Friday, December 24, 2010

Monday, December 20, 2010

UnConstitutional Mandate

Virginia's Attorney General discusses the unconstitutional nature of the individual mandate in PPACA

Friday, December 3, 2010

Have You Ever Been Experienced?

"That Case is A Dog With Fleas." This is what an underwriter will say just before issuing a decline to quote letter or a bid 20% over your renewal rates. Over the years I have heard the phrase and used it myself while working on the carrier side to discuss a group with appallingly bad loss experience. A carriers underwriting methodology is designed to account for the results whatever the cause of poor experience. In other words the carrier does not care why the experience is bad only that they are accurately pricing the bad experience. So what makes a dog a dog when it comes to group claims experience. Is it bad hring practices or a poor corporate culture? Some insights are available froma respected source.

It Seems that Tom Rath and Jim Harter  of The Gallup Company have coauthored a bestselling Book, Wellbeing:The Five Essential Elements.

Career Wellbeing: how you occupy your time and liking what you do each day.


Social Wellbeing: having strong relationships and love in your life.

Financial Wellbeing: effectively managing your economic life to reduce stress and increase security.

Physical Wellbeing: having good health and enough energy to get things done on a daily basis.

Community Wellbeing: the sense of engagement and involvement you have with the area where you live.

These five elements of wellbeing are measured by Gallup’s Wellbeing Finder, an assessment with scores that range from 0-100. When Gallup compared overall wellbeing indexs for those employees who were struggling (defined as 50-59th Percentile) they found an average annual cost associated with sickdays of  $6,168 based on a median wage of $200/sickday. Comparably, those employees who were thriving (defined as 70-79th percentile) had an average annual cost associated with sickdays of  $2,784. For those keeping score that is a difference of $3,384 per employee per year which for a company with 1000 employees would translate into $3,384,000 annually. If one were to drop down to the 40th-49th percentile the average annual cost associated with sickdays is $7,560 which is a differential of $4,776 or $4,776,000 for the fictitious 1000 life company.
 
Traditional wellness targets physical wellbeing like diagnoses of hypertension, high cholesterol, back pain, diabetes, depression, sleep apnea and insomnia. Looking at the the employees who with such diagnoses were struggling(50-59th) incurred an average of  $6,763 in disease burden annually just based on these diagnoses which compared to $4,929 (70-79th) a per person differential of $1,834 or $1,834,000 for our fictitious 1000 life company. For those keeping score the combined we are now up to an annual cost of $5,218,000 just for sick days and disease burden associated with chronic conditions.
 
Gallup then took the disease burden a step further in order to pinpoint the annual increase in disease burden costs just year over year. Based on new cases of disease burden only (and adjusting for demographic differences), the average annual new disease burden cost for people who are thriving is $723, compared with $1,488 for those who are struggling/suffering — a per-person difference of $765. Based on these figures, those who are struggling/suffering realize two times higher new medical costs due to disease burden (2008-2009). For those keeping score the combined we are now up to an annual cost of $5,983,000 annually just for sick days, legacy and new disease burden associated with chronic conditions.
 
If you are not completely depressed yet do read on. Among randomly selected U.S. workers, a mere 28% are engaged in their jobs. People in disengaged workgroups are nearly twice as likely to be diagnosed with depression, have higher stress levels, and are at greater risk for heart disease.
 
There are many employers who will no doubt believe ardently that their employees social wellbeing has no connection with their job. Gallup results bear out this opinion.
 
Just 5% of workers strongly agree when asked if their organization helps them build stronger personal relationships, while most employees disagree with this statement.  



People in disengaged workgroups are nearly twice as likely to be diagnosed with depression, have higher stress levels, and are at greater risk for heart disease.
Gallup has extensively studied the impact of friendships on an organization’s productivity. By asking more than 15 million workers if they have a “best friend at work,” we discovered that people who have high-quality friendships on the job are seven times as likely to be engaged in their work. Without a best friend, work can be a very lonely place: Those without a best friend in the workplace have just a 1 in 12 chance of being engaged. Social relationships at work have also been shown to boost employee retention, safety, work quality, and customer engagement. It seems that like it or not management has a strong need to assure all employees are encouraged to thrive. Good managers know this but why on earth would a smart company not institutionalize the expectation that the integration of all employees into the social fabric of the company is the expected standard for those managing people?

Like most Gallup research the book is painstakingly footnoted and the data is statistically significant.

If you are an employer that has taken a massive rate increase on your group Health or Group Disability due to poor losses you have been "experienced." The underwriters do not care why your experience is so bad they just want no part of your risk and they price accordingly. While that may be bad news the ability to implement sound human resource countermeasures along with coordinated employee benefit design plan changes and strategies to hire and  assist more employees in thriving in the 5 areas of wellbeing just might pay enormous dividends in stabilzing benefit costs and boosting productivity and profitability. Or you could just do nothing while complaining your insurer is ripping you off and all those large claims will not happen again next year .

We all laugh when R. Lee Ermey impersonates a therapist in the Geico Commercial. There are without question many executives who will view the Gallup research on wellbeing and conclude its just another voyage to namby pamby land. Many of these executives will will have invested in health insurance, wellness, EAP's, short and long term disability. How could just 8% of those surveyed agree their organization helps them improve their physical health as the Gallup research shows? Easy. They are not engaged. Some executives are eyeing 2014 when they can dump their employee population into the Obamacare Exchange and take the savings to the bottom line. One might ask whether it makes more sense to craft a strategy now that can lower health costs in order to gain a profound human capital advantage over competitors planning to dump their populations into the exchanges. The hard reality employers must face is that the issues this Gallup survey brings into focus on wellbeing persist whether your employees are in the exchange or not. It will certainly be impossible to access disease management data in aggregate for an employers population in an exchange in the era of HIPAA.