R&R Insurance Blog

I though that this was only something that insurance companies did? Et tu, CMS? What makes anyone think that health care reform is going to deliver a better, more affordable health care reality? You don't have to "wait and see" for the federal government to build the house when the foundation they have been laying is already cracking! I am comforted to learn, though, that the government is doing everything it can "to avoid running out of money." Welcome to the risk business! That's why the states have insurance regulators! Who's regulating you?

Link to full article to Obama Administration Cuts Benefits to Those in High Risk

Medications have side-effects; so do health care laws. Is California's scramble to find a solution to the overwhelming provider access issue a sign of things to come? California may be different in many respects and the same could be said of any of the other 49 states, but on this issue, they do not stand alone. Their "solution", however, may create some new side-effects of its own.

The LA Times article cites the following:

Problem: There aren't enough doctors to treat a crush of newly insured patients.

California Lawmakers' Solution: Fill the gap by redefining who can provide healthcare. They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure. Read more...

Interesting poll results from a recent MD News.com physician poll.

Q: Would knowing the cost of a diagnostic test to the insurance company and the patient affect your opinion about the need for the test?

40 % Yes. I would try to select the least expensive testing available without compromising patient care.

33 % Maybe. I would at least weigh the pros and cons associated with more expensive diagnostic methods.

27 % No. Pricing has absolutely no place in the practice of medicine. My role is to diagnose patients regardless of costs.

Obviously, there is still a long journey ahead when it comes to physician networks, partnering with care givers that provide health care for your employee base, and educating the impact not only to employers and their employees - looks like there is more need for education on the provider side as well.

For any help with understanding health care consumerism, lowering health care costs through the implementation of proven wellness and work comp techniques, please contact me, Riley Enright, knowledgebroker and health benefits specialist at R&R Insurance Services.

If you think medical costs are expensive, that's just the tip of the iceberg when you start to consider the health-related productivity costs....

According to Rutgers University, employee health problems cost employers approximately $226 billion each year. Of these substantial costs, approximately 70 percent resulted from a reduction in productivity, with the rest coming from work absences due to illness. While offering health coverage and benefits for employees and dependents is a major business expense, lost productivity due to physical and emotional health problems can be far more costly for employers.

Lost productivity is classified in two ways: presenteeism and absenteeism. While absenteeism means that the employee is physically not at work, presenteeism is when an employee is physically at work but a physical or mental health condition negatively affects their work quality and quantity. Employers spend two to three dollars on medical-related productivity costs (presenteeism) for every dollar spent on pharmacy and health care costs.

Employers spend two to three dollars on medical-related productivity costs for every dollar spent on pharmacy and health care costs.

The AdvancePCS Center for Work and Health in Hunt Valley, Md. conducted a study of 29,000 employees in the United States to determine how many hours and dollars were spent on lost productivity. The study revealed that 71 percent of lost productivity time was directly related to deficient performance on the job, while only 23 percent was due to actual absences from work. The remaining 6 percent of productivity costs were found to be associated with family health obligations. In addition, smokers who smoke at least one pack per day had productivity losses double that of their nonsmoking counterparts.

Effects of Presenteeism
Presenteeism can have many negative effects on your workforce, including:

• Spending unneeded additional time on tasks
• Decreased quality of work
• Lack of initiative
• Infecting other employees, clients or customers with an illness
• Lowered ability to perform at a high level
• Decreased quantity of work completed
• Inability to be social with co-workers
• Lack of motivation

Causes of Health-Related Productivity Costs

• Back and neck pain (notoriously a very expensive and prevalent medical condition)
• Headaches
• Colds and the flu
• Sinus trouble
• Obesity
• Allergies
• Diabetes
• Depression and/or anxiety
• Ongoing chronic conditions

Decreasing Health-Related Productivity Costs
To reduce productivity costs in your workplace, consider the following:

• Address conditions that affect many individuals of your employee population in your wellness initiatives.
• Offer health fairs, screenings and health risk assessments to evaluate the needs of employees.
• Integrate your health benefit strategies with your health management and wellness initiatives.
• Design your benefits package to support the behaviors that you want to see at your organization.
• Partner with a health care company that takes an innovative approach to wellness and offers productivity, wellness and disease management resources. Your health care company could offer 24/7 nurse line, wellness and health risk assessment tools, lifestyle management and chronic condition assistance, and/or solutions that empower individual employees to take control of their health care.

If you don't address your employees’ health care needs, your workplace is far more likely to experience the negative effects of both absenteeism and presenteeism. However, if you can commit time and funds to help your employees get and stay healthy, you will reduce medical and pharmacy costs and increase worker productivity.

At R&R, we are seeing more and more small businesses in Wisconsin having serious discussions about the link between obesity and workplace injury. On top of that – when you factor in wellness programs that will increase the health and longevity of employees and their families – small businesses can have a lot control over their health insurance costs and the productivity of their employees - control that they don't know they have. At R&R Insurance, we call this program WellCompForLife! Join the WellCompForLife discussion on LinkedIn!

