Friday, May 31, 2013

Choosing Between a High Deductible Health Plan and a Traditional PPO

My sister called last night and asked me to help her evaluate her health plan choices. She was trying to decide between a traditional PPO offered by her employer and a high deductible health plan (HDHP aka CDHP) with an health savings account (HSA) offered by her husband's employer. I asked her some questions to help her hone in on some of the plan features that might differentiate her choices. This is what we talked about:
  1. What are the monthly premiums for each plan?
  2. How much money will the employer contribute to the HSA with the high deductible health plan and when will the contributions will be made (e.g., at the beginning of the year, quarterly, monthly)?
  3. What is the deductible under each plan?
  4. What is the difference in co-pay levels once the deductible is met? 
  5. What is the annual out-of-pocket maximum under each plan? (If you reach this limit, the plan pays 100% of covered expenses for the rest of the plan year, so this is your maximum exposure.)
  6. What networks of providers do the plans use? Is one stronger than the other?
  7. Do both plans have an in and out-of-network benefit?
  8. What are the copays on prescription drugs?
They've actually been covered under the high deductible health plan since the first of the year. She said the $4,000 family deductible scared her at first, but that it had actually worked out ok. All their well visits were covered in full and they had incurred about $1,000 in expenses that were applied to the deductible for a couple of maintenance medications and when my niece broke her thumb. They were able to cover these expenses with money they had contributed to the HSA. 

I shared a few things with her that she didn't realize about the HSA. The money in the HSA is theirs and can be used for any qualified medical expenses. All their contributions were made pre-tax. For 2013, the maximum contribution is $6,450 since they have family coverage. It is $3,250 for single coverage. (This will rise to $3,300 for individuals and $6,550 in 2014.) In addition to what you would expect, the money in a HSA can be used to pay for long-term care insurance premiums, COBRA premiums, medicare and other health care coverage. So, they could deliberately save up money in their HSA to cover medical expenses when they retire. They own the money in the HSA and they should be able to invest it much like they do a 401k. Again, it's their money and completely portable. 

We put together this chart to compare her choices. As you can see, the high deductible plan is the most cost effective choice given the assumptions we made. 

I was struck by how many items that would have differentiated the choices in the past have been taken off the table since the passage of the Accountable Care Act. All plans now cover preventive care and birth control at 100% (these services are not subject to a deductible.) In 2014, there will be no limits on essential health benefits. All plans cover dependents through age 25.

Tuesday, May 28, 2013

Introducing Ben-IQ

Have you ever found yourself at the optometrist unsure of what your plan allowance is for new frames? Or, at the pharmacy questioning whether you're being charged the appropriate copay? Or maybe, you've been at the dentist office sifting through the enrollment cards in your wallet unsure of which one is current. Now there is an app for all those situations and more. Download Ben-IQ to your smartphone and keep all your key benefits information right in your pocket. 

Ben-IQ contains all the basic information about all your benefit plans. You can use Ben-IQ to:
  • review a summary of each of our plans that includes copays, allowances, etc...
  • find a phone number to contact any of our benefit providers
ASHA staff can find log-on information on ASHAnet, our online benefits system, or request it from anyone on the HR team. 

Ben-IQ will serve as a nice compliment to the United Healthcare Health4Me app that allows you to dig deeper into your individual health plan information. You can use Health4Me to access your id card, locate participating providers, view claims, see how much of your deductible has been met and much more. Between the two apps, you'll have all the information you need at your finger tips when you need it. 

Ben-IQ is available to us through Alliant, our broker. At this point in time, the information is maintained at an organizational level, but there are plans to have it reflect individual enrollment and plan information in the future. Please share your feedback with the HR team. 

Monday, May 20, 2013

Wellness Program #Fail

Found on Piccsy
During the Human Resources Health and Benefits Leadership Conference, a group of us were talking about how people don't often share their wellness program failures.  So, I thought I'd take a few minutes to describe one of my ideas that just didn't pan out. 

We held a weight loss program in 2011 for people that had more than 30 pounds to loose. We partnered with LWS and they carefully interviewed and selected the participants. They assessed a number of things -- the support candidates had at home, health conditions that might be improved by weight loss, readiness to change, and what worked and didn't in past attempts at weight loss. 32 staff members expressed an interest in the program and 12 people were selected to participate. We had so much interest, we actually expanded the program from 10 to 12 participants to accommodate more people.

