Tribune Company Rescinds $100/month Penalty For Smokers, Keeps Spousal Carve Out...

I've talked a lot in the past about the future of wellness programs, medical costs and the potential for incentives/penalties related to living a healthy lifestyle.   While this area is rife with complexities, the cost trend of medical care seems to make it inevitable that companies will eventually reward those leading healthy lifestyles.

With that said, companies naturally migrate the lowest hanging fruit when approaching any issue.  In the area of wellness incentives/penalties, the low hanging fruit is smoking.  While family history and genetics are at play in areas like blood pressure and cholesterol, smoking is seen as a voluntary choice.  As a result, many companies are charging higher medical premiums for smokers, or refusing to employ them.

There hasn't been a highly visible company that had started penalties to smokers - until now.  LA Observed and John Hollon both recently highlighted that the Tribune Company, which started charging smokers an extra $100 per month in medical premiums on 1/1/08, reversed course in April and is refunding the charges to smokers.  Here's the Tribune memo to employees as reported from LA Observed (with a hat tip to John Hollon):

----------------------------------------------------------------------------------------
From: Tribune Communications
Sent: Tuesday, April 22, 2008 1:32 PM
Subject: Message from Gerry Spector/Tobacco Use Fee Rescinded

Since the closing of the going-private transaction last December, we’ve been reviewing policies and practices across the company, including Tribune’s healthcare benefits. While well-intentioned, we think the tobacco-use fee implemented by the previous management team is inconsistent with the new culture we’re developing---we’d rather you use your own judgment when it comes to tobacco use, not impose ours upon you.

This policy was a part of open enrollment last fall and took effect January 1, 2008. I’m pleased to tell you that we’re eliminating this fee effective April 28th.

If you successfully participated in the smoking cessation program, have quit and been reimbursed for all fees, then congratulations are in order. Quitting is one of the hardest things you’ll ever do.

If you’re still being charged the fee, it will stop and Tribune will reimburse you 100 percent for the fees you have paid. This reimbursement will occur in late May.

Tribune will continue to offer the smoking cessation program free of charge to all employees and their covered dependents age 18 and older.

The spousal medical fee, implemented at the same time, will remain in place. We believe that if an employee’s spouse has access to coverage through his/her employer, that employer has the primary responsibility to bear the cost of coverage. Our obligation is to take care of our own employees, first and foremost.

If you have questions about the tobacco use fee, contact the Tribune Benefits Service Center at XXX/XXX-XXXX (sic - phone number changed for publication)
-----------------------------------------------------------------------------------------------

Interesting move.  Not sure it will be the norm with smoking...

DNA Discrimination Bill set to go into Law.... Good News and Bad News...

People learning, through genetic testing, that they might be susceptible to devastating diseases wouldn't also have to worry about losing their jobs or their health insurance, under anti-discrimination legislation the Senate passed Thursday.

The 95-0 Senate vote sends the Genetic Information Nondiscrimination Act back to the House, which could approve it early next week. President Bush supports the legislation.  The measure bars insurers from denying health coverage or charging higher premiums based on a person's genetic information. Also, it bars employers from using genetic information to make hiring, firing, and other job-related decisions. The measure applies only to people who have a genetic makeup that carries the risk of a disease. It does not cover people who already have the disease.

As with everything, there's good news and bad news

First, the good news.  The law provides protection, which should encourage more people to be tested for a variety of things earlier, which allows people to change behaviors and seek treatment earlier.  That's a good thing, as the prognosis for almost every condition improves if people have the information they need to make better choices.

Now the bad news.  The legislation offers no protection for those who already have a disease.  Seems a little unfair if you're already battling something.  Additionally, I think this will limit the potential effectiveness of wellness initiatives down the road.

Not following me on why this may hamper wellness initiatives?  When trying to motivate people to live healthier lifestyles, companies usually focus on the following measurements as a basis for how healthy a person is:

1.  Blood Pressure
2.  Body Mass Index (BMI)
3.  Blood Sugar/Glucose
4.  Cholesterol
5.  Resting Heart Rate

With that in mind, how many of these factors do you think might ultimately prove to have genetic predisposition based on your family history?  4 out of 5?

These are the measurements that any wellness incentive program would hold employees accountable by.  Whether you use the carrot (rebates on employee contributions for good scores) or the stick (charging employees with poor scores and no efforts to improve), the DNA bill will likely ultimately limit your ability to economically motivate your employees to live healthier lifestyles.

If I have high blood pressure and there's a test that shows I am genetically predisposed to that condition, you won't be able to use the carrot or the stick.  It would likely be discriminatory under the law.

Even if the employee is eating 4 Grand Slams at Denny's a day.   File it under the Law of Unintended Consequences...

HR Jobs From Hell - The LOA Administrator

By now, readers of the Capitalist know that I am a HR Generalist, meaning I do it all - recruit, employee relations, benefits, performance management, etc.   I'm also a firm believer that Generalist roles span the globe of HR titles - Generalists can be found at the Rep/individual contributor, manager, director and VP levels.

One of the things that is cool about being a HR Generalist is the variety - if you're sick of doing one thing, you just need to wait about 20 minutes, because you'll get a call shifting your priorities to another area as a routine course of business.

Some people call it chaos, I call it variety...

So, for me, a HR job from hell is one that includes no variety, and resides in an area of the HR practice where little joy is found.  Here's my first HR Job from Hell - the corporate Leave of Absence Administrator.

First up, let me say that me tagging the LOA Administrator as a job from hell has nothing to do with the people in the job, but instead has everything to do with what these folks have to put up with on a daily basis.  As luck would have it, HR Wench is currently in the job market, and recently phone screened for an LOA Administrator role:

"I had a phone screen yesterday that went ok. It was for the Leave of Absence Specialist. Get this: the organization has 15,000 employees. Guess how many NEW leave of absence cases were processed last year? 4,400. That is almost a 1/3 of their workforce, yo! Geez. Anyhow the in person interviews aren't until a few weeks from now due to vacations. So, we'll see".

UGH.  That pretty much sums up why I would consider the LOA Administer role as a HR role from Dante's 9th circle.  Here's what you have to deal with in that role:

-Primary focus is interacting with folks going through very rough times.  For the right person, this would be a plus, as they could use their empathy to make a difference.  But a steady diet of this over years surely leads to burnout.