For more information, contact knowledgebroker Stephanie Riesch-Knapp concerning how to execute an effective wellness plan.

This is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice. © 2009-2012 Zywave, Inc. All rights reserved.

Chronic conditions not only deeply affect those who suffer from them, but can also lead to increased medical expenditures and lost productivity for employers. However, in spite of their devastating effects, most chronic conditions are preventable. While some factors such as age, genetics and environmental triggers may be unavoidable, controlling modifiable risk factors such as smoking, physical inactivity and eating an unhealthy diet can play an important part in preventing chronic conditions.

According to the Center for Prevention and Health Services, chronic diseases are health conditions that require ongoing management over an extended period of time. Some chronic conditions have very few symptoms while others severely limit a person’s ability to perform normal, routine tasks. There are many chronic conditions affecting the workforce today, some of the most common being:

• Being Overweight or Obese
• Cancer
• Cardiovascular Disease (coronary artery disease (CAD), stroke, congestive heart failure (CHF) and hypertension)
• Chronic Obstructive Pulmonary Disease (COPD) (chronic bronchitis, emphysema or a combination of the two)
• Diabetes

Employer Role in Chronic Condition Management

Approximately 133 million Americans live with the conditions of one or more chronic diseases, which translate into an increased cost for employers. On average, employer healthcare coverage for an employee with a chronic condition is five times higher than coverage for those without a chronic disease. So what can employers do to reduce healthcare costs for themselves and their employees? Think prevention. Treating chronic diseases involves physician visits, extended hospital stays, prescription drugs and expensive treatments. Prevention is the most cost-effective method of reducing chronic diseases among at-risk employees. To assist in prevention efforts, employers should implement workplace policies that encourage employees to use preventive services and health promotion programs. Ultimately, encouraging healthy behavior should be a corporate healthcare strategy to reduce costs. Here are some strategies to prevent chronic conditions within your workforce:

Understand your employee populations:
This way, you can tailor benefits and wellness programs to specific populations based on their current healthcare needs and risk factors.

Encourage usage of clinical preventive services by either covering those benefits in full or with a nominal copayment:
Financial barriers (high co-pays or out-of-pocket expenses) may prevent employees from receiving valuable preventive services, in spite of their significant health benefits. Make preventive services costs more affordable for employees to eliminate this barrier and improve utilization rates among your employee population.

Conduct employee health risk assessments (HRAs):
Conduct an HRA to identify employees who are at risk of chronic diseases. This creates an opportunity to intervene before the disease develops, or at least, during an earlier, less expensive stage of the disease. To encourage employees to take an HRA, offer incentives.

Educate employees about preventive services and benefit coverage:
Develop culturally competent materials to present to employees on preventive services and techniques.

Implement health promotion programs that address the top three causes of chronic conditions (tobacco usage, unhealthy diets and lack of physical activity):

Tobacco Use

• Provide smoking cessation programs as a covered service within your health plan. Cessation benefits cost between $1.20 and $4.80 per employee per year, yet the cost of tobacco use is about $3,400 per smoker per year. By year five, the benefits of smoking cessation programs begin to exceed the costs to implement the programs.
• Implement a smoke-free workplace to discourage smoking and to prevent the harmful effects of secondhand smoke.
• Subsidize smoking cessation aids by negotiating with your pharmacy benefit manager to include smoking cessation assistance as a covered benefit.

Healthy Diets

• Develop incentives for employees to participate in weight reduction programs or nutritional counseling programs. To encourage participation and success, provide rewards.
• Subsidize company cafeterias and vending machines to offer healthy food choices.

Physical Activity

• Develop exercise programs to promote physical activity. Consider providing additional financial incentives such as subsidized gym memberships, financial rewards and on-site fitness facilities to boost participation.

Chronic diseases are serious, costly and most importantly, preventable. Once they are fully developed, these conditions may be managed, yet never cured. Despite this, there are safe, cost-effective interventions to avoid chronic diseases altogether. To avoid productivity loss, presenteeism, absenteeism, disability and early retirement for your employees, you must educate on the value of chronic disease prevention. By implementing a health promotion program and investing in prevention, you can retain a healthy and productive workforce.

At R&R, we are seeing more and more small businesses in Wisconsin having serious discussions about the link between obesity and workplace injury. On top of that – when you factor in wellness programs that will increase the health and longevity of employees and their families – small businesses can have a lot control over their health insurance costs and the productivity of their employees - control that they don't know they have. At R&R Insurance, we call this program WellCompForLife! Join the WellCompForLife discussion on LinkedIn!

