The data come from 245,055 employees enrolled in an employer-sponsored health plan between Jan. 1, 2010, and Dec. 31, 2018, of which 42,326 eventually switched to an HDHP.
“To reduce risks of selection and voluntary bias, we only included individuals whose employers did not offer a choice between HDHP and non-HDHP plans,” the study said.
The enrollees were separated into ethnic and racial categories because Black and Hispanic individuals with diabetes experience hypoglycemia- and hyperglycemia-related ED and hospital visits significantly more often than white patients. In addition, they’re less likely to enroll in health savings accounts, which can offset the costs of healthcare for enrollees.
These realities have not gone unnoticed by employers. Last April, the Northeast Business Group on Health released a guide for employers looking to tackle obesity and diabetes through a racial lens.
The JAMA Network Open study found that the detrimental outcomes caused by HDHP enrollment should encourage employers to offer a variety of benefit packages to workers and provide more transparency about costs in different clinical settings. Often, employees aren’t familiar with the details of the health plans that they sign up for and might focus on the relatively less costly monthly premiums for HDHPs.
In the wake of the coronavirus pandemic, many employers expanded their mental health benefits to improve employee wellness. However, research has indicated that more mental health benefits do not necessarily equate to a robust wellness culture, which leaves employers wondering: what is the alternative?
The pandemic delivered a severe blow to employees’ mental health. Initially, employers responded with an influx of mental healthcare benefits. More than nine in ten employers reported that they would increase mental healthcare and wellness programming in 2021.
The benefits may not have had the intended effect. Although mental health benefits multiplied, wellness culture continued to suffer.
Half of employee participants agreed with most employers that mental healthcare access had improved, but only a little over a third of employees said that this was due to employers’ resources (35 percent), according to a study from The Hartford. Less than half of employees said that their companies promoted conversation about mental health and an inclusive environment.
Meanwhile, almost eight out of ten employers said company resources were partly responsible for better access to mental healthcare. Additionally, more than 80 percent of employers said their workplace environments were open to conversations about mental health and were inclusive atmospheres.
Clearly, there is dissonance between employers’ and employees’ perspectives on mental healthcare benefits. These trends may point to the distinction between having more mental health benefits and having a company culture that promotes wellness.
Recognizing this divide between employers and their workforces, Amy Tippett-Stangler, senior vice president at Northeast Business Group on Health (NEBGH), rallied a team of fifteen executives and mental healthcare providers to address the issue. Companies including Anthem, the National Alliance on Mental Illness–NYC (NAMI-NYC), and PepsiCo converged to ascertain how employers can create a wellness culture.
“What we have heard across the board from point solutions from health plans and employers is that offering benefits is a given today, but the utilization, the engagement is a whole different story,” Tippett-Stangler told HealthPayerIntelligence. “Building the culture is certainly about communicating why you have these benefits, why they're important, but also it's about walking the talk.”
After months of conversations and workshopping, the committee came forward with a cohesive vision of what a workplace wellness culture should look like and produced a tool that employers can use to assess their internal culture around mental and behavioral health.
The committee’s first priority was to develop a mission statement. Tippett-Stangler described the committee’s goals as a pie with five slices, each slice representing the key areas that the group wanted to tackle. The five areas that the group addressed were:
However, in the committee’s first meeting, the participants recognized that a key portion of wellness culture was missing from that visual: inclusion.
“Our multi-stakeholder group committee said, ‘Wait a minute, all of those things are important, but we can't even talk about that until we address what we call inclusion—diversity, equity, stigma, belonging,’” Tippett-Stangler recounted.
The committee emerged with a new visual in which equity was central: five slices representing access to care, telebehavioral health, measurement-based care, collaborative care, and parity arranged around the goal of inclusion.
These elements are what set offering mental health benefits apart from building a wellness culture, Tippett-Stangler indicated. A company with a wellness culture will assess why employees are not using mental health benefits, what employers can do to create a safe space for employees to communicate their needs, and will be characterized by inclusion.
Once the committee had established the mission statement, they explored how to turn their vision into an actionable resource. The result was Well Gauge, a free tool that employers can use to both assess their company culture around mental health and behavioral health and to ascertain potential steps toward improving their culture.