-Being the tough gal/guy regarding compliance.  Folks are going through rough times, and you're the one that has to hassle them about the FMLA certification forms even though that's the last thing on their mind.

-Deciding when to play hardball on fraud.  You have 4,000 applications for LOA, you're going to have some folks gaming the system.  You have to decide when to play hardball and go after it.  You see the 5-10% that game the system - how can you not become jaded after a year or two of that?

Let me be clear - if you are in the LOA Administrator role in your company - thank you.   You are taking multiple hits daily for the HR function as a whole, and you're likely doing it very well.  If you get burned out, I hope your company has a rotational program in place, because you have skills that are a valuable resource.

That being said - HR Wench - Don't do it!!

Will You Eventually Have a Heath Care Score Similar to Your Credit Score?....

Imagine a Health Care system that functioned like the consumer credit industry.  Scott Kornhauser has.  The CEO of Healthation thinks the system will ultimately deliver a personal health care score (like a credit FICO score) that drives what consumers pay for healthcare, complete with the ability to improve rtheir rating over time with the right behaviors/performance. 

That tidbit was part of the vision Kornhauser delivered in "Processing the New Business of Health Care in a Retail Marketplace" at the World Heath Care Congress.  Kornhauser's bigger vision is that the retail transformation of the U.S. health care delivery system is going to demand real time claims adjudication.  To make real time claims adjudication a reality, Kornhauser sees a combination of indexes and other data points coming together to make the real time claims process work.

What the heck does that mean to a HR Pro?

In Kornhauser's vision, consumers will have the ability to opt in or out of sharing their data with various types of providers.  However, to get the best health care credit score possible, they would have to share a great deal of data and then have their overall health judged - via a numerical score that looks a lot like the FICO score that drives your personal access to credit.

Ready to tell Danny in Accounts Payable he has a health care credit score of 500 and will have to pay double what others do for healthcare?

Great!

Have a bad health care FICO score like Danny?  In Kornhauser's world, you'd probably pay more for medical premiums.  But like the credit FICO score, you could improve your health care credit score by demonstrating desired behaviors - like paying your bills on time (easy for Danny, right?) or losing weight to get your BMI score within an acceptable range (harder for Danny...).

Obesity Surgery and Notre Dame Football - While Insurers Don't Automatically Approve...

Every time I think of obesity surgery, I think of the risks - see this article about Notre Dame football coach Charlie Weiss, who almost died on the table...

I took in a session at the World Health Care Congress led by James Roosevelt, the CEO of the Tufts Health Plan.  While the session focused on Tools for Consumer Engagement, Roosevelt focused on the Tufts strategy for Obesity/Bariatric Surgery.

Here's the definition of Obesity/Bariatric Surgery from Wikipedia:

"Although diet, exercise, behavior therapy and anti-obesity drugs are first-line treatment, these forms of medical therapy for severe obesity have limited short-term success and almost nonexistent long-term success.  Therefore, obesity surgery (or bariatric surgery for the professors reading this) has been a popular treatment in the war against obesity. Weight loss surgery generally results in greater weight loss than conventional treatment, and leads to improvements in quality of life and obesity related diseases such as hypertension and diabetes."

Several readers took exception to that definition, and I have to agree.  To say diet and exercise have non-existent long term success is clueless to say and the piece sound like it was written by a lobbying firm.

Roosevelt's rundown of the Tufts approach to Bariatric surgery was interesting in several ways.  First, Tufts gates access to the Bariatric program through BMI limits - including limits on the high side.  Have a BMI that goes over the acceptable threshold, and you can't get in the program due to the relative health of your body.  With the related stress that morbid obesity can cause, it's thought that those with super high BMI's were at the highest risk of not making it through the procedures.

Additionally, Tufts requires anyone entering the program to do a 6-month behavior modification program, where they get education and have to set and achieve two behavioral goals, such as to stop drinking soda.  So much for the Wikipedia definition from the Bariatric lobby... 

It's interesting stuff, as were the stats Roosevelt quoted regarding obesity surgery.  229 covered individuals have been accepted into the obesity surgery program, and at this point, 119 have graduated.

The education regarding alternatives to obesity surgery during the program must be working, as 17% of the graduates opt to forego or defer the obesity surgery they originally sought.

Estimated lifetime savings to the plan according to Roosevelt - 4 Million, or over 17K for each covered individual who's opted into the plan.

Smoke 'Em If You Got 'Em - German Company Fires Non-Smokers....

Has there ever been a harder transformation in societal expectations than the one that has occurred in the last 30 years regarding smoking?  I was raised in a family of smokers, and in the 70's and 80's, as a kid, it really never occurred to me that the whole habit was dangerous.  In a weird twist, it also never occurred to me that I should smoke. 

I hear I beat the odds...

Then, society got cracking and made all who smoke a little uncomfortable.  Don't smoke here, here or here, and just so you got the message, here's a fishbowl to smoke in at the airport with your friends.

Of course, the whole thing has been good for our health care plans.  Fewer people smoking is good for what ails your PPO.  I'm channeling John Lennon when I say "imagine" if the U.S. made the same shift with Crisco.  Now that would really help the PPO trendline.

Of course, smoking is now seemingly uncool in the U.S.  Other countries however, like Germany, would like to thank you for smoking:

"The owner of a small company in Germany fired three workers because they were not smokers. It seems that their boss (evidently a smoker himself) felt that they were “disturbing the peace” in the workplace by being vocal about their smoking colleagues.

“I can’t be bothered with trouble-makers,” said the boss. “We’re on the phone all the time and it’s just easier to work while smoking. Everyone picks on smokers these days. It’s time for revenge. I’m only going to hire smokers from now on.”

Of course, being anti-smoking doesn't fall in a protected class.   Here's my ridiculous list of other things that are easier while smoking:

1.  Filling out a health history at your local doctor's office.
2.  Helping your son bat during a father/son baseball game.
3.  Engaging a fire extinguisher.
4.  Typing a Blackberry message while driving, and smoking...

Hat Tip to Andrew Scott-Holman, keeper of the best blog in Kiwi-land....

Superbad Graph - "Total Odds of Dying, Any Cause: 1 in 1"...

