Corporate Wellness Magazine

CorporateWellnessMagazine.com | May 2011

Volume 9, No 2 | March 2011

EDITORIAL STAFFEDITOR

Jonathan Edelheitjon@employerhealth�

carecongress.com

ASSISTANT EDITORSarah Hunt

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Copyright © 2011Corporate Wellness Magazine. All rights reserved. Corporate Wellness Magazine is published monthly by Global Health Insurance Publications. Material in this publication may not be reproduced in any way without express permission from Corporate Wellness Magazine. Requests for permissionmay be directed to [email protected]. Corporate Wellness Magazine is in no way responsible for the content of our advertisers or authors.

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EDITOR’S LETTER

Jonathan Edelheit

am very excited at this year’s upcoming Employer Healthcare Congress, October 26-28th, 2011 in Chicago. This will be our 3rd year, and each year we have focused on making improvements. Last

year, only in our second year, we became one of the largest employee benefits conferences in the country beating out almost all other benefits conferences, some of which have been around for over 23 years.

We have moved to Chicago this year because of it’s central location which will draw a much larger audience. Our attendance this year is already almost at 200% higher than at this same time last year, and I believe this is because of our location and that Chicago is home to a high concentration of mid-size and large employers.This year we have reinvested in the congress significantly to make this the biggest and best year yet. We have two great keynote speakers, Bill Rancic, the winner of Donald Trump’s 1st “Apprentice” TV Show, and Cecil Wilson, the President of the American Medical Association.

We have changed the format of the congress to have more cross-overs as to bring our symbiotic conferences closer together, and we will have more advanced educational sessions and workshops. We have also expanded our VIP program and will be including not just employers but agents and consultants also this year.

What I am most excited about is our new networking software which has been newly built and is more of a social networking tool on top of meeting scheduler. It will make it easier for attendees to view who is coming to the conference, through photos, bios and allow for attendees to synch to twitter, LinkedIn and Facebook to see who in their network is attending the conference.

Tomorrow I am headed to New York City for an interview with FoxNews. See you soon.

IUS Employee Benefits Industry Players Head to Chicago

ASSERTIVENESS REDUCES STRESS PUTTING YOU IN THE DRIVER’S SEAT OF YOUR OWN LIFEby Jacquelyn Ferguson

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CONTENTS

FOLLOW US ON:

Issue 22 • May 2011

FEATURES

EMPLOYEES ARE WHAT THEY EAT ~ THE IMPORTANCE OF INTEGRATING NUTRITION IN CORPORATE WELLNESS 4by Amanda Carlson-Phillips

GENDER STRESS RESPONSE... IT’S ALL IN YOUR HEAD 8by Jason Krausert and Donna Tosky

ARE YOU LEADINGLIKE A DICTATOR?SIX SIGNS YOUR MANAGEMENT STYLE IS TOXIC 18by Keith Ayers

BOOST YOUR EMPLOYEES’ ENERGY AND FOCUS IN 2011 30by Tom Jordan and Courtney Day

MEANINGFUL THOUGHTS BEYOND “MEANINGFUL USE” 35by Kevin Shrake

UNIONS CHEAT MEMBERSOUT OF HEALTH AND WEALTHby Lisa Holland

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by Kay Kimball GruderTHE COST OF COLLEGE21

CONNECTING EMPLOYEE HEALTH TO VOLUNTARY DISCOUNT DENTAL PLANS 44by Nicole Ropiza

REDUCING NARCOTICS ABUSE IN WORKERS’ COMPENSATION 52by Tron Emptage

5 STEPS TO GOOD DECISION MAKING 26by Kescia D. Gray

PHARMACEUTICAL IMPORTATION ~ LOGICAL, LEGAL, SAFE 47by J.J Summerell

by Amanda Carlson-Phillips

Employees Are What They EatThe Importance of Integrating Nutrition in Corporate Wellness


or many years, corporate wellness programs focused almost entirely on movement programming, ranging from on-site fitness

centers to group classes to online modules around general fitness. All of these options deliver significant value to the employee, but for too many years, optimal nutrition integration has been a missing part of the puzzle. Here we have outlined five reasons why employees are what they eat, and why on-site nutrition programming should be top of mind for employers in evaluating wellness solutions.

Rising Medical Costs: Simply put, employers can’t afford to ignore the impact of heart disease and diabetes on their healthcare premiums—the American Heart Association estimates heart disease costs alone will triple by 2030. Lowering the risk factors for diabetes and heart disease alike requires more than just fitness programming: employers must provide integrated, dynamic and engaging nutrition education content and support so that employees think differently about how they eat each day. To quantify potential impact, we recently did a program with Intel that included both on-site fitness and personalized nutrition. Over just fourteen weeks, the average percentage decrease in cholesterol was 5.03%, average fat loss was 14 pounds, and V02 scores increased by an average of 19%. There was a 30% change in participants characterized as “at risk” based on their lipid profile—a staggering number when you consider the potential impact on claims data.

Meeting People Where They Are: For many employees, the notion of working out is simply too big of a jump given their current health state. Nutrition is a great way to reach non-movers with simple, actionable programming they can incorporate slowly into their lives. For many years, nutrition has become synonymous with weight loss. While trying to lose weight, people often lose sight of why we really eat. Bringing in dynamic and supportive nutrition programming can help guide people to choose foods that nourish the body, provide sustainable energy, and improve the way they feel as opposed to short-term fixes to lose five pounds. Every employee has to eat, so finding a way to meet them where they are and make small upgrades to their daily rituals can lead to the sustainable change employees and employers are looking for.

Nutrition is a Family Affair: Employers have offered a wide range of on-site solutions for corporate wellness, but continue to

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struggle with ways to engage the employees’ families in a meaningful way. The result? Often poor nutrition habits are fostered at home, leading to higher claims for the entire family. Finding ways to meaningfully engage with employees around nutrition can have a positive impact at home. By way of example, one of our wellness clients at Intel said he always knew he should eat breakfast, but didn’t know how to create a quick, convenient, and healthy option. After figuring out what worked best for him, he purchased healthy breakfast options, including whole-grain, high-protein cereal, for his entire family, the start of what we call “an upward spiral” in their home toward healthier habits.

The Results Speak for Themselves: Simply put,

many people sabotage even their best efforts at fitness with poor nutrition. At C&S Wholesale Grocers, based in Keene, NH, we watched as many of their employees worked eight hour shifts with significant physical exertion without consuming a single ounce of water throughout the day. As little as 2% weight loss due to sweating can lead to up to a 25% decrease in productivity, so even educating employees about small changes in hydration can lead to significant improve in how an employee feels throughout the day at work. To address this issue, we provided simple education tools at warehouse sites, along with urine charts for their bathrooms so that employees could monitor their own hydration levels. These simple reminders and changes can lead to noteworthy results for employees and employers alike. Now that we’ve addressed the importance of nutrition in wellness programming, I’ve outlined a few key considerations for employers when considering nutrition programs at their corporation:

• Integrate Nutrition into Fitness Programming: Nutrition programming often lives in the medical and clinical side of corporate wellness programs. This creates an association of nutrition with disease management or a reactive solution that needs to be addressed when something is wrong. A new avenue for the delivery of nutrition content and programming should be in parallel with the fitness programs. Fitness programs focus on having more energy, stamina, and strength. Linking nutrition to these goals allows for employees to see nutrition as fuel for their performance and a way to expedite the process of reaching their goals.

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WORKSITE WELLNESS

• Re-frame the Approach: Everyone can benefit from a nutrition tune-up. The foods we choose to eat are linked to the energy we have to be productive in our careers, present with our families, and enjoy the activities that make us who we are. Learning to choose the right foods, in the right amounts, at the right time is the key to feeling and performing the best you can in whatever you choose to do. Nutrition programming should focus on food as the fuel for our lives and provide the education and simple strategies to take advantage and get the most out of every time we eat.

• Keep it Simple: Employees need simple strategies that they can incorporate in their daily lives, so focus on key priorities like hydration, increasing fruit and vegetable intake, or upgrading healthy snack options on your campus, and create simple ways for your employees to learn more and take part.

• Make it Fun: Nobody wants to be lectured on what they are doing wrong, so making nutrition programming fun and relatable is imperative to its success with your teams. Creating nutrition challenges, remake a recipe contests, or lunch and learns where employees can have interact with

one another and have fun while learning more are all great options to keep employees excited rather than tired by nutrition programming.

• Build Community: Invite employees and their families to participate in a healthier barbeque or picnic lunch on campus and work with a local grocery store to provide a coupon for employees to try out healthier breakfast fare for a week. Engaging a broader audience in the conversation with lead to broader engagements and results for everyone involved.Whether your employees are unloading pallets every day, manning a service center, or traveling non-stop, nutrition has the ability to transform their lives, increasing energy levels, improving performance, and advancing their health state. To date, most employee nutrition programs have been stand-alone online modules or education seminars without the personalization, ongoing support, and integration necessary to make them a sustainable success. To create impactful nutrition programming, it’s imperative that companies consider integrating nutrition education and support with fitness, maximizing each individual’s ability to make sustainable changes to their overall health.

BioAmanda Carlson-Phillips is the Vice President of Nutrition and Research at Core Performance. Core Performance combines innovation, coaching, and

technology to deliver unmatched, sustainable results for employees and companies alike. Amanda has designed leading-edge nutrition protocols for wellness programming at Intel and C&S. To learn more about Core Performance, please visit www.coreperformance.com/corporate-wellness.

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Gender Stress Response...It’s All In Your Head

by Jason Krausert and Donna Tosky

tress is a part of life and work. It doesn’t matter if you are a man or a woman. Similar things create stress for both men and women. Job demands, career moves,

not getting along with colleagues and supervisors, having children, not to mention relationship or marital problems at home are all leading causes of stress for both genders.

That’s where the similarities end however. Recent studies prove men and women respond to stress very differently. As we’ll explain below, those differences can directly impact job performance.

Therefore, it is important for managers as well as those responsible for implementing corporate wellness and employee assistance programs to be aware of these gender differences and to respond accordingly.

The Stress Response - It’s All in Your HeadIn 2007, researchers at the University of Pennsylvania’s School of Medicine conducted functional Magnetic Resonance Imaging scans on 32 healthy subjects – 16 men and 16 women – before, during and after they were asked to do a

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complex mathematical task under pressure. The researchers measured the subjects’ heart rate, cortisol levels (a stress hormone), their perceived stress levels throughout the experiments, as well as regional cerebral blood flow (CBF), which is an indication of regional brain function.

