"Wellness" took on new meaning amid the novel coronavirus pandemic, with employers racing to support workers through personal and professional disruptions.
Companies moved fitness benefits online and increased offerings around mental health but more was needed. Such offerings were "designed to address a set of wellness issues that were rooted in a pre-COVID environment," Visier Chief People Officer Paul Rubenstein told HR Dive. Instead of just moving the programs into a virtual environment, the question became, "how do we get people to engineer their work differently as a part of wellness?"
To that end, employers offered flexibility and tried to take a holistic view of employees' lives. But new challenges arose as a spike in cases coincided with the start of a new school year, leading experts to warn employers about a "mental health tsunami."
The following stories explore these issues and more, including:
Wellness perk delivery amid a pandemic;
How the pandemic may reshape corporate wellness offerings long term;
A case study on chief wellness officers in hospitals;
How generational concerns are changing the landscape;
Mental health as an emerging wellness trend; and
Reaping wellness savings from behavioral health spending.
These are just a few of the many aspects of employee well being that employers are thinking about and developing programs around. We hope you enjoy this deep dive into the current trends.
Employee well-being slow to recover from pandemic, survey says
By: Ryan Golden
Forty percent of employees in a survey published May 13 by outsourcing firm Alight Solutions and the Business Group on Health said they held a positive view of their overall well-being, a slight increase from 39% in July 2020 but a decline from the 49% recorded last year prior to the COVID-19 pandemic.
The decline in well-being levels was "disproportionately higher" for members of Generation Z and people of color in the survey, Alight said. Employee experience scores also continued a downward trend going back to early 2020, but respondents who reported a "great" employee experience were more than three times as likely to report having a positive view of their overall well-being.
Although 61% of employees said they felt in control of their health, only 38% were positive about their physical well-being. Alight said one-third of respondents reported often struggling to access clean water, healthy food, health services and safe housing, among other necessities. People of color, hourly workers, part-time workers and workers with financial challenges were more likely to answer this way.
Before 2020, wellness programs were beset by challenges ranging from an always-on, digital culture to an explosion of choice in employee benefits offerings. A pandemic and subsequent economic downturn has served to further complicate these issues.
"The pandemic exposed vulnerabilities around employee wellbeing and where they can find support," Laine Thomas Conway, vice president of communication strategy and total rewards product manager at Alight, said in a statement emailed to HR Dive. "Now, it's up to employers to assess the needs of their workforce and experiment with fresh ways to help them achieve their wellbeing priorities."
Early on in the pandemic, many were forced to transition wellness programs to an online, remote-work environment. Fitness classes and doctor's office visits moved to virtual formats, where possible, and employer and benefits partner messaging shifted to encourage workers to care for their physical, mental and emotional health. The latter initiative contended with a rise in anxiety and depression, particularly among caregivers, and with other troubling trends, such as domestic violence.
Alight's report indicated that work relationships "play a significant role in driving overall experience and wellbeing," but fewer than half of employees felt that their managers communicated effectively about work-life balance. Conversely, 60% of managers surveyed by Alight said they felt comfortable having well-being conversations with their direct reports, and 86% saw value in training to better encourage well-being.
Employers also have leaned heavily on employee assistance programs to provide access to key wellness resources during the pandemic, according to panelists at last year's Disability Management Employer Coalition Virtual Annual Conference.
Amid broader HR industry conversations around diversity, equity and inclusion, employers also may be able to address well-being concerns through D&I work. Speakers at one August 2020 virtual event outlined limits imposed by systemic discrimination which can drive health access inequality. In its survey, Alight found that respondents who felt their workplaces were diverse, inclusive and equitable were two times as likely as other employees to say they had a positive overall well-being.
Article top image credit: Warren Little via Getty Images
Rethinking employee wellness perks in the age of the coronavirus
With many working from home, traditional benefits must change to meet the new needs of workers, sources say.
By: Pamela DeLoatch
In years or even months past, companies offered employees wellness perks such as midday in-office yoga classes, discounted gym memberships and free healthy snacks in the break room. With many employees now working from home, many of the those traditional healthy lifestyle perks are no longer an option. And yet, now may be the time employees need wellness benefits the most.
Supporting the well-being of remote employees is not as simple as adjusting in-person offerings to an online setting. Instead, it may mean re-engineering the concept of work, sources say.