Sometimes you run across a graphic that says it all - and this one (pictured below) from the WSJ journal does just that. 

We're all going to that "big records retention facility" in the sky at some point.

Want to make sure you have the longest period possible before your "records" go to deep storage?  Then take Bob Coffield's advice on the Health Care Law Blog and do the following:

"the graphic highlights advice from my dad, a retired physician in West Virginia, who always warns us of such risks. He says, "eat better, eat less, take small bites, drive defensively with two hands on the wheel, don't climb ladders and be careful with guns." Looking at the graph if we listened to this advice we would take care of most of the larger circles"

Good advice.  But what about death from hot weather? (odds of croaking from that - 1 in 13,000) 

I gotta get out of the South.  I don't see cold weather on the chart....

   

Update - The Likelihood of You Being Forced to Provide Sick Time (in addition to PTO) in 2009 Just Increased...

Back in December, I riffed about the proposed Healthy Families Act (HFA), which would require employers with more than 15 employees to offer full-time employees seven days of paid sick leave.  The HFA would also mandate the sick time could be used for the employee's illness or to care for a child/parent/spouse/individual related by blood/domestic partner.   Here's some commentary on the merits of the bill....

UPDATE - The District of Columbia just passed something called the Accrued Safe and Sick Leave Act.  That can't be a good precursor to what might happen with the HFA.  Details from the Washington Post:

"The D.C. Council voted unanimously yesterday to make Washington the second city in the country to require employers to grant their workers paid sick leave, but not before council members added several amendments that business leaders applauded and labor leaders said significantly weakened the legislation.

Under the Accrued Sick and Safe Leave Act, full-time employees at businesses with 100 or more workers will get seven days of paid leave, and employees at businesses with 24 or fewer workers will get three days.

Advocates say the legislation could affect 200,000 workers who don't have paid sick leave, but an amendment will require new workers to wait for the benefit. That measure will require an employee to be on the job for 12 months before becoming eligible for sick leave."

As far as the HFA, it's a broad bill that is likely to get a lot of traction in 2008/2009, if Congress continues to be controlled by the Democrats and the White House goes "blue state" as well. 

Here's the catch and why more government isn't always the best solution - the HFA as currently written, would also prohibit employers from eliminating existing leave coverage in order to comply with the Act.  That can get complicated.  Early readings suggest that if you are an employer trying to do the right thing, by offering a Paid Time Off (PTO) plan, you couldn't adjust the total number of PTO days, to reflect the legal requirement, for a stand-alone sick-time policy.   You would have to simply add the seven to what you currently offer to be in compliance.  For those of us offering a great benefit, that's crazy talk...

Here's hoping someone gets to the bill's sponsors and explains that if an employer is already offering 3 weeks of PTO to new employees, they're taking care of people.   Otherwise, expect companies to start breaking out their PTO policies into vacation/sick designations, if it looks like the bill will pass. 

42% of Tampa Bus Drivers Have Signed Up for Intermittent Leave..(!)

WOW.  It's been a few years since I supported a big consumer call center as part of my practice, so I had really forgotten about the pain that Intermittent Leave under FMLA can cause employers. 

The desire for maximum flexibility and at times, the avoidance of accountability, can cause Intermittent Leave to spread like a virus through an operating unit of a company.

For me, I thought bad news in this area would be about 3-4% of all employees in a division or company being approved for Intermittent Leave (10-12 employees in a call center of 300 would cause a big impact to scheduling, etc.).

But 42% of all employees?  You're kidding me, right?  Apparently not - from the Tampa Tribune:

"...Case in point is HARTline, the county's(Tampa metro) public transit service. Forty-two percent of the bus drivers have signed up for a benefit the federal law calls "unscheduled intermittent leave." Many of them are using the law to extend weekends and go home "sick" to avoid unwanted assignments.

The law designed to cost nothing is costing HARTline and other employers many millions of dollars. The family leave act was intended to cost little or nothing while providing 12 weeks of job security to help workers through challenges (sic) times - such as bringing home a new baby, recovering from illness, or helping an incapacitated relative.

Some workers, including many HARTline drivers, have discovered that minor ailments also qualify, such as back pain and headaches. A one-time doctor's certification can give a worker a perpetual excuse for going home early, sleeping late, or not showing up at all.

Lawmakers were wrong in thinking that two features would minimize employee abuse and employer expense: One, the worker on leave under the act gets no pay and thus has no incentive to malinger, and two, the law applies only to organizations with 50 or more workers, which seems to be ample manpower to make up lost productivity."

But employers like the bus agency can't make up in the afternoon for a bus that doesn't run in the morning. In many businesses, schedules must be kept.

To keep its buses on time, HARTline is spending $2 million a year on overtime, an agency spokesman says, and 39 percent of that cost is attributed to FMLA absences."

42% of all employees.  Maybe it would be easier for that HR Team to certify the people who don't need intermittent leave....

Ralph Kramden would never approve...

HR Press Releases Gone Bad - Wal-Mart Takes Credit for Universal Heathcare and the Internet...

I'm not a Wal-Mart basher.  I shop there, and I'm not bothered by the big box store.   

But I'm glad I don't have to recruit for associates at the store level, because that would stink.  Not because they don't have good candidates coming through, but they have NO TOOLS to close them.  Comp is middling at best, customers are irritable about 90% of the time, and when you walk out the doors after your shift, you have to do that crosswalk dance where you try not to get run over as the Camry with the tunes turned up decides whether to gun it or be a nice guy 5 feet from the door...

But I digress...

The biggest issues impacting Wal-Mart's ability to recruit are Comp and Benefits.  Since I don't have data on the Comp side, let's look at Benefits.  Ever since that nasty memo came out, Wal-Mart's been on a PR mission to say things are improving.  That's a good thing.  But how good are things really?

Here's some data from a recent press release from Wal-Mart touting the fact that 92.7% of their associates have health care coverage:

"Associates surveyed cited the following sources for their health care coverage:

• 50.2 percent – Wal-Mart plan;
• 22.3 percent – Spouse;
• 7.3 percent – Uninsured;
• 4.3 percent – Medicare;
• 4.2 percent – Parents, school or college;
• 3.2 percent – Other/previous employer;
• 2.4 percent – Individual policy;
• 2.3 percent – VA or military;
• 1.9 percent – Medicaid;
• 1.2 percent – State program other than Medicaid; and
• 0.7 percent – Another source than those listed above.

