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Generous health insurance and a retirement savings plan have long served as pillars of protection, but they’re now considered baseline offerings along the ever-changing employee benefits landscape. Forward-thinking employers realize that traditional ancillary plans such as dental, vision, disability and life insurance no longer serve as window dressing to draw top talent.
So they’re polling the workforce and getting creative, acknowledging mounting interest in more tangible, personalized and flexible benefits that strike a better work-life balance and improve financial wellness. There’s even an emerging category under the lifestyle moniker that grew out of the concierge-services movement that took shape decades ago. Two of my recent magazine articles examined these developments in greater details. Corporate America recently acknowledged these developments when nearly 200 chief executives belonging to the Business Roundtable pledged to provide more meaningful benefits, fair compensation, training and education. And in a rare moment of candor, captains of industry admitted that focusing only on shareholder value is a short-sighted strategy when they should be investing more in human capital. It comes when employment has never been stronger over the past century than it is today. In the meantime, venture capital pours into startups and stalwarts that aim to make the workplace more responsive to the needs of working Americans as part of a holistic approach. One driving force is a demographic shift involving more women entering the workforce and senior-level roles while the population ages. An unintended consequence is that working parents in the so-called Club Sandwich Generation are tied down to both children and elderly parents and need a helping hand as never before. Savvy employee benefit brokers and advisers who know core and ancillary group insurance products and services have become commoditized are freshening up their portfolios. Unusual and innovative offerings appeal to multiple generations with changing expectations about their employment contract. One of my sources suggested that while the word lifestyle implies nice-to-have benefits, these offerings have actually become necessary in today’s competitive workplace. The category was built around the notion of employee wellbeing – an all-encompassing effort featuring physical, mental, emotional, social and financial components to pack a more powerful punch. Another expert described the benefits as a tangible way of delivering work-life balance and employee satisfaction. Key trends include student loan refinancing and financial wellness programs that help people of all ages manage or avoid debt. There’s even a lifestyle spending account modeled after the health savings account, as well as growing interest in plans or apps that promote healthy living. It’s easy to see why: employee health benefit costs represent the largest P&L expense after payroll, while two-thirds of the nation is overweight. Employers realize that healthier and happier employees are good for business on a number of levels. And the quest to reduce health care costs, absenteeism and presenteeism alongside improving productivity and morale for their most valuable asset (i.e., people) ultimately gives them a competitive edge.
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When Abigail Disney recently revealed her outrage at learning undercover the extent to which Disneyland workers were struggling to make ends meet, she highlighted a serious national embarrassment across Corporate America.
The Disney heiress and daughter of Roy E. Disney, who has been described as both a filmmaker and activist, urged CEO Bob Iger to fix an enormous wage gap between his annual pay and the company’s average worker. Iger was paid $66 million last year, whereas the median salary of a Disney employee was $46,127. How can people who work at the so-called Happiest Place on Earth possibly match the smiles of paying customers, she wondered, when scores of disgruntled employees shared such extreme financial struggles? Rather ironic, I thought, considering how the theme park’s admission keeps rising at obscene levels. So much for sharing in the wealth. Although praising Iger for being “a great CEO by any measure, perhaps even the greatest CEO in the country right now,” she lamented that “by any objective measure, a pay ratio over a thousand is insane.” In May, she stressed to a House committee the importance of delivering returns to shareholders “without trampling on the dignity and rights of their employees.” Recent federal data shows that an S&P 500 company CEO earned 287 times more on average than his or her median employee last year. It was a staggering $14.5 million in 2018 ($500,000 more than the previous year) compared to $39,888 for rank-and-file workers (whose raise was barely more than $1,000 from 2017). Interestingly enough, all public companies were required this year to disclose for the first time their pay ratios in filings with the U.S. Securities and Exchange Commission. In the past, they only needed to report compensation for top executives. I feel strongly about this topic, which I first blogged about in 2009 when lamenting not only the cringe-worthy pay ratio problem in this country, but also golden parachutes for executives who missed earnings targets and spoiled shareholder value. “How much pay is enough to live on comfortably without arrogance and disregard for one’s underlings?” I wrote 10 years ago. “Is it $3 million? Is it $50 million? Is it $1.5 billion?” Noting a growing concentration of wealth that deeply separated average working Americans from their corner office occupant, I also referenced how chief executives were “said to have earned anywhere from 179 to 369 times the pay of an average worker.” My conclusion a decade later is the same as I initially suggested: Let’s not begrudge captains of industry for earning their keep but at least rethink capitalist zeal “to ease the system’s extremes, correct any perceived imbalances and aspire to true pay-for-performance packages. There’s just no escaping this moral imperative and the time to act is now.” Corporate boards clearly need to address the pay-ratio issue and decide on amounts that not only seem reasonable, but also reward all employees for a job well done. There are many avenues available, including profit-sharing plans and stock options as well as bigger matching contributions to retirement savings plans. I have noticed a cultural shift in the workplace where younger employees increasingly value respect from supervisors and corporate responsibility. The customers of these companies also share those ideals, so it makes perfectly good business sense to ensure that prudent pay ratios are in place. About 30 years ago I started researching and writing a story about repetitive motion injuries. Ironically, I incurred one of them by the time I met my deadline!
