Returning to the Workplace Amidst COVID-19...2020 NFP COVID-19 RETURN TO WORK SERIES 3 Ronald S....

Returning to the Workplace Amidst COVID-19Recalibrating Work and Health in the New NormalChallenges and Practical Guidance

Ronald S. Leopold, MD, MBA, MPH, Medical Advisor and Consultant– Atlanta

Please note that the following is intended to be used for general

guidance purposes only — it is not intended to constitute legal

advice, nor is it a dispositive position on coverage. Each claim is

subject to review by the applicable insurer and coverage is

dependent upon the terms and conditions of your specific

insurance policy.

2020 NFP COFID-19 RETURN TO WORK SERIES 2

2020 NFP COVID-19 RETURN TO WORK SERIES 3

Ronald S. Leopold, MD, MBA, MPHMedical Advisor and Consultant

www.ronleopold.com

[email protected]

Dr. Leopold brings expertise on a variety of benefits-related topics, including high medical cost drivers, medical and pharmacy claims analytics development, go-to-market strategies for health innovators, and value on investment determinations for health and medical solutions.

Dr. Leopold provides advice and consultation in the following areas:

• Medical cost containment strategies and solutions for employer plan sponsors.

• Data analytics reporting development and analysis for medical and pharmacy claims.

• Medical necessity determination review and analysis.• High cost claimant strategies and solutions.• Global medical benefits and cost containment strategies.• Health care innovation, including precision medicine, condition

management and digital health.• Employee health and productivity; and integrated benefits.

His recent book on the future of employee benefits entitled The Benefits Edge: Honing the Competitive Value of Employee Benefits has been described as a blueprint for benefits strategies. He is also the author of A Year in the Life of a Million American Workers, an almanac of absence data, in addition to numerous by-lined articles in the benefits media.

http://www.ronleopold.com/

mailto:[email protected]

Agenda


• The New World Order: Next 5 Months, Next 5 Years

• 5 Megatrends Accelerated: Course Corrected, New Trajectories

• 5 Dimensions of Work and Health: What We Focus On and Why

• 5 Dimensions of Work and Health The New World Order

THE NEW WORLD ORDER

The Next 5 Months, The Next 5 Years



• This is the greatest world disruption of our lifetime.

• We collectively face greater uncertainty than at any other time in our lives.

• There is no surefire recipe for businesses.

• There is, however, scientific guidance which must be incorporated into multi-disciplinary planning.

• This is a public health event.• This is an economic event.

THE PANDEMIC

2020 NFP COVID-19 RETURN TO WORK SERIES


THE WORKPLACE

• Shelter in place has disrupted all businesses in this country.

• Every industry has been impacted in unique ways.

• Social distancing is a logistics problem in many workplaces.

• The risks of transmission are front of mind for every employer.

• Compliance and regulations are of paramount concern.



THE WORKFORCE

• Peoples’ lives have been upended in an unprecedented way.

• Employees and their families are stressed, afraid and exhausted.

• People are avoiding seeking medical care.• More employees are financially strapped.• People need to work.• People are terrified to go to work.



5 MEGATRENDS ACCELERATED

Course Corrected, New Trajectories


VIRTUAL MEDICAL CARE and TELEMEDICINE

We are witnessing a juggernaut of telemedicine, virtual care solutions, tele-pharmacy, mental health applications, dermatology care, physical therapy, follow-up patient visits and chronic condition management.

10


Digital Health

• Healthy Lifestyle• Personal Health Care• Diagnostics• Genomics• Pharmacy Price Transparency• Digital Insurance Tech• Condition Management• Health Care Delivery


The New Healthcare Consumerism

On-demand insurance solutions

Price Transparency

Insurance Tech

Deconstruction of one size fits all

Quality Transparency

Risk Shift

New Health and Medical Technologies

• Digital Medicine• Digital Therapeutics• Genomics• Pharmacogenomics• Medical Devices• Specialty Medicines• Decision Support• Regenerative Medicine• Epigenetics and Biomics• Medical Imaging

Screening and testing.