The study found that men responded to stress with increased CBF in the right prefrontal cortex, an area of the brain associated with the so-called “fight or flight” response. In women, the limbic system - a part of the brain primarily involved in emotion - was activated when they were under stress. Researchers noted that the stress response lasted longer in women than in men.

According to a summary of the research on the Science Daily website, “These findings suggest that stress responses may be fundamentally different in each gender, sometimes characterized as ‘fight-or-flight’ in men and ‘tend-and-befriend’ in women.”

According to Dr. J.J. Wang, the lead author of the study, “Women have twice the rate of depression and anxiety disorders compared to men…Knowing that women respond to stress by increasing activity in brain regions involved with emotion, and that these changes last longer than in men, may help us begin to explain the gender differences in the incidence of mood disorders.”

In an independent study, Tara M. Chaplin, Associate Research Scientist at Yale University School of Medicine, found that differences in how men and women respond to stress are not limited to neurological evidence. Their reactions have far-reaching implications for their overall well-being.

According to Chaplin, “We know that women and men respond to stress differently. For example, following a stressful experience, women are more likely than men to say that they feel sad or anxious, which may lead to risk for depression and anxiety disorders. Some studies have found that men are more likely to drink alcohol following stress than women. If this becomes a pattern, it could lead to alcohol-use disorders.”

What This Means to Business

The University of Pennsylvania findings are simply interesting facts until you understand that:

• the different stress response exhibited by each gender is just one tiny thread of an intricate web of differences between men and women, the strands of which fit perfectly together to create the personal and professional interactions that define life;

• this web of interacting gender differences directly impacts people’s well-being and how they function individually and in groups both at home and in the workplace every single day.


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In short, gender does make a difference in life and in business. For example, what are the real-world implications of each gender’s different stress response for businesses and for the managers who lead them?

Men Think Strategically

In our “Between Men and Women” Couples Wellness Weekend we explain that the overriding factor for men when making decisions and assessing circumstances is, “How likely am I to win or lose if I take this action?” This explains a man’s fight-or-flight response to stress. When given a task men size up a stressful situation - maybe it’s an intransigent client, a tight deadline, a declining sales trend or personal problems with a spouse. Then they mentally, if not subconsciously, start doubting whether they can handle the task. A man’s doubt is like gas to a car. It fuels his mental engine’s process of assessing whether or not there is a chance of a winning outcome. Basically, he is asking himself, “Can I do this?” If the answer is “Yes” they fight. They go for it. If the answer is “No” they flight. They pull back, procrastinate or avoid the project.

A man’s response to his doubt is almost always

influenced by personal confidence and knowledge. A senior executive has more experience and a better real-world understanding of his capabilities. As such, he will either use his deeper repertoire of strategies for winning and choose to fight, or he will strategically withdraw. A junior manager with fewer arrows in his quiver may be more inclined to hide, delay acting or withdraw in the face of impending failure. Alternatively, his enthusiasm may cause him to over-estimate his ability so he rushes head-long into a losing situation. That’s how he learns. There may be exceptions to how each man finally responds to his assessment of a situation, but the process is always the same - stress is asserted when he receives an assignment, he starts doubting (i.e., assessing) his ability to produce a winning outcome, and depending on his answer he either goes for it or holds back.

Women Think Communally

Women, on the other hand, are naturally more communal than men. They are relationship masters. From an evolutionary standpoint, they value the safety of the “tribe” so-to-speak. They value community. As such, when stressful situations strike, they are less likely to go-it-alone than men. Women respond by tending-and-befriending. They build community around them.


that’s within your control: “To tell him I find his gum cracking distracting and request that he stop;”

Is this within your control? Yes: It’s within your control to tell him it bothers you and to request he stop.

Just because you ask him to stop, though, doesn’t mean he will. You won’t always get your way because you act assertively. You’ll definitely increase your batting average, however.

In the political discussion example, determine if it’s worth it to you to counter with your own opinions by identifying your goal. Let your goal guide you.

If your objective is to present an opposing belief, then jump in. To do this assertively you must

respect the others’ rights to believe as they do. Listening well communicates this respect. If your intent is to convince the other person how wrong he is and how right you are, good luck.

Assertive Skills

Assertive techniques, which are mostly formulas, are great because:

they force you to think before you speak. They may be clumsy at first but once you become proficient they become effortless to use. they are problem-solving and goal-oriented in nature.If it takes you two minutes to create an assertive message using these formulas then you need to think that long before you speak.Use the “I” Message

You’ve learned before that “you” messages encourage others’ defensiveness, which discourages cooperation. Avoiding the blaming “you” message is vital, so let’s take a look at this lesson again.

No matter how mature and sophisticated a person is, you can see them flinch when someone hurls a “you” message at them.“You are so unfair. You never take my ideas into consideration.” Virtually everyone gets defensive when on the receiving end of “you” messages.

Instead, use the simple, yet powerful “I” message: “I think this is unfair. I feel like my ideas aren’t taken into consideration.” The more difficult your message the more diligently you need to eliminate “you” messages and substitute with “I” messages. With criticisms: “I’d prefer you be less personal about my faults.”Too many demands: “I’m feeling overwhelmed. I need you to prioritize my tasks for me.

Simple Assertion ~ The Easiest Skill

This skill is a direct statement of what you want, which right you want to defend, or which belief or opinion you want to communicate using the “I” message:E.g., “Tom, I need you to get these copies made for the meeting at 2:00. Thanks.”

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They talk with family, friends, and co-workers; they seek advice; they build the social support structures and alliances that safety and security depend on. Again there are always exceptions, but this basic natural reaction is universal.

The above is not to say that women won’t go for it on their own. Women, especially in business, can and do react this way. That is because of the dual nature of their logic. This sort of reaction, however, is less common and less comfortable for the majority of women. Being forced out front in a stressful situation can actually augment the stress inherent in that situation. For men, on the other hand, the stress of “leading the charge” is motivational and is far less than the stress of doing nothing or feeling restrained.

What is there for business to do?

According to the lead University of Pennsylvania researcher, Dr. J.J. Wang, “In the future, when physicians treat patients - especially for depression and post-traumatic stress disorder - they need to take it into account that really, gender matters.”

There is an opportunity here for wellness program coordinators. If the medical community is recognizing the need to incorporate an understanding of gender differences in their treatment practices, it’s time for the business community to do the same in their wellness programs and their management training efforts. Understanding that gender matters in business, not only in terms of how someone performs and communicates, but also in terms of how

people are managed, is a key step in creating a 21st century workplace characterized by well-being, reduced stress, deeper engagement and maximized productivity.

Bio

Jason Krausert is CEO of Inner Sync Systems Inc., a leading-edge Canadian personal and professional wellness company specializing in workplace

gender communication programs as well as in supporting employees’ personal relationships so problems at home don’t negatively impact either their quality of life or their performance in the office.

Donna Tosky’s status as a leading gender-in-relationship expert evolved over almost two decades in the wellness industry. Now as a leading expert

on gender, Donna educates individuals, health care professionals and managers in the natural laws of gender that are critical components of true success in life and in career.

For a free consultation email Jason and Donna at [email protected]. For full program details visit their website at www.InnerSyncSystems.com.

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Assertiveness Reduces Stress Putting You in the Driver’s Seat of Your Own Lifeby Jacquelyn Ferguson

ince stress is the perception of insufficient control and assertiveness increases personal control, being assertive is one of the best ways to

lower stress. It puts you in the driver’s seat of

your own life.

Conversely, being passive decreases your control and puts others in the driver’s seat of your life. While aggressive people attempt to

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control too much and pay the consequences later: they win the battle but ultimately lose the war.

As a review from last month’s article, here are the four communication styles from which you can choose no matter the situation. They exist along a continuum with each style honoring different parties’ rights therefore producing different outcomes:

Passive: not standing up for yourself, or attempting to so ineffectively that your rights are easily violated; others’ rights and needs are more important than your own;

Aggressive: standing up for yourself in a way that violates the rights of others; your focus is getting what you want without concern for others’ rights;

Passive-aggressive: indirect expression of anger or frustration, which appears passive and non-hostile but you sabotage the other person; you’re too indirect to assert yourself so communicate in a manipulative way, like gossiping;

Assertive: standing up for yourself in a way that respects the rights of others; you’re direct, honest and appropriate in expressing your feelings and opinions;

When assertive you accept that others’ rights are as important to them as yours are to you.

When rights collide you’re willing to negotiate to ensure everyone gets their most important needs met and their rights respected, which is easier said than done.

Assertive Tips

Pick and Choose Your BattlesIt’s important to pick and choose your battles since not all are worth fighting; like whether or not to speak up during political conversations. It’s certainly possible to carry on respectful political dialogue; it’s just difficult with some people.

Start SmallIt’s also wise for those who are especially passive to begin asserting themselves in situations and with people who represent the least threat. Practice using the following skills in less stressful situations first. Then as your self-confidence increases you can handle more challenging situations with greater skill. Save the most threatening people and situations for later, after you’ve been successful in easier situations.

Be Goal-oriented: Make Sure the Goal is within Your ControlDo you often regret speaking before you think? To avoid this, consciously identify your goal before speaking, particularly in difficult situations. Your goal basically outlines what you want to say. Be careful, however, to state your goal in a way that’s within your control. If your goal requires someone else to change it’s beyond your control.

E.g., Your co-worker cracks his gum, which drives you nuts! Rather than getting aggravated, identify your goal: “To get him to quit cracking his gum.” But he’s beyond your control; therefore your goal is beyond your control and will only stress you. Restate the goal in a way

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Feedback Statement

This great three step formula helps you say almost anything to almost anyone:

1. Describe (not judge) the situation you are referring to;

2. Say how you feel about it if you want to;

3. Say what you’d like to see done about it (the problem-solving step):

For example, you have out-of-town-family whose visits are too long. You’ve said nothing for fear of hurting their feelings. But if it’s important enough to you, honor your right to set limits rather than allow their rights to be more important than yours. You could say,

1. “When your visit lasts longer than a week …

2. … I feel distracted and stressed.

3. We want you to continue visiting every year and would appreciate you keeping your visits to no more than one week.”

Listen, Don’t Defend and ParaphraseBeing assertive is more than stating what you want. You must also be respectful of the other party’s rights and needs. After you present the above request your family may feel offended. Listen carefully to their response. Then, paraphrase what you heard:

Your relative says, “So we’re too much trouble? Maybe we should just find a hotel.”

1. Your response: “It seems you feel I’m rejecting you.” - “Yes! That’s what it feels like.”

2.“We enjoy your visits. We just want to protect

our time and energy, too. Would keeping it to a week be too uncomfortable for you?”

- “Not uncomfortable, it just hurt my feelings.”

3. “That wasn’t my intent. I’d like for us all to be happy with your visits.”