For the next five years, I would endure a highly random and uncomfortable tingling sensation in my left hand – that is, until a combination of physical and occupational therapy that included dipping my hand in hot paraffin wax and redesigning my office workstation bore results. Thankfully, the pain would never return, but I learned a hard lesson about the importance of ergonomics, which is defined as “the study of people's efficiency in their working environment.” Just three years ago I became painfully re-acquainted with this topic – and it literally and figuratively became a pain in my neck. Decades of viewing a desktop (and then laptop) computer monitor on too steep of a downward slope landed me in a chiropractor’s office where an X-ray of my then-chronically stiff neck revealed that the three lower vertebra were nearly bone on bone. Misguided workplace ergonomic practices finally caught up with me. So I bought a wireless keyboard and adjustable shelf for my laptop to elevate the monitor. I also re-learned the importance of frequently stepping away from my workstation to relieve my hands, eyes and neck and not skipping the suggested 12-minute spinal daily spinal conditioning program that was prescribed. But it took about 18 months for daily neck discomfort to finally go away. The next chapter in this ergonomics journey was written just three short months ago when I decided to finally purchase a split-level, adjustable standing desk that as the name suggests allows people to work on a computer in a sitting or standing position. There’s a place to put a wireless keyboard below a larger area for the computer to prevent neck pain associated with poorly designed workstations. About a month or so later I decided to buy an adjustable stool that can significantly reduce low-back pain from prolonged sitting. Between these two recent acquisitions, I took my ergonomic knowledge to the next level in hopes of avoiding further work-related injuries. I’m gradually easing into the new arrangement, starting each work day on my feet getting caught up on email, which can take about half an hour, then sitting through most of the day with a few additional standing breaks. I have high hopes for the remainder of my ergonomic journey and career. One of them is to no longer encounter any additional body pain that will eventually be turned into another blog on this topic! After more than three decades of writing about employer-based health care delivery, I have a pretty keen sense of where the bread crumbs of innovation are leading. Of all the exciting trends and practices that have taken hold, one really stands out. It’s a simple solution to an overly complex marketplace mired in perversity, waste and inertia.