The Workplace Rebooted

• The Digital Revolution was already impacting nearly every aspect of how we work and how we manage our workforce.

• There has been a groundswell of start-up activity in virtual tools, programs and services that enable greater flexibility.

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5 DIMENSIONS OF WORK AND HEALTH

What We Focus On and Why



5 Dimensions of Work and Health

WELLNESS AND PREVENTION

ACCESS TO CARE CONDITION MANAGEMENT

MEDICAL COSTS SAFETY


Wellness and Prevention

Healthy LifestyleHealthier lifestyle choices pay dividends over time. This has been a major focus for many employers over the past decade.

Risk MitigationTargeting high risk attributes and behaviors can improve health outcomes and reduce costs.

Stress ReductionFocusing on mental health and true well-being requires addressing emotional concerns, relaxation and general complacency of employees.

Disease PreventionChronic conditions benefit from early intervention. Programs that narrow gaps in care and provide multi-channel support help employers mitigate progression of disease.

Well-beingA focus on workforce financial, spiritual and interpersonal well being has been growing in importance for more employers.


Access to CareTelemedicine

and Virtual Care

• Broadening where, when and how medical care is delivered has been increasing over the past 5 years.

Retail Medicine and Urgicenters

• National chain and regional players are commercializing delivery of convenience and primary care.

Onsite Solutions

• A focus for employers with larger populations in one area or facility include onsite clinics and visiting health care professionals.

Digital Health

• Digital applications are becoming a more fundamental part of how we find a doctor, make an appointment and interact with health care providers.

Benefits Design: Utilization

• How you address incentives and affordability of medical care can greatly influence how your covered population accesses care.


Condition Management

Cardiovascular and Diabetes Strategies

Orthopedic and Musculoskeletal Strategies

Mental Health Strategies

Cancer Strategies

Other Condition-Specific Strategies


Medical CostsBenefits Design: Costs Value-based design, richness of benefits and clinical

coverage considerations all come in to play.

High Cost Claimant Management 3% of members drive 56% of costs.

COEs and Narrow Networks Cancer, Spinal surgery, Infertility, Bariatric Surgery and others.

Specialty Medicine Strategies The number one driver of increased medical costs for most employers.

Cost Management Audits and Reviews Traditional cost management strategies often are insufficient to mitigate high cost claims.


Safety(COVID-19 Edition)

Workplace Mitigating risks of COVID-19 transmission has become a universal "high priority."

WorkforceThinking through the risks at the worksite and for job responsibilities will be a challenge for every employer.

Absence PoliciesCompliance requirements, new clarifications and well-written policies effectively communicated will be needed.

“Vulnerable Individuals”The identification and special handling of medically vulnerable individuals will be paramount.

Policies, Procedures and Communications

Ongoing vigilance of workplace, operations, benefits, absence and other policies will require a multi-stakeholder team.


5 DIMENSIONS OF WORK AND HEALTH

The New World Order


WELLNESS AND PREVENTION: LOSING GROUNDIMMEDIATE CHALLENGES: COVID-19 RECOVERY

HEALTHY LIFESTYLEAs employees shelter

in place, for many, healthy eating and

regular exercise have fallen by the wayside.

Gyms and fitness centers are closed

and food habits have been disrupted.

RISK MITIGATIONHigher risk employees

and plan members have gone largely

unchecked. People are reluctant to seek primary care and we have been in “urgent-

only” mode.

STRESS REDUCTIONIn every way, your

employees face new and greater stress. So

do you! As our daily routine and way of life

is disrupted we all face unprecedented

levels of stress.

DISEASE PREVENTION

Screening for illness and conditions have

essentially been interrupted and will

continue to lag. Primary care,

diagnostics and preventive outreach have been severely

delayed.

WELL-BEINGFor so many

American workers, money has never

been tighter. Spiritual and community

wellness have been tested more than at any time in our lives.

Good habits have been replaced with bad ones.

Higher risks withless intervention.

Unprecedented levels of stress.

Screening activity has come to a halt.

Financial Unwellness.