Total: 100 percent"

So they have health care coverage.  But about half don't get it from Wal-Mart.  Oh, NOW I get it...

Hat tip to John Hollon on this one.  I had the press release in my inbox, then he had something up two hours later.  That's fast coverage I can't match.  But I agree with his analysis - the title to the press release, which touts 92.7 coverage, is opportunistic at best. 

That kind of stuff gives spin a bad name.  I think Wal-Mart's better than this. 

Pharma Rep Playbook - 4 Minutes with Doctors = 52% Jump in Scripts Written...

I want all of our employees to have the medical care they need.  Let's start there before anyone brands me as a fiscal hawk looking at numbers rather than employee well-being...

If there's one area of Medical care that drives me crazy, it's got to be big Pharma vs. doctors, patients, and yes, your local company medical plan. 

Big Pharma gets paid off of blockbuster drugs that they hold exclusive rights to.  That part of the system I get, since there are development costs tied to the R&D effort.  It's the repackaging of brand name drugs, once generics are available, that drives me crazy.  Hey, why take that generic every day?  We've just revamped the brand name equivalent with enough potency to last 5 days.   Uh, yeah... It'll cost your medical plan $1,000 more per year, but who cares?  Your employee contribution is the same regardless.

In case you needed more examples of the power of the Pharmaceutical Rep over most doctors, consider this article in a recent BusinessWeek entitled "Just Say No to Drug Reps":

"Dr. Adriane Ugh-Beman wishes more doctors would greet marketing pitches from drug companies with skepticism. So she is taking her message to medical schools. An associate professor of physiology and biophysics at Georgetown University, she has spent the past six months lecturing med students at Georgetown and neighboring schools on how to resist sales reps' overtures, such as doling out free drug samples to physicians and bringing lunches for office staff.

Often, the audience starts out belligerent, Ugh-Beman says, protesting that they're "too smart to be bought by a slice of pizza." But that changes when "we correct them with the numbers," she says. A doctor who spends just one minute with a sales rep typically ends up prescribing 16% more of that rep's product than he or she was prescribing before. And a four-minute encounter is likely to prompt a 52% jump in prescriptions, says Ugh-Beman."

I didn't dig around on the net for the white-paper behind Ugh-Berman's claims, but I am assuming if it made BW, it's legit research.

Let's assume programs like this can prepare doctors for the drug rep pushing product.  No sweat to Big Pharma, because they've got an even more powerful marketing tool.   It's called the demands of their patients after watching 20 Pharma ads every night during American Idol... What's a busy M.D supposed to do when someone brings him an ad for Paxil during a routine visit?  Prescribe (gasp) exercise? 

Every seen a Viagra ad?   All they have to do is create a market with a couple of Billion dollars worth of ads, and all of a sudden the pressure is on to pick up the full tab for each new class of drugs that's introduced... 

Man, am I tired of scrambling for the remote during a basketball game on the weekend or during prime time when the Viagra ads come on (hello? kids are watching when these things run!).  But those guys throwing the football sure are accurate throwing it through that tire in the back yard... 

When Sticker Price in Medical Insurance Reminds You Of Buying a GM Car...

Bought a new car recently?  If so, you know sticker price is for suckers... Do two things - wait for the juicy rebates always offered by Detroit automakers, then head to the lot and try to dicker the sales people down even further.  That's right, the marketing machine of US automakers has conditioned us not to move until there's a $5K rebate involved off the top. 

Health care is similar in some ways, but different in some critical aspects.  First up, there's a sticker price that hospital facilities quote to the general public related to what different procedures cost. Think of that as their "sticker price".  Here's the big difference - rebates aren't available to everyone, just to the folks with quality health care plans.  The Blue Cross networks (as well as other big insurance providers) are able to extract HUGE discounts from doctors and facilities alike through the power of their network.  If doctors/hospitals want BCBS patients, they've got to be a part of the network, and to be part of the network they've got to agree to the fee schedule touted by BCBS. 

That's where the discounts/rebates come into play.  The rebates can be huge when compared to the sticker prices touted by hospitals.  Here's a new record in my world I just came across.  Employee goes in for a procedure, with the company billed 19K for the entire bill.  Sticker price from the hospital before BCBS got ahold of the claim and went all Tony Soprano on it?  $152K.  That's right - the sticker price was over 7 times the actual cost ultimately allowed by BCBS.

Which makes me think two things.  First, I'm glad we have a good provider that can extract deep discounts off of sticker price.  Second, the common guy out there who's not covered by a plan like ours and is trying to go without insurance is a car wreck away from a lifetime of bills he can't pay and a probable personal bankruptcy.

There's something wrong with health care when sticker price on medical procedures makes buying a car look like a "one price, no haggle" experience...

Career Exercises for New Year's Eve....

Let's face it - if you are in the office today and not tethered to a headset, it's going to be a slow day.  About 50% of America is packaging the day into a four-day weekend, and you'll be out of stuff to motivate you by Noon.

No better time to think about the future and about the past.  To help with your brainstorming, I'm offering up two articles to get the creative juices flowing from a Career standpoint:

-The always solid Paul Herbert at Incentive Intelligence advises us how to get excited about our future potential by looking at everything we've accomplished in the past.  The tool?  A Life-Map of Achievements, which will shock you with all the cool stuff you've accomplished in your lifetime, regardless of age.  Draw it up during your downtime this afternoon and feel good about what's coming up in 2008. (from Paul, via LifeHacker, via DIY Planner)

-Lest you get too comfortable with the past, Seth Godin re-posts this oldie-but-goodie, asking the question "What did you do back when interest rates were at their lowest in 50 years, crime was close to zero, great employees were looking for good jobs, computers made product development and marketing easier than ever, and there was almost no competition for good news about great ideas?".  The moral, as you might expect, is don't wait to chase the dream (whatever it is) any longer....

Have a great New Year's Eve and New Year's Day.  See you in 2008....

Christmas Eve Notes - Hug Your Family as You Read About This CIGNA Claim Denial....

I'm not very political when it comes to the topic of Universal Healthcare.  Like Mongo from Blazing Saddles, I'm just a pawn in this game of life...