At a time of rising costs with no end in sight and embarrassing inefficiencies, we’ve been beholden for far too long to health insurance carriers, pharmaceutical manufacturers and pharmacy benefit managers that answer to their shareholders at the expense of patients. What’s lacking is transparency. When shopping for coverage is a completely transparent process, health plan participants make far better decisions and can drive down the cost of medical services by helping force greater competition across the healthcare supply chain. Seven years ago I started to dig into the weeds of self-insurance and within the past year I’ve had the pleasure of connecting with an industry thought leader who’s creating a new category of innovative solutions he calls transparent health benefits. Lester Morales, CEO of Next Impact LLC, says THB can help employers cut their health care costs 20% to 40% cost savings while vastly improving the quality of care being accessed. It’s a multi-pronged approach with several key components that include direct contracting with facilities, direct primary care (DPC), a 2.0 version of reference-based pricing that eliminates obstacles associated with that approach, more meaningful Rx strategies devoid of opaque contracts and eye-popping revenue-sharing arrangements, bundled and cash payments. His goal is to help benefit brokerages and advisories take control of the biggest P&L expense after payroll, as well as turn employees and their dependents into better healthcare consumers. I know we’re on the right track after seeing an interview Adam Russo, co-founder and CEO of The Phia Group, LLC who currently serves as chairman of the Self-Insurance Institute of America, did with Ana Christina for the May edition of SIIA News + Views. He validated our work by citing three key innovations that are expected to have a game-changing impact on employer-provided health plans. The first is pure transparency of cost and quality information on specific medical procedures, as well as patient reviews of doctors that are easily accessible on multiple technology platforms. Russo, who I have interviewed several times, also mentioned the importance of understanding the cost and efficacy of pharmaceuticals prior to paying for drugs at the pharmacy counter and DPC physicians who act as more efficient gatekeepers for a flat monthly rate without insurance claims. As politicians struggle to find enough middle ground to reform the nation’s ailing health care system and litigate their strategic vision, I take solace in knowing there are many market innovators who aren’t waiting for a government solution or consensus. If enough of these disruptors keep at it, then hopefully we’ll all be able to turn private insurance on its head, unleash competitive forces and find better solutions that save both lives and money. Now that Democrats won back the U.S. House of Representatives, they’ve wasted little time shining a spotlight back on health care reform. That’s an important development, and I applaud them for doing so in the face of Republican inaction since Donald Trump began occupying the White House.
But a leading proposed solution from the party’s progressive wing takes us in the wrong direction, at least for the time being. I’ll elaborate a bit later as to what I mean. Knowing the Affordable Care Act (ACA) is on life support, several high-profile members or leaders of the party are supporting a Medicare-for-all proposal. The moniker replaces calls for a “single-payer” system, whose wonky jargon always sounded as opaque as the perverse system that both parties agree needs fixing. Not surprisingly, Republicans are scoffing at such an idea. Even former Starbucks CEO Howard Schultz, whose potential 2020 presidential run would be as an independent, has dismissed the Medicare-for-all plan as unrealistic and financially unfeasible. The ACA’s irony is that it rendered health care unaffordable for many American citizens who don’t qualify for federal subsidies. A new analysis by economist Robert Genetski, for example, found that health insurance premiums soared by 84% for individuals and 126% for families last year above what would have been expected without the landmark legislation. Here’s my bottom line assessment: Let’s not decimate or eliminate choices for Americans who want to keep their doctor or health insurance plan, or employers who have the option to fully insure or self-insure health benefits as a recruitment and retention tool, earmark dollars for them to shop for coverage in the individual insurance market or not provide anything at all. To do so would be downright un-American, especially considering how choice drives the U.S. economy. Look no further than the Amazon platform. People are used to shopping this way for everything. Democratic candidates running for president in 2020 who have called on dismantling the entire private insurance model are promoting a concept that would toss the proverbial baby out with the bathwater. While removing options that place profit ahead of people is desired by policymakers, business people and consumers, let’s instead breathe enough life into the free market to render inferior plans obsolete. The best solution is to preserve and promote parts of the private system that are working. Examples include self-insured and pooled health plans offered by employers or organizations comprised of like-minded individuals with innovative approaches to containing costs and improving outcomes. These entities, which provide coverage for roughly half of all Americans, are employing a number of strategies that include reference-based pricing, patient advocacy, direct primary care, value-based purchasing, fiduciary pharmacy benefit management and more. Health care is