Request Behavior Change You can feel like you’re walking on thin ice when you ask someone to change a behavior. So it’s even more important to think before you speak. Use this three-step formula:

1. Describe the other’s unacceptable behavior;

2. State the consequences of it;

3. Give expectations for future behavior;

For example, you gave an employee several messages to call a customer. The customer has not yet been called and is getting upset. Explain to your employee the importance of returning customer calls.

1. “Janice, when you don’t return a customer’s call within 24 hours …

2. “… they can develop the impression that we don’t value their business and may take it elsewhere.

3. “So I need you to recommit to always returning customer calls within 24 hours.”

Fogging

Do you react defensively to others who trigger your hot buttons? For this reason, fogging is my favorite skill. The intent of Fogging is to take the wind out of someone’s sails. Use

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it when someone is unjustifiably criticizing you or attempting to emotionally hook you. Fogging means agreeing with everything they say (although you’re not really agreeing). - E.g., Your nemesis approaches your messy desk and says, “How can you get anything done with a mess like this?”

1. Your response: “Yeah, it is messy.”

2. Or, “I don’t get much done.”

Obviously, if your boss said, “Your report was lousy,” you shouldn’t Fog by responding, “Yes, it really was bad.” Fogging is useful only to take the wind out of someone’s sails who deserves it. Say “No” Saying “no” is especially difficult for passive people who want to please others, avoid hurting their feelings, appear to be cooperative, etc. If saying “no” is very difficult for you, revisit last month’s article on seeing your own rights as important to you as others’ are to them.

Use this four-step approach to set appropriate limits:

1. Paraphrase the request;2. Say “no;”3. Give a reason or two (but not too many) why you are saying “no;”4. Offer an alternative if you have one;

- E.g., You’ve served on a committee for three years and you no longer wish to do so. The chair has just asked you to serve again:

1. “Keisha, I’m flattered you’ve asked me to join the committee again.

2. “I’m going to say “no” …

3. “because I was just assigned another

responsibility that will require an additional five hours of work each week.

4. “Jill Johnston’s interested, though. You could ask her to join.”

After saying “no” if the person requesting tries to talk you into a “yes,” …

Make the “No” StickParaphrase each attempt to get you to say “yes” then say “no” again:

Requester: “We really need you; you’re so creative.”

Your response: “Thanks, I’m really flattered and I’m going to say “no.”

- “But there will be important people on this committee who’d be good for your career.”

- “I’m sure there will be interesting people. I’ll be too busy to serve.”

Expose Manipulation

Successful manipulation requires:

1. Your cooperation;

2. Remaining hidden;

Exposing manipulation to the light of day decreases the likelihood the manipulative person will use it again with you. Shine the light with these ideas:

When your mother pulls the, “I carried you for nine months” manipulation:

- “I get the feeling I’m being manipulated. What’s going on?”

You told a colleague you won’t work this

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weekend and she attempts to manipulate you by labeling you negatively. Use this great formula:

1. “Whether or not __________ is not the issue. The issue is _________.”

2. Your co-worker says, “You’re not a team player.”3. Your response: “Whether or not I’m a team player is not the issue. The issue is will I work this weekend and the answer is “no.”

Your co-worker rolled his eyes over an idea you gave. Without judging him as, for example, arrogant you could surface his indirect, manipulative gesture (behavior) by using these three steps:

1. Describe what you perceive as his manipulative behavior;

2. State your interpretation of it;

3. Ask if you’re correct;

“Stan, when I stated my ideas for the XYZ project I noticed you rolled your eyes. This makes me think you have a problem with my idea. Is that right? Do you have a problem with it?”

Once you expose his manipulation be prepared for his response. Use the listening skills to let

him know you heard and understood before responding assertively back.Assertive formulas help you think before you speak. At first they require a minute or more to think through but the results of successfully asserting yourself are definitely worth the learning and risking. Consistent assertive behavior puts you in the driver’s seat of your own life while improving your relationships.

Bio

Jaquelyn Ferguson is the founder of InterAction Associates, her speaking and coaching firm. For over 25 years Jackie has designed and

presented keynotes and workshops on stress management, diversity, workplace harassment, motivation, and communication skills

Jackie is also a Stress & Wellness Coach helping people achieve more success with less stress. Jackie is the author of “Let Your Body Win: Stress Management Plain & Simple” and a weekly column “Stress for Success” in Gannett Newspaper, at www.letyourbodywin.com.

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Are You Leading Like A Dictator? Six Signs Your Management Style is Toxicby Keith Ayers

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t doesn’t matter if someone is managing a nation or a four-person professional service firm; leading like a dictator leads straight to the gutter.

Dating as far back as anyone can remember, history has provided us with countless examples of dictators being overturned by “the people.” Most recently, we’ve watched the upheaval in the Middle East, spurred on by the not-so-early exit of Egypt’s former leader Hosni Mubarak. After thirty years of rule and pocket full of cash about a third as big as Egypt’s entire GDP, there were riots in the street and the dethroning of a ruler. While this is an extreme example, on a large scale, with tons of publicity, it doesn’t mean that the lessons seen here don’t apply to business management.

Take for example Jack Griffin, the former Chief Executive of Time Inc. The NY Times reported that employees described his leadership style as “brusque” and that he created an unworkable office culture for the Time Inc. team. He implemented “swift and sweeping” changes without communicating his purpose well and undermined his team’s confidence in their abilities. Although it would be a stretch to classify Griffin and Mubarak in the same category, it is reasonable to assume that Griffin was an inflexible leader. Consequently, in February, Griffin was forced out of Time Inc. after less than six months in office.

These examples are more common in business than most people think. In fact, from 2000 to 2006, one in four CEO tenures ended in forced dismissal, a rate of almost four percent annually according to Fortune magazine. While not all of these dismissals resulted from the boss being overly inflexible or too demanding, the fact remains that these dismissals do happen, and they happen when employees and coworkers

are unhappy. And make no mistake; leading like a dictator is one of the fastest ways to foster workplace discontent.

The good news is that managers no longer need to wait until they get a pink slip to find out that they’ve been leading like dictators. Instead, they can just review the list below of the “Six Signs You’re a Dictator.” If three or more signs apply, then it’s time for some serious changes in leadership style.

Six Signs You’re a Dictator

1. The Company Revolves Around You — Employees are able to describe you in one word: self-centered. Without your brilliant guidance, they all would be lost. Your inferiors are merely there to carry out orders that further your personal objectives. When success comes your way, you gladly take all of the credit and reward yourself with a little extra cash in your pocket, just like Mubarak did.

2. You Obsessively Control Employees — You enjoy wasting time by micromanaging every employee task; you make people work precisely when, where, and how you want them to. You think of your office as an elementary school classroom where you need to monitor every movement, action, and breathe your students make.

3. You “Inspire” with Fear —You like people to know that any mistake can be punishable by unemployment. You think the best way to motivate people is to make them feel like their job is something they must do to survive rather than something they want to do. All the emails you send out are typed in ALL CAPS and flagged as

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urgent to maximize employee panic.

4. Priorities Start and End with Work — There is no room for excuses like “my kid is in the hospital” or “I’m not feeling well” when there’s work to do. To you, having a “work/life balance” and “personal time” don’t exist. You feel entitled to employees weekend time just as much as their work time and expect them to cater to your needs 24/7.

5. Respect Doesn’t Matter—Your ideal image of a leader-follower relationship is to give as little as possible and get a lot back. Whenever you’re stressed or an employee has done something wrong, you don’t hesitate to “chew-out” a person in classic Jack Griffin style. After all, why waste the chance to make an example of one person and motivate the others to do their job right?

6. You are Never Wrong — Why would you ever admit to being wrong when you have a line of scapegoats outside your office just waiting to take the blame? You’re the leader of the company, your image is its most important asset, and being wrong is not an option. You take credit for all the company successes and pass off failures on to your employees.

By running a business like a dictator, leaders create toxic jobs, stressful workplace environments and begin to carve out a legacy that even suppliers are ashamed to be involved

with. However, by recognizing and actively addressing leadership deficiencies before disaster happens, employees are usually receptive to leaders who make a genuine change.

Trust and respect are the most essential ingredients to develop healthy leader-follower relationships. An effective boss needs to value positive social relationships in the office and nurture his or her employees to become self-directed individuals who will produce their best work, not because their boss threatens them, but because they want to. Employees need to be treated with respect, shown appreciation, and given recognition from their leaders to maintain engagement in their work. Just remember, idle threats and paychecks may be enough to get one task done, but in the long run they don’t come close to motivating employees the same way trust and respect do.

Bio

Keith E. Ayers is President of Integro Leadership Institute, a global business, management, and leadership consultancy

firm with offices in Australia and associates located around the world. He is the author of Engagement is Not Enough (Elevate 2008) which show leaders how to create an organization of passionate workers in pursuit of a common purpose. For more information visit www.integroleadership.com.

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What does a family with a newborn have in common with a family who has a son or daughter entering college?

This sounds like the beginning of a joke, but both have far more in common than most work/life balance programs have considered. Employees with young children and employees with a son or daughter embarking on the college years share high levels of stress, uncertainty, financial changes, a long list of new expenditures, constant transitions, heightened worry, and changing family relationships. The employees with the pre-college or college-enrolled child

often additionally experience a sense of loss and anxious feelings around the shifting locus of their control. So let me ask, “What percentage of your work/life initiatives provide a range of offerings and programs to employees who have a child either entering college or currently enrolled in college?”

Societal Factors and Trends

Our society provides many more offerings and resources to parents who have young children than to parents of older children. This pattern is also reflected in many work/life wellness

By Kay Kimball Gruder

The Cost of College

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programs, yet the teen through college years are high stake and high transition. Maybe as a society we hope that parents have figured out how to successfully parent by the time children have entered their mid-teens, but parenting has one stepping into new or unknown territory at a steady pace.

As a Parent Coaching InstituteTM Certified Parent Coach®, with over 22 years in higher education as an advisor to students and families, I can share that my clients are your employees. They are men and women from all job levels. Some went to college decades ago and some have never set foot on a college campus. Some clients have had one child already attend college, but most have not. Some families are financially secure, but most are just getting by. What they all have in common is that they share varying degrees of stress, worry, confusion, and distraction by virtue of parenting either a pre-college or college enrolled student. Their list of parenting concerns spans from the college application process through to having their recent college graduate move back home. In between they are parenting children who have lots of opportunities to make mistakes. While it has always been true that college environment is fertile ground for errors in judgment, today the impacts are greater due to the cost of a college education. When in history:

• has college cost so much;

• has a college education been essentially a mandatory next step for virtually every high school student;

• has parent involvement played such a significant role in the day-to-day decisions and the personal organization of a child’s life;

• has there been a time when young people are so insulated from experiencing risk and failure?

