googles findings differ so dramatically from the governments. Be sure to look at your data in the 10 job categories that will be used in the new EEO-1 reports.) 
  8. Compare the average pay of men to the average pay of women in the same roles to determine if any statistically significant differences exist 
  9. If you find a problem, dig deeper to see what might be explained by factors you're including in your analysis like education and years of experience. You can do a regression analysis using each of these factors to determine how much of the disparity they explain. 
  10. Again, if you find a problem, develop a plan to fix it. You may need to modify your compensation program policies, procedures and practices in addition to making market adjustments to the salaries of some people. 
Consider protecting confidentiality by involving an attorney. If you need a statistician to help with the analysis, you may want to have your attorney hire or contract for those services. I attended a session at a Kilpatrick Townsend seminar last week with attorneys Jim Coil and Flora Manship that was excellent. If you don't know who to call for help, you might want to start with them. 



Explore more:

Thursday, October 20, 2016

Four Things You Can Do to Avoid Overpaying for Prescription Drugs


We recently hosted a number of sessions to help staff learn more about prescription drug benefits. 
There is a delicate balance to having discussions like this with our staff. I don’t want anyone to feel bad about getting what they need, but we don’t want people to be taken advantage of either. We focused in on four things we can do as consumers to avoid overpaying for prescription drugs.


Look for Generics
This sounds like an obvious suggestion, but maybe not for the reason you think. Generics are not just cheaper. Generics are safer. Generic drugs have been on the market longer and have been taken over longer periods of time by more people. Because of this, the side effects and long term health implications are better known.

Choose a Pharmacy the Same Way you Choose a Gas Station
Prescription drug prices vary from pharmacy to pharmacy the same way gas prices vary between gas stations. Most of us want to strike a balance between convenience and cost when we make this choice. We showed staff how to use the GoodRX tool provided on our Magellan site to compare prices between pharmacies. Right now, this feature is only effective four our staff that have our high deductible plan with the HSA. (Anyone can use the GoodRX app.) 


Participants were shocked to see how dramatically prices vary. We looked up a number of drugs to see how much we could save by driving as little as two miles. For example, 

  • Rosuvastatin the generic for Crestor was $13.59 at Giant pharmacy and $60.46 at Walgreens. 
  • Aripiprazole the generic for Abilify was $100.19 at Harris Teeter and $292.61 at CVS. 

It’s easy to transfer a prescription--if you find it for less at a different pharmacy, just call the new pharmacy and ask them to help you. 

It's access to the GoodRX tool that lead us to Magellan. I liked the app, but wanted it integrated into our health plan so people with our insurance could use it, see our pricing and have what they pay track toward their deductible. That's exactly what Magellan has done. 

In all honesty, we got a little bleeding edge on this one and we spent a lot of time working out the glitches with Magellan, but they are pretty well sorted out at this point and we have a state of the art tool for our staff to use. If you have a high deductible health plan and you don't have this tool, talk with your HR folks and ask for it. 

Beware of Drug Combining
We asked participants to watch out for drug manufacturers combining two old drugs into a single, costly “new” drug. We had a $9,027 charge for Zegerid. Zegerid is a compound of omeprazole [over the counter Prilosec] and sodium bicarbonate [alka-seltzer] that could be purchased for $20.

Similarly, we had a claim for Treximet for $1,471. 
Treximet is a migraine medication that is a combination of generic sumatripan and over-the-counter naproxen [Aleve]. Bought separately, the components cost about $37 for a 90-day supply. 

My doctor shared that she no longer accepts free samples from drug companies because they only provide samples of the newest, most expensive medications. When she shared them with her patients, they either thought they needed that brand and insisted on it or quit taking it because of the cost. I wonder if that’s what led to the claims we have had for Zegerid and Treximet. Check out openpaymentsdata.cms.gov to see the payments your doctors received from pharmacy companies. It won't tell you if they accept free samples, but it will provide useful information.

Ask Five Questions

How can you avoid being taken advantage of by the prescription drug manufacturers? Ask the 5 questions recommended in the Choosing Wisely campaign before getting any test, treatment, or procedure and carefully considers all options before deciding among them:

► Do I really need this test or procedure?