now teeming with disruptors that are entering the field at a frenetic pace with an emphasis on technology that includes medical applications for artificial intelligence, software, data analytics, telemedicine, etc., along with the emergence of electronic medical records that vastly improve efficiency. Also look at Amazon’s partnership with Berkshire Hathaway and JPMorgan Chase, which has led some insiders to speculate that the largest online retailer intends to test market health care cost containment strategies on its own workforce that it hopes to turn into a profit center. Let’s give these innovators a chance to revolutionize the industry and not reinvent the wheel. I’d also like to see so-called skinny plans added to the legislative mix across all states so that people at least have the option of buying affordable catastrophic coverage while self-insuring routine doctor visits. The rap on these products is that they provide inadequate benefits, but there are many people like myself who are healthy and/or self-employed, and we don’t need all the bells and whistles. Again, let’s expand choice. But make no mistake: The status quo is unacceptable. So let’s reform parts of the system that aren’t working. Those efforts largely revolve around reducing the sky-high cost of prescription drugs, particularly specialty scripts, by importing more medicine from so-called tier-one nations whose quality control standards mirror those in the U.S. Another area that’s ripe for massive improvement is to manage the wild cost variation of inpatient and outpatient services by requiring transparent pricing and credible quality standards, as well as tying physician compensation to outcomes vs. volume, known as value-based purchasing. The same thinking applies to a handful of large insurance companies (Blue Cross and Blue Shield, UnitedHealthcare, Cigna, Aetna and Humana), whose costs are also soaring each year. If the pharmaceutical industry and health insurance carriers keep jacking up their prices with no end in sight and little to show for it in terms of better outcomes, then they’ll at least face price controls somewhere down the line. We need to pass legislation that introduces more competition in these areas. One idea has been to allow insurers to sell plans across state lines, though how such a move would be regulated with 50 different insurance commissioners is scary to ponder. There’s one area, however, where I think the federal government can continue to play a role as it has under the ACA. In a nutshell, the focus clearly should be on widening access to affordable health insurance through Medicaid expansion. Block grants allow states to cover uninsured populations as they see fit in keeping with the spirit of an old industry expression suggesting that all health care is local. This approach is far preferable to stretching one or more entitlement programs across the entire population, and I think it’s a fair compromise between liberal and conservative proposals. But if these incremental steps fail to expand access to health insurance, tame rising costs and improve health outcomes, then I think the U.S. will need to re-examine its options and give serious consideration to government-run universal health care or in partnership with the private sector. Ultimately, the voters will have their say on this at the ballot box in 2024 or 2028. But let’s at least try to give the free market a fighting chance to resolve these systemic problems. In the end, we must be realistic about the prospect of government intervention. The federal bureaucracy cannot be trusted to do an efficient job paying the nation’s health care bills or managing the system. Look no further than the disastrous website rollout of the ACA, as well as countless other examples of wasted and inefficient use of hard-earned taxpayer dollars. Health care is complicated, and thus, I believe it’s best fixed by industry experts vs. policymakers and bureaucrats who don’t fully grasp its complexity. We’re taxed enough. Can the public really stomach even higher taxes to pay for everyone’s health care? I think not based on how unhealthy a country the U.S. is, which would make for a steeper financial commitment than people expect. Howard Schultz is right. A government-run solution would be unrealistic and financially unfeasible. The ACA offers a glimpse of how government intervention has struggled to contain health care costs. Then again, we have to figure out a way to reverse course because we can no longer sustain rising costs and poor health outcomes. Whatever happens, it’s plain to see that we need a bipartisan fix, not one-sided solutions like the ACA, which passed without a single Republican vote, or any repeal-and-replace scenario that doesn’t appeal to Democrats. Common ground can be easily found in efforts to protect patients with pre-existing medical conditions and rein in the high cost of prescription drugs, which are low-hanging fruit on the money saving tree. I believe there could be many more modest reforms enacted that please both political parties if only our elected leaders would put aside the partisan rancor for the good of the country. Health care reform is critically important to the health of our nation, which spends nearly one-fifth of its gross domestic product on medical products and services, but trails in health outcomes relative to other developed nations. Lives literally hang in the balance, so it’s vital that we make it a top priority. Three weeks – and counting – on a partial federal government shutdown that’s at least tied for the longest one on record in U.S. history. But that dubious distinction is a mere symptom of a much larger problem that has been brewing for decades, though some may argue centuries.