What We Already Know

Family-to-work interference makes concentration at work difficult, and we know that when people are preoccupied they are less focused – though there is ongoing debate and research about whether there is a systematic relationship between work/life balance and productivity. We know that too much stress is bad for one’s psychosocial well-being and that stress-related illnesses raise medical costs, and that absenteeism comes at a price too. We know that not everyone seeks or solely needs counseling to improve family-to-work interference, so to assume that employees will have their needs met by accessing mental health services is a narrow view. In the wellness industry we recognize the value of preventative measures. As with other physical and emotional life occurrences, families that are better prepared for the stressors associated with parenting a pre-college and college enrolled student, and who can anticipate the range of parenting challenges that they will likely encounter, have the greatest opportunity to more effectively handle stress and transitions with expanded skills and knowledge.

What are businesses providing to parents of pre-college and college enrolled students?

The work/life balance initiatives that are available to parents of pre-college and college-enrolled students are uneven. While there are now industry expectations for what great childcare looks like or what offerings make for a generous fitness program, the same is not true for work/life initiatives targeting parents of pre-college or college-enrolled students. At one end of the spectrum you have companies like SAS which have an on-site Teen/College Resource Consultant as part of the Work/Life program staff.

The Work/Life Center creates and delivers an annual “College Series” and invites experts in

The Cost of College

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too, to share their knowledge about topics of interest to parents of teens and adolescents. As Page Cvelich, the Teen/College Resource Consultant shares, the presentations not only address the nuts and bolts of things like saving for college, test prep, and the college selection and admission process, but offerings also consist of seminars designed “to help parents support their college-bound students as well as to parent more effectively” during this time in their child’s development. Through evaluations of services, SAS employees report “feeling a reduction in stress and cared for by the company.” In addition to a steady stream of parent education, Ms. Cvelich provides parents with resources, referrals, and parent coaching. She also offers family programs and topics for the teens.

The department has a work/life lending library and two electronic lists which facilitate a flow of information to parents of teens and parents of college students and beyond. After students are at college, Ms. Cvelich is available as a point of contact to parents, providing suggestions about whom best at the college to act as a resource to their student in crisis. The average age of SAS’s world-wide employee population is forty-five, which places many in the throes of parenting a pre-college or college enrolled child. SAS presents a very comprehensive work/life program to parents of teens and college students. A more common model is one by which a company contracts for services that focus largely on guiding parents and their student through the college admission process or helping employees to address financial concerns and needs associated with sending a child to college. While these services are definitely meeting employee needs, they often lack a continuum of offerings and support that truly carry a parent through the teen and college years.

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The “best fit” for your company or organization should be determined through consultation with employees from all segments of your workforce. As well, take a reading on whether your organization’s culture is open and ready for the benefits you intend to offer and whether you can respond to the demand if a new program or initiative is a huge success. Remember too that parents may know that they are stressed and frustrated about various circumstances related to their pre-college or college enrolled student, but they might not recognize that the bulk of the stress comes from their inability to effectively parent their student through problems, crises and challenging situations. Parents won’t come running to you expressing a need for a parenting class, though having new knowledge and expanded parenting tools and strategies leads to reduced stress and more confident parenting. It is over time and through a continuum of offerings that parents can reach a comfortable and effective new parenting paradigm as they navigate their role with their emerging adult.

Recommendations That Won’t Break the Bank

If you historically have not offered work/life balance programs tailored to parents of pre-college and college enrolled students you can

definitely test employee interest with relatively low-cost and low-risk pilot programs and services. Consider the following:

• If you have a work/life lending library consider adding and featuring books that guide parents in their parenting of pre-college and college enrolled students – not just the nuts and bolts of how to get into college, but books about experiencing transitions, making the most of college, and parenting a college student.

• Consider organizing a monthly discussion group that targets parents of college students or parents of high school seniors.

• Create a mentor program where parents with students already in college act as a sounding board for parents who are just embarking on this stage of parenting.

• Start a lunchtime book group that reads a range of parenting books or shorter articles of interest to parents of teens and college students.

• Contract with a provider to deliver live presentations or on-demand parenting webinars.

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• Survey your parents and identify “hot topics” – then invite speakers in from different departments at area colleges to share information and to answer questions.

• Celebrate a student’s success by sending a company note when a student is on the Dean’s list, has graduated, or receives an athletic award, etc.

• Create or deliver an electronic parent publication that is expressly for parents of college students.

• Consider short-term flex time for employees who need to make a round of college visits with their child – that way they won’t call in sick or take vacation time for an experience that is anything but a vacation!

There are definitely other considerations to factor in as you learn about employee needs and interests. For example, if you have employees who have children who will be the first generation to go to college you will likely want to tailor some offerings to address their questions and desire for information. Additionally, if you have a global workforce you will find that there are very different norms elsewhere in the world for how involved parents are with their teen or college student. You might also find that some of your global workforce desires to send their child to college in the U.S., and this too provides content for niche programming. Exploring the right fit for your workforce might mean offering variations on a theme.

As with any new initiative or program, the ROI for creating new or broadening your existing work/life offerings might be realized immediately or it might take more time for the

intangibles to emerge. Interestingly much of parent education revolves around improving parent communication skills which usually has a ripple effect on one’s personal and workplace interactions. My clients often share that they find themselves applying the parenting strategies that they gained through parent education to other situations where they are faced with challenges, transitions, decisions, and difficult people.

The cost of college to your workforce is more than just a financial commitment. It comes at an emotional expense, complete with parenting confusion, unanticipated twists and turns, sleepless nights, and sometimes even weeks or more of worry. As you evaluate older initiatives and cycle in the new, consider evaluating what you might offer to a potentially significant segment of your workforce. Chances are that they will be both surprised and grateful – as much of one’s parenting of older children occurs without guidance or inspiration.

BioKay Kimball Gruder, M.Ed. and Parent Coaching Institute™ Certified Parent Coach® founded SuccessfulCollegeParenting.com and is also the College Parent Expert for

CollegeParenting.com.

Kay delivers on-site and webinar-based parent programming on topics that guide parents in their evolving relationship with their student. She also provides individual and small group parent coaching. She is the author of “Successful College Parenting Strategies”, a free electronic monthly newsletter.

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5 Steps to Good Decision Making

ach day we are faced with situations in life that require us to make choices. Some of these choices are easy, and

at times, some of them can be difficult. Easy decisions consist of things like what clothing you should wear; most people choose what to wear based on the season of the year, the weather of the day, and where they might be going. Other easy decisions consist of things like what to eat, what movie to see, and what television programs to watch. Decisions that seem to be the most difficult are those that require a deeper level of thought. Examples of difficult decisions consist of thinks like where to attend college, what career path would be best, and/or whether or not to marry and start a family. These types of decisions are difficult because they are life changing decisions; they shape who we are, and they shape our future.

Making good decisions is a method that must

be learned. It is not something with which we are innately born, but merely a step by step process that is usually ascertained from life experience. Most adults know that experience can be a costly, ineffective teacher that teaches more bad habits than good; and because decisions can vary so obviously from one situation to the next, the experience gained from making one important decision is often times of little or no use when another decision-making problem arises.

When making decisions, there are many steps that can be taken; but when making good decisions there are really only five steps that need to be considered. These steps are as follows:

Step 1: Identify Your Goal

One of the most effective decision making

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by Kescia D. Gray

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strategies is to keep an eye on your goal. This simply means identifying the purpose of your decision by asking yourself what exactly is the problem that needs to be solved? And why does this problem need to be solved?

Figuring out what’s most important to you will help you make good decisions. When you know the reason why you have making a particular decision; it will better serve you in staying with it, and defending it.

Step 2: Gather Information for Weighing Your Options

When making good decisions it is best to gather necessary information that is directly related to the problem. Doing his will help you to better understand what needs to be done in solving the problem, and will also help to

generate ideas for a possible solution.

When gathering information, it is best to make a list of every possible alternative; even ones that may initially sound silly or seem unrealistic. Always seek the opinions of people that you trust or speak to experts and professionals, because it will help you to come up with a variety of solutions when weighing all your options for a final decision. You will want to gather as many resources as possible in order to make the best decision.

Step 3: Consider the Consequences

This step can be just as important as step one because it will help you determine how your final decision will impact yourself, and/or others involved. In this step, you will be asking yourself what is likely to be the results


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of your decision. How will it affect you now? And how will it affect your future?

This is an essential step because it allows you to review the pros and cons of the different options that you listed in the previous step. It is also important because you want to feel comfortable with all your options and the possible outcome of whichever one you choose.

Step 4: Make Your Decision

Now that you have identified your goal, gathered all necessary information, and weighed the consequences, it is time to make a choice and actually execute your final decision. Understanding that this step can cause some people a lot of anxiety is important because this is where you have to trust your instincts. Although you may still be slightly indecisive about your final decision, you have to take into account how this makes you feel. Ask yourself, does it feel right? And does this decision work best for you now, and in the future? When you answer those questions back, you should feel good about the result.

Step 5: Evaluate Your Decision

Once you have made your final decision and put it into action, it is necessary to evaluate the decision and the steps you have taken to ensure that it works. This final step is probably just as important as step one, if not more important, because it will help you to further develop your decision making skills for future problems. This step is also fundamental because it may require you to seek out new information and make some changes along the way.

Remember, this step requires some patience and it can also encourage perseverance. Why? Because it may take some time to see the final

outcome. Recognizing that if the first decision is not working, you may have to go back to step two and choose another option. Always looking for and anticipating unexpected problems will help alleviate undue stress, if and when a problem occurs.

Although these five steps can help assist in simplifying the decision-making process, there are some common drawbacks that you must also take into account. Consider these:

Misidentifying The Problem

Many times the problem will be obvious; but there may come a time when identifying the main problem is not that easy. When this issue arises, figuring out exactly what it is, and where you need to focus your efforts will save you a lot of time and energy in the long run.

Having a Single Source

When considering the consequences, you must be open to a broad choice of alternatives in order to find the best solution. This can become a problem if you rely solely on a single source of information because that one source may not b reliable, or may not be completely inline with the problem; thus altering your chances of making the best decision.

Having Too Many Sources

Having a variety of sources is usually not a bad thing; but not in every situation. Collecting as much information as possible can be very helpful at arriving to a decision, but an overload of information can leave you confused and misguided, and prevents you from following your intuition. Remember, trusting your gut instincts is a major key to making good decisions.


