79: Percentage of employers who say caregiving will be an increasingly important issue over the next five years
In a survey of 117 mostly large U.S. employers by the Northeast Business Group on Health, more than three quarters of respondents (79%) said caregiving will be an increasingly important issue over the next five years. The survey was conducted in late 2019 and early 2020. Meanwhile, while nearly half (45%) believe they are on par with similar organizations in developing caregiving-friendly benefits, almost a quarter (22%) see themselves as below or well below average, a sign there is much room for improvement.
As millions of employees are faced with balancing work with caregiving responsibilities, companies are increasingly prioritizing benefits to help them do so.
The trend started before the Covid-19 pandemic, according to a new survey by the Northeast Business Group on Health. However, additional efforts are needed to help employers avoid higher health care costs and lower productivity.
Nearly 80% of survey respondents said they believed caregiving would be an increasingly important issue for the foreseeable future. The survey compiled feedback from 117 mostly large U.S. employers and was conducted in late 2019 and early 2020. About one-third of participants were organizations based in or near the city.
Though close to half of respondents felt they were on par with similar organizations in developing caregiving benefits, about a quarter viewed themselves as below or well below average—"a clear sign there is much room for improvement," NEBGH said.
"Caregiving is becoming an increasingly important issue, and it will become even more important over the next five years," said Candice Sherman, CEO of NEBGH. That's due in part to a rapidly aging population, millennial workers who take care of both parents and children, and gaps in the health care system for people who are ill and aging but not yet ready to enter a nursing home or other facility.
"I do think the current crisis has underlined the need for employers to be thinking about how to support their employee caregivers," Sherman added.
Data show that employees who shoulder caregiver responsibilities are more apt to have chronic illnesses, such as diabetes, obesity and cardiovascular disease, as well as mental health issues, including anxiety and depression, she said. And companies are more often recognizing that it is difficult for people to care for themselves while caring for others, which can lead to burdens on employers, such as higher health care costs.
The vast majority of survey respondents—91%—recognized that caregivers may abandon self-care, a 17% increase from a study in 2017, NEBGH said. At the same time, though more than half of respondents thought their C-suite-level executives were supportive of caregiving policies—a 14% increase from 2017—nearly 40% were not sure how supportive the C-suite would be. The latter group believed that building a strong business case for caregiving benefits would be needed to secure leadership buy-in.
Other findings from the survey were that more employers are providing paid leave specifically for caregiving, and increasing leave for caregiving and implementing flexible work arrangements were at the top of benefit managers' wish lists.
The environment for recruiting and retaining valuable employees is competitive, Sherman said. "People were really looking to see the kinds of benefits companies were offering," she said. "I also think it's helpful to understand that, even in an environment in which companies are stressed financially, there certainly are things they can do to help employees balancing caregiving."
That may include low-cost offerings such as flexible work hours, the ability to work from home, virtual employee support groups to exchange tips and best practices, and even simple guidance as to what resources are available in the community, Sherman said.
"The crisis has socially distanced people, and that means that more people are trying to figure out how to get care for loved ones who they cannot physically get close to," she added. "I would imagine there are innovators who would really be thinking about more tools and technology to help people do that."
Robert Stephen, vice president of caregiving and health at AARP, also noted the importance of employer support for caregivers, particularly during the Covid-19 pandemic. Employers are a valuable source of information for caregivers to stay connected to and a source of potential benefits, he said.
AARP provided financial support for the NEBGH survey and earlier this month launched a portal for caregivers looking for additional resources during the pandemic.
Though AARP has focused on support for caregivers for decades, when the coronavirus hit, it realized things were going to shift a great deal, Stephen said.
Some of the areas of work have been self-care, guidance on loved ones in nursing homes and long-term-care facilities, and telehealth temporarily covered in part by Medicare, he said. Additionally, he said he believes the pandemic may lend greater awareness to some of the day-to-day challenges caregivers face.
Those can include feeling isolating and experiencing financial woes during normal times, Sherman said.
"Caregiving will only become more important over the years to come," she said. "We think about it as the tip of the iceberg." —Jennifer Henderson
Diabetes is seventh on the list of leading causes of death in the U.S., according to 2017 data from the Centers for Disease Control (CDC). The CDC's "crude estimates for 2018" show a total of 26.9 million people in the U.S., or about 8%, had diagnosed diabetes. But the agency also estimated an additional 7.3 million adults ages 18 and older who met criteria for diabetes were not aware of or did not report having diabetes.
The risk of developing prediabetes and Type 2 diabetes is affected by a variety of factors, which can be exacerbated by low income, according to NEBGH. The group's guide pointed to research showing that low wages "are frequently associated" with living in poorer communities, food options that are high in salt and sugar, and working in "food deserts" where healthier food options are scarce.
Good health benefits are essential to attracting top talent, but for employers, this comes at a price. An initiative by the Northeast Business Group on Health estimated that US employers spent $125 million on cancer care in 2015, or 12% of their entire healthcare spend.4 Cancer therapy costs have increased substantially since then, with the expanded use of immunotherapy, including the introduction of chimeric antigen receptor (CAR) T-cell therapy.
As today’s employers try to balance the need to provide healthcare for their workers while keeping an eye on cost, they are banding together to learn more about cancer care and how to gain value for the millions they are spending. Meanwhile, provider groups like the Community Oncology Alliance (COA) are reaching out to employer and purchasing coalitions to discuss how community oncologists can help hold down costs.
Last fall, the 2 came together during COA’s Payer Exchange Summit, held October 28 and 29, 2019, in Tysons Corner, Virginia. Evidence-Based Oncology™ listened as leaders from employer and purchasing groups shared experiences from their members in a roundtable discussion.
