Physicians and employee health experts are increasingly recommending that employers include diabetes screening, prevention and management in their company-sponsored wellness programs.
Diabetes — known as the “silent killer” — afflicts more than 29 million Americans, or 9% of the population.
Type 2 diabetes — or adult-onset diabetes — accounts for about 90% to 95% of all diagnosed cases of diabetes. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.
The fallout from the disease has a significant impact on businesses as it can lead to stress, depression and a number of other health problems, including cancer, stroke and heart issues. That in turn leads to lost productivity for you as well as presenteeism, or the dilemma of a worker being at work but not being productive.
Medical costs and costs related to time away from work, disability and premature death that were attributable to diabetes totaled $245 billion in 2019, according to the U.S. Centers for Disease Control. Of that total, $69 billion was due to lost productivity.
With these statistics in mind, it’s imperative that employers help their workers manage their diabetes. Helping them get diabetes under control or helping them avoid developing the disease can keep your productivity strong, reduce your workers’ comp claims and also chip away at your health insurance expenses thanks to lower premiums.
Diabetes means decreased productivity
Of the roughly $69 billion that U.S. employers lost in 2019 from decreased productivity due to diabetes:
$21.6 billion was from the inability to work as a result of diabetes.
$20.8 billion was from presenteeism.
$18.5 billion was from lost productive capacity due to early mortality.
$5 billion was from missed workdays.
$2.7 billion was from reduced productivity for those not in the labor force.
Prevention and management
Employers can help by providing their employees with a voluntary diabetes management and prevention program. This wellness benefit can take many forms.
The Integrated Benefits Institute during an annual forum recently held a session highlighting what some employers are doing to educate their workers on how to manage diabetes:
The San Francisco Municipal Transportation Agency has partnered with the American Diabetes Association to deliver educational seminars on diabetes to its workforce.
The agency also offers as part of its diabetes program health risk and orthopedic assessments, glucose and cholesterol screenings, nutritional counseling, exercise classes and a walking club. (Since the transport agency’s wellness plan provider initiated the diabetes program, its workers’ comp claims have also fallen.)
Caterpillar, Inc. found diabetes to be one of its primary cost drivers, so it now provides incentives for employee risk assessments and care management. For example, half of the employees in its diabetes management program reduced their A1C levels (a measure of diabetes control), while 96% reported measuring these levels regularly and 72% reported meeting recommended activity levels.
The City of Asheville, NC, used local pharmacists to coach employees on how to manage diabetes. More than 50% of those in the program experienced improved A1C levels, and the number of employees with diabetes that achieved optimal levels increased.
Vanderbilt University expanded a pilot program of intensive exercise and nutrition that helped employees with diabetes improve cholesterol and blood sugar. About 25% of the employees were able to stop taking their diabetes medications.
The Ohio Police and Fire Pension Fund works with its health insurer to offer its employees access to diabetes prevention and control programs. Employees voluntarily participate in worksite health screenings. Those who have pre-diabetes can attend YMCA-led diabetes prevention programs either at work or in the community.
The takeaway
Having a diabetes wellness program among your voluntary benefit offerings can help your employees avoid diabetes or manage it if they already have the disease. That helps not only their health, but also your bottom line.
If you would like to know more about educating your employees about diabetes and helping those with pre-diabetes or diabetes manage their condition, call us.
More hospitals and insurers have started charging patients for virtual care services as they have grown in usage and providers are spending more time meeting patients in telehealth appointments and responding to their e-mails.
Many hospital systems have started billing patients for e-mails they send to their physicians and, depending on the level of out-of-pocket expenses in their plan, they may pay just a few dollars for a copay or up to $100 if they have a high deductible.
With these forms of communication growing in use, employers may want to remind their employees to look at their plans’ benefits summaries to see how much they will have to pay for these services.
The hospitals argue that physicians spend a significant amount of time responding to inquiries and it takes just as much time for them to conduct telemedicine and phone appointments as it does in-person visits.
A short five-minute session with a patient on a phone or video appointment will typically result in associated work, including reviewing the patient’s chart, updating notes and putting in orders for medications, tests or referrals.
Billing under insurance
The Centers for Medicare and Medicaid Services introduced Medicare billing codes for telemedicine in 2019, paving the way for providers to allow patients to seek reimbursement for messages their doctors send them using an electronic portal.
Under the rules, a provider can bill for a message only if it’s in response to a patient inquiry and requires at least five minutes of the doctor’s time.
