Courtesy of Building Indiana • June 5, 2019

Written by Nick Dmitrovich

What’s the top health issue employers should be concerned about?
Why should they care? How can they address the issue?

Building Indiana reached out to health experts from around the state to learn more about their recommendations for employers on how to help keep employees healthy.

Sean Dardeau, Market CEO
Porter Regional Hospital

Chronic diseases such as diabetes, high blood pressure, cardiac conditions, and even mental health are driving up employer healthcare related cost.

Without appropriate management of chronic conditions, the health of the employee will decline. With that employers will certainly see increased healthcare related costs, production declines and even a potential rise in absenteeism. Providing good health insurance benefits, at a reasonable cost, with reasonable out of pocket expenses will demonstrate their commitment to the employee. Encouraging employees to take advantage of preventive services as a way of managing chronic conditions could have a significant economic impact in terms of expense reduction.

Employers should work with qualified benefit design professionals to craft an insurance offering that provides screening services, preventive services and educational resources. The use of onsite employee health services that provide education can also be of benefit to improve the health and well-being of your staff.

Barbara A. Ihrke, Vice President of Academic Affairs, School of Nursing
Indiana Wesleyan University

A top issue for employers in the healthcare market is employee retention. Low unemployment, competition for skilled employees, and changing employee expectations are eroding retention statistics and forcing employers to rethink their employment practices. Retaining skilled employees is critical in order to maintain excellent patient care, meet care expectations, and meet profitability expectations. Employees want market rate salaries, great benefits, and fair treatment. Employers can address each of those expectations at time of hire and then regularly thereafter. Employers need to think like an employee, listen to their concerns, and provide opportunities for employees to expand their skills and explore career advancement. Employees often are more interested in work-life balance than some other employment benefits.

Retention of skilled healthcare employees, especially nurses, has been a challenge in the last few years. Understanding the costs involved in losing a valued employee is step one in fixing the problem. Robust onboarding, mentorship, and reasonable work/life balance will improve employee retention. The focus during hiring must be on long-term retention. Employers with a focus on retention could see long-term benefits that reduce the cost burden experienced following loss of skilled employees.

Dr. Mukund Komanduri, Orthopaedic Surgeon
Pinnacle Hospital

Last year Indiana posted a 7% decrease in injury rates, but if they were stratified by age, we would find that certain injuries are more common with age. As the labor market tightens, available employees are often older and have associated risks.

What are the risks? Every body part, whether it is a muscle or tendon, has an elastic component which allows stretching and lengthening and rigid components that can tolerate weight and force. With age and prior injury, elasticity is lost and rupture of tendons becomes more common. It is no surprise that rotator cuff tears and Achilles’ tendon ruptures peak at age 45-55. Along with loss of elasticity, other habits like smoking and excess alcohol consumption start to have a cumulative impact resulting in negative outcomes. Both are associated with osteoporosis and poor wound healing which can lead to more fractures and poor recovery.

What can we do to shield ourselves from risk? Some options like more automation and lifting equipment or better ergonomics are very expensive. The best method is prevention. Preparticipation exams with therapy and an experienced orthopaedic surgeon can identify work capacity deficits that may not qualify a hire for the job. Smoking cessation programs with modest financial benefits are worth their weight in gold. Warehouse workers that start their day with a modest group stretching and exercise program diminish their injury rate by half. The cheapest health care is always good health care.

Mark Lantzy, President
Indiana University Health Plans

Employers face tough choices in designing health plans that best serve their employees.

How much of the cost burden should employees shoulder? How to cover rising premiums? What incentives encourage healthier lifestyles?

In Indiana, the need to offer health plans that work is critical. Our state ranks 41st nationally in health, with 34 percent of the population obese, 22 percent smokers, and 12 percent diabetic. (America’s Health Rankings)

More than ever, employers need a holistic approach to manage healthcare costs. That means nuts-and-bolts coverage for illness/injury, combined with a high-quality network and preventive wellness. Innovative solutions, like plans that integrate claims and clinical data or offer on-demand provider visits through telehealth, ensure that your employees receive convenient access to the right care at the right time.