The stressed remote employee
Between the pandemic, job insecurity, juggling of family responsibilities and the loss of social connections, people working at home are stressed. Career platform Monster found in a recent survey that 69% of remote employees have burnout symptoms, CNBC reported.
A lengthening work day doesn't help matters. The average workday for those working at home in the U.S. increased three hours since the beginning of the COVID-19 pandemic, according to findings from NordVPN, CNBC said.
But widespread remote work will likely continue for some time, and employers are adjusting perks to support employees' current needs.
Translating wellness perks to the remote environment
Ensuring employees balance work to avoid burnout can be difficult, said Steve Beauchamp, CEO of Paylocity, an HR and payroll services provider. Unlike many companies that had to pivot suddenly to working from home, half of Paylocity employees already worked remotely.
"The biggest challenge is making sure people are taking time off," he said. Because of limitations in travel and other activities due to the pandemic, employees are less likely to take vacation days, so companies have to proactively remind employees, he said. As companies offer more flexibility, Beauchamp noted it could be difficult to track employees' work hours. That makes it hard to know when an employee is working too much.
Beauchamp said Paylocity had to rethink how wellness perks translate in a virtual environment. The company moved in-person yoga classes online and added virtual groups so employees could connect. It unveiled a free mental health mobile app as social justice conversations heated up and coronavirus transmission rates spiked. Teams have after-work happy hours via Zoom and host game nights for the social aspect, he said.
Instead of considering a perk as a one-size-fits-all option, employers should ask employees what they need, Beauchamp said. With one-third of the Paylocity's workforce having children 12 and under, the company looked at how different scheduling, such as a split schedules, could help parents manage school activities, he said.
Tailoring wellness options
The pandemic highlighted several aspects of employee wellness, said Erika Zauner, founder and CEO of HealthKick, a platform that gives employees personalized access to well-being brands. Making healthy living accessible and supporting employees' mental and emotional well-being are key. "We need to invest in helping people make healthy choices before they get sick," she said, adding that many who were affected by the coronavirus had underlying health conditions.
As companies make decisions about the future, the question becomes, "how do we sustain and adapt to the reality of today?" she said. Allowing employees to tailor wellness perks to their specific needs is one way to do that. "Providing maximum flexibility for people is truly servicing their well-being needs because every person has different preferences and different gaps they're looking to round out," Zauner said.
Creating a new concept of wellness
When Visier, a people analytics company, shut down its office and sent employees home to work, the company had to rethink wellness quickly, Visier Chief People Officer Paul Rubenstein said. Visier had previously offered traditional wellness perks, with programs employees could attend, like fitness classes, or services they could access, like employee assistance programs or employee resource groups.
"It was one thing to flip those online, but those are designed to address a set of wellness issues that were rooted in a pre-COVID environment," Rubenstein said. Instead of just moving the programs into a virtual environment, the question became, "how do we get people to engineer their work differently as a part of wellness?" That might mean 90 minutes working and 20 minutes off; having teams declare quiet hours without meetings so people can get work done; or telling people they don't have to respond to emails immediately, he said.
Companies can also make sure employees aren't isolated, Rubenstein said. Through network analysis, employers can see if employees are talking to each other — or if some aren't and are lonely.
When employees first switched to remote work, they felt a certain excitement, Rubenstein said, but that has faded. The stress employees feel from health, economic and societal concerns are taking a toll, he said; "You can't just ignore what's going on outside."
As employers look at allocating funds for the future, the notion of wellness is no longer a perk, said Rubenstein. Instead, companies should take a holistic approach, with a focus on individual needs, he added.
"It's not about coddling employees," Rubenstein said. "It's about adapting to this set of norms and making it easy for people to bring their best selves to work."
Article top image credit: Getty Images
Fitness benefits moved online during COVID-19 — but will they stay there?
Companies largely haven't cut back on fitness classes, citing cultural and employee-health concerns as cause for continued investment, sources told HR Dive.
By: Ryan Golden
During the U.S. public-health response to COVID-19, many employees witnessed the closure of their physical workplaces and other community fixtures, including gyms, yoga studios, spas and similar facilities.
The latter group of closures affected employee engagement and retention efforts among employers that offer benefits programs centered around physical fitness and personal wellness. According to the Society for Human Resource Management's 2019 Employee Benefits survey, nearly one-third of U.S. employers offered fitness center memberships or subsidies or reimbursements for fitness classes. Such arrangements were more common than on-site fitness centers or classes, offered by 29% of employers as of last year.