Many of the country’s health insurers have followed Medicare’s lead, reimbursing hospitals for doctors’ e-mails. In turn, insurers may charge patients a copay or they may have to pay for the service fully if they have a deductible they must first meet. Even then, fees for these types of appointments are typically lower than for in-person visits.
It should be noted that there may not be fees associated with some services such as asking a doctor for a prescription refill or follow-up care.
How it’s being billed
The amount that patients are being billed varies among hospital systems and insurers.
According to recent surveys, out-of-pocket telemedicine visits are an average of $30-75 nationally, with most visits at around $40-50. According to Becker’s Hospital Review:
Medicare pays around $50 per televisit on average.
Mayo Clinic started charging $50 for some online emails written by its doctors after a surge in mail volume.
Humana’s health plan On Hand charges $0 to $5 per visit.
Walmart offers its employees $4 telehealth appointments.
SSM Health, a hospital system in St. Louis, charges $25.
Summa Health, a hospital system in Akron, Ohio, charges $30.
The takeaway
Hospitals and providers are all charging different amounts for televisits, phone visits and their doctors sending e-mails. As well, insurers have different cost-sharing structures for their enrollees.
It’s important that you warn your employees to read plan summaries of these costs if they are regular users of these services, as health plan coverage will vary depending on deductible and copay levels. Doing this can help them avoid surprise bills, particularly if they have grown used to paying nothing for such services.
It’s almost time for group health insurance open enrollment and your top priority should be to drive participation by helping your employees make informed decisions about their options.
You’ll want to help your staff understand all of their options so they can choose plans that are best for their age, health and life situation.
This is an important exercise to ensure that any of your workers don’t pick a plan that costs them too much in premium if they rarely use their health insurance, or costs them too much in out-of-pocket expenses if they are frequent users of health care.
It’s a balancing act, since each employee has different needs. Here’s our advice for the open enrollment:
Listen to your workforce
Before you make any decisions, you should listen to your employees and better understand their needs and preferences.
With answers and feedback in hand you can create a benefits package that is more appealing to them, which in turn gives you a competitive edge when attracting and retaining workers.
Engage employees and solicit feedback through quarterly employee-benefits round table meetings. Invite employees from different age groups and different departments to participate in these meetings, to ensure you have a good cross-section of your staff represented.
Give advance notice
You can start now with simple reminders for them to start thinking about open enrollment and evaluate their current health plans. Send out memos and place posters in high-traffic areas.
If you start with this in September or October, they can have time to assess their options, particularly if anything has changed in their lives like marital status, new children or health issues.
Costs are paramount
You can work with us to settle on plan arrangements that will be within your and your employees’ budgets, and that comply with the Affordable Care Act’s affordability and minimum value rules.
Employees have a right to understand the costs they’ll be facing in each plan, including:
Their share of the premium,
Their deductible,
Their copays or coinsurance, and
Other out-of-pocket expenses.
Typically, the higher the premium on a plan, the lower the employee’s out-of-pocket costs are. The lower the premium on the plan, the higher the deductibles and copays.
Get an early start
If your plan year starts Jan. 1, you should hold open enrollment meetings and dispense plan materials in October or November.
This will give your workers time to review all of their options and compare costs and coverages.
Communicate effectively
Your task is to get employees out of cruise control and truly assess all of their options.
This is especially true if you are making changes to cost-sharing, introducing new plans, or offer voluntary benefits, a wellness plan or health savings account or flexible spending account.
You should use a variety of different media to communicate with them. Use video, virtual and live meetings, e-mail communications, text messages and print materials to get through to your employees. Each generation will often have a preferred medium, so using a multi-pronged approach may be most effective.
Get spouses involved
If you also offer insurance to your workers’ families, you should communicate through your employees that their spouses are also invited to join your open enrollment meetings.
You may also invite them to view any electronic material you may post online, like the aforementioned videos.
If they cannot make a general meeting, you can invite them to come in to meet with your human resources manager if they have questions.
Remind staff of the ACA
You can use open enrollment as a way to remind your workforce of their responsibilities to secure coverage under the ACA.
Let them know that employees who refuse coverage that complies with the ACA from their employer and opt to purchase it on a public exchange, will usually not be eligible for government premium subsidies.
The meeting
Send out meeting notices early to give your employees time to prepare and set aside time.
Try to make the meeting engaging with props, videos, printed materials and more. You may also want to consider recording the session so that staff who can’t make the meeting can watch it, particularly if you have employees that don’t work on-site.