The program was highly individualized and designed around lots of one-on-one counseling with a nutritionist. We also provided other resources -- books, Fitbits, and group meetings to support participants.

At first, we were encouraged by participant's enthusiasm and some initial weight loss. (As a group, they'd lost 17 pounds in the first two weeks.) Then, I started to hear reports from LWS that sounded something like this, "I know no one lost weight this week, but they are eating more fruits and vegetables." I worried the participants would get discouraged if they didn't lose weight and sought feedback. What I heard from folks was that they didn't have enough time to shop, cook, or exercise. 

Between September 20, 2011 and January 3, 2012, the 12 participants lost a total of 28.5 pounds. That was less than one percent of their starting weight. 5 of the 12 participants actually gained weight during the program. 

We wrapped up the program after 12 weeks, but offered some additional counseling to three individuals that seemed to be having some success. During the next 12 weeks or so, they seemed to get derailed too. I know how difficult weight loss is, but the results of this program were dismal. This was the biggest investment we had made in helping people lose weight and we were wholly unsuccessful.

I can only speculate about the reasons, but my best guess is that the participants weren't in the preparation or action stage of change. I work with a lot of very intelligent people. They know if they are overweight and they know what kind of answers we're looking for when they're asked questions about the stage of change they're in. I don't think anyone intentionally duped us; I just think they were overly optimistic about what they could accomplish given what they were willing to invest. Since then, I learned about the commitment continuum and I've wondered if we would have fared any better if we would have tried to assess applicants level of commitment e.g., what were they willing to commit to doing to achieve their goals.

So, there you have it -- our biggest wellness program failure to date.

Wednesday, May 15, 2013

Social Media Roundtable at #AWE13

Alliance for Workplace Excellence
Image from 

The Alliance for Workplace Excellence held its annual award event today. The morning included a series of roundtable discussion on trends in workplace wellness. Judy Ashley kicked off the day by pointing out some trends in workplace wellness. She shared five essential questions and encouraged us to contemplate them as we considered the ideas we picked up during the roundtable discussions. 
  1. Will it fit your culture?
  2. Will it help develop team building, collaboration and employee inclusion?
  3. Will it favor the well-being of customers and employees?
  4. Does it help connect the dots between organizational goals, performance, and employee engagement?
  5. Can can you see and measure outcomes to determine effectiveness?
The Alliance used a slightly modified version of the "World Cafe" methodology for the meeting and offered round table discussions on:
  • Wellness Programs
  • Sustainable Workplaces
  • Flexible Work Arrangements
  • Corporate Philanthropy
  • Employee Engagement
  • Employee Resource Groups
  • Communication Tools to Promote Wellness Programs
  • Social Media
Each discussion group lasted 20 minutes and participants had the opportunity to participate in three. I facilitated the discussions on social media. I started by asking folks to share their name, employer, where their employer is on the adoption curve and where they see themselves on the adoption curve. 

Some of the things we talked about:

  • Reverse mentoring -- partnering entry level employees that are social media savvy with seasoned executives
  • Employees opting out of using business cards and relying on online services instead. I was curious what services people are using. I've used Vizify, Twtbizcard and have been meaning to try the Card Flick app for my iPhone. I tried Bump and, well, I just felt like an idiot using it. No one in the discussion had a favorite. Please share your experience in the comments below. 
  • Sarah Halzack shared some of the interesting things NPR is doing with employer branding. Sarah covers employment and workplace issues for the Washington Post's Capital Business and wrote this column about NPR earlier this year -- For nonprofit NPR, social media is ‘a great equalizer’ when it comes to hiring.
  • Caroline Wizeman from Near Infinity said they created a tool to gamify social media sharing to encourage employees to share content and build their employer brand. I'm absolutely fascinated by this idea.  
  • I shared this grid we developed for an educational series we created for ASHA staff last year.

It was an interesting morning and I'm grateful to have been part of the discussion. 

Tuesday, May 14, 2013

Sunscreen PSA


Terry, Nina, Emily and Janet at the Flower Show in 2010
In my yoga class on Saturday morning, Jafar took a moment to remind us all to use sunscreen. It's a message worth passing along this time of year. And, I thought I could up the ante by telling you about a new sunscreen my friend Lisa introduced me to last month.