WELLNESS AND PREVENTION ROADMAPStra teg ies for COVID-19 Recovery

Revisit all aspects of your health and wellness communications and access capabilities. Reach out to current vendors to understand how they are shifting. Check in regularly with your workforce.

CONNECTTelemedicine is leading the charge as we look to provide mental health support to employees and their families. It is particularly well-adapted for the delivery of behavioral health support and counselling.

VIRTUAL MENTALHEALTH CARE

Leverage the platforms you’ve invested in and plan to look for others for wellness initiatives. The vendor ecosphere in this space is exploding- identify new opportunities.

DIGITAL WELLNESSEvery company is different. Your culture, workforce, and workplace are unique. Best practices exist, but a multi-perspective plan developed internally and customized to your company will be vital.

PLANNING


ACCESS TO CARE: IMPEDEDIMMEDIATE CHALLENGES: COVID-19 RECOVERY

TELEMEDICINEVirtual care and the growing number of

applications for telemedicine are now center stage. Patients

and providers are flocking to these

solutions as they emerge as a key part of the new

health care delivery.

RETAIL MEDICINEMore employers are

covering convenience care options and are

starting to promote those alternatives. Delays in care during the early

months of the pandemic will create shortages in

provider availability in the coming months.

ONSITE SOLUTIONS

For some businesses, onsite solutions create ideal opportunities to

deploy onsite screening, protection, education and health care services in the

coming months.

DIGITAL HEALTHVendors are leveraging mobile app solutions for an increasing number of functions in health care

delivery. Functional use is already accelerating- stay

ahead of the curve to enable employees and

plan members to get the medical care they need.

BENEFITS DESIGN:UTILIZATION

The annual cycle for benefits redesign does

not match employer needs in a pandemic. Waiving copays for certain services and

strengthening incentives can have a huge impact on care access during COVID-19 recovery.

The virtual care explosion.

Primary care evolutionis accelerating.

Workplace screening. Mobile apps. Incentives impact

utilization of care.


ACCESS TO CARE ROADMAPStra teg ies for COVID-19 Recovery

Review medical claims data information to understand your baseline for medical care utilization. Identify under-utilization patterns and where higher risk members are found.

REVIEWYour plan members will need to be able to access care more readily than ever. Partnering with additional providers, convenience care and virtual care solutions will help considerably.

OPEN CHANNELS

This is an era of more carrots and fewer sticks. Revisit co-pays and penalties.

RECALIBRATEINCENTIVES

The situation will change quickly. Monthly tracking of trends and identification of bottlenecks will help your teams make more informed decisions.

MEASURE


CONDITION MANAGEMENT: DECONDITIONEDIMMEDIATE CHALLENGES: COVID-19 RECOVERY

CARDIOVASCULAR AND DIABETESPatients with heart

conditions and insulin-dependent diabetics are

particularly at risk for worse outcomes with COVID-19. Many of

these employees and plan members have avoided seeing the

doctor.

ORTHOPEDICSPatients with chronic

back conditions are at much greater risk due

to deconditioning during shelter in place. Individuals depending on Physical Therapy

have had to avoid treatment and delay

care.

MENTAL HEALTHPlan members with

mental health conditions, and those prone to these conditions face serious challenges. Increases in

substance abuse and domestic conflict are known to be greatly

increasing.

CANCERPrevention and screening for cancer has come to a standstill. Treatment for

cancer requires navigating a healthcare delivery

system under construction. Patients receiving

treatments are often immunocompromised and

face greater risks.

OTHER CONDITIONS

Asthmatics and patients with other respiratory

diseases are particularly vulnerable to the serious consequences of COVID-

19. Other vulnerable patients include those with

renal, autoimmune and other chronic conditions.

Greater COVID-19 Risks. Delay in care. Surge in depressionand anxiety disorders.

Cancer screening andtreatment face obstacles.

Vulnerable individuals.


CONDITION MANAGEMENT ROADMAPStra teg ies for COVID-19 Recovery

Every condition faces unique challenges during COVID-19 recovery.