The first step in solving any problem is understanding what the problem is. Employers who want to create a culture of wellness centered on inclusivity must first be aware of their company’s current culture and its proximity to their wellness culture vision.
One of the key challenges that employers face in assessing wellness culture is distance.
“You see it in survey after survey: the employer thinks they're doing X, Y, and Z and they're offering the moon and the stars, and employees are saying, ‘No, you're not,’ or ‘you're not hitting the things that matter to me,’” Tippett-Stangler explained.
Employers have implemented various solutions to address the mental health crisis, including offering preventive care, employing collaborative care models, and using employee assistance programs.
However, research from organizations like The Hartford and McKinsey has highlighted the disconnect between employer and employee perceptions of wellness culture. In these studies, most employers reported that their companies successfully supported employee wellness, while significant populations of employees voiced that their mental and behavioral health needs remained unmet.
These conclusions indicate that employers may be too distant from the employee experience of the company culture to identify mental and behavioral healthcare barriers.
It is crucial that employers assess the impacts of their programs and benefits and genuinely seek to understand whether these resources are meeting employees’ needs.
Well Gauge walks participants through four areas of wellness culture to provide that feedback. Participants answer questions about how mental health and behavioral health show up in the company’s communication, leadership engagement at all levels, companywide equity efforts, and their endeavors to create an environment of total health.
The survey’s 22 questions provide a temperature check on any organization’s wellness culture. While the NEBGH committee initially designed this tool for benefits managers and senior management, committee members and employers have also administered the survey among employees who are not as involved in benefits decision-making to gauge the broader experience of wellness in the company.
“One of the key things is making sure that mental health is part of the company strategy, that it is something that's talked about in earnings calls, in town halls, and it is really incorporating that language into everyone's thinking,” Tippett-Stangler said. “I have heard from some folks that have completed this survey: ‘we talk a good talk, but we're not walking it yet.’ It's baby steps. But this is a way in which we can raise the flag to say, ‘We need to do a better job in this area.’”
Insights into a company’s wellness culture are only useful if employers act on them. While Well Gauge users’ initial feedback focused on the tool’s usefulness as an assessment, the survey also offered insight into actionable steps.
“Take a moment to assess what they are doing as an organization that is meeting the employees' needs, but also what isn't,” Tippett-Stangler said. “Internal surveys to employees are great, but if you don't act on them, they're kind of worthless.”
The survey results are accompanied by a list of follow-up suggestions so employers can integrate wellness culture strategies. Tippett-Stangler highlighted three possible actions.
First, employers can ensure that mental health is incorporated into the company’s agenda, including earnings calls and annual reports. When the topic is featured in these public forums, employees might feel more confident about voicing their mental health needs.
Second, employers can ensure that ongoing training is a part of their policies and procedures. For example, some health insurers have partnered with vendors to offer educational mental health programs for employers. Through such programs, employers learn to identify and address employees’ mental health needs compassionately.
Finally, employers can engage with mental health vendors to pursue health equity. For instance, they might work with a vendor to improve access to culturally competent care. Additionally, they might partner with other organizations to expand access to mental healthcare in mental health deserts. Employers can overlay social determinants of health data over their employee data to understand regional access to care challenges and other social determinants of health barriers.
“The next step is to look at the data with your health plan partners. That can help you define what your strategy going forward should be. Where's the utilization? What are you hearing from the plan side as well as what you are seeing internally?” Tippett-Stangler said.
“From a health plan perspective, they want to offer services, they want to offer programs, expand their network, but are not necessarily sure what it is that people need and want. If you don't step back and assess that, clearly you're offering things that people aren't going to use.”
Health systems can also support employers’ efforts, particularly in expanding access to care and telebehavioral health.
The NEBGH committee is already considering ways to improve the Wellness Gauge. Tippett-Stangler hinted that a Wellness Gauge 2.0 might be on the horizon.
“While this was very rewarding work for sure and it will continue, if I could leave you with one thought it is: having all of the stakeholders represented over many, many months is remarkable because it isn't about finger-pointing, it isn't one sector's fault that the mental health crisis is what it is,” Tippett-Stangler emphasized. “The collaboration was remarkable.”