CoTZ is a mineral based sunscreen that is free of chemical sunscreens, oils and fragrances. It actually feels powdery on my skin and has a nice matte finish. I like that it has a tint, so I can wear it in lieu of a base or tinted moisturizer. It blends very well with different skin tones. (It's not often we can find one skincare product that our whole team can use.) And, no, I don't have stock in the company or anything. I just like it enough that I want to share. I know you can get it on Amazon and at Ulta. 

Update 6/5/13:

Lisa just shared this on Facebook. She's spent years working for companies in the pharmaceutical and cosmetic industry and she's very knowledgeable. I'm following her advice.
"I have read enough research and listened to enough medical experts to conclude that a vitamin C serum should be used every morning under sunscreen to help prevent damage caused by UV exposure. This infographic details how it works:"

Related reading:

Monday, May 13, 2013

Budgeting for Health Insurance Using Decisive

Decisive -- How to Make Better Choices in Life and Work by Chip and Dan Heath

Our health claims experience is looking pretty bleak right now. If we stay on this trend, we could be facing a 28% increase in 2014. That kind of news serves as a tripwire even if it wasn't deliberately set. Yes, I just finished reading the Heath brothers new book, Decisive. If you haven't read it, it's well worth your time. And, if you're wondering what a tripwire is, David Lee Roth explains it best, but in short, a tripwire ensures you are aware it's time to make a decision, that you don't miss a chance to choose because you've been lulled into autopilot.

Another concept introduced in Decisive is bookending. Bookending helps us stretch our sense of what the future might bring, considering many possibilities both good and bad. So, if I look at our situation optimistically, I'd say we might get away with a 15% increase.

Health insurers are warning employers they may face sharp increases next year. The Wall Street Journal covered this in an article in March -- Health Insurers Warn on Premiums. UHC is telling clients to plan for 3.8% just to cover new taxes and fees mandated by the ACA which include:
  • PCORI, the Patient-Centered Outcomes Research Institute fee aka comparative effectiveness fee ($2 PMPY in 2013 indexed to medical inflation in subsequent years) 
  • Insurance carrier fee
  • Transitional Reinsurance Fee ($63 PMPY) 
  • Some plan design changes for 2014 like no pre-existing conditions, coverage of clinical trials, no limits on essential health benefits. 
UHC is suggesting groups in Maryland plan as follows. (This is a little different than what UHC is advising nationally according to this post.) The dynamics in the DC area tend to be a little different than the rest of the country. Employers provide richer benefits in our area and people have easy access to care. 
  • +125% for individual 
  • +25-50% for small group 
  • +15-25% for large group
That makes 15% on the optimistic end and 28% on the other. Not pretty or sustainable either way. So, we'll be engaging our executive team to explore options. I mind mapped this process to guide us. Ultimately, that's the big lesson in Decisive -- you need a deliberate process to make good decisions. 

Sunday, May 12, 2013

Mediterranean Challenge Results

30 Day Mediterranean Lifestyle Challenge

We had 50 staff members formally participate in our Mediterranean Lifestyle Challenge and 18 individuals participate in the pre and post screenings we offered. We looked at blood pressure, BMI, cholesterol and glucose. Cyndi Fales and Kellie Burkinshaw at LWS collected and analyzed the results and reported:  

The flow of risk is exactly what we want to see-- we had people move from 3-4 risk factors to 0-2 risk factors.  Cholesterol and glucose levels showed the most decrease in risk, body fat and blood pressure didn't show as much (if any change).  Overall I think for a 30 day challenge -- the results are heading in the right direction.
I'm really pleased. As much as I believe in following a Mediterranean diet, I wasn't sure that people would get very measurable results over 30 days. 

Our intent was to have people try a Mediterranean lifestyle for 30 days with the hope they would feel better, find it sustainable and want to continue. We're looking at what we can do to support staff and their families going forward. One of the challenges with a campaign style approach to some of our wellness initiatives is in sustaining support after the conclusion of the initiative. I think we're onto something good this time, so we're going to figure it out. Stay tuned!

Tuesday, May 7, 2013

Recap of the Human Resource Executive Health & Benefits Leadership Conference

Last week, I had the good fortune to attend the inaugural Human Resource Executive Health and Benefits Leadership Conference in Las Vegas. The real highlight for me was getting to sit down with a group of people I've been collaborating with online for years -- Fran Melmed, Carol Harnett and Bob Merberg

I have 13 pages of mind maps from the sessions I attended and I've been trying to decide what might be interesting to share. Here are a few of the highlights. You can get another perspective from Jen Benz's post. A number of participants Tweeted from the conference, so you can also view the Twitter Stream. And, be sure to check out the reading list I created from what was mentioned during the conference.