The employer coalition Northeast Business Group on Health has released a guide for employers looking to better manage diabetes in their low-wage workers.
Low socioeconomic status doubles the risk of developing Type 2 diabetes, according to the NEBGH guide “Diabetes and Lower-Wage Workers,” released Feb. 12. Income determines what basic necessities like food, housing and education people can access, which may in turn affect people’s health. This is true for both hourly and salaried employees with low wages.
The Northeast Business Group on Health has issued new guidance to help benefits leaders address the health care needs of lower-wage workers with diabetes and the rising costs associated with them.
The group outlined factors that should be considered for managing diabetes, such as limited access to healthy food options, stress, ethnicity and culture. It pointed out that lower-wage workers face unique challenges, including the potential for negative impacts from high-deductible health plans that are often favored by this group of workers for their smaller premiums.
The role of social determinants of health in the prevention and management of chronic conditions has garnered significant attention in Medicaid populations, said Candice Sherman, CEO of NEBGH. Some of the needs and differences in employee populations, however, have not been as closely considered.
"There are specific conditions like diabetes that are more prevalent among lower-wage workers," Sherman said. "For higher earners, diabetes is a hard enough condition to manage. It requires a lot of attention and lifestyle changes."
Lower-wage workers are more likely to live in food deserts or areas that lack parks or outdoor spaces in which to exercise, she explained. They also may be single parents with limited time and have more financial stress than their higher-earner counterparts.
To help address some of the issues, the group said, it recommended that employers give paid time off during working hours or grant a half day off for an annual checkup. It also recommended that employers provide access to on-site biometric screenings to give employees insights into their risk for diabetes.
Other recommendations included offering counseling services to help employees pick the best health plan for their personal needs and making insulin exempt from deductibles with no or very low patient cost sharing.
From the employer perspective, better managing the health care needs of lower-wage workers with diabetes can help avoid absenteeism, lower productivity and even higher costs from related conditions, such as cardiovascular disease.
U.S. studies have put the cost of diagnosed diabetes at nearly $330 billion annually, the group said. Low socioeconomic status doubles the risk of developing Type 2 diabetes. —J.H.
The Northeast Business Group on Health will lead new efforts to improve mental health and substance-use care in New York, northern New Jersey and southern Connecticut.
NEBGH told Crain's it has been selected to do so as part of the five-year, private sector initiative the Path Forward for Mental Health and Substance Use. The program was launched last month by the National Alliance of Healthcare Purchaser Coalitions, the American Psychiatric Association, the American Psychiatric Association Foundation Center for Workplace Mental Health and Meadow Mental Health Policy Institute.
NEBGH will lead one of the initiative's eight Regional Employer Stakeholder Engagement Teams, or RESET, regions. The goal is to leverage the influence of employer and other health care purchaser members to work with health plans, hospital systems, consultants and other stakeholders to better address the ongoing public health crisis. (A recent report from Seattle-based consulting firm Milliman found that the crisis is getting worse when it comes to accessing the right care at the right time, and patients are more likely to resort to out-of-network providers for behavioral health care than for other care.)
"It's going to take a major effort on behalf of all stakeholders involved to solve this," said Candice Sherman, CEO of NEBGH. "The priorities set forth as part of this effort, and the fact that it's purchaser driven, are really going to make a difference."
The priorities are to improve access to in-network behavioral health specialists, expand the use of the collaborative care model to integrate behavioral health care into primary care, implement measurement-based care in both of those areas, expand tele-behavioral health and ensure mental heath parity compliance.
"These employers are the primary financiers of the system, and they will both set the tone and hold the stakeholders accountable for accomplishing these goals," said Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, in a statement.
Efforts also have started in California, the District of Columbia, Florida, Kansas, Maryland, Minnesota, Tennessee, Texas and Virginia.
The Path Forward is pursuing funding from a number of sources nationally, and RESET regions are expected to raise funding in their area. —Jennifer Henderson
A national coalition to improve mental health in the U.S. has named eight regional centers to boost its five-year plan to address workplace well-being and substance abuse care for Americans.
The national steering committee for The Path Forward for Mental Health and Substance Use — including the National Alliance of Healthcare Purchaser Coalitions, American Psychiatric Association (APA), American Psychiatric Association Foundation (APAF), Center for Workplace Mental Health and Meadows Mental Health Policy Institute — picked eight locations across the nation to carry out the initiative, which was first reported by Employee Benefit News last month.
The national steering committee for The Path Forward for Mental Health and Substance Use – National Alliance of Healthcare Purchaser Coalitions, American Psychiatric Association (APA), American Psychiatric Association Foundation (APAF) Center for Workplace Mental Health and Meadows Mental Health Policy Institute – has selected eight locations across the nation to implement its multi-stakeholder transformative initiative.
Launched last month, The Path Forward has embarked on a five-year plan to execute a first-of-its-kind private sector approach to improve mental health and substance use care for Americans across the nation. As a key part of the initiative, the Regional Employer Stakeholder Engagement Team (RESET Regions) will leverage the influence of business coalitions, and their employer and other purchaser members, to work with health plans, health systems, medical and behavioral health providers, consultants and brokers to combat this public health crisis.
The RESET Regions and coalitions leading these efforts are:
The effect of inadequate staffing of care workers can result in a cascade that begins to affect all businesses in a community.
It is estimated that one of every six employees provides informal care for a relative. A 2017 collaborative report by the Northeast Business Group on Health and AARP noted that those employees who are family caregivers spend, on average, four years in the role and 24 hours each week providing that caregiving assistance. Employers in the U.S. lose a reported $38 billion each year in caregiving-related costs due to lost productivity, absenteeism, increasing healthcare costs. and recruiting and training new staff.