Concerned about the disappointingly low levels of COVID vaccinations in the U.S., the Northeast Business Group on Health (NEBGH) has stepped into the fray to help plan sponsors tackle the issue with their members.
“Creating a Vaccination-Friendly Culture: What Employers Can Do,” is intended to serve as a guide to develop and implement strategies to boost vaccination rates for seven medical conditions, including COVID, in employee populations, and hopefully, their families and significant others.
“The public’s mixed response to COVID-19 vaccines has highlighted the urgent need to create a more vaccination-friendly culture if we are to reap the benefits of scientific advances in fighting disease and illness in the future,” says Candice Sherman, CEO, NEBGH. “The data shows that employers are a trusted source of information and therefore in a unique position to fight misinformation, promote vaccination as an essential part of overall wellness and set an example by communicating their commitment to vaccination.”
In compiling its 40-page guide, NEBGH surveyed 103 large employers about their vaccination policies. The big picture: 85% don’t set targets for employees to be vaccinated, and 75% cite misinformation and vaccine hesitancy as barriers to boosting vaccination rates among their employees.
Other survey results:
71% of employers say they host vaccinations campaigns.
83% say they have launched vaccination communications campaigns for employees. (Far fewer have included family members or retirees in these campaigns.)
75% have reduced or eliminated out-of-pocket costs for vaccines.
33% offer vaccination incentives.
50% provide paid time off for vaccinations.
3% offer transportation for vaccinations.
To give plan sponsors and advisors a better understanding of the subject, the association’s guide includes information on vaccination history; data on uptake; racial and ethnic disparities in vaccination status and barriers to vaccination; and more.
Here are the eight steps offered by the guide to raise the vaccination rate among plan members. The guide discusses each step in detail:
“The critical focus over the past two years has been on vaccinations to fight COVID-19, but employers recognize that vaccinations against other diseases and illnesses can play a significant role in improving the overall health and wellbeing of their employees, families and beyond. And it starts with creating a vaccination-friendly culture. We are hopeful that employers will take specific actions described in the guide and work hard to boost vaccination rates in the coming years,” says Sherman.
Although health care costs are increasing, Mercer found that most employers do not plan to shift costs to their employees by raising deductibles or co-payments.
In fact, many employers are planning to expand their health benefit options in 2023, focusing on improving affordability and access. According to a July survey of 700 employers from Mercer, more than two-thirds said they planned to enhance their health and benefit offerings next year, and 61% are currently surveying employees on their benefit preferences.
Some benefits that employers are considering adding include mental health benefits, such as meditation apps and substance use treatment, and family planning benefits, such as in vitro fertilization treatment. According to Modern Healthcare, data suggests that these benefits, among others, are highly important to younger employees.
Outside of providing more benefits, some employers are working to better communicate with employees about the benefits already offered.
According to Candice Sherman, CEO of the Northeast Business Group on Health, many employees at the group's member companies do not understand the full scope of their benefit plans.
"Many of our members talk about employees saying they've got this issue, and they're surprised to learn they have benefits for that," Sherman said. "Members are focused on how to communicate and promote benefits."
In addition, Sherman said she believes businesses will focus on providing more "wraparound, holistic" benefits in the future, including more family-building resources, financial wellness, child care, gym memberships, and even pet care.
The Northeast Business Group on Health launched a new tool Thursday to help employers determine if their company provides adequate mental wellness support to their staff.
The survey tool, called Well Gauge, asks participants a series of questions through four sections: communicate a commitment to mental health, engage leadership at all levels, demonstrate a commitment to mental health equity and foster environments that support total health.
Northeast Business Group on Health’s tool comes as more employers are looking to bulk up their mental health support for employees. A recent Willis Towers Watson survey of 455 employers found that 67% are looking to make mental health and emotional wellbeing programs a top priority in the next three years. It also found that 88% of respondents have already acted on mental health in the last year, with some of their top strategies including covering telebehavioral health services, providing employee assistance programs and giving access to digital behavioral health support.
But while mental health benefits and programs are necessary, companies need to do more for their employees, Tippett-Stangler said.