Overestimating the Outcome

When making a decision and putting your plan into action you should have taken care to weigh all your valid options. Making a decision based upon an outcome that may not be plausible will not help you solve the problem. Poor Timing

Time can be a futile friend. Sometimes it is good, and sometimes it is not. When making major decisions, it beneficial to take your time in order to make the best choice from your options. But understanding the timing process is crucial because sometimes it is best to delay a decision, and other times delaying a response can cause more problems. There are also times when making a quick decision is advantageous because it allows you more time to make necessary changes should problems arise.

In summary we all have to make many decisions throughout our daily lives. Some of these decisions require little effort, while others require more time and deeper thought before coming to a final solution. Remember, there are five basic steps to good decision making. Why is those five the ideal number? Because a significant part of decision making skills is understanding and knowing a simple technique; and also regularly practicing that technique. When there are more steps than we can count on one hand, most people tend to either forget a step, or misconstrue the order in which the steps must be taken.

If you follow these five steps, and also remember the common pitfalls previously addressed, you will be well on your way to making good decisions for yourself.For more information on decision making skills, you can read: Smart Choices: A Practical Guide to Making Better Decisions

by Hammond, J.S., Keeney, R.L., and Raiffa, H., The Right Decision Every Time: How to Reach Perfect Clarity on Tough Decisions by Kopeikina, L., or How We Decide by Lehrer, J.

Bio

Kescia D. Gray, RN, MS, PHN, CHES is the owner and president of GrayKo Clinical Consultants, LLC. Previously published

in Corporate Wellness Magazine, she is also an international author and speaker. Some of her most recent works includes co-author of Raising Healthy Children in an Unhealthy World, The Teen Handbook for Self-Confidence, and Transformation: Reinventing the Woman Within.

GrayKo Clinical Consultants, LLC is a health and wellness education company dedicated to providing quality education programs, workshops, in-services, and seminars tailored to individuals, groups, and corporate clients. Their detail-specific program plans can be customized to fit your needs in order to foster success at meeting your goals of better health, increased productivity, job satisfaction, health safety, and more. Subject content related your needs and the needs of your company may include, but is not limited to stress management, emotional wellness, personal development, diet, and exercise. To contact Kescia Gray, please call (866) 653-2570, or go to www.graykoclinicalconsultants.com.


Boost Your Employees’Energy and Focus in 2011We all understand that employee productivity boosts bottom line. It’s also well known how much of an impact sick days can have on production. But sick days are not the number one culprit when it comes to hampering employee output. The truth is we lose more employee man-hours from sluggish performance than from sick days.

Even our executives and leadership staff suffer from fatigue or lack of focus at times—and they should be our highest functioning team members! How much more debilitating is the “mid-shift droop” when it attacks our general work force? There is good news however—it’s beatable!

Production Comes From Energy

Your assembly lines or computers run because they are energized—and so do our bodies. To produce thoughts and actions we need two things: a reliable source of energy (nutrition), and an efficient system of delivery (cardiovascular function). Unlike a computer however, the human body has a third requirement—rest.

Most Employers Sabotage Their Own Work Force

Most of us wouldn’t try to power our lights, computers, and phone lines with a weak source of energy, yet we have junk food abundantly available to our most valuable assets, our employees. To further complicate matters, our employees are sedentary for the majority of the day which by itself slows circulation and impairs our nutrient delivery system (the heart). With unlimited access to poor nutrition, and no systematic programming to encourage physical activity how can we expect employees to perform well in our fast paced, over-stressed-under-rested culture?

Breaks and vending machines are common to all jobs but as leaders, our responsibility lies in providing the types of breaks and access to the types of foods that will enhance health and performance rather than sabotage it. For sedentary employees this may mean incorporating active breaks to re-establish circulation and revitalize the brain, while physically active employees may need active down time to enhance overall performance.

by Tom Jordan and Courtney Day


What do your employees do on break?

Let’s look at what typical employees do with that break time. They head to the vending machine or the snack drawer and grab highly refined high-fat, high-sugar junk food snacks. This concentrated source of calories provides very quick rises in blood sugar with very little inclusion of nutrients vital to cognition or energy production. The end result is a crash is blood sugar a few hours later which is quickly followed by a crash in productivity.

From an activity standpoint, they typically go from sitting at their desk to sitting in the break room. We all know blood flow increases with movement but there is generally little encouragement for cerebral workers to take a brisk walk, do a few yoga poses or tai chi movements that would restart blood flow. Plus, with highly processed “junk foods” the circulatory system shunts blood from the brain and muscles to the stomach in an attempt to digest it.

Given the above metabolic burden our typical employee is imposing on their body, it’s no wonder that our “mid-shift droop” happens like clockwork, only to leave a big chunk of the workday rendered useless. But the damage doesn’t stop there…

These lifestyle habits also happen to result in the “big ticket” medical items that affect the health of employees (Cardiovascular Disease, Diabetes, Hypertension, Orthopedic Disabilities, Cancer, and Depression—the number one disabler of U.S. employees).

So what can you as employers, HR directors and managers do to help in the year ahead? Here are some simple things you can do to improve your employees’ focus, energy and overall mental health:

Kiss Your Vending Machines Goodbye

Frequent trips to the vending machine can strike your office like the plague. When your employees eat potato chips, doughnuts, candy, etc., they are depleting vital brain chemicals such as Serotonin, Dopamine and Norepinephrine which help stabilize energy and mood. Also, the saturated and trans fats found in junk food can cause fat build-up in the blood, which leads to higher blood pressure, clogged arteries and an increased risk of heart disease. And they cause blood sugar spikes that ultimately drain energy. The only people benefiting from the vending machines are the vendors.

Supply Healthy Fuel

The first line of defense in boosting energy and focus isn’t prescribing anti-depressants or anxiety medications, it’s nutrition! Regular doses of high quality lean proteins, nutrient- dense fruits and veggies and healthy fats can do wonders for both emotional well-being and job performance. So the next time you decide to give your employees a treat, replace junk food with some of the following options:

• Breakfast: Instead of doughnuts, stock your company’s kitchen with yogurt, fruit, whole wheat bagels or oatmeal. Starting the day off right can give the body a sustained release of blood sugar. Encourage your employees to eat a “heart healthy” breakfast.

• Lunch: Avoid ordering from fast food restaurants for work lunches. Instead, choose low-calorie options that everyone can enjoy. Examples include grilled turkey burgers with fresh lettuce and tomato, grilled chicken salads

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with low-fat dressing, and low-calorie sandwich options like Subway or Jimmy Johns.

• Snacks: Treat your employees with snacks that are high in fiber, such as granola bars, apples, and celery. Food that is high in fiber keeps your blood glucose levels from rising too fast. This means that your employees won’t feel hungry right after eating and will prevent them from overeating.

Provide Time to do the Opposite of Their Jobs at Lunch and On Breaks

Although this may seem counter-intuitive, providing your employees with an adequate, guilt-free break allows for positive reinforcement and an increase in overall productivity. It also gives them a chance to recharge their batteries and come back to work refreshed and energized. During the break can also be a good time to provide a healthy snack. This way, your employees can rejuvenate both their mind and body.

If your employees have physical jobs provide restful breaks. This gives their muscles and joints time to recover and prepare to retackle the next bout of physicality. If on the other hand your employees sit at a desk or are in stagnant positions for long periods you should provide them with the opportunity to get a little physical. It restarts circulation and revitalizes their minds.

The Bottom Line: A little change can go a long way. Promoting small steps towards workplace wellness can net huge gains in performance, retention, and morale of the entire employee base.

Bio

Tom Jordan, M.S., R.D.Tom Jordan is the wellness director at First Health Associates family medical center in Arlington Heights, Illinois. Jordan,

a Registered Dietitian and an ACE Certified Personal Trainer, oversees First Health Associates’ Corporate Wellness and Weight Management programs including the Largest Loser Fitness Challenge. He is a member of the American Dietetic Association (ADA) and the Association of Sports, Cardiovascular and Wellness Nutritionists (SCAN). For more information, Tom Jordan can be reached at 847-593-3330 or online at www.FirstHealthAssociates.com.

Courtney Day, M.S. Courtney leads the Exercise Physiology Department at First Health Associates. As an Exercise Physiologist

and ACSM Certified Personal Trainer, she oversees the corporate fitness programs, weight management programs, and sports performance programs in conjunction with the First Health Wellness Department. For more information, Courtney can be reached at 847-593-3330 or online at www.FHAWeightCenters.com.

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Join The Corporate Health and Wellness Associationwww.WellnessAssociation.com


Join The Corporate Health and Wellness Associationwww.WellnessAssociation.com

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Corporate Wellness Magazine

w w w. C o r p o r at e We l l n e s s Ma g a z i n e . c o m


FEATURES

Meaningful Thoughts Beyond “Meaningful Use”

by Kevin Shrake

ealthcare reform issues have frequently dominated the headlines over the past year.

There are many new changes yet to roll out depending on the final regulations of the bill still being debated by our legislators. One major change has been in full swing and has captured the attention of healthcare organizations across the country. The need for an electronic health record (EHR) is obvious and ties to issues of privacy, efficiency, medical errors

and duplication of tests to name a few. The healthcare industry has clearly lagged behind when you acknowledge the fact that we have had ATM cards for several decades that allow us to perform banking transactions all over the world. Although the federal government is not always the leading edge innovator of change, in the case of the electronic health record, they have actually led the pack as evidenced by the system that has existed in their Veteran’s Administration (VA) network for many years. Recognizing the value of such a system, the government developed an incentive program as

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H


Meaningful Thoughts Beyond “Meaningful Use”

part of the American Recovery and Reinvestment Act (ARRA) of 2009. Under this act, provisions were developed for a program known as the Health Information Technology for Economic and Clinical Health (HITECH) Act. The final rules of this program were released in July of 2010 and offers financial incentives under Medicare and Medicaid to hospitals and eligible professionals who demonstrate “meaningful use” certified EHR technology. Although clearly an important step, health care leaders must look beyond meaningful use to implement a solution that will fit seamlessly into the process of patient care and provide value rather than turmoil.

“Meaningful Use”

There has been an enormous amount of attention placed on these two words and information is available from a variety of sources. A prudent approach is to go right to the source and gain information regarding rules and regulations from the Centers for Medicare and Medicaid Services (CMS). www.cms.gov

Demonstrating meaningful use is the key to receiving the incentive payments but it is not the driver of the key objectives of the program which relate to achieving health and efficiency goals. The recovery act specifies three main components of meaningful use:

• The use of a certified EHR in a meaningful manner (e.g.: e-Prescribing);

• The use of certified EHR technology for electronic exchange of health information to improve quality of care; and

• The use of certified EHR technology to submit clinical quality and other measures.