Ron Leopold opened the conference with a presentation called "Are benefits forever?" He shared:

7 Factors Driving Health Care Costs
Fran Melmed with Jake Butler from Me You Health,
Dr. Rajiv Kumar from ShapeUp, Melissa Yoakam
from Chipotle and Ritu Riyat from Blue Shield of CA
discussing health games

  1. We pay providers in ways that reward doing more, rather than being efficient.
  2. We're growing older, sicker and more obese.  
  3. We want new drugs, technologies, services and procedures.
  4. We get tax breaks on buying health insurance, and the cost to patients of seeking care is often low.
  5. We don't have enough information regarding which medical care is best for us.
  6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.
  7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.
And, 10 Trends that will Impact Employee Benefits
  1. Health care costs have been running 2-3x inflation for nearly two decades. People are living longer which is taxing the social security system and legions of baby boomers are entering an already bloated Medicare system. 
  2. Defined contribution worked in retirement because it contained employer financial liability. This will be equally attractive for health benefits. ACA rules will accelerate this imperative.
  3. How we select benefits, submit a claim, check a balance, change coverage and interact with benefits services is becoming increasingly device-centric. 
  4. The war for talent is about skilled labor. Unskilled laborers have few opportunities. 
  5. Employers focus on productivity. To mitigate losses they focus on energy, resiliency, mental wellness and fulfillment.
  6. Digital health is here to stay. The conversation continues in new and exciting ways: between patient and provider, consumer and vendor, and people with similar situations.
  7. 75 is the new 65. Seeing and hearing are becoming more important to people as they work longer. (Good news for ASHA members.) 
  8. The pendulum shifts on outsourcing with the cost/benefit shrinking to a point where we keep more jobs in the U.S.
  9. Employers focus more on population health and matching the intervention to the level of risk. 
  10. What it means to "be employed" will look radically different. Think employer as exclusive club where access to value programs comes with membership. 
During a Long Road to Wellness Bob Merberg and Jake Flaitz shared their experience at Paychex. They highlighted some of their wellness program keys to success:
Carol Harnett with Amy Moore from Healthways
Rosemary Passantino from the City of 
San Francisco,and Vlad Gyster from h.engage 
discussing behavior change
  • Robust communication
  • Network of champions
  • Sound incentive structure
  • Emphasis on evidence
  • Creating a culture of health
  • Social approach
The also shared three barriers they encountered when implementing their wellness program that I can definitely relate to:
  • Organizational culture
  • Technology (Things you expect to be simple like single sign-on can be real challenges.)
  • Employee wariness
The Ideas and Innovators session lead me to check out Good Rx to compare drug prices (your insurance isn't always the best deal) and Wiser Together to help health care consumers make evidence-based, cost-effective treatment decisions that are aligned to their personal preferences and financial constraints. I'm also thinking about holding a challenge that involves strengthening your memory and resilience, so I will definitely be checking out My Brain Solutions