If your plans support all aspects of health, you’ll gain a workforce that’s more focused, engaged and productive. We’ve seen great payback from well-crafted plans that encourage weight loss, identify prediabetes, and improve stress-coping abilities. That’s vital to prevent chronic diseases that drive employer healthcare bills ever-higher and lower Hoosiers’ quality of life.

Through wellness programs, population health, and tools like telehealth and onsite clinics, employers can go beyond treating symptoms and look toward prevention for the physical and mental sides of the healthcare equation.

Julie Kissee, LCSW, Administrative Director
Franciscan Health Employee Assistance Program

Poor mental health is one of the biggest issues in the workplace today with 19.95 percent of Indiana adults experiencing a mental health disorder and 85 percent of that population going untreated. This impacts employees and employers through turnover, absences, decreased motivation and lost productivity.

Good mental health is vital to business performance. Happy, well-cared for employees are more engaged, motivated and loyal. One factor why mental health has become such an issue in the workplace is that many cases go unrecognized until they become severe. Identifying problems can be difficult. Here are some common signs of an employee struggling with mental health at work:

Irritability
Sensitivity to criticism
Loss of confidence
Increase in mistakes
Problems making decisions
Difficulty concentrating
Sudden drop in work performance
Tardy issues
Missing deadlines
Acting out of character
Increase in common illnesses
Fatigue
Disheveled appearance
Changes in weight loss or gain.

Employers can encourage good mental health by:

Making it safe to talk about employee mental health needs.
Providing training to help recognize the early signs of mental health conditions
Addressing symptoms early, preventing development into something more serious.
Providing services and resources to employees that may need professional support.

Shawn McCoy, CEO
Deaconess Health System

The health issue causing the most harm to Hoosiers, medically and financially, is tobacco use.

In Indiana, the direct cost of health care attributable to smoking was estimated to be $3.3 billion in 2017. Hospitals and health systems across the state see the ill effects of tobacco use each day. These patients visit the doctor’s office, hospital, or emergency room to address complications of chronic obstructive pulmonary disease (COPD), heart disease, congestive heart failure (CHF), or lung cancer – all health problems caused or worsened by tobacco use.

To cover expenditures for tobacco-related diseases, residents of Indiana pay an additional $1,125 per household in state and federal taxes.

Consequences for employers go beyond increased health insurance costs as employees who smoke are absent from work more frequently than those who don’t smoke. That level of absenteeism can negatively impact a company’s bottom line.

What can employers do to address this health issue? In short, they can support raising the Indiana cigarette tax by $2 per pack and provide employee benefits that include coverage for smoking cessation programs.

A healthy workforce is a more productive workforce. Use the power of your company to flip the script on tobacco use in Indiana.

Ed Romero, Vice President, CFO
Methodist Hospitals

A top health issue that employers should be concerned about is employee health care cost. The cost of health insurance has risen by 50 percent in the last decade. Employers are increasingly buying their services direct through self-funded plans where they create their own benefits, pay health claims directly or through a third-party administrator (TPA), and purchase stop-loss insurance to limit liability. Many large employers opt to go with a self-funded plan. While large employers dominate the self-insurance space, approximately 14 percent of businesses with fewer than 20 workers are in a self-funded plan. The average cost of insurance for employers is over $6,000 per year with a deductible to match.

The bottom line is that even if employers pay half of the premium for employees, neither the employer nor employee can afford to pay a high percentage for coverage. Employers have relentless pressure to identify cost savings, while simultaneously finding ways to attract and retain talent. As a result of these industry pressures, high-performing health care organizations need to engage in innovative strategies and partner with strategic advisors.

Recommendations that could assist with employee health care costs are changing to the preferred tier 1 medical treatment plan with a lower deductible versus out-of-network providers that should cost more. Also, adding inpatient admission copay in non-tier 1 plans could assist in direction to lower costs. In addition, adding a spousal surcharge when having a likewise employer-funded plan, and a smoker surcharge. For Rx plans, opting to a mail order for maintenance drugs can also help service an employee’s needs while maintaining lower pharmaceutical costs.

Mark Savage, Director of Operations, Occupational Health
Community Healthcare System

Today, Americans are working longer contributing to a rise in the median age of the workforce. Workers also are more sedentary than previous generations. As a result, work-related musculoskeletal disorders (MSDs) currently make up the largest job-related injury category (30 percent of all injuries), according to the Occupational Health and Safety Administration (OSHA). Employers are paying approximately $20 billion in workers’ compensation costs for MSDs annually.