Provide enough time for the main presentation, as well as for questions from your employees.
The takeaway
Open enrollment can be a hectic and stressful time for both the employer and workers. By getting a head start on planning and communications, you will be ahead of the game and your employees won’t feel harried into making a decision. That benefits both them and your organization.
Some of the nation’s largest insurers have announced plans to roll back their prior authorization requirements for medical services.
Prior authorization — or prior approval — has always been a thorn in the side of patients, often keeping them from accessing care in a timely fashion. The moves by these insurers come after the Centers for Medicare and Medicaid Services (CMS) announced earlier this year that it would require health insurers to automate prior authorization and return decisions more quickly.
These developments are good news for your employees and should improve their health care experience and access to timely care. Many of these changes took effect immediately and some will start in 2024.
Under prior authorization, doctors and other health care providers must obtain advance approval from a health plan to qualify for coverage before they deliver a specific service to the patient. Health insurers have lists of services that require prior approval, in order to control their costs.
During the process, a provider must submit administrative and clinical information to the insurer when requesting approval for a certain procedure or service. The process can sometimes be time-consuming, and doctors argue that it often delays care and results in negative outcomes.
On the other hand, insurers say that prior approval helps protect patient safety and improve affordability by increasing adherence to evidence-based standards of care.
Not all services require prior authorization, and each insurer has a different list of services that require it.
What insurers are doing
Here are what a few of the nation’s largest health insurance players are doing:
Cigna — In August 2023, Cigna announced with immediate effect that it would no longer require prior approvals for nearly 25% of medical services. That includes some 600 prior authorization codes in its commercial plans. This adds to the more than 500 codes that Cigna had removed prior authorization for since 2020, according to the insurer.
UnitedHealthcare — UnitedHealthcare, starting in Spring 2023 and lasting through the end of the year, aims to eliminate almost 20% of its current prior authorizations. In 2024, the insurer plans to roll out a “gold card” program, which will allow certain providers, whose prior authorization requests are consistently approved, to perform most procedures without needing prior approval.
Independence Blue Cross — The insurer and Philadelphia-based Penn Medicine are piloting a program that will allow qualifying physicians to skip prior authorization approvals needed for ultrasounds, CT scans and PET scans.
Aetna — In 2022, The insurer rolled back prior authorization requirements on cataract surgeries, video EEGs and home infusion for some drugs. Aetna said that it had also reduced automated prior authorizations by more than 10% in 2022, with plans to more than double that this year, according to press reports.
Forcing insurers’ hands
Analysts say that insurers are reacting to regulators’ and lawmakers’ attempts to address some of the problems that prior authorization creates.
The CMS in April 2023 announced a rule that would require health insurers to automate prior approvals and expedite decisions. That was followed by a rule addressing prior authorization in Medicare Advantage plans.
Meanwhile, there are bipartisan efforts in Congress that aim to streamline prior authorization, in order to speed it up and reduce the chances of delayed care in Medicare Advantage plans.
States are also taking matters into their own hands. Legislation in Pennsylvania, for example, requires health insurers to provide a more streamlined process for approval of non-urgent and emergency services. Texas exempts doctors with a 90% authorization approval rate for certain services from prior authorization requirements.
The takeaway
As regulators and lawmakers bear down on health insurers around the country, expect more carriers to roll out plans to reduce the use of prior authorizations for services.
The reasoning among many insurers is that they can get ahead of them by taking steps before regulations and laws are implemented. It will be your employees who will benefit from these actions.
The Equal Employment Opportunity Commission has issued new guidance for employers to provide reasonable accommodations for visually impaired workers who request it.
About 18.4% of all American adults have at least some difficulty with their vision, even when wearing corrective lenses, according to the U.S. Centers for Disease Control and Prevention.
The new guidance addresses what employers who have a vision-impaired job applicant or worker can and can’t do under the Americans with Disabilities Act and what to do if they request, or if you want to offer them, specific accommodations to help them perform their jobs better and more safely (or help them complete the application process).
Under the ADA, if a worker with a disability asks for accommodation so they can better perform their job, their employer must enter into an interactive process with them to discuss ways that accommodation would be possible. You do not have to provide accommodation if doing so would be an “undue hardship.”