But as a media/news consumer, I know a potential tipping point when I see one.  And a sad story that makes you value a lot of the things you take for granted.  Especially during the holidays.

Here's the headline - "Health Insurance Company Denies, Then Belatedly Approves Liver Transplant That May Have Saved The Girl".   Here's a clip from CBStv in Los Angeles:

"A 17-year-old girl from Northridge died Thursday night, just hours after insurance giant CIGNA reversed itself and agreed to approve a liver transplant for the cancer survivor.

CIGNA originally declined to pay for the transplant for Nataline Sarkisyan because her plan does not cover "experimental, investigational and unproven services," her doctors said.

The reversal was announced at the rally attended by a crowd estimated by organizers at 150. Hundreds of telephone callers also clogged lines at CIGNA offices around the nation Thursday on Nataline's behalf.

"This is an incredible turnaround generated by a massive outpouring around the country that proves that an engaged public can make a difference and achieve results," said Rose Ann DeMoro, executive director of the California Nurses Association and National Nurses Organizing Committee, one of the rally's organizers."

Unfortunately, the reversal came too late:

"Nataline was diagnosed with leukemia at age 14. After two years of treatment the cancer went into remission but came back this summer, Sarkisyan told the Daily News.

When doctors said Nataline could use a bone-marrow transplant, the Sarkisyans discovered that her only sibling, Bedig, 21, was a match, and he donated his bone marrow the day before Thanksgiving, the newspaper reported.

However, Nataline developed a complication from the bone-marrow transplant and, because her liver was failing, doctors recommended a transplant, according to an appeal letter sent to CIGNA earlier this month, the Daily News reported.

The Sarkisyans filed an appeal with the California Department of Insurance, which sent a letter this week saying it needed more information."

So hug your family over the next couple of days as you celebrate Christmas or whatever holiday your faith recommends. 

A nice gift idea for you last minute shoppers?  How about a Carpe Diem T-Shirt to remind you and your loved ones that tomorrow isn't guaranteed?

Why You May Add 7 Sick Days to Your PTO Policy in 2009...

Went to a local SHRM chapter meeting this week and heard Mike Aiken, a Governmental Affairs expert from the National Office of SHRM, talk about what was going on in Washington.  Great talk, very knowledgeable guy...

One of the things that caught my attention was the proposed Healthy Families Act (HFA), which would require employers with more than 15 employees to offer full-time employees seven days of paid sick leave.  The HFA would also mandate the sick time could be used for the employee's illness or to care for a child/parent/spouse/individual related by blood/domestic partner.   Here's some commentary on the merits of the bill....

It's a broad bill that is likely to get a lot of traction in 2008/2009, if Congress continues to be controlled by the Democrats and the White House goes "blue state" as well. 

My take?  Who can be against providing paid sick time for employees?  Most employers already do this.  My company offers 10 sick days a year that can be rolled over year after year, providing a nice cushion for those that have to go out on FMLA leave related to a health condition for them or their families.  Package the sick days with a benefit like Short-Term Disability, and you've got a great safety net for employees, in addition to what's required by law.   

Employers of choice already do this since they have to compete for talent.  Organizations with mostly entry level jobs - food service, poultry processing plants, etc., probably don't offer that type of leave.  You show, you get paid, you don't - tough - regardless of the circumstances.  That's harsh and worthy of trying to come up with a better way.

Here's the catch and why more government isn't always the best solution - the bill as currently written would also prohibit employers from eliminating existing leave coverage in order to comply with the Act.  That can get complicated.  Early readings suggest that if you are an employer trying to do the right thing by offering a Paid Time Off (PTO) plan, you couldn't adjust the total number of PTO days to reflect the legal requirement for a stand-alone sick-time policy.   You would have to simply add the seven to what you currently offer to be in compliance.  For those of us offering a great benefit, that's crazy talk...

Here's hoping someone gets to the bill's sponsors and explains that if an employer is already offering 3 weeks of PTO to new employees, they're taking care of people.   Otherwise, expect companies to start breaking out their PTO policies into vacation/sick designations, if it looks like the bill will pass. 

If You Don't Have a Meaningful Answer to this Question From Your CEO, Update Your Resume...

My latest article is up at Workforce.com, entitled "7 Ways to Reduce Benefit Costs Without Decreasing Coverage", so go out and take a look if you have a chance.  Here's the intro:

"By now you’ve read the latest yin and yang of benefits news. Health care premium increases rose at their lowest rate in eight years. But the increase is still more than 6 percent, and that’s still more than twice the rate of inflation. It far exceeds the average annual increase (3.6 percent) for employees in the U.S.

With that data in mind, the reality remains the same. Your benefit cost structure is increasing, and it remains difficult to shift some, much less all, of the increasing costs to employees. The crunch continues, and you’re in the middle. Your CEO is looking to you, the HR pro, to squeeze dollars out of the overall plan structure without causing a riot. So much so that she walks into your office and asks the following question:

"You follow these things: What can we do to reduce our benefit costs without dropping coverage levels significantly or increasing employee contributions?"

Yikes! That’s a credibility call for HR—an opportunity to be at the table. Or to clean the table after the meeting if you don’t have a meaningful response."

Click over to get my cliff notes for the top seven strategies to drop benefit costs without decreasing coverage.  Let me know ideas I've missed as well...

$25 for a Fake Excused Absence? Do You Take Visa?

There are lots of opportunities out there, my young jedi.  All you have to do is sell out to the dark side...

A couple of days ago, I riffed on the single worst example of human behavior I had witnessed as a HR professional.  The winner?  Some dude who was faking funeral programs on fictional deaths in his family to get a couple of extra days off from a call center.    That's just wrong...

So that guy got fired, which is what you would expect..

What you wouldn't expect is that he might be cashing in on his brainstorm via a web business called the Excused Absence Network, which, for about $25, provides students and employees excuse notes that appear to come from doctors or hospitals. Other options include a fake jury summons or an authentic-looking funeral service program complete with comforting poems and a list of pallbearers. 

My former employee seems to have landed on his feet.  From a CNN report:

"Millions of Americans work dead-end job, and sometimes they just need a day off," said John Liddell, co-founder of the Internet-based company Vision Matters, which sells the notes as part of its Excused Absence Network. "People are going to lie anyway. How many people go visit their doctors every day when they're not sick because they just need a note?"