In a session on Essential Health Metrics, John Riedel, Wayne Burton and Donna Cornwell shared 10 Workforce Key Health Dimensions:
  1. Financial (cost)
  2. Program participation
  3. Biometric screening
  4. Health risks
  5. Utilization
  6. Preventive care
  7. Chronic conditions
  8. Lost work time
  9. Lost productivity
  10. Employee engagement
I walked away on Wednesday thinking about:
  • Finding better ways to measure absenteeism and presenteeism. The money spent on medical and pharmacy only account for 30% of the cost. Lost productivity accounts for another 70%. Absence data is also a good leading indicator of health issues in the workplace. AmEx uses the Work Limitations Questionnaire (WLQ) from Tufts Medical Center to measure productivity. 
  • How are organization driving patients toward centers of excellence and premium designated providers and what measures are they using to gauge effectiveness? The lack of connection between cost and quality is befuddling. (The price of a hip/knee replacement can vary from $15,000 to $110,000.) How can we help consumers make informed decisions about their care?
  • If health = wealth in HSAs do people with chronic conditions feel estranged?
  • What process are organizations using to decide what behaviors to incentivize? How do you avoid incenting things that don't improve health -- e.g., incentives can lead to over screening of biometrics and many do not find health risk assessments useful. 
  • Delaying the implementation of the exchanges by one year will save the government 80 billions dollars. It already seems highly unlikely that they'll be ready. Hearing this, it's hard to imagine that they won't be delayed. 
  • Will employers feel less obligated to provide affordable coverage to spouses and dependents since they'll have other options for coverage? Will this create a confusing mess for families who each have their coverage through different providers? Who will help people? Will technology solutions be developed to aid families in this situation? 
  • Will employers push active employees over age 65 and retirees toward exchanges? What will health care look like for retirees in the future?
  • There is a trend to bundling payments again. Bundle > Unbundle > Bundle. Everything old is new again.
  • Thinking about medical tourism. We know people will drive farther for dinner than to seek medical care. Will they really consider leaving the country as costs are shifted? 
  • Fewer plan sponsors are carving out pharmacy benefits because it complicates CDHPs.
As you can probably tell, I was pretty focused on health care costs. Our claims experience is high right now, so I'm looking for things we can do to provide affordable, comprehensive coverage to our staff and their families in the future. 

Monday, May 6, 2013

Reading List: From the Human Resource Executive Health & Benefits Leadership Conference

As books, studies, movies, etc... were mentioned during the conference, I took note. Here is my reading, watching and listening list:
Image from

  1. Escape Fire: The Fight to Rescue American Healthcare -- A well-done documentary about how our health care system is designed to profit from disease, not health. I downloaded it from Amazon and watched it on the flight home. 
  2. Bitter Pill: How outrageous pricing and egregious profits are destroying our health care -- This was a special report from Time Magazine published March 4, 2013. It's long -- about 54 pages, but worth reading. I stopped by the library and they emailed it to me. (Don't know why I don't think to use the library more often.)
  3. Employee Benefits: Are You Getting Your Money's Worth? a white paper from Colonial Life 
  4. Well on the Way: Engaging Employees in Workplace Wellness a white paper from Colonial Life
  5. Reshaping Health Care -- 18th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care
  6. Workforce Health and Productivity: How Employers Measure, Benchmark and use Productivity Outcomes -- Mentioned by John Riedel
  7. Mindspace -- Influencing behavior through public policy mentioned by Amy Moore.
  8. mHealth Report from Ruder Finn -- How consumers in the U.S. are using mobile devices to manage their health. 
  9. Salt Sugar Fat: How the Food Giants Hooked Us by Michael Moss
  10. Contagious: Why Things Catch On by Jonah Berger
  11. The Conversation Project -- Carol Harnett mentioned this initiative and she talks about it a bit in this post on how we can support caregivers in the workplace. 
And finally, I was one of five employee benefits leaders invited to participate in a discussion about the conference and employee benefits in general that was recorded for CoHealth Checkup. Fran Melmed and Carol Harnett are the hosts. I was honored to be included in the discussion with Andrew Gold, Executive Director, Global Benefits Planning, Pitney Bowes, Vlad Gyster, CEO and Founder, H.Engage, Bonnie Pang, Vice President, Employee Benefits, Atlas Insurance Agency, and Jennifer Benz, Founder and Chief Strategist, Benz Communications. Listen here or tune in on iTunes. (You really should listen to CoHealth Checkup every month.) 

Listen to internet radio with CoHealth Checkup on BlogTalkRadio

If you know of something I missed, please leave a comment below.

Sunday, May 5, 2013

Mediterranean Potluck

30 Day Mediterranean Lifestyle Challenge

Last Thursday, Diane Paul organized a Mediterranean potluck lunch for those of us who participated in the challenge. We enjoyed chicken, hummus, whole wheat pita, a kale salad, a yummy soup, a spinach salad, an Israeli salad, a black bean salad, a warm spinach and chick pea dish, fresh fruit and I'm sure a few more things I'm overlooking. (I knew I should have written this right after lunch.) 

We chatted a bit about the challenges we faced with our new way of eating -- getting off track with holidays and special occasions, sugar cravings, and a lot of chopping which has put our knife skills to the test. And, the results we'd seen -- some substantial drops in cholesterol and a few pounds lost. We also discussed ways to continue to build on what we've done. Stay tuned on that front. Many thanks to Diane for getting us together.