Our two-party political system has been seriously impaired by a culture war pitting so-called social-justice warriors on the left against make-America-great-again foot soldiers on the right. Democrats and Republicans alike have waged long-fought internal battles over the heart and soul of their respective public-policy platforms. And extreme elements on both sides of the political aisle are shouting past one another without listening or negotiating in good faith. The resulting stalemate isn’t really about border security and safe communities. It’s about gamesmanship and scoring political victories. It’s not about fulfilling promises to constituents. It’s about obstructing the other side. It’s not about governing within reason. It’s about advancing a baseline cynicism that passes for acceptable political strategy in a blood sport built on opposition research each time there’s a so-called free election. In short, it’s disgusting. In times like these, I’m relieved to have long been a registered independent voter leery of both established political parties, but I’m also deeply embarrassed to be an American. We’re better than this as a country – much better. We’re the best example of governance in world history, albeit far from perfect and certainly mired in serious social ills, but we now struggle in simple conversations with those with whom we disagree. There’s no longer any civility or mutual respect, nor are there any Ronald Reagan-Tip O’Neill-style summits where we can agree to disagree, strike important political compromises somewhere between opposing positions and then grab a brew together afterward at our favorite local pub. Instead, we let perfectly good friendships wither on the vine and allow philosophical differences to tear apart our own families. It’s about us vs. them. This is the new normal from both a political and sociological standpoint. The fact is, it’s unconscionable that the Democrats and Republicans we elected to Congress and the White House are incapable of solving this problem. Both parties are to blame. It’s not that hard to meet halfway. That’s how nations govern. Is it so important to be right all the time that it’s acceptable to bolt the office door for millions of civil servants and prevent lawmakers from actually passing laws? This has to end. I’m not sure exactly how that happens, but if we all want to move forward as the United States (the former being the operative word), then we have to tone down the heated rhetoric on both sides, find common ground and live the Golden Rule in every conversation we have, whether it’s with a high-ranking government official, business associate, your spouse, sibling, child, friend or acquaintance. Only then can we have a fighting chance to continue competing on the world stage and set an admirable example for everyone else to follow. Every football season, I look forward to becoming a couch potato on Sundays. But a fierce battle is brewing off the gridiron that I feel compelled to weigh in on.
A group of National Football League Hall of Famers recently threatened to boycott future induction ceremonies unless the NFL agrees to their demand for lifetime health insurance coverage and an annual salary, even though they’re retired. They also want to obtain health insurance and a better pension for active players. Leading the effort is legendary running back Eric Dickerson, who believes all 318 inductees should receive roughly $300,000 a year, which would total $95.4 million. The Hall of Fame Board (HOFB) argues that it’s a drop in the bucket given the league’s more than $14 billion profit in 2017. Some players who are enshrined in Canton, Ohio have died, including those with a history of repetitive brain trauma known as chronic traumatic encephalopathy or CTE. In those cases, their heirs could reap any sweetened benefits. The widow of elite defensive end Reggie White, a member of the HOFB, expects the additional benefits and compensation being sought will extend into a post-mortem phase. At first, I wasn’t sure how to react to this movement. So I did some research and figured the numbers would shape my view. A Society of Actuaries report found that the NFL pension plan’s 78% funding level, based on $2 billion in assets against projected benefit liabilities of $2.6 billion, is less than the multiemployer industry average of 85%. While various reports indicate that the NFL’s plan is better than the National Basketball Association’s pension, which is funded at just 61%, it pales in comparison to Major League Baseball at 90% and the National Hockey League at a surprising 135%. One reason cited for the NFL pension’s $600 million shortfall is a player lock-out in 2011 and negotiation of a collective bargaining agreement (CBA) that includes a