The company's customers receive templates so they can print the notes after typing the name and address of a local doctor or emergency room. Those who choose jury duty as an excuse to miss work enter their county courthouse information on the form.

Though the company's disclaimer advises the notes are "for entertainment purposes only," its Web site shows pictures of people sunbathing and playing golf using the fabricated excuses. One testimonial says: "I've managed to take the nine weeks off using these templates! It couldn't be any easier!"

Actually, for one New Jersey woman it wasn't so easy. She was arrested this year after using one of the company's notes to support her claim she was too injured to appear in traffic court for a speeding ticket. She was caught after court officials called the chiropractor listed and he told them he never heard of the woman."

The founder started the business for $300 and currently runs it off a laptop in a small Oklahoma town.  The site gets about 15,000 hits a month.

Somewhere out there, a HR Manager who subscribes to the Capitalist has just turned to the dark side as they were reading this.  Like Darth Vader, they've thought up a money making idea, but one that uses their powers for bad, not good.

Resume' doctoring and fake absence notes are taken.  What's next?  Maybe fully-faked employer references that reverse engineer the background check process?

(hat tip to Capitalist reader Scott for the link...)

Do Companies With the Lowest Healthcare Burden Just Have Heathier Employees?

A couple of days ago I featured the 2008 Towers Perrin Annual Health Care Cost Survey, which summarized that next year's gross health care expenditure is expected to rise by an average of $577 per employee, to an average total cost of $9,312 per employee.

Here's a nugget buried towards the bottom of that report.  The TP survey divided respondents in its annual health care cost database into three categories -- low-performing, average-performing and high-performing companies. Performance designations were based on relative costs and cost increases, as well as whether an organization is meeting its health benefit objectives in such areas as efficient purchasing, employee engagement and managing health risks in the employee population.

Here's the TP findings related to high performers and low performers:

"Among high performers, 45% have cost increases of 5% or less -- evidence, in Towers Perrin’s view, that active management of program performance is an exercise in the “art of  the possible,” and an increasingly urgent mandate for companies still experiencing double-digit growth rates. The cost spreads between high-performing companies and low performers can be significant and can have a tremendous impact on an organization’s profits and positioning in the marketplace. And if left unchecked over a number of years, the competitive differential can become a significant business threat to the organization.

Here's what the TP report identified as behaviors separating the high performers from the low performers:

"Commitment to employees -- High-performing companies are highly committed to employees -- supporting employees’ ability to make sound health care decisions, taking steps to motivate employees to manage their health care purchases responsibly, and working to manage health risks and conditions in the employee population overall.

Managing by measuring --  High performers are far more rigorous than low performers in developing and documenting their health care strategies. They also manage by fact. For example, the vast majority of high-performing companies conduct extensive measurement of program costs versus less than half of the low-performing group.

Ensuring critical success factors are in place -- While the 2008 data show that all companies are doing more than ever to ensure that critical success factors -- such as senior leadership involvement, support from managers and supervisors, and disciplined execution processes -- are in place, high-performing companies are much more committed to these program pillars.

Increasing accountability -- High-performing companies design their programs to make the true costs of care visible to employees, and hold them accountable for the decisions they make at the point of care, using, for example, coinsurance rather than copays to share costs with employees

Engaging employees -- High-performing companies require employees to be more accountable for their decisions, and take steps to help employees do that by expanding communication initiatives and providing a variety of tools and resources to support employee awareness, understanding and action.

Building a culture of health -- High performers are much more likely to say they’re committed to building a culture of health in their organizations and to report that their employee education efforts are succeeding. For example, a strong majority of the high performers say employees accept their roles and responsibilities under their health plan, are comfortable with the level of risk under the plan, and understand and use decision support tools."

So those are drivers that allow companies with the lowest heathcare burden to keep costs down.  It's a good list, and I need to dig in a little bit more to ensure we are doing everything we can at our company.

Only one thing bothers me.  Look at the graph above.  The companies with the good cost structures have a cost per employee that is 20% cheaper than the high cost companies.  Yet on average, the annual cost increases of the low performers is 7%, vs. 5% for the high performers.

Is it possible the companies with the lower cost structure just have healthier employees?  Average age, blue collar vs. white collar, geography, etc. all come into play. 

The truth, as it always does, probably lies somewhere in the middle.  The factors above are things we should all pursue, but at the end of the day, the overall health of the employee base is what it is.  That takes years to change...

After the Interview, We'll Just Need You To Jump On The Treadmill....

I'll admit I don't have a lot of hard-core manufacturing experience.  That's why I had one of those "What the..." moments when I read that a Black and Decker plant uses their pre-employment screening package to determine, among other things, whether production candidates have a high probability to develop carpel-tunnel syndrome via the required job responsibilties.

From CNN's Coverage:

"Victor Breehe has filed a class-action suit against Black and Decker in Tennessee, claiming the  company violated the Americans with Disabilities Act.

Breehne, who applied for a job last year at a Black & Decker plant in Jackson, Tenn., that manufactures Porter Cable brand power tools, said in a court filing that he was offered the job contingent on passing a medical exam.

A company doctor stimulated forearm nerves that control hand muscles and concluded it would be inappropriate for Breehne to work in a "highly wrist- sensitive job," the filing said.

The U.S. Equal Employment Opportunity Commission has also challenged the tests, which aren't uncommon in manufacturing settings, on ADA grounds. The agency lost a federal lawsuit in 2001 against Rockwell Automation Inc. (ROK) after that company denied jobs to 72 applicants at an Illinois plant.

The EEOC believes the test doesn't reliably predict the likelihood of developing carpal tunnel syndrome, or whether it would pose an imminent threat to the person's safety, Chris Kuczynski, assistant legal counsel and director of the ADA policy division at EEOC, told The Baltimore Sun."

Wow.  "Company doctors stimulated forearm nerves that control hand muscles" kind of caught me off guard.  My first thought is that, positioned the right way, this could be spun as some sort of spa treatment.  My next thoughts are the obvious ones for a HR person and more grounded in reality.   Is having weak hand and forearm muscles a disability and covered by the ADA?   If the employee can do the job today but is simply more probable to develop a condition down the road, can you eliminate them from consideration?  Should the companies using these type of tests conduct them pre-offer so it becomes one of 10-20 hiring criteria?