► What are the risks?

► Are there simpler, safer options?

► What happens if I don't do anything?

► How much does it cost?

Interested in learning more? Take a look at the resources Consumer Reports has put together. Or, search my blog. I've written quite a bit on this topic most recently The Dark Art of Prescription Drug Pricing. Don't miss the John Oliver video in that post. It's definitely worth a few minutes of your time. 


I enjoy Sarah Kliff's reporting on health care for Vox. I recommend The true story of America's sky high prescription drug prices and If Trump wants to lower prescription drug prices, he's going about it all wrong

It's also worth giving some thought to who funds the studies. The Cochrane concluded: "Sponsorship of drug and device studies by the manufacturing company leads to more favorable results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments." Learn more about the industry sponsorship and research outcome study here.

This Freakanomics Podcast is worth a listen too. 

Bad Medicine, Part 2: (Drug) Trials and Tribulations

ReleasedDec 08, 2016
How do so many ineffective and even dangerous drugs make it to market? One reason is that clinical trials are often run on "dream patients" who aren't representative of a larger population. On the other hand, sometimes the only thing worse than being excluded from a drug trial is being included. 

Monday, August 8, 2016

How We Think About Stress Matters

What Doesn't Kill Us Makes Us Stronger

I've never been a fan of stress management programs in the workplace. For a long time, I've believed that stress comes from how we respond to events at work, not the actually events themselves. Instead of managing stress, I've tried to focus on helping people build resilience so that we can better withstand the stressful events when they occur. 

Recently, I read an article in the Economist that expanded my thinking. It suggests that stress makes us stronger in the same way weight baring exercise makes our bones stronger. How we think about stress matters. And, knowing this gives us a few more ounces of control. 





Friday, July 22, 2016

The Student Debt Crisis: What Role Should Employers and Professional Associations Play?

Generations of Americans have been raised to think that money spent on education is always a good investment. If you study hard and get decent grades, the rest is supposed to work itself out. You'll get job, pay off your loans and live the American dream. Unfortunately, many students are lent more than they can pay back in the years after graduation. The rule of thumb I've read is that you shouldn't borrow more than what you expect to earn annually when you graduate. Years after earning their degrees, today's graduates can't buy a home or start a family because they can't dig out from under their student loan debt. The statistics are startling:  

Sunday, May 22, 2016

Ten Takeaways from Health & Benefits Conferences [#BenefitsConf & #WHCC]


I recently attended the HRE Health and Benefits Leadership Conference in Las Vegas and the World Heath Care Congress in DC. I sat down after the two events and made some notes about what stood out for me. Here are ten takeaways.

Bob Merberg, Fran Melmed and I at the HRE Conference.
One: We Need to Agree on What Matters

There was lots of agreement that we need one set of measures about what creates value and indicates quality. And, agreement that we need good functional level measures for patients too. This is the discussion that kicked off the Health Care Congress and Rajiv Leventhal captured it well in this post, so I won’t try to recap it again here.

Monday, March 28, 2016

10 Behaviors of An Engaged Healthcare Consumer Infographic

Just in time for my presentation at the HRE Conference in Las Vegas, I'm introducing my first infographic -- Ten Behaviors of An Engaged Healthcare Consumer. Practicing these ten behaviors will assure you receive the best and safest medical care. 

Unfortunately, few people have the knowledge necessary to successfully navigate the healthcare system and get themselves and their loved ones quality care when they need it. In most organizations, healthcare is the second-largest expense — second only to salaries — yet most employers don’t teach people how to get the most out of their investment. Employers implement consumer-driven health plans to encourage employees to behave as consumers, but until now no one had defined the behaviors an engaged healthcare consumer demonstrates, so employees don’t understand what they’re being asked to do. I've been on a journey to educate people to be more healthcare savvy and I hope to inspire other employers to do the same. 

You can view my presentation on Haiku Deck. I'm still putting the finishing touches on the slide notes, but they'll done before my presentation on Wednesday. I've included links to some useful studies and resources. 

Many thanks to Samantha Allen for developing this infographic with me. And, many thanks to all those who contributed to defining the behaviors. I'm eternally grateful.