significant increase in pension benefits for retired players and runs through post-season 2020. That’s when the NFL will celebrate it is 100th anniversary – a critical piece of the puzzle I’ll get to later. Despite large salaries for high-profile players, the average annual pension was $43,000 in 2014 – the latest number available. The average career of an NFL player, who becomes fully vested in the plan after three years on active roster or injured reserve status, is just four years. The benefit amount is based on the number of credited seasons played. An NFL pension plan was created in 1959 and supplemented in 1993 by a 401(k) plan to which players contribute and again in 1998 with an annuity program. Pension benefits have been increased three times for former players since 2011. In acknowledging the role of pre-1993 players, a so-called legacy fund was established under the current CBA with team owners for the first time funding a $620 million increase in benefits from their share of revenues. In a letter to the NFL, an impassioned Dickerson’s wrote that “the total cost for every Hall of Famer to have health insurance is less than $4 million – less than that of a 30-second Super Bowl ad, or about 3 cents for every $100 the league generates in revenue.” As for paying HOF inductees an annual salary, he added that it “works out to about 40 cents for every $100 in annual revenue, a figure that will increase dramatically in the near future with legalized gambling.” While the CBA doesn’t include lifetime health insurance, NFL insiders have suggested that a deal on this issue is within reach between HOFB pressure and the looming centennial celebration that no doubt will offer a tip of the cap to football greats. The average annual health insurance premium is now more than $5,700, though obviously it will be higher for former players who have various health issues. Affording coverage, of course, boils down to how well each member of the HOF managed his money. One staunch critic noted that the proposal “reeks of selfishness,” comparing it to the formation of the NFL Quarterback Club that once divided players and arguing that it should include all retired players – not just the ones who don gold jackets. I completely agree with that assessment, especially since Hall of Famers are in a much better position to capitalize on their name recognition in the free market and earn decent money in retirement through special appearances. Rather than asking for an annual salary, which flies in the face of the idea of retirement, it makes more sense to seek incremental improvements to their three retirement savings vehicles. As for the HOFB seeking lifetime health insurance, that makes total sense to me. It’s a promise made to many public-sector employees, which is why those jobs have become so sought after in recent years. In stark contrast, private enterprise began slashing retiree health care benefits since I began writing about employee benefits 30 years ago. The trouble, however, is that city, county, state and federal governments have long been on the hook for unfunded pension and retiree health care benefit liabilities – a terrible burden that all taxpayers must shoulder. If the NFL continues to grow and meet its ambitious revenue targets, then lifetime health insurance coverage probably wouldn’t make much of a dent in the bottom line. The HOFB also could work closely with the players union to include these demands in the next CBA. But in all fairness to the NFL, I keep hearing anecdotal evidence to suggest that the league could be in big trouble in the years ahead. For starters, the concussion issue has caused countless parents to pass on football for their sons (and possibly daughters in some cases). I heard one sports talk show host speculate that only hardened criminals or burly men desperate for cash would dare compete in an NFL of the future. Most young people already have lost interest in baseball, so it’s possible that also could happen with football on a professional level. We all are well acquainted with how the NFL ratings tanked following the controversy over some players taking a knee during the national anthem, which alienated scores of die-hard fans. And with the NBA becoming increasingly popular, the bloom may stay off the rose for the NFL long term. Either way, I think anyone – even those who are not football fans – can relate to the humanity and real-world issues associated with this story. And I hope there’s a happy outcome for everyone involved. Climate change has long been in the news, but the issue came to a head in 2018. That’s when four major winter storms pounded the Northeast, temperatures soared to record highs across much of the nation in July and Texas is still rebuilding from hurricanes.