Prior to the pandemic, physical fitness benefits formed "a major component" of wellness strategy, according to the SHRM survey. But providers that facilitate these benefits told HR Dive that COVID-19 necessitated a massive shift.
Providers follow the remote trend
Since the pandemic took hold, a number of employers have closed physical worksites and asked employees to work from home. Per a survey by Gartner, more than 80% of company leaders planned to permit some form of remote work after the pandemic.
The move to online work was accompanied by a movement to online delivery of certain employee benefits, including many healthcare services. A shutdown of in-person care led to increased use of telehealth services, and experts in the space suggested telehealth can continue to be an important part of the benefits ecosystem moving forward.
A similar development may be emerging with respect to fitness benefits. ClassPass, a fitness class booking platform with a business-to-business product, pivoted "very quickly" to virtual offerings as certain markets entered lockdown, said Nicole Wolfe, the company's head of corporate programs.
Employees using ClassPass can access online video sessions either by signing up for them in advance or by accessing pre-recorded content on demand. Since the move to virtual delivery, users are trying new types of programs in different markets, Wolfe said. Those based in New York, for example, might take yoga sessions delivered by studios in London. Fitness centers have also helped the company navigate certain public-health closures. When officials in San Francisco prohibited indoor workouts, some providers held outdoor events like bootcamps instead.
One-on-one fitness sessions have increased in popularity since the pandemic began, perhaps due to the fact that group classes are no longer available in many markets, but employers are also using ClassPass benefits as a way to team build, Wolfe said.
Other vendors made a similar transition. Peerfit, which offers an employee-benefit platform for scheduling personalized fitness activities, launched a digital product that made use of existing digital classes and other activities already on its provider network. It also allowed employers to purchase this digital product without the company's traditional brick-and-mortar offering, said Emma Maurer, vice president of enterprise health at Peerfit.
Before the pandemic, Peerfit also emphasized the ability of its platform to bring employees together via shared fitness experiences. That's continued during the pandemic, Maurer said. Streamed classes allow employees to invite their co-workers to join virtually.
"We are seeing our users starting to go back to in-person classes," Maurer said, adding that the number of subscriptions and views of digital content on Peerfit is also down. Providers within the company's network are beginning to reopen, albeit with additional health and safety precautions. "Gyms are taking this health crisis seriously and there are additional precautions that our members need to know about," she said.
COVID-19 hasn't led to significant cuts
Digital offerings might make sense in the current environment as some research suggests a potentially negative outlook for brick-and-mortar fitness centers. For example, a TD Ameritrade survey of U.S. adults found 61% planned to exercise at home instead of paying for the gym. Across the country, reopening gyms and similar locations have struggled to comply with public regulations and mitigate the risks of exercising indoors during a pandemic, NPR reported.
Yet these observations haven't necessarily caused employers to drop fitness benefits. Most large-employer members of the Business Group on Health, roughly 80%, "have no plans to open on-site fitness centers anytime soon," said LuAnn Heinen, vice president of BGH and leader of its Well-being and Workforce Strategy Institute. "Clearly that only reflects the impact of COVID and not the import and the value of fitness programs that employers know employees need and value," she added.
Other Business Group members are either continuing with plans to open such centers in the future or have existing centers open in select locations, Heinen said, and vendors that offer access to digital fitness classes have become popular. "Companies that didn't already have those kinds of options are certainly looking into them," she explained.
Moreover, pushback on virtual fitness classes has been minimal, Heinen said. On a recent benchmarking call of BGH members, one HR representative said they had received some internal pushback on virtual-class usage. For the most part, however, Heinen said she hasn't heard talk of any cuts to fitness benefits from members. "Things may be a little bit on pause and getting recalibrated, but we haven't heard about cuts — I haven't."
This tracks with findings about employers' larger well-being investment during the pandemic. A survey conducted by Willis Towers Watson found the vast majority of employers would not be changing their wellness benefit budgets, said Regina Ihrke, North America well-being leader at the firm.
The two vendors who spoke to HR Dive noted that they were both flexible with their payment options as the pandemic set in. Wolfe said that ClassPass has traditionally moved away from a per-employee-per-month payment model so that employers are paying for workers who actually use the program. "When the pandemic hit, we actually froze all our memberships," Wolfe said. "Now it's really kind of on them to determine when they want to come back on."