Source: Center for Prevention and Health Services, Issue Brief

This information is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. © 2013 Zywave, Inc. – republished from Zywave

On Jan. 24, 2013, the Department of Labor (DOL) announced that employers will not be held to the March 1, 2013, deadline. They will not have to comply until final regulations are issued and a final effective date is specified.

EXCHANGE NOTICE REQUIREMENTS
In general, the notice must:

• Inform employees about the existence of the Exchange and give a description of the services provided by the Exchange;
• Explain how employees may be eligible for a premium tax credit or a cost-sharing reduction if the employer's plan does not meet certain requirements;
• Inform employees that if they purchase coverage through the Exchange, they may lose any employer contribution toward the cost of employer-provided coverage, and that all or a portion of this employer contribution may be excludable for federal income tax purposes; and
• Include contact information for the Exchange and an explanation of appeal rights.
  This requirement is found in Section 18B of the Fair Labor Standards Act (FLSA), which was created by the ACA. The DOL has not yet issued a model notice or regulations about the employer notice requirement.

WHEN DO EMPLOYERS HAVE TO COMPLY WITH THE EXCHANGE NOTICE REQUIREMENTS?
Section 18B provides that employer compliance with the notice requirements must be carried out "in accordance with regulations promulgated by the Secretary [of Labor]." Accordingly, the DOL has announced that, until regulations are issued and become applicable, employers are not required to comply with the exchange notice requirements.

The DOL has concluded that the notice requirement will not take effect on March 1, 2013, for several reasons. First, this notice should be coordinated with HHS's educational efforts and IRS guidance on minimum value. Second, the DOL is committed to a smooth implementation process, including:

• Providing employers with sufficient time to comply; and
• Selecting an applicability date that ensures that employees receive the information at a meaningful time.

The DOL expects that the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges.

The DOL is considering providing model, generic language that could be used to satisfy the notice requirement. As a compliance alternative, the DOL is also considering allowing employers to satisfy the notice requirement by providing employees with information using the employer coverage template as discussed in the preamble to the Proposed Rule on Medicaid, Children's Health Insurance Programs and Exchanges.

Future guidance on complying with the notice requirement under FLSA section 18B is expected to provide flexibility and adequate time to comply.

"This information is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. © 2013 Zywave, Inc. – republished from Zywave."

As a general rule, if an employee is terminated for cause, the obligation to pay workers compensation benefits continues. Similar to a layoff or the employer's inability to provide light duty work, a termination is viewed in much the same way. The injured worker is still considered to be restricted in the general labor market due to injury, until he or she reaches maximum medical improvement, or is released to return to work without restrictions.

See Brakebush Brothers Inc and Employers Insurance of Wausau vs LIRC 1997

However, in recent years, the Wisconsin Department of Workforce Development has expanded their scope of potential situations where benefits may be suspended as the result of termination.

Here are a few exceptions:

1. The employee's employment with the employer has been suspended or terminated due to the employee's violation of the employer's policy concerning employee drug use during the period when the employee could return to a restricted type of work during the healing period. Compensation for temporary disability may be denied only if prior to the date of injury the employer's policy concerning employee drug use established in writing and regularly enforced by the employer.
2. The employee's employment with the employer has been suspended or terminated due to the employee's alleged commission of a crime, the circumstances of which are substantially related to that employment, and the employee has been charged with the commission of that crime. If the employee is not found guilty of the crime, compensation for temporary disability shall be payable in full.
3. The employee has been convicted of a crime, is incarcerated, and is not available to return to a restricted type of work during the healing period.

The exceptions listed above all make good sense as it relates to benefit cessation. Without those exceptions, the employer's insurance carrier is obligated to continue benefits. This certainly makes good sense as you could create a moral hazard whereby an employer terminates a work simply to circumvent the payment of benefits.

Single wage earners need to see to it that their greatest asset, their ability to earn income, is adequately protected. Also, as more of today's households are dependent on dual incomes, it becomes crucial to protect both of them. Even if their employer offers group disability insurance, in many cases, the amount of the coverage is insufficient to protect their needs and won't allow them to continue the lifestyle they have become accustomed to.

Read the full article

Today, every customer is a reporter and every employee is a potential marketer. Learn about the basics of social media and how to apply it to your own Human Resource functions.

Presenters:
Jeff Coon, Art Director & Partner at Stream Creative - Social Media Expert and Inbound Marketing Certified Educator

Who Should Attend:
Human Resource Managers; Benefits Managers, Recruitment Professionals, Office Managers, Business Owners, Marketing Professionals, Social Media want-to-be’s.

Seminar Content:

• What is Social Media?
• How to Use Social Media for Internal Branding
• How to Use Social Media for Recruiting
• Employee Policies on Social Media Use

Social Media for HR Managers
Free Seminar
Wednesday, September 21, 2011
MRA Conference Center - Waukesha, WI
7:30-8:00am Registration
8:00-11:30am Program

Contact Pam Baule for registration
262-953-7238