Much to my surprise, it also appears to be affecting the workplace. New research from the Integrated Benefits Institute (IBI) suggests the presence of a perfect storm. In a nutshell, climate change triggered more short-term disability (STD) insurance claims that resulted in lost income and productivity. Since IBI cautions that extended absences may continue even after an extreme-weather event, employers are advised to incorporate their operational impact into risk assessments and business continuity plans. Another significant finding is that one in seven claims for non-occupational STD leaves involves anxiety disorders, acute stress reaction, adjustment reaction, depression, ischemic heart disease, heart failure, cerebrovascular disease, respiratory infections, upper respiratory disease, pneumonia and asthma/COPD. That’s some fascinating food for thought. It makes me snicker to imagine how climate-change deniers might react to these findings, especially since IBI is headquartered in San Francisco – the epicenter of progressive liberal thinking in the bluest of states. Be that as it may, business people obviously care about numbers, and if something is eroding the bottom line, it’s going to command their attention. But IBI’s report detailing climate change’s impact on STD claims has got me thinking about another topic that’s been in the news a lot lately, which is mental illness. I couldn’t help but notice that several leading drivers of employee absences involve behavioral health conditions. After writing a recent article on the connection between depression and workers’ compensation claims, and prior to that several others that closely examine the mind-body connection, I’m convinced more than ever before that mental health represents a huge blind spot in the U.S. health care system. I’m sure mental illness has been around as long as humans have walked the earth. What’s different is that we know so much more about these conditions and they’re being demystified, though there’s still a stigma associated with seeking treatment. And therein lies the rub: if working Americans aren’t accessing mental health or substance abuse services, then we’ll continue to see both a business and societal impact. We’re all unfortunately well-acquainted with horrific headlines involving the latter phenomenon (i.e., when firearms fall into the hands of mentally ill individuals). Sometimes it spills into the workplace (i.e., disgruntled former employees exacting revenge against co-workers or supervisors). While I believe federal legislation aimed at achieving parity for accessing medical services to treat physical or mental ailments has helped move the needle, many people still resist getting help for several reasons. They include the aforementioned stigma, as well as rationing or avoiding care because of unaffordable out-of-pocket costs. It’s incumbent upon every employer that provides benefits to their employees to do a better job communicating the existence and purpose of employee assistance programs, which can refer people to the right clinician or community services. The trouble is program usage is historically pretty low. It also can help if human resource leaders can do their part to remove the stigma of seeking treatment and make less expensive telehealth services available for psych visits. In addition, it’s critical to ensure that health plans are designed with mental health parity in mind and that case management involving STD or work comp take a holistic approach to returning claimants to work. One such solution involves the biopsychosocial model. Until we take mental illness and substance abuse problems more seriously, especially in the workplace where so many Americans receive health insurance coverage, the U.S. will continue to see sad results. Not only will productivity suffer if employees are absent or collecting less of a paycheck, but we’ll also see more mass shootings and a national opioid epidemic get even worse. It’s easy to lament the current state of the U.S. health care system. Monthly medical insurance premiums, along with various services and drugs, cost way too much – with no end in sight. People ration pills or treatment, or file for personal bankruptcy because they can’t afford to pay their hospital bills. Navigating care practically requires a personal assistant. Doctors are almost always paid based on volume and not value. Misdiagnosis is a serious problem. Pharmaceutical kickbacks run rampant. I could go on, but I digress.
While there’s much to gripe about, and with good reason, all this white noise can eclipse some pretty exciting developments. Case in point: the emergence of precision medicine, which as its name suggests, tailors treatment to each patient’s unique genetic or molecular profile and condition. What’s so promising about this customized approach is the opportunity to prevent disease, improve clinical outcomes and reduce costs for patients, insurance carriers, employers, doctors, etc. To allay privacy concerns, health plan operators must comply with the Genetic Information Nondiscrimination Act. Perhaps nowhere is the potential for progress more breathtaking than in the area of prescription drugs to ensure that patients receive the correct medication at the right dose and duration. As I wrote in a recent trade magazine cover story, a pharmacogenomics test “can evaluate how hundreds of drugs interact with an individual’s genetic makeup and suggest an ideal clinical pathway for each patient.” Their power is undeniable as a means of achieving better control of rising costs associated with a myriad of chronic illnesses. One knowledgeable industry source I interviewed used a baseball analogy to guess that medical science is in the top of the third of nine innings on implementing precision medicine, which means there’s still a lot more that needs to be done. Seventeen years after cracking the code on how to sequence the human genome, we’re clearly at the cusp of a new era that by today’s standards sounds a lot like science fiction. Another noteworthy development that’s gaining traction is telemedicine, also known as telehealth. The virtual delivery of care through video conferencing, telephone calls, email or text messages has the potential to save a substantial amount of both time and money. Diagnosing the common cold, flu, skin rashes, or similar conditions in this way bypasses notoriously crowded waiting rooms, reduces unnecessary visits to urgent care or emergency rooms, lowers tardiness and absenteeism, and improves productivity and patient satisfaction. A telemedicine call typically is $40 compared with $125 for a traditional office visit. The approach also is being applied to mental health visits. It’s remarkable to watch marketplace innovation, but the latest and greatest medical treatments will be out of reach for most Americans unless there’s enough meaningful competition or reasonable price controls. Shopping for health care isn’t like buying a car or groceries because services are priced in an opaque or arbitrary fashion. Consequently, it may be only a matter of time before Uncle Sam steps in to end the madness. Conservative columnist Charles Krauthammer last year predicted that there will be a single-payer health care system in the U.S. in less than seven years. While blasting ObamaCare as a failure “at every level,” he said it changed expectations to a point where most people believe the federal government should guarantee health care for everyone. The clock is ticking, and unless the marketplace adjusts, we’ll all be paying this price in terms of higher taxes and a serious commitment to expand the reach of government. Whether it will be worth the investment, a disastrous turn of events or somewhere in the middle, no one really knows. But everyone can agree that the current system is perverse and unsustainable. Unless we take substantive action to reform it for the long haul, we’ll never cure what ails us and health spending as a share of Gross Domestic Product will far exceed the nearly 18% rate that economists have calculated. Someday, HR leaders will be studying turnover in the Trump White House for lessons to be gleaned for their own workforce – both positive and negative.