CONDITION-SPECIFIC

The performance of the major health care systems servicing your plan members needs to be closely monitored.

HEALTH CARE SYSTEMS

Programs that supplement and bypass face-to-face delivery have never been more important.

CONDITION MANAGEMENT

People have been delaying care and will continue to. Eventually there will be a flood of demand for health care services that employers should plan for.

THE DAM


MEDICAL COSTS: THE DAM IS SWOLLENIMMEDIATE CHALLENGES: COVID-19 RECOVERY

BENEFITS DESIGN:COSTS

Many employers will experience several months of reduced

medical and pharmacy costs. The pendulum

will likely swing heavily in the other direction as recovery progresses.

HIGH COST CLAIMANTS

Delays in care may alter the mix of high

cost claimants. Direct expenditures for

COVID-19 and related medical events may become a significant

part of what members generate costs over

$50,000.

COEs and NARROW NETWORKS

Targeting high quality, appropriate cost

treatment for specific conditions is

especially important during this time.

SPECIALTY MEDICINE

The unrelenting surge of specialty medicine costs will likely not ebb during COVID-19 recovery. It is

important that employers assure that

PBMs and vendors sustain their delivery and cost mitigating

efforts.

COST MANAGEMENT

It is easy to get lost in chaos. Health care

providers and hospital systems face serious economic challenges.

Monitoring medical costs will become even

more important for employers looking to

contain medical spend.

Medical costs willeventually surge.

The cost of COVID-19 care. Targeted treatment. Costs continue,

unabated.Detailed cost

audits.


MEDICAL COST ROADMAPStra teg ies for COVID-19 Recovery

Review medical claims and audit provider charges to keep vigilant: especially for high cost claims and discretionary services.

REVIEWStaying on top of carriers, TPAs, medical supply, condition management and other vendors will be critical.

YOUR VENDORSExpect unprecedented month to month variances in spend. Claim lags will widen. Benefits managers will need to vigilantly monitor activities.

ROLLER COASTEREmployee benefits planning cycles will be erratic and uncertain. Expect curve balls.

PLANNING


SAFETY (COVID-19 EDITION): UNCHARTED TERRITORYIMMEDIATE CHALLENGES: COVID-19 RECOVERY

WORKPLACEWho is required to come in to work and who can

work from home will have serious consequences.

Some industries will face especially difficult

challenges. Collaborative RTW planning

committees are key.

WORKFORCEOne of the hallmarks of

the pandemic will be the dilemma of workers

returning to work: “I need a paycheck but

I’m afraid of the risks of transmission.”

ABSENCEThe hallmark of

absence management are well-written

policies effectively communicated to

employees.

VULNERABLEINDIVIDUALS

Employers will need to understand and accommodate

employees who meet CDC Guidelines for

“vulnerable individuals.” Attention to HIPAA and confidentiality issues

will need to be considered.

POLICIES ANDPROCEDURESHow your company

operates during recovery will be significantly

altered. Employers will need to be specific about

what employees must do, what managers must

consider and what mitigation measures are

mandatory.

Every business willneed to take ownership.

“Frightened, tiredand strapped.”

Policies and compliance.

Employees withchronic conditions.

Financial Unwellness.


SAFETY (COVID-19 EDITION) ROADMAPStra teg ies for COVID-19 Recovery

Clear, comprehensible policies around work, the workplace and absence have never been more important.

DOCUMENT POLICIESToday’s policies are based on what we know to date. It is important to anticipate unexpected shifts in what you need to do.

BE NIMBLEDecisions are clearly not being made in the traditional way. Legal, compliance, medical and operational perspectives must all be at the table.

MULTIDISCIPLINARY“What were you doing when….” Take a breath. Be your best. Challenge yourself to be a leader and a force for good at your company.

CHALLENGE YOURSELF


www.ronleopold.com

[email protected]

Ron Leopold Consulting

http://www.ronleopold.com/

mailto:[email protected]

Returning to the Workplace Amidst COVID-19...2020 NFP COVID-19 RETURN TO WORK SERIES 3 Ronald S....

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