Once established, providers must demonstrate meaningful use of their installed system for 3 months prior to becoming eligible for any financial incentives. For hospitals there are a total of 24 meaningful use objectives. There are 14 core objectives that are required and a remaining 5 that may be chosen from the list of 10 menu set objectives. Facilities that are on the leading edge of this change process may become eligible for the financial incentives beginning in mid 2011.

The Real Objectives

Although the government is providing financial objectives to incentivize providers to develop an EHR solution, the real objectives of the program are as follows:

• To improve the quality, safety and efficiency of care while reducing disparities; • To engage patients and families in their care;

• To promote public and population health;

• To improve care coordination; and

• To promote the privacy and security of EHR’s

In practical terms those goals relate to such things as reducing medication errors due to the inability to read a physician’s handwriting, or eliminating duplication of tests because the results of previous tests do not easily follow the patient as they seek care in multiple locations. Health care leaders must meet the criteria to

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to locate information, make rounds on my patients, order medications and establish routine order sets, etc. Nurses have their own issues related to availability of computer terminals, ease of documenting nurse’s notes and accessing test results. Intimate involvement of the key stake holders in the evaluation and implementation process is a major factor in success or frustration.

One Size Does not Fit All

Clearly there are differences in capabilities and resources in a 25 bed critical access hospital and a 700 bed medical center. The former often has very little on site information technology (IT) personnel and support unless they are part of a larger health system. Larger institutions often have a full complement of IT support and have different needs when it comes to EHR implementation. For this reason, when evaluating vendors, health care executives should look for a total solution which has a menu of options to choose from that can be customized to the specific needs of the client. This could range from a total outsourced solution

for smaller hospitals to working in a support capacity utilizing existing resources in a larger facility.

Choosing the Best Option

There are a number of qualified companies with viable EHR solutions to pick from. When choosing a vendor it is important to consider these meaningful thoughts beyond meaningful use.

• The software must be certified;

• The vendor must have an efficient process of meeting meaningful use criteria;

• System costs should be structured to minimize total costs while taking advantage of positive adjustments in Medicare Cost Reports (for critical access hospitals) or enhancing payments to larger facilities;

• Total costs of the implementation should be calculated. Is this an all inclusive package deal for a defined period of time, or will there be ongoing maintenance and upgrade costs? Beware of a low acquisition cost followed by expensive upgrades;

• Are financing options available that meet your needs? and;

• How will your system be supported and maintained and how will it interface with existing systems?

qualify for the incentive payments but then clearly focus on how an EHR can improve quality and lower costs in their organizations.

The Change Process

Health care executives must realize that implementing an EHR requires understanding of the change process as well as a commitment to a “total solution” and not just software implementation. The acceptance of this major change by the end users; physicians, nurses and other clinical professionals is critical to the process. Physicians want to know, how easy will it be for me

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Avoiding the “CEO Nightmare”

As we enter the age of EHR we are moving into a scenario of dependence on technology that we have not experienced to this point. The typical issues that a CEO worries about have historically related to things such as patient safety, quality measures, financial performance, medical staff relations and employee satisfaction. The CEO did not have to be concerned about how orders would be processed or patient documentation achieved because it was accomplished via people and paper. This might be a good system based on “up time” but as described earlier it does not offer the safety, efficiencies and portability of data advantages that an EHR provides. The most critical issue that CEOs should ask is, “how will our EHR system be maintained and supported and by who?” Making sure that you have a clear, professional, cost effective answer to that question will avoid the CEO nightmare of frustrated physicians and staff complaining about not being able to care for their patients.

We are entering a major era of change in the healthcare industry as it relates to implementation of EHR. It is important to meet meaningful

use criteria and qualify for financial incentives offered by the federal government as soon as possible. It is equally important however to engage in a process that takes in account the change process with the users as well as the need for a total solution that that is cost effective and meets your ongoing system support needs. Healthcare leaders that recognize these key elements will provide the best environment for serving their patients while enhancing the satisfaction of their clinicians.

BioKevin Shrake is an experienced Health Care CEO . He is a Fellow in the American College of Healthcare Executives as well as an accomplished author

and public speaker. He currently serves as the Executive Vice President and Chief Operating Officer of M*D Resources, Inc. based in Fresno, California.

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FEATURES

27

UNIONS CHEAT MEMBERSOUT OF HEALTH AND

WEALTHby Lisa Holland

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et’s start by saying that we are pro-member, pro-health and pro-wealth! Now that we’ve gone on record stating that we are not bias towards Unions, let’s talk about the health of America.

It’s not good. It’s getting worse and union members aren’t any healthier than the general population, yet they have some of the best health benefits in the nation! So, what’s wrong with this picture? Just look at the recent CDC stats on obesity…it’s appalling.

America spends more on healthcare and is one of the sickest nations in the world. You can draw your own conclusion on that fact but it’s now obvious that the amount of money in terms of benefits that are available to an individual or union member makes no difference in their health status. It’s the member that makes the difference in their personal health. If we accept these facts as correct then union members are paying huge amounts of cash to doctors, hospitals and administrators. Why not pay union members to be healthy? Yes, that’s right. It’s the concept inherent in a Consumer Directed Health Plan with an HSA. But Unions have been loath to listen to the facts. We say it’s time for the Unions to stop cheating their members out of health and wealth. Here’s how:

The facts speak for themselves that CDHP changes an individual’s healthcare behavior. McKinsey’s research and recent findings continue to show that 25% or more of members in a CDHP change their actual health behavior for the better. They stop smoking and lose weight. First year medical trend reduction is in the range of 14-17%. Health spend continues to decline as members maintain their better health status year after year. This demonstrates how improved health behaviors and lifestyle changes can impact healthcare affordability. Where does the saved money go? In a CDHP model it goes to the member’s HSA account. Cash, tax free… accumulating tax free for the use of members and their families for future medical care and retirement. Who can argue with a plan that makes members healthier and wealthier? The transfer of wealth to union members might possibly be the largest transfer in history and will eclipse any rate of pay increase that most Americans may see in the next 20 years.

L


Union leaders continue to perceive CDHP as a “take away” rather then a benefit and continue to ignore the hard facts that members on a CDHP are not only getting healthier but wealthier.

Unions have special leverage with their management and are in a position to seek this wealth transfer to their members. This is not a wealth transfer from management but from the medical establishment as a reward for just being healthy. We think it’s a no-brainer for Unions to go to management and seek a CDHP/HSA plan that pay first dollar for preventive care, then ask management to fund the first two year deductibles essentially giving members a “ZERO” deductible plan. Stay healthy and get wealthy! It’s a win/win/win situation for members, union leaders and management.

Here are the facts: 80% of members in any health plan never spend on average more than $800 a year on healthcare and that includes families. Most members will have their deductible accumulated within a year or two. For every

dollar “shifted” from a member’s paycheck to their own HSA account they will save about 42 cents in taxes while management saves about 8 cents in taxes. For example, a contribution from management of $2,000 a year saves enough taxes ($840) to pay for 80% of all workers’ healthcare in any one year. Re-routing tax dollars for the benefit of union members seems to be a good idea too.

New point-of-service adjudication and payment technology now makes the implemention of a CDHP with HSA a hassle free experience for members, since members no longer get reams of bills at home nor have to deal with a debit card. Just walk in, get treated and walk out. It’s Simple. Imagine a system that enriches the union member with tax savings, tax free dollars, a “zero” deductible plan, paid preventive healthcare, additional money for retirement, no more bills at home and that actually can make the member more healthy while at the same time saving management money that makes the Union leaders look like heroes. The time has come for

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Unions to take a real close look into the world of CDHP.

About Simplicity Health Plans

Cleveland, Ohio - Simplicity Health Plans is the best implementation of a CDHP/HSA. It aligns the interests of the Employer, Employee and the Provider to provide a turn-key, fully integrated Consumer Directed Health Plan. It also delivers a low cost, scalable solution to control claim costs. The Plan fuses unparalleled technology, point of service adjudication, real-time data, and first of its kind anti-fraud controls. Services include an ERISA compliant health plan, HSA administration and banking, medical claims administration, TPA functions, pharmacy, dental & vision, COBRA, stop loss reinsurance, real-time Utilization Review and Case Management, Health Coaching, Comparison Shopper, Health & Wellness programs, and a host of on-line tools for Providers, Employers and Members.

Bio

Gregory J. Hummer, M.D., has spent the last 18 years developing and perfecting Simplicity Health Plans to solve the vexing complexities, out-of-control costs, burdens and inefficiencies that are associated with healthcare coverage in America today. Dr. Hummer is chairman and CEO of Simplicity Health Plans.

Lisa M. Holland, RN, MBA has been in the healthcare care industry for over 18 years and held senior level positions within

major healthcare organization in the US. Lisa is an accomplished business development professional. Lisa’s professional objective is to promote appropriate utilization of healthcare services/solutions that empower healthcare consumerism.

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Connecting Employee Health to Voluntary Discount Dental Plansby Nicole Ropiza

Studies and word-of-mouth in recent years have brought much needed attention to the connection between dental care and a person’s overall health.

According to the Academy of General Dentistry, more than 90 percent of all systematic diseases have oral health symptoms. Poor or lacking dental health may have negative effects on a range of diseases and conditions, including diabetes, osteoporosis, heart attack, stroke, pregnancy and pre-term birth weights.

In addition, a report in Dental Health Magazine from February 2011 goes on to read, “People with gum disease are almost twice as likely to suffer from coronary artery disease as those without gum disease, according to the American Academy of Periodontology.”For those who religiously keep up with their

dental hygiene ; brushing twice daily, flossing daily and scheduling semi-annual dental checkups, the preventive care and daily dental hygiene habits can help them avoid some major out-of-pocket dental expenses tomorrow.

Proper dental care can also help keep employees at work. Considering that lost work due to dental problems equates to 164 million hours of employee productivity each year, according to the U.S. Department of Labor’s Bureau of Labor Statistics.

But sometimes, dental health is not as simple as just brushing, flossing, chewing sugarless gum and so on. You might need a cavity filling or root canal and our children might need braces. And, sometimes our mouth

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is a major investment not covered by employer-sponsored insurance plans.

Meanwhile, the cost of dental care procedures is rising faster than you can say “commission.”

According to a 2010 report from Pew Center on the States, the total annual spending for dental care is expected to increase 58 percent, from $101.9 billion to $161.4 billion, through 2018. Coincidentally, a 2009 poll by Harris Interactive and Health Day found that 50 percent of uninsured Americans skipped necessary dental care visits due to financial burdens.

