Hartford Business Journal

8 Hartford Business Journal • November 28, 2016 www.HartfordBusiness.com FOCUS EMPLOYEE BENEFITS Employers slow healthcare costs with innovative plan designs By John Stearns jstearns@HartfordBusiness.com T he total health benefit cost per employee increased an average of just 2.2 percent this year in Connecti- cut as more employees moved into high-deductible consumer-directed health plans (CDHPs), according to an annual survey by a global health and benefits con- sultant encouraging employers to drive transformative change in health care. Mercer, which has an office in Hartford, said this year's mild increase mirrored a nationwide trend, in which U.S. employers experienced the smallest rate hikes since 2013 and, before that, since 1997. It added that Connecti- cut employers are predicting a 3.8 percent increase in premiums next year, as they try to hold down costs by adding a CDHP, switch- ing carriers or changing plan design. The moderate rate hikes run counter to double-digit increases in premiums next year on public exchanges, including Access Health CT. The disparity speaks to the exchanges' more challeng- ing risk pool with greater healthcare needs versus the pool for employers, who've been educating employees for years on being better healthcare consumers and whose risk pool is well understood, said Dawn O'Shaughnessy, health and benefits leader for Mercer's Hartford office. While employers have launched a number of initiatives to help control costs, from HDHPs with lower monthly premiums than PPOs to accompanying Health Savings Accounts (HSAs), lower-cost telemedicine and other incentives, Mercer sees greater opportunity for employers to move the cost pendulum long term, O'Shaughnessy said. "Mercer has a much larger point of view on all of this in that we really feel there's got to be a transforma- tion," she said. "What we continue to see is cost-shifting. Even high-deductible health plans with Health Savings Accounts, it's a cost-shift. You're putting more onus on the employee. You're giving them a great tax-advantage account (HSA), to build for future healthcare expenses, but at the end of the day, employers know cost-shifting is a short-term solution. There's going to be a point where we can't continue to cost-shift." Employers have the greatest potential to transform the system because they provide coverage to a large per- centage of the population, O'Shaughnessy said. Mercer believes employers can affect change four ways: pay for care with the best value; point employees to the high- est-quality provider for the right condition; personalize employees' healthcare experience; and embrace disrup- tion by continuing to do new things. On the first item, providers should be reimbursed based on value and quality of their services, not volume, and employers can design their programs to impact that hugely, she said of value-based pricing. Second, to help guarantee quality outcomes, some large, self-funded employers are contracting directly with health systems to funnel all their employees there for guaranteed value and quality outcomes. Similarly, some employers are requiring employees needing cer- tain high-cost treatments for procedures like trans- plants or complex cancer cases to use a particular facil- ity — even out of state with all travel covered — if data EXPERTS CORNER New guidance clarifies employer-provided leave for disabled workers By Shel Myers A re you an employer con- fused about when you may need to provide leave to a disabled employee as a reasonable accommodation under the Ameri- cans with Disabilities Act (ADA)? You are not alone. The U.S. Equal Employment Opportunity Commission (EEOC), the federal body that enforces the ADA, recently issued some guidance meant to clarify this topic. As you may be aware, the ADA "pro- hibits discrimina- tion on the basis of disability in employ- ment and requires that covered employ- ers (employers with 15 or more employ- ees) provide reasonable accom- modations to applicants and employees with disabilities that require such accommodations due to their disabilities. "A reasonable accommodation is, generally, any change in the work environment, or in the way things are customarily done, that enables an individual with a dis- ability to enjoy equal employment opportunities. That can include making modifications to existing leave policies and providing leave when needed for a disability, even where an employer does not offer leave to other employees." This topic is unquestionably complicated and fraught with landmines. Here are the key points directly from the EEOC's latest publication on the topic that every effected employer should understand to avoid sub- stantial liabilities. • If an employer receives a request for leave for reasons relat- ed to a disability and the leave falls within the employer's exist- ing leave policy, it should treat the employee requesting the leave the same as an employee who requests leave for reasons unre- lated to a disability. Employers do have the right to request a doctor's note to substantiate the need for any such leave requested, as long as all employees are required to provide such documentation. • An employer must consider providing unpaid leave to an employee with a disability as a reasonable accommodation if the employee requires it, so long as it does not create an undue hardship for the employer. An employer may not penalize an employee for using leave as a reasonable accommodation. • The ADA requires that employ- ers make exceptions to their poli- cies, including leave policies, in order to provide a reasonable accommodation. Although employ- ers are allowed to have leave poli- cies that establish the maximum amount of leave an employer will permit, they may have to grant leave beyond this amount as a rea- sonable accommodation to employ- ees who require it because of a disability, unless the employer can show that doing so will cause an undue hardship. • Many employ- ers, especially larger ones and those with generous maximum leave policies, may rely on "form letters" to communicate with employees who are nearing the end of leave provided under an employer's leave program. These letters frequently instruct an employee to return to work by a certain date or face termination or other discipline. • Employers can require employees who seek leave for a dis- ability to provide information from their doctors and authorization to enable the employer to commu- nicate with their doctors in order to evaluate the request for leave. Typically, the medical information that an employee can be required to provide would be: (1) the nature of the condition for which leave is sought; (2) the specific reason(s) for the leave (i.e., surgery, adjust- ment to medication, etc.); (3) the nature and duration of the leave requested (i.e., whether it is every day for three months or intermit- tently for one to two days over cer- tain weeks); and (4) when the need for leave ends. • If an employee returns from a leave of absence with restric- tions from his or her doctor, the employer may ask why the restrictions are required and how long they may be needed, and it may explore with the employee and his doctor (or other healthcare professional) possible accommodations that will enable the employee to per- form the essential functions of the job consistent with the doc- tor's recommended limitations. • Requiring an employee to be 100 percent healed or recov- ered before returning to work may not be allowed under the ADA if the employer has an existing position for which the employee could perform within 2016 average total health benefit cost per employee, all employers Nation: $11,920, up 2.4 percent from 2015. Connecticut: $13,910, up 2.2 percent. 2016 percentage of all covered employees enrolled in a high- deductible consumer-directed health plan (CDHP) Nation: 29 percent. Connecticut: 44 percent. S O U R C E : M E R C E R N A T I O N A L S U R V E Y O F E M P L O Y E R - S P O N S O R E D H E A L T H P L A N S Shel Myers More employers are using telemedicine services to reduce employee healthcare costs, similar to a system used by Yale psychiatrist Dr. Laine Taylor. Companies are also incentivizing employees to use fitness trackers (shown below) to maintain an active lifestyle. Continued Continued Dawn O'Shaughnessy, health and benefits leader, Mercer's Hartford office P H O T O | C O N T R I B U T E D P H O T O | P A B L O R O B L E S

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