So, today, it's testing to limit liablity that can be caused by a specific job activity.  With health care becoming more and more expensive, does tommorrow bring testing to see if the company can afford to provide medical coverage to the candidate in question?

Just need you to get on the treadmill after the second round of behavioral interviews.  Don't worry, we'll do it last and then you can go.  If you break 20 minutes in the 5K, there's a signing bonus involved....

Generics Are a Good Thing... Unless Your Board Has Directors From Big Pharma...

Overall health care costs continue to soar. But annual inflation in drug costs is at its lowest rate in 30 years--just 1% over the last 12 months according to this recent article in the New York Times.

What's up on the drug front?  One word - Generics.   First the good news - Generics made up 63% of prescriptions in 2006, up 13% over 2005.  Also, generics have come on the market for several blockbuster drugs--Zocor, Ambien, and Norvasc.  Finally, the Wal-Mart effect continues to have an impact as Wally World launched a program to offer discounted generics, with retailers like Target and Kmart following suit.

Now for the bad news - Even though drug price inflation has slowed, overall spending on drugs has not. The government estimates Americans will spend $275 billion on drugs this year, and that the number will reach $500 billion within ten years.  So even though your unit cost is decreasing through the use of generics, your employees are going to use more drugs moving forward.  Like Huey Lewis, they want/need a new drug...

That'll keep the pressure on HR Pros and Benefit Administrators to keep costs at bay moving forward.  I'll post more in the future about some additional tools beyond drug formularies to keep the lid on Rx costs, including generics for free at selected retailers (if Wal-Mart only charges $4, why even charge employees?  Might as well say "free" to offer the right marketing message and get employees to use the lowest cost channel) and the nuclear option, forced mail-order.

I'll end the drug talk with this note.  You think everyone could agree that decreasing cost without impacting benefit levels is a good thing, right?  WRONG.   To see how politics can be involved, read up on the recent AFL-CIO allegation that G.M. and 20 other corporations with board members who were directors or executives of drug or health insurance companies failed to move their companies to newly introduced generics in a timely fashion.  I'm never a big fan of what labor's selling, but this is one of those things "that makes you go hmmm.."

Dirty Little Secrets and Your EAP (Employee Assistance Program)

Want to get a bunch of HR people nodding their heads?  Make a statement about the value of the Employee Assistance Program (EAP) our companies offer, usually as part of the Life Insurance suite.  It's true, it's a great product and every once in a while we get a great chance to refer someone to it and it does some good.  Much patting on the back usually commences...

Of course, most of us don't market it hard enough.  Or anywhere close to hard enough - including me.   I have no marketing strategy other than to simply list it on my benefit marketing collateral we use in the recruiting biz.   Most of you are just like me.  I really, really need a strategy in this area to make sure people understand it's there for their confidential use...

What's got the Capitalist thinking about EAPs?  Uh...It's not my life, honest...  Nothing but a Ward Cleaver, vanilla-type existence here.  Please don't stare at me....

OK, two things actually got me thinking about our EAP.  First up, Deb at 8 Hours and a Lunch did a rocking post about the value of an EAP, which I thought was great.  Second, I was watching FUSE the other night for a fix of Alternative Rock (what did you expect from the Capitalist?  Britney Spears?), and a video came up from a band called the All-American Rejects.

The cut is called "Dirty Little Secret", which features about 30 people holding up cards detailing what makes them feel like a freak.  It's a good reminder that all of us have our issues (except of course, for Ward), and at times of weakness we might need a resource like your underutilized EAP.  Check out the video to get the flavor and think about it during the next four random conversations you have in the office...

Maybe I should get outside the box and use this video to market the EAP inside our company... 

"Big Boned" 101 - Why You Will Have Your BMI Memorized in the Next 5 Years...

Michael Moore, resident blogger at The Pennsylvania Employment Law Blog (A capitalist favorite and a top 5 HR blog in the Power Rankings) has been busy running down the 411 on Body Mass Index, also known as your BMI.  For those of you who don't know, BMI is a function of height and weight (BMI calculator).   The Center for Disease Control classifies a person who has a BMI of less than 18.5 as underweight; normal is 18.5-24.9; overweight is 25-29.9; obese is over 30; and extremely obese is over 40. Among the nuggets from the "other" Michael Moore:

"Other than being incorrectly labeled "overweight" or "obese", why should we care whether BMI is a accurate health status predictor? BMI is fast becoming the legal standard for determining whether someone is "obese" and therefore a "health risk". With this label comes a whole host of employment and benefit consequences:

• Cost of and Eligibility for Certain Employee Benefits

Individual insurance policies for life, disability and medical insurance almost universally use underwriting procedures that take into account BMI as a basis for determining insurability and premium.  A survey by the Texas Office of Public Insurance Counsel found that insurance company individual health plan underwriting guidelines used BMI as a basis to deny coverage, charge a higher premium, and offer less coverage. The California Insurance Commission has made comments alerting consumers about BMI as a basis for insurance denial.

Some group health plans are community rated and not subject to medical underwriting. These plans calculate premium based on the expected claims of the community not the individual employer group.  Other group health insurance programs can be subject to medical underwriting in which BMI analysis and other factors will be used to price the coverage for the group.  An employer with  a compliment of employees with potential for high claims (including high BMI) will face higher premiums or denial. Likewise, self-insured medical plans that utilize stop loss coverage may undergo medical underwriting where BMI will be factored into the rate for reinsurance.."

If all that's too heavy for you (no pun intended), check out MM's breakdown of collective BMI across PA-area pro sports teams:

BMI BOWL

TEAM	Average  BMI	% Roster with BMI  >   30
Philadelphia Eagles	32.77	62.96%
Pittsburgh Steelers	31.84	56.7%
Pittsburgh Pirates	27.30	9.67%
Philadelphia Phillies	27.16	3.1%
Philadelphia Flyers	26.82	0%
Pittsburgh Penguins	26.58	4.5%
Philadelphia 76ers	24.51	0%
Detroit Shock (WNBA)	23.26	0%
1996 U.S. Olympic Women's Gymnastics	18.79	0%

Looks like the Offensive and Defensive lineman are at risk.  Would be interesting to see what the average expected lifespan of a NFL lineman is.  I'm guessing with that type of BMI for a long period of time, it's well below average.