Here are the main points of the EEOC guidance:
Reasonable accommodation
The guidance lays out a number of accommodations that employers can provide for workers or job applicants with visual impairments, including:
Guide dogs,
Assistive technology, including:
Screen readers (or text-to-speech software). These are software applications that can convert written text on a computer screen into spoken words or a Braille display. These tools can allow individuals to quickly review written text.
Optical character-recognition technology that can create documents in screen-readable electronic form from printed ones, including an optical scanner (desktop, handheld or wearable).
Systems with audible, tactile or vibrating feedback, such as proximity detectors, which can alert individuals if they are too close to an object or another person.
Website modifications for accessibility. This entails taking steps to ensure that job applicants and employees can access and timely complete job applications, online tests or other screening tools.
Documents in Braille or large print.
Ambient adjustments (such as brighter office lights); and sighted assistance or services (such as a qualified reader).
Asking about vision impairment
According to the new guidance, applicants are not required to disclose they have any type of vision impairment or disability unless they are seeking a reasonable accommodation to assist with some aspect of the application process, such as a larger font or Braille on the written application.
Employers cannot generally ask questions about obvious vision impairment. However, if you “reasonably believe” the applicant will need an accommodation to perform the job, you may ask if one is needed, and if so, what type.
For example, if a job applicant uses a white cane when entering the room for a job interview, you can ask if they would need a reasonable accommodation in the workplace.
Once someone is hired or after they’ve received an offer, you may ask certain questions such as:
How long the applicant has had the vision impairment.
What, if any, vision the applicant has.
The applicant’s specific visual limitations and what reasonable accommodations may be needed to perform the job.
The takeaway
The EEOC guidance is expansive, and this article focuses on the main parts of it. Among the other areas it covers are:
How an employer should handle safety concerns about applicants and employees with visual disabilities.
How an employer can ensure that no employee is harassed because of a visual disability.
The importance of keeping medical records of workers with a vision disability confidential.
How to avoid discriminating against individuals who are vision-impaired.
Finally, considering that nearly one in five U.S. adults has some form of visual impairment, this guidance aims to help employers find a solution for reasonable accommodation. Many accommodations can be implemented with little cost to a business.
If you have questions about the new guidance, please call us.
The IRS has significantly reduced the group plan affordability threshold — which is used to determine if an employer’s lowest-premium health plan meets the Affordable Care Act rules — for 2024.
The threshold for next year has been set at 8.39% of an employee’s household income, down significantly from 9.12% this year. The lower threshold will likely require employers to reduce their employees’ premium cost-sharing level for their lowest-cost plans in 2024, to avoid running afoul of the ACA.
This is happening just as group health plan premiums are expected to climb at a much faster clip in 2024 than the last three years.
Under the ACA, “applicable large employers” — that is, those with 50 or more full-time or full-time equivalent employees (FTEs)— are required to offer at least one health plan to their workers that is considered “affordable” based on a percentage of the lowest-paid employee’s household income.
The lowest level yet
The new level is the lowest affordability threshold since the ACA took effect, and almost one-and-half percentage points lower than the 9.89% threshold in 2021. The new threshold will apply to all health plans when they incept in 2024. For plans that incept after Jan. 1, the 2023 threshold will apply and change to the new rate when they renew later in the year.
Employers can rely on one or more safe harbors when determining if coverage is affordable:
The employee’s W-2 wages, as reported in Box 1 (at the start of 2022).
The employee’s rate of pay, which is the hourly wage rate multiplied by 130 hours per month (at the start of 2022).
The federal poverty level.
Example: The lowest-paid worker at Company A earns $25,987 per year. To meet the 2024 affordability requirement, they would have to pay no more than $2,180 a year in premium (or $181 a month).
Employers with a large low-wage workforce might decide to utilize the federal poverty level ($14,580 for 2024) affordability safe harbor to automatically meet the ACA affordability standard, which requires offering a medical plan option in 2024 that costs FTEs no more than $101.94 per month.
If an employee’s coverage is not affordable under at least one of the safe harbors and at least one FTE receives a premium tax credit for coverage they purchase on an ACA exchange, the employer may have to pay a penalty, known as the “employer shared responsibility payment.”
The shared responsibility payment for 2024 will be $4,460 per employee that receives a premium subsidy on an exchange, up from $4,320 this year.
The takeaway
As 2024 nears, you should review your health plan costs and premium-sharing to ensure that your lowest-cost plan complies with the affordability requirement.
We can help you assess affordability to ensure you don’t run afoul of the law. It will be particularly crucial in 2024, considering the significant drop in the threshold.
