Benefits Quarterly

The Affordable Care Act (ACA) has magnified the problem of short-sighted human resource (HR) software purchases that reflect a siloed mindset about HR technology investment. This article outlines the problem with the siloed approach and the many advantages offered by an HR technology revolution. The author reviews best practices to consider, whether from the perspective of a consultant or that of an HR professional building a case internally for integration. When investment in HR technology is based on how the technology can help employees make better decisions because of greater access to accurate data, the ripple effects of improved decision making translate into real savings...

The cost and complexity of specialty medications are keeping employers and plan administrators up at night. A 2016 survey found that large group employers (100+ full-time employees) struggle with specialty drug trend and cost management, using a variety of unconnected tools and techniques. This article outlines employer challenges and suggests a medical/pharmacy integration paradigm as a successful model for controlling costs and improving health outcomes.

Pharmacy and medical benefit integration's most meaningful value lies in obtaining a comprehensive understanding of someone's health journey. An effective way to control health care costs for all stakeholders and improve overall wellness is to understand and manage health conditions in their entirety, not just the prescriptions. This article highlights (1) how pharmacy and medical benefit integration provides a more holistic view of health, (2) how individuals inquiring about their pharmacy benefits can be successfully engaged to participate in health coaching and other programs available through their medical benefits, (3) how integrated data pro-vides real-world insights for evaluating the value that drugs and health management programs deliver and (4) what plan sponsors might attain in cost savings through the use of integrated benefits...

Specialty biotech drugs represent 1-2% of prescriptions yet 35% or more of overall pharmacy costs-and are projected to reach 50% of costs over the next three years. In the United States, the cost of these drugs is multiples more than in other countries, and their use presents global competitiveness and philosophical challenges for plan sponsors. This article examines specialty drug trends, discusses balancing access to them versus their impact and reviews the current state of specialty drug management. It provides plan sponsors with key considerations for the future...

Although determining the driving forces behind double-digit price inflation trends for pharmaceutical costs has proven increasingly difficult, one thing is clear: Drug trend rates are unsustainable for plan sponsors and will continue to be a top challenge in the coming years. This article discusses emerging strategies for dealing with prescription drug cost trends, best-in-class contracting, changing and affecting drug mix, the changing reimbursement model and what's next in mitigating evolving pharmaceutical costs...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The pressure on employers to justify providing health benefits or to prove the value of health investment has never been greater. Many employers have resorted to cost shifting to employees to dampen the impact of health care costs on their companies or have avoided health investments, believing they don't deliver a return. Both strategies come with significant risk to employees, their dependents and the company's business performance. This article provides a framework for employers to better understand the full impact of workforce health and well-being on bottom-line costs and the opportunities for connecting workforce health and well-being to topline business performance metrics...

There's no question that employers can no longer ignore mental health issues. Compassion and support for employees aside, it is simply good business to protect the mental health and productivity of employees. This article describes existing challenges surrounding employees with mental disorders: the link between mental disorders, disability and an employee's ability to return to work; best practices for employers, employees and health care providers; and the role of the insurance company. Together, using proven strategies, everyone contributes to the optimal solution of helping employees with mental disorders return to work...

This article describes how methods of personalized medicine-specifically, pharmacogenetic (PGx) testing-can benefit private health plans, benefits managers, care providers and consumers alike. The authors cover pharmacogenomics as a science and also introduce an innovative way to optimize drug treatments. The article touches on some important clinical outcomes drawn from a recent study in community pharmacy and reviews the application and return on investment of PGx testing in disability and medication management...

Studies of employee assistance program (EAP) clinical use across multiple industries and multiple EAP delivery models range from highs greater than 5% to lows of less than 1 %. Despite the range in utilization, the rates of employee behaviors that indicate a behavioral health issue are significantly higher, suggesting far too little use of EAPs overall. Studies of the costs to an employer for an employee with a mental health issue are as high as 37% lost annual productivity. EAPs have attempted to raise utilization through a variety of efforts, with mixed results...

Although the prevalence and destruction of opioid addiction have touched individuals and families across all social groups and geographies, until recently, federal and state-level efforts to confront this growing problem have lacked focus and rigor. With several legislative actions already underway and the recent enactment of the Comprehensive Addiction and Recovery Act (CARA), we will continue to see a focus on program development and treatment strategies. Employers can contribute toward curbing the opioid addiction epidemic in a number of ways and should play an instrumental role in facilitating increased awareness of and access to needed programming...

Investing time and effort to uncover and mitigate today's stressors for employees can help employers avoid tomorrow's more damaging and expensive consequences. A comprehensive assessment of workplace stress can generate a substantial return on this investment, measured in enhanced individual well-being, reduced health care and disability costs and improved company performance. This article discusses the structure of stress diagnostics, the dimensions of those diagnostics, leading and lagging indicators of employee stress and how employers can use diagnostics to take actions that benefit employers and employees alike...

Although the Mental Health Parity and Addiction Equity Act (MHPAEA) and associated regulations have been around for a while, behavioral health advocacy groups have expressed significant concern about a lack of enforcement to ensure compliance among health plans and employers. Federal and state governments have stepped up efforts to encourage MHPAEA compliance. This article presents recent developments in mental health parity, including a summary of the parity law requirements, new warning signs for nonquantitative treatment limitations, a confusing answer to a frequently asked question from the U...

Today, for mental health, it is the best of times, and it is the worst of times. The barriers to achieving the mental health system we need are not just a chasm of a poorly organized system of care but a mountain range of issues that stop us from bringing mental health and well:being into the 21st century on a par with the rest of health care. This article reviews the progress that has been made, describes the continuing concerns and outlines a path forward toward holistic mental health and well-being in the workplace...

More and more employers recognize the business impact of behavioral health concerns in the workplace. This article provides insights into some of the current innovations in behavioral health benefits, along with their rationale for development. Areas of innovation include conceptual and delivery models, technological advance- ments, tools for engaging employees and ways of quantifying the business value of behavioral health benefits. The rapid growth of innovative behavioral health services should provide employers with confidence that they can tailor a program best suited to their priorities, organizational culture and cost limitations...

As episodes of workplace-centered violence have increased in the United States, a focus on emotional and mental health matters is more essential than ever. It is imperative for organizations to be proactive about violence prevention and have a plan that is supported by top management and understood by all managers and employees. Employers can take a number of steps in collaboration with a comprehensive violence prevention plan to promote a supportive and safe work environment. This article addresses workplace violence, risk factors and the components of a violence prevention plan as well as the importance of building a psychologically healthy workplace...

The need for long-term care (LTC) is on the rise as the Baby Boomer generation ages. This article will focus on the projected future drivers and costs for LTC, why the private LTC approach has not worked to date and alternate approaches in the market that appear to help address some of the current needs.