The fast increase in dental costs and lack of dental coverage has prompted some workers to get creative with their dental care budgets. A few money saving dental care solutions that have hit the newscycle in recent years include: visiting local university dental schools for dental care at a fraction of the cost; heading overseas for a dental vacation and discount dental work in countries like Costa Rica and Tijuana; and negotiating with dentists to find a discount wherever possible.

Employees More Conscious of Employer Dental Benefits

Other media reports in recent years, including the New York Times, “How to manage dental costs, with or without insurance” and BankRate.com, “Dental insurance or discount plan,” have brought attention to the struggle against high dental expenses and the growing gap between employers and dental benefits.

These days, the reality is that many employer-offered health care plans do not include dental coverage or offer it as a supplementary benefit. According to the U.S. Department of Labor’s Bureau of Labor Statistics, only 48 percent of

workers have access to employer-offered dental plans, compared to the 74 percent of workers with access to similar medical coverage. As many companies do not offer dental coverage and are considering insurance cuts in response to a questionable economy and newfound financial strategies, dental benefits are beginning to play a major role in employers attracting and retaining workers. Dental is the third most requested benefit after major medical insurance and retirement benefits, according to a report by LIMRA. And nearly 80 percent of workers participate in benefit programs if dental care is part of the program.

Giving employees an option and resources for dental plans is an investment for companies. Employees with dental benefits are more likely to take part in preventive dental care, contributing to their overall health and well-being. According to a recent survey by The Long Group, 83 percent of employees with an employer contributory dental plan visited the dentist twice or more a year.

Brush Up On Voluntary Discount Dental Plans

Some companies find employer-paid dental programs too expensive and not necessary to their employees overall health and well-being.

And while employers discuss how best to respond to cost challenges and the anticipated effects of health care reform, voluntary dental plans are becoming an alternative for companies to share with their employees and save on health care costs. But, let’s say for instance “Company A” offers a mom of three a full-time job with a healthy base salary, halfway decent medical insurance, a 401k program to participate in and no dental insurance. The mom considers the offer and reviews another opportunity with

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anticipating a cavity filling or two this year. She decides to go with “Company B,” knowing that she will take advantage of the voluntary discount dental plans for her family and save money in the long-run versus paying out more of her salary. She also knows that she’ll be more productive at work without having to worry about how she is going to afford her son’s orthodontist bill, which can cost up to $7,000 without any benefits. With voluntary discount dental plans, employees and families typically pay an annual membership fee that gives them access to discount dental dentists have agreed to offer at dental care services at discounted rates. Major providers, such as Aetna and Cigna, offer plans where savings can range from 10 to 60 percent on routine exams, x-rays and costly dental procedures.

Voluntary discount dental plans are not dental insurance. Employees and families typically pay an annual membership fee starting at $79.95 per year for individual employee and $129.95 per year for families. Plans also activate within three business days, without paperwork hassles or health restrictions.

Plans do not have annual limits and can be used as often as needed, which offers employees a choice and affordable alternative to dental insurance while they choose the plan that best fits their needs. Some plans can also be used for procedures such as cosmetic dentistry, and may include discounts on vision and prescription

drugs.

As a solution for employees and employers, voluntary discount dental plans can help companies cut costs while providing workers with an option to manage necessary dental expenses. It also gives brokers an alternative to provide clients who want to cut dental benefits as a whole.

And the next time the sensitive topic of no help with employee dental care comes up for your client, they could say, “We do not provide employer-paid dental plans, however, you can join a voluntary discount dental plan with access to significant savings on dental care procedures for you and your family. And you have the flexibility of choosing an affordable plan without annual limits.”

BioNicole Ropiza is the broker/affiliate and group manager at DentalPlans.com. The leading online source for discount dental plans, DentalPlans.com connects individual, family and group members to significant savings on dental care procedures such as cleanings, braces, root canals and crowns. The company offers more than 30 of the leading regional and national discount dental plans with more than 100,000 participating dentist listings in combined networks across the country. For more information and to find a discount dental plan that fits your family’s needs, visit www.DentalPlans.com.

For more information about a turnkey sales solution for insurance brokers to fill the growing need for affordable dental care, visit www.DentalPlans.com or call 1-888-632-5353 choose option 5 for brokers and 6 for groups or email [email protected].

“Company B,” which will provide everything that “Company A” will, as well as voluntary discount dental plans.

The mom weighs her options while considering one of her sons is going to need braces soon and she’s

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Pharmaceutical Importation ~ Logical, Legal, Safe

harmaceutical costs, especially those for brand name, maintenance drugs, have been a primary driver of health

costs and, in turn, health insurance costs, for well over a decade. Interestingly, the costs for these drugs vary widely around the world and are on average 44% higher in the United States than elsewhere. That’s 44%! Countries with centralized, single-payer health systems are able to negotiate lower prices for drugs than are the myriad of insurance companies in the US.

However, the lost revenue from lower prices paid by the single-payer countries is simply shifted to payers in the US. Effectively, the US is subsidizing the research and development ventures of the drug companies more than their single-payer counterparts. Given free markets, this is not a sustainable business model.

As pharmaceutical costs have risen, more and more Americans have begun sourcing their brand name, maintenance medications from countries enjoying the lower price structures. As Americans, we have the right to source legitimate prescriptions, for personal use only, from whatever country we choose. Over the past decade a small industry of importation management companies has evolved.

One of the more interesting developments in this industry applies to self-funded, ASO

by J.J Summerell

health plans. Because the FDA stipulates that pharmaceutical importation must be voluntary and for personal consumption only, ASO plans can give employees the option of participating in these plans. The advantages of such an arrangement accrue to both employer and employee:

• The employer pays the lowest price available in Tier 1* countries, usually a savings of 35% to 55%.

• The employee no longer is responsible for the co-pay. This can be a significant savings for a family with multiple co-pays on brand name maintenance meds.

The remainder of this article will discuss what is involved in implementing one of these plans, including Prospective Accounts, Products and Pricing, PIM Company Analysis, Projected Savings, Future Implications and Legal Substantiation. Prospective Accounts

Only self-funded, ASO (administrative service only) groups are allowed to participate and employees can only participate on a voluntary basis. Fully insured groups are ineligible.

The reason ASO groups are eligible is because they are acting as individuals. That is, with no underlying true insurance on the group and participation only on a voluntary basis participants are legally acting as individuals. This is discussed in more detail within the links under “legal substantiation.”

Generally, group size should be 100+ employees. Older employees consume more maintenance drugs, thus increasing

P

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participation. Ideally, an older employee population is better. Employee communication is paramount to the success of the program. Employees need to be assured that the imported drugs are authentic and will be delivered reliably. Most groups experience about 30% participation initially, growing to 60%+ within a few years.

Products and Pricing

The formulary of the IPP is quite important, both what is provided in the formulary as well as what is not provided. It is important for employees to have the widest possible range of drugs available that may be prescribed by a doctor. However, it is equally important that

the IPP not give employees access to:

• Narcotics. Scripts such as Valium, etc may be prone to theft.

• Illegal drugs.

• Drugs not specifically approved by the FDA for use in the US. Many drugs are approved for use in other countries but not the US. Such drugs may be available for importation but their availability ‘muddies the water’ for both the FDA and the IPP.

• Immediate needs drugs. If a patient needs antibiotics, they do not want to wait 5 days for delivery. These meds should be sourced through the traditional PBM.

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Pricing is at the crux of the matter. Consider the top ten medications shipped by a leading IPP:

These are the same products, from the same manufacturers, as those available via the traditional PBM. The only difference is with Nexium, whose US advertising firm had the color changed to purple for promotional reasons.

In the rest of the world the ‘purple pill’ is pink! Otherwise, they are the exact same drugs.

Company Analysis

There are no long-established players in this market because it is so new. There are a number of firms which have targeted the individual market for over a decade, but the ASO market is just beginning to develop. No doubt, these plans are ‘pushing the envelope’ with the pharmaceutical manufacturers and regulatory bodies, but their objections appear to be negated by various pieces of legislation; points of law and precedent (see ‘Legal Substantiation’).

Look for an IPP’s ability to source meds from the top 4 Tier 1 countries: Canada, United Kingdom, New Zealand and Australia. Prices vary from country to country and you need to provide the lowest possible cost. As noted above, it is not advisable to contract with companies who also provide narcotics via overseas sources, even if

these narcotics are legal and legitimate. They are a target of criminals which you need to avoid.Another critical need is top notch customer service. Although the importation of scripts is legal for personal consumption, occasionally US Customs will intercept a 90 day supply and deem it not for personal consumption since it is for more than 30 days. In this case, the IPP should be willing to overnight a replacement script to the employee. US Customs interceptions occur in less than 1% of shipments but it is a situation which needs to be addressed.

Managerial and financial capacities are important but difficult to determine, again because of this being an ‘infant industry.’ IPP’s which have addressed the individual market have the most experience at sourcing and distributing the meds, but very few have long

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term experience list-billing the client company and providing superior customer service in the HR arena.

The best bet is to look for an IPP which has been in business the longest, has the widest possible formulary of non-narcotic maintenance meds and the administrative resources to make the program simple and successful.

Projecting Savings

Savings to an employer will depend upon the number of employees, the use of brand name maintenance medications and participation in the program. For example, Schnectady County (NY) projects an annual savings of $1.3 million + for their 2,300 employees in 2010 after 6 years of offering the program, an average savings of $565 per employee .

Muncie (IN) is saving $586K per year on their 750 employees, an average of $780 per employee.

How much can any individual employer expect to save? It depends, but contact me and I will share an Excel spreadsheet which will estimate

the savings. A utilization report from the current plan administrator will give the most accurate projections.

Future Implications

This may well be a temporary industry. That is, once a significant amount of meds are purchased overseas, the pharmaceutical manufacturers will adjust prices globally to address the imbalances, rendering IPPs unnecessary. However, for the next several years this is an excellent option to show prospects which other brokers may not even be aware of.

Legal Substantiation

Is this legal? The regulators and legislators have been intentionally vague on the subject. I am not an attorney and will simply use links to give readers an overview of legislation, points of law and precedents. Seniors living in the United States along the Canadian border have

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their scripts from Canada for years. Brokers and human resource managers should consult their attorneys regarding their individual situations.

Joe Morris is the attorney for a leading PIM. Mr. Morris was Assistant Attorney General under President Reagan and a lead negotiator for the United States with NAFTA, the North American Free Trade Agreement. His opinion is that pharmaceutical importation, on an individual basis and with a legitimate prescription, is protected by NAFTA. The FDA has not disagreed. Mr. Morris, interestingly, has recently served as Hearing Officer in Rham Emmanuel’s residency hearing regarding his eligibility to run for mayor of Chicago.

An April 2004 statement by William Hubbard, Associate Commissioner for Policy and Planning for the FDA is here. These statements were prepared for the Senate Committee on Finance, subcommittee on Health Care and International Trade.