“Providing benefits coverage and offering programs for mental health are essential — but not sufficient — to support employee well-being,” Tippett-Stangler stated. “Creating inclusive environments in which mental health is a priority, mental illness is de-stigmatized, and employees feel valued as whole people is central to building a healthy, productive and committed workforce.”
The cost of providing health insurance in New York in the last year is higher than the national average and could continue to rise because of worsening inflation and increasing premium rates.
A new health benefits report from the Kaiser Family Foundation that surveyed more than 2,000 employers shows that in 2022 the national average annual premium for family health insurance was $22,463, about a 1% increase from the $22,221 average reported in 2021. In the Northeast, the average cost for covering a family was $24,126, about a 2% increase from 2021.
Nationally, employers paid just under $21,000 for point-of-service plans; just over $21,000 for high-deductible health plans; nearly $23,500 for preferred provider organization plans and almost $23,000 for health maintenance organization plans. By comparison in the Northeast, those figures were all higher: employers paid nearly $22,000 for POS plans; about $23,000 for HDHP plans; just over $24,000 for PPO plans and more than $28,000 for HMO plans, which experts say can be attributed to increasing premium rates and the rising costs of health care, which are climbing more steeply in New York and New Jersey than the rest of the country.
Leslie Moran, the senior vice president at the New York Health Plan Association, pointed to insurers asking for higher rate increases within the last few years, and continuing to do so for 2023, as another indication that New York is bucking national trends.
The state Department of Financial Services, which approves insurance plans’ requests for rate increases each year, or how much the cost of paying for certain types of coverage will change reports that in 2022, insurance firms that are part of the individual market requested to increase their rates by more than 11%; companies in the small group market requested to increase their rates by 14%.
For 2023, companies requested to increase premiums by nearly 10% for insurers on the individual market and almost 8% in the small group market.
The prices New York consumers pay for their health care are already high, Moran has said, because state law requires that more than 3,000 procedures be covered by insurers, such as second opinions for cancer patients. High costs–for the employer or employee–can lead to concerns around care accessibility.
Inflation compounds the issue of rising health care and health insurance costs. The premium growth rates Kaiser collected from employers have kept pace with inflation and wage increases over the last five years, according to Matthew Rae, the associate director for the program on the health care marketplace at KFF and an author of the study. But "keeping pace” can get tricky when inflation is soaring in the city.
New York’s inflation rates squash those in other parts of the country. The Consumer Price Index shows that the price of medical care has surged in the New York and New Jersey area by 8% from Sept. 2021 to Sept. 2022. For all urban consumers in the country, meanwhile, the cost of medical care services has increased by 6.5% for the same period. The “modest” insurance cost increases from 2022 might not hold up in 2023 as inflation climbs higher, Kaiser’s report warns.
All of these factors are coming together at a time when employers are particularly concerned about staying competitive amid the great resignation–and as employees are asking for more from their benefits packages. Larger and smaller employers are handling that differently, whether it be by offering in-demand benefits such as fertility treatment coverage or by struggling to afford providing insurance at all.
A company’s size can also impact how it shares insurance costs with employees. According to Kaiser’s newest survey, in 2022 workers at small companies with less than 200 employees paid $7,556 on average for family coverage, while employees at large firms on average paid $5,580.
This trend “holds true” for many larger New York companies, said Candice Sherman, the chief executive of the Northeast Business Group on Health, a coalition of businesses and benefits providers in the region.
“Given their interest in retaining valued employees and attracting new ones, [larger] employers are reluctant to pass on any higher premium costs to employees right now,” she said.
In the aftermath of the pandemic, there is one area in which New York’s employers are sticking with national trends: mental health coverage. According to Kaiser, about 27% of employers surveyed nationally added mental health providers to their networks in 2022. Experts say that employees continue to rank mental health as one of the most important aspects of coverage, and New York employers are figuring out what to add to their packages. Many venture capital investment firms are beginning to invest in New York City startups tackling serious mental illness, as well. —Jacqueline Neber
The costs employers will incur providing health care to employees are expected to increase by 5.6% next year, according to early results from consulting firm Mercer’s latest survey of employers.
In the report, which was released June 22 and remains open, 864 employers across the nation responded by Aug. 4. The 5.6% cost increase for next year is significantly higher than the 4.4% increase that was predicted for this year, and 2023’s predictions still lag behind national inflation rates. Mercer predicted that employers have not fully felt the effects of inflation. The 5.6% prediction reflects changes employers would make to “hold down” costs.