Regardless of what side of the political aisle you identify with, the breathtaking mass exodus of talent in the first 14 months of Donald Trump’s administration has been one of historic proportions. In short, it has more closely resembled a season of “The Apprentice” than anything Pennsylvania Avenue has seen in years. During his presidential campaign, the brash businessman boasted about recruiting the best and brightest candidates to support his strategic vision. The idea was to drain a swamp full of complacent civil servants and ineffective political appointments, and replace them with fresh faces who were devoted to operational efficiency. In short, Washington’s staid political corridors would be disrupted by C-Suite thinking about how to govern and, as was suggested at every rally, make America great again. Sounds terrific on paper, right? He won over just enough independent voters to make it a reality. Trump then infamously insulted and intimidated his way past 16 competitors for the GOP crown in 2016 en route to the Oval Office in a pledge to end political gridlock and wasteful spending. At the end of a brutal presidential campaign, Trump was the last candidate standing in reality-TV-like surreal fashion. It was a Darwinian finish for a man who was used to firing scores of would-be apprentices from corporate and celebrity talent pools alike on his long-running hit show on NBC. He’s on record saying how much he relishes a good fight. So it’s no surprise how he got there. But here’s where his plan to shake up the establishment went sideways. That same blunt style has translated into dealings with a carefully handpicked staff of political advisers and cabinet members. So while Trump may have made recruiting a centerpiece of his White House, the same cannot be said about retaining talent. Of the administration’s top 61 senior officials, 21 were fired, reassigned or quit in 2017. This astonishing 34% first-year turnover rate was the highest in at least four decades of Oval Office management and double the previous record of 40% set by the Reagan administration in 1982, according to The New York Times. Here’s how that compares to recent administrations: just 6% for George W. Bush, 9% for Barack Obama and 11% for Bill Clinton. The ones who left are now household names: former National Security Adviser Michael Flynn, White House Chief of Staff Reince Priebus, chief strategist Steve Bannon, FBI Director James Comey, press secretary Sean Spicer, Secretary of State Rex Tillerson and the list goes on. No one was on the losing end more than Omarosa Manigault, whose short-lived stint in the cryptic title of Director of Communications for the White House Public Liaison Office was preceded by three firings from various seasons of “The Apprentice.” What are chief human resource officers and corporate recruiters to make of this historic turnover, and are there any lessons that apply to their own talent-management challenges? In all fairness to Trump, he recently suggested that deepened relationships with key players around him has finally raised his comfort level and will translate into better hiring decisions in the first place. That, of course, remains to be seen. I think the bigger issue is how to motivate people to perform the best they can at work – an employment contract that’s built on trust, loyalty and a shared strategic vision of the future. Some people respond well to fear and intimidation and need a push in this direction. But in all honesty, I think they’re few and far between. This is especially true in times of growing personal enlightenment and career development programs that seek to empower hearts and minds – not tear them to pieces on a long climb up the corporate ladder, or in this case, dealing with three branches of government. |
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