The Council of State Governments issued a report, Prescription Drug Importation, in 2004, in response to inquiries from state and local governments.

WebMD researched the subject in an article The Letter (and Spirit) of Drug Import Laws.

Pharmaceutical importation can be a powerful tool in the effort to reduce health care costs in self-funded, ASO health plans. Though the

legality has been questioned, the regulators and legislators have opted not to pursue the matter and there is a ‘deafening silence’ from the courts on the issue. Until conclusive decisions are handed down from DC, these programs are a terrific way of opening doors to new accounts and allowing employer’s immediate savings on their pharmaceutical utilization.

BioJ.J Summerell manages Worksite Insight, a benefits communications and enrollment firm in Greensboro, NC. An independent general agency, Worksite

Insight markets exclusively through brokers and agents. Worksite Insight also owns Easy Benefit Statements, LLC, a software product sold to benefits brokers and human resource departments. Past President of the Greensboro Association of Insurance and Financial Advisors, Summerell currently serves on the Board of Directors of the Greensboro Society of Financial Service Professionals. Mr. Summerell earned his Masters in Business Administration from Wake Forest University and has industry awards include the Frederick W. Joyner Distinguished Service Award, the W.H. Andrews Member of the Year award, qualification for the Leading Producers Round Table and Golden Eagle awards.

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Best practices a PBM can implement to reduce abuse and cost

On-the-job injuries often involve chronic pain for injured workers and long-term liability for workers’ compensation self-insured payors. Many times, pain from a chronic injury is treated with narcotics. According to the 2010 Progressive Medical Drug Spend Analysis, narcotic spending accounts for 34 percent of workers’ compensation medication expenses. And while narcotics can be beneficial in the treatment plan for a patient in pain, there are serious risks involved when they are not used properly.

The Centers for Disease Control (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) both indicate increasing misuse and abuse of narcotics over the past decade. SAMHSA data shows that there was a significant increase from 2000 to 2006 in the treatment of substance abuse

cases related to abuse of opioid analgesics. In addition, another study co-released by CDC and SAMHSA found that emergency room visits linked to non-medical use of narcotics rose 111 percent between 2004 and 2008.

Risks Associated With Narcotics Abuse

While narcotics are considered safe and effective if used properly, they have the potential for leading to addiction and abuse if their use is not monitored and controlled. Misuse and abuse of narcotics represent three areas of particular concern for workers’ compensation self insurers including:

▪ Potential for serious health risks

▪ Higher percentage of medical expenses as claims age

▪ Risk of litigation

As the cost of prescriptions ─ including narcotic medications ─ directly impacts the cost of a workers’ compensation claim,

Reducing Narcotics Abuse in Workers’ Compensationby Tron Emptage

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insurers are looking for ways to quickly get control of cases of misuse and abuse. One of the most efficient ways to manage narcotic use in a claimant population is to partner with a pharmacy benefit manager (PBM). A PBM can clearly define a strategy for proactively and effectively monitoring narcotics. These plans and strategies help payors ensure injured worker safety and reduce expenses.

Best Practices to Reduce Narcotics Abuse and Manage Expenses

Forming a partnership with a PBM can provide workers’ compensation self insurers a valuable resource in controlling narcotics use and thereby reducing risk for all stakeholders. There are several key best practices that can be deployed by PBMs to assist self-insured payors.

Best Practice #1: Defining a strategy

Getting control of narcotics usage requires a well-defined strategy. Once the PBM reviews the prescription history, it should be used to develop a customized narcotics strategy for each medication plan to identify which medications are appropriate for the injury type and body part. They also account for proper duration of use and quantity limits.

Best Practice #2: Capturing prescriptions at first fill

When new claims are filed, it is important to capture when and what type of medication is filled at the onset of injury. PBMs should have in place a mechanism to capture this prescription information. Often these early prescriptions begin telling the story of the medication history and medication therapy to come. One method to capturing this data is through First Fill cards. These cards are typically distributed by the employer to the injured worker at the point of accident or injury. To ensure that both employers

and injured workers use the program, PBMs should offer training programs on their use.

Best Practice #3: Offering home delivery programs and retail drug cards

Both retail and home delivery programs provide the workers’ compensation self insurer an effective means to monitor and control an injured worker’s medication utilization. They also provide self-insured payors an opportunity to fully leverage pharmacy network participation and discounts, thereby reducing medication expenses.

Retail drug cards. When an injured worker requires additional medications, a retail drug card program will give the self-insured payor control over what, when and where the prescriptions can be filled.

Home delivery programs. A home delivery program offers the injured worker the convenience of ordering prescriptions online or on the phone while providing the workers’ compensation self-insured payor the ability to engage in proactive utilization review programs. They also give the self insurer a mechanism to educate injured workers on the risks associated with narcotics through direct interaction with the pharmacist dispensing the injured worker’s prescriptions.

Best Practice #4: Managing prospective and concurrent narcotics utilization review programs

The PBM should have a clinical management process to govern narcotics utilization that is managed by clinical pharmacists. The clinical drug utilization review (DUR) program should use a combination of evidence-based guidelines, peer review journals and recommendations provided by government organizations. Both

53


prospective and concurrent review processes are essential to a successful program:

Prospective utilization reviews. A prospective program allows all involved parties to plan for future outcomes with up-front information. Historical data and practices guide future decisions at the establishment of the PBM relationship. This prospective process allows for the achievement of cost control and utilization control.

Concurrent utilization reviews. The PBM triggers concurrent alerts to inform the dispensing pharmacist about possible reasons a prescription should be questioned further prior to filling. These point-of-sale alerts may establish behaviors that could indicate abuse involving the use of multiple pharmacies and physicians for different narcotics or excessive early refill attempts. The messaging from the PBM ensures that prescriptions for narcotics will not be fulfilled at the point-of-sale unless the medication is allowed or the PBM receives authorization from the self-insured payor.

Best Practice #5: Conducting retrospective drug utilization reviews and clinical intervention programs

Retrospective reviews. After a prescription is fulfilled, a PBM’s clinical pharmacist team should audit these prescriptions for indicators of inappropriate use. Indicators often include:

▪ Sole use of narcotics as treatment

▪ Multiple physicians

▪ Use of multiple short or long acting narcotics

▪ Excessive duration and use

These types of utilization review programs are essential to maximize the effectiveness of a narcotics usage strategy and are most effective when leveraged in conjunction with prospective and concurrent drug utilization reviews. PBM programs should be flexible enough to allow for customization of review requirements for clients, as client goals and objectives often vary even within organizations.

Physician monitoring. A PBM should continually monitor the use of multiple physicians by one injured worker.

The physician monitoring program should be based on established best practices and contain multiple components including:

▪ Monitoring for appropriate medication utilization using evidence-based published therapeutic guidelines

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▪ Overseeing prescribing patterns at the physician level to establish appropriate/inappropriate use of brand name medications when an FDA-approved generic equivalent exists

▪ Participating in mandatory and voluntary state reporting programs that monitor for excessive prescribing patterns

Clinical intervention programs. The PBM should have a range of clinical intervention programs to assist a client with evaluation needs. The range of programs should consist of registered pharmacists, nurses and other health professionals available for consultation on medication questions to more detailed evaluations including peer reviews and direct consultation with prescribing physicians. The PBM’s clinical intervention team should provide recommendations for specific claims that require further evaluation through the use of the information gathered in prospective, concurrent and retrospective review processes.

Best Practice #6: Providing ongoing consultation

A quality narcotics utilization program is an essential component of controlling narcotics use. To ensure the utilization program is effective, the pharmacists managing the programs should take proactive measures to continually expand utilization review programs as the workers’ compensation industry evolves. As changes occur, they should also be available to consult with clients on how to adapt their DUR programs accordingly.

Best Practice #7: Validating narcotics use through reporting

If a DUR program is successful, there will be

a reduction in unnecessary medication usage, including narcotic use. A PBM should easily be able to validate those reductions through a wide range of real-time and ad-hoc reports.

User-run reports. The PBM should offer a tool that gives a client an option to run a wide range of reports to gain an in-depth understanding of all activity. To maximize the effectiveness and ease of use of the reports, the PBM should ensure the reports are categorized into varying levels depending on how the reports will be used.

Management level users should be able to run reports to assist with managing the claims professional, such as a report that provides exception or override information as well as a report that provides details on actions sent to the PBM.

Other available reports should include: savings reports that can be sorted by a range of time periods, jurisdictions, groups and/or branches, pharmacy network utilization and savings reports, generic efficiency and opportunity, as well as a wide range of trending reports including top prescribing physicians, top therapeutic classifications, top pharmacy medications, top ICD-9, top injury type and reports detailing prescribing physician habits.

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Drug utilization review report. To provide information on savings achieved as a result of the program, the PBM should have a detailed DUR report. This report should provide information on savings achieved as a result of the program and should document savings in distinct areas rather than broad categories in order to provide the complete picture of DUR activity.

Ad-hoc reporting. The PBM should have the ability to supply ad-hoc reports to assist with narcotic utilization management. If the PBM captures the data, then the PBM should be able to provide reports based on those data elements.

Best Practice #8: Reduce Out-of-Network Bills

A high number of out-of-network bills can lead to issues with managing utilization of narcotics. Not only are individual out-of-network bills typically higher than those in-network, they are often not included in the utilization process. It is vital for payors to have a process in place for properly driving those bills back into the network. This can be done by working with a PBM that offers both paper and electronic out-of-network bill solutions. This will ensure that critical injured worker data on number of prescriptions, duration of therapy, doctor information and other related factors are captured to better monitor utilization.

However, the best method for controlling out-of-network bills is to make it easier for the injured worker to go in-network as early in the life of the claim as possible by utilizing First Fill cards, which are distributed by the employer at the onset of the injury. Two other strategies for reducing out-of-network bills are home delivery and retail drug card programs.

Summary

It is expected that narcotics will continue to play a role in treating pain in workers’ compensation, so self insurers must take proactive measures to reduce misuse and abuse. By doing so, they decrease risk for litigation, improve injured worker safety and obtain more control over medication expenses.

By partnering with a PBM, workers’ compensation self-insured payors can put an effective narcotics utilization strategy into place. A relationship with a strong PBM partner experienced in workers’ compensation will enable the self insurer to not only monitor utilization but stop point-of-sale fulfillment of unnecessary narcotics.

Bio

Tron Emptage is Chief Clinical and Compliance Officer for Progressive Medical, a leading provider of cost management solutions for the workers’ compensation and auto no-fault industries. Emptage can be reached at [email protected].

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Corporate Wellness Magazine

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