“Because health plans typically have multiyear contracts with health care providers, we haven’t felt the full effect of price inflation in health plan cost increases yet. Rather it will be phased in over the next few years as contracts come up for renewal and providers negotiate higher reimbursement levels,” said Sunit Patel, the company’s chief actuary for health and benefits. “Employers have a small window to get out in front of sharper increases coming in 2024 from the cumulative effect of current inflationary pressures.”
Mercer does not have specific data on New York employers’ responses yet.
Eric Linzer, chief executive of the New York Health Plan Association, which works with 29 employers across the state that provide coverage for 8 million New Yorkers, said the rising costs of providing benefits are “inextricably tied” to the rising costs of health care—which won’t be going away anytime soon.
Linzer cited higher prices that doctors, hospitals and pharmaceutical companies are charging for care and drugs; ongoing costs for Covid-19 testing, treatments and vaccines; and legislative moves that drive up the cost of insurance, such as the $6.5 billion the state collects on health plan taxes annually.
Despite the rising costs, Linzer said, members of the association remain focused on providing quality care for their employees.
Survey results echo that. According to Mercer, employers are prioritizing increasing the benefits they provide next year while focusing on affordability for employees. Most employers reported they would not raise employees’ deductibles or copays. While 36% of employers said they would make cost-cutting decisions next year, that is down from 40% this year and 47% last year.
Mercer’s survey suggested that employers will not be increasing workers’ share of the cost of coverage next year. Large employers—companies with 500 or more workers—reported their employees would have to pick up 22% of health care premiums through paycheck deductions. That holds stable from this year and last year.
Candice Sherman, chief executive of the Northeast Business Group on Health, which is based in the Financial District, said the group’s members are focused on providing care that takes the impact of the last two years into account.
“Prioritizing benefits to retain and attract employees is definitely what we are hearing from our members,” Sherman said. “Employers are also keenly aware of the toll the pandemic and sociopolitical issues have had on overall employee health and well-being, including mental health, and want to ensure they are offering and communicating about a continuum of support, including a robust EAP and digital options.”
She added that making sure care is affordable for employees with lower incomes is a priority as well.
Linzer said the same for employers in his association, adding that many are trying to negotiate better reimbursement rates with doctors, hospitals and pharmacies.
Patel told Crain’s that health care costs are likely to soar next year, and Mercer expects employers will need to change the way their employees seek and get care.
“Strategies may include promoting the use of higher quality providers,” he said, “leveraging technology [such as] virtual health [and] remote monitoring and improved clinical management.”
Although Mercer said the Covid-19 pandemic’s impact on the price of care has been “fairly modest” thus far, that could change.
“We do expect that as provider contracts are renegotiated (which will be accompanied with larger increases than in the recent past), new, expensive gene and cellular therapies are introduced and staffing shortages ease, these will add to the growing cost pressures,” Patel said.
The predicted 5.6% jump in the cost of providing care next year would not be as significant as the increase in 2021, when employers’ costs rose by 6.3% to an average of more than $14,500 per employee. New York has the highest price of care per employee—more than $17,000 in 2021, Mercer reported.
Mercer, which is headquartered in Midtown, is a subsidiary of global firm Marsh McLennan. —Jacqueline Neber and Maya Kaufman
Racial disparities in healthcare have become point of focus for employers during the pandemic, not least because of COVID-19’s impacts. According to a February analysis by Kaiser Family Foundation, cumulative data showed that Hispanic individuals represented a larger share of COVID-19 cases relative to the total population, whereas Black individuals represented a slightly higher share of deaths compared to the total population.
Other diseases show similar disparate impacts. According to a March 2022 report published by the Northeast Business Group on Health, Black, Indigenous and people of color populations had disproportionate rates of obesity and diabetes. The report also found that inequities in care access were a major driver in health disparities.
What they're saying: "It's a serious issue for employers," said Candice Sherman, the CEO of the Northeast Business Group on Health. The group represents roughly 80 large companies such as American Express, Colgate, Moderna and Pfizer.