Like Willie once sang (or was it Don Meridith?) "Mommas, don't let your babies grow up to be Left Tackles".....

Bad News For Your Health Plan - Obesity Rises in 31 States....

A while back, I asked the sophisticated readership of this blog (shameless plug to vanity of HR pros worldwide) if you were ready to start fining employees for poor health screening scores.  The answers in my in-box went a little something like this:

• "No".
• "Heck (reply was actually stronger than "heck") No"
• "I'm not ready to fine my employees.  Since you seem to be on drugs, maybe we should just focus on you..."

What can I say besides, "Don't hate the player, hate the game".  In an environment of double-digit annual increases in the cost of health care, it was just a matter of time before a company (Clarian Health) started increasing the cost of heath care to employees that carry the greatest risk.  As a HR pro, this aggressive approach is full of issues I would rather stay a million miles away from.  Make that two million miles...

But the data keeps on rolling in to suggest that Americans probably won't change the behaviors necessary to reduce utilization rates of medical plans without penalties to the pocketbook.  The latest?  The Trust for America's Health reports that obesity levels increased in 31 states last year, and no states experienced a decrease. 

That means the health screening metrics (Body Mass Index, Blood Glucose, Blood Pressure, LDL) that drive the utilization you can control will continue to degrade over time.   

Hard to say where we will be in 5 to 10 years....

Ready to Fine Employees for Poor Health Screening Scores?

Think I'm crazy?  Unfortunately, it's just a matter of time.

Consumerism is slow to develop bottom-line results.  The employees most likely to use your fitness benefit are the ones who are already healthy.   Your medical costs keep multiplying...

Oh yeah, and this little tidbit - employers can now charge employees who are are unhealthy more for benefits under the final rules the federal government issued in December 2006 to ensure that wellness programs comply with the nondiscrimination provisions of the Health Insurance Portability and Accountability Act of 1996.  The rules became effective July 1, 2007.

Workforce recently reported that Indiana-based Clarian Health will begin charging employees more for their health insurance in 2009 if they allow health risks such as tobacco use, obesity or high cholesterol to go unchecked.  From the Workforce article:

"Clarian’s decision to impose fees came after several years of operating a comprehensive wellness program, according to Steven Wantz, senior vice president for administration and human resources at Clarian, which has 13,000 employees working at five hospitals in the Indianapolis metropolitan area.

"We didn’t just decide this. We have five years of wellness program history that included health risk appraisals, health coaching and other resources to help people reduce their risk factors," he says.

But even with the wellness initiatives, Clarian’s annual health benefit costs continued to climb, growing 12.9 percent in 2006 and 15.7 percent in 2007.

So when the U.S. departments of Labor, Health and Human Services and Treasury released final rules to ensure that wellness programs comply with HIPAA, "it was our window of opportunity," Wantz says.

"We believe that by using this premium charge approach, where it shows up in employees’ paychecks every two weeks, it will keep [costs] in front of the person, and we think it will be more effective at creating behavior change," he says. "It seems that a charge gets people’s attention more readily than an incentive."

The program will assess $5 per-paycheck fees on employees who do not meet minimum standards for body mass index, cholesterol, blood glucose, blood pressure and nonuse of tobacco. Although it will not be fully implemented until 2009, the effort was announced this year to give employees plenty of warning, Wantz says."

And that, my friends, is the cold hard reality.  Minus more significant results from consumerism and happy wellness programs, the stick will slowly begin to replace the carrot.  The only question is the pace of change. 

If you have ever read about recruiters doing negative recruiting among college sports programs, wait until you have to spin and rationalize this type of program in the marketplace as you try and recruit and retain the employees you have...

The Downside of Sponsoring Company Sports Teams (Video)....

As the HR person in the house at my company, I (like you, I'm sure) get periodic requests for the company to sponsor employee sports teams.  Basketball, softball, you name it.  For the most part the companies I have served have never sponsored them.   As a result, we've probably missed out on some good team-building opportunities. 

Why don't companies sponsor employee sports teams?  You know the reasons, so sing along with me:

3.  Worker's Comp Concerns - Is an injury during the sport league a work injury?  Can we get sued by a wrongful injury lawyer with a two-page spread in the Yellow Pages?

2.  Consistency - There's only so many duckets (that's hip talk for dollars, people) to go around.  If we say yes to the softball team, can we say no to the Toastmasters team?  Isn't that discriminating against those with verbal, rather than physical dexterity?

And of course, the reason I never cite, but perhaps the biggest one:

1.  You Don't Want to Know Some Things About Your Co-Workers - As a person who has played in his share of sports leagues, there are always one or two people who are a little dicey on the team.  Maybe they are so uncoordinated people would snicker behind their back around the break room, or maybe they take it way too seriously and make everyone uncomfortable.  Or maybe they wear short shorts....

Or maybe they do all the above like my buddy Chip in the video below.  I like this level of intensity in my candidates, but I don't want to try and talk to Chip about the quarterly numbers after a hoops session like this. 

It's True - Smokers are 7.67 Days Sicker Than Non-Smokers...

I know, I know - that's a cynical title.  From the world of the obvious, the New York Times cites a Swedish study indicating that smokers take 7.67 more days of sick leave annually than nonsmokers, even after adjusting for smoker's general health and the tendency of smokers to take more stressful or physically taxing jobs.  Aside from the cynical title, it's nice to have some numbers to quantify what we think we have known...

From the study:

Using data on 14,272 workers ages 16 to 65, researchers studied sick leave reports from a nationwide survey conducted from 1988 to 1991. According to background information in the article, smokers are known to choose more dangerous jobs than nonsmokers and are more likely to be involved in risky activities. Those tendencies, the article said, rather than smoking, might contribute to the greater number of sick days among smokers. But even after statistically controlling for these factors, the large difference between smokers and nonsmokers was evident.

Compared with people who never smoked, smokers took an average of 7.67 more days of sick leave. After controlling for other factors, former smokers took no more sick days than nonsmokers. The study appears in the April issue of Tobacco Control.

Every time I see data on smoking, I always think about Dennis Leary and his No Cure For Cancer Off-B