To help reduce the number of job-related MSDs, Community Healthcare System Occupational Health recommends the implementation of a strategically designed workplace ergonomics program. Proactive injury intervention will increase productivity and overall profit by preventing company payouts related to workplace injuries.

A high-quality workplace ergonomics program should have a team of trained and experienced ergonomic consultants who provide the following:

A job site analysis
Analysis and interpretation of OSHA 300 logs
Development of functional job descriptions
Development of a screening to assure the employee can perform the job’s essential physical demands
Onsite injury intervention
Safety team facilitation
Ergonomic/safety training

Companies that consider their employees’ work environment and how it can affect health and efficiency potentially can reduce workplace injuries and the high costs associated with them.

Kevin P. Speer, JD, President and CEO
Hendricks Regional Health

The issue that should be top of mind for employers is the cost of health care and the value they get for their company health plan.

As healthcare leaders, we know employers are struggling to find sustainable solutions to reduce healthcare expenses while ensuring quality care for employees. Now more than ever, companies need a voice in pricing transparency — and need to be willing to move their health plans away from lower-value providers.

Employers can address these issues by working collaboratively with brokers, TPAs and healthcare providers who focus on high-quality care at lower prices. This includes partnering with organizations using innovative and proven wellness models that lead to healthier outcomes. This is important because health and wellness is linked to chronic conditions and higher costs of care. A 2018 Gallop Poll placed Indiana in the lowest ten states for overall well-being. This provides an opportunity for employers to engage partners who can help create programs for healthy sustainable behavior change.

Also, by ensuring employees have access to convenient, preventative care near where they live and work, employers will be able to get the most value for their organization and health plan members.

Dr. Jeff Wells, President and Co-founder
OurHealth

Addressing the prevalence of chronic conditions in the workforce and the financial impact they have for employers.

According to the CDC, 60 percent of the population has at least one chronic condition like hypertension or diabetes. These conditions have a disproportionate impact on an employer’s bottom line, accounting for approximately 90 percent of all healthcare costs.

And many chronic conditions are directly tied to unhealthy lifestyle choices such as immobility or smoking, but they’re also avoidable.

So, what can be done?

First, remove barriers to accessing healthcare. It shouldn’t be difficult or overly time-consuming for employees to receive care. Consider offering primary care as an employee benefit via an onsite or near-site clinic solution so employees can access care close to work or home.

Second, incentivize employees to prioritize their health through fun wellness challenges and by encouraging preventive care. A single biometric screening can test for multiple chronic conditions. Increasing awareness of healthy biometric ranges often motivates employees to adopt healthier lifestyles.

And finally, when specialty care is needed, provide resources to help employees navigate our complex healthcare system. It’s estimated that as much as 30 percent of the U.S. healthcare spend is wasted, often due to huge price variations for the same specialty care. In other words, an MRI at specialist A might cost $3,400 but the same MRI at specialist B is only $800. Helping an employee navigate that choice results in $2,600 in savings.

Candace Wells-Myers, Manager, Human Resources
Regenstrief Institute

From the cost of benefits, to health care access, to impacts of the opioid crisis, we at Regenstrief Institute have myriad concerns related to employee health.

It is not enough to offer reasonably priced health coverage. We need to provide access to resources for health/wellness, educate employees about how to get the most from their benefits, and encourage them to engage in healthy behaviors, like managing conditions before they have a medical emergency.

Our own health research scientists often point out the critical nature healthy behavior choices play in overall health and wellness. Managing conditions such as diabetes or hypertension before they become a major issue is more cost effective for the insurer. Those cost savings can decrease the organization’s overall claim expenditures, helping to control premium costs, which positively impact employees and the organization. More importantly, employees who manage chronic conditions, including accessing mental health care, should be healthier, more engaged members of all of our organizations.

Working on this issue requires a multi-pronged approach. Engage in ongoing communication to educate employees. Offer educational sessions on health-related topics. Provide incentives for making healthy choices (like exercising, completing health risk assessments or not smoking). Destigmatize taking a sick day for physical or mental health care. People need to know that organizations value them as individuals, not just as employees.