"Things may be a little bit on pause and getting recalibrated, but we haven't heard about cuts — I haven't."
Vice President, Leader of Well-being and Workforce Strategy Institute, Business Group on Health
"I think everyone was worried," Maurer said, noting that Peerfit's many public-sector clients faced falling revenues and had difficulty maintaining existing benefits without making adjustments, as did others. The company offered clients the opportunity to freeze their contracts for up to 60 days, keeping the benefit an option for employees if they wanted to buy fitness experiences for themselves. "It was more from a position of compassion [to freeze the contracts] than really anything else."
Peerfit is now seeing interest from clients in ramping up their fitness benefits, Maurer said, adding that employers may be concerned about COVID-19 causing workers to feel isolated. "I think employers are looking for a way to build back their culture, to create a sense of connectivity and togetherness again."
What wellness may look like post-pandemic
Employers who spoke to HR Dive mainly confirmed the importance of wellness benefits moving forward. Ultimate Kronos Group, the company formed from the merger of Kronos and Ultimate Software, set up virtual fitness classes for employees and their children and the company plans to hold a competitive company-wide step challenge, said Chief People Officer Dave Almeda.
Tess Hamberg, a wellness consultant employed by Aetna who works with engineering consulting firm WSP, said that WSP shifted its wellness strategy to focus on supporting employees during the transition to working from home. WSP had already brought on ClassPass before the pandemic, and the ability to offer virtual access to classes was a component of a broader strategy to better match benefits strategy to the virtual environment.
Those virtual offerings are likely to be a permanent feature of WSP's benefits package moving forward, Hamberg said; "It’s like the cat's out of the bag at this point because we realize that it's an option that's now available to us. COVID really pushed a lot of people to realize we can do all these offerings that we didn't think of before or just never utilized."
Worries about employees' mental health are also likely to continue, Ihrke said, but employers who've spoken to Willis Towers Watson noticed increased engagement on digital communications regarding mental health, even as use of employee assistance programs decreased at some firms.
Those concerns can be addressed by digital offerings, though sources still perceive deficiencies in mental healthcare in the U.S. "COVID, like so many other things, exposed the cracks, the weakness and the needs that we haven't met in our healthcare system," Heinen said. "If [companies] didn't have a full suite of virtual benefits, they certainly have it now."
But wellness isn't one-dimensional. "There is this 'watch out' phase that's now starting to get heightened in not ignoring the physical well-being aspects," Ihrke noted, due to worries that employees are getting less activity and making less healthy decisions. "I think there is concern that, if we ignore that piece too long and just focus [on] mental health, we are going to face more significant issues long-term."
In the meantime, gyms, studios and other businesses are moving to accommodate the virtual trend long-term. "I think it's here to stay," Maurer said. "[Providers] have kind of learned that they needed another way to stay alive … if folks were still fearful of going back to gyms then they would need to offer virtual content."
Article top image credit: Yujin Kim/HR Dive
Case study: Hospitals add C-suite officer to boost staff wellness
Chief wellness officers are becoming more mainstream
By: Meg Bryant
As healthcare organizations look for ways to reduce physician burnout, some are placing their bets on a new C-suite role: chief wellness officer.
Hospitals that appoint an executive to oversee wellness anticipate not only happier employees but also improved patient experience and outcomes.
Even before the COVID-19 pandemic, physician burnout was at an all-time high. In a Medscape survey, nearly two-thirds of doctors reported feeling burned out, depressed or both. Worse, 33% of respondents said those feelings impacted their patient interactions. Burnout rates were highest among family physicians, intensivists, internists, neurologists and OB-GYNs, and were higher among women than men.
This epidemic, if you will, comes as the nation faces a growing shortage of doctors. The Association of American Medical Colleges projects the physician shortage could reach 105,000 by 2030.
Among factors fueling burnout are long hours, increasing regulatory and recordkeeping requirements and administrative and computer tasks. An Annals of Family Medicine report found that primary care physicians spend more than half their workday on EHR tasks. But the implications go beyond the looming shortage; physician burnout has been linked to lower productivity and absenteeism, medical errors, poorer outcomes and lack of engagement with patients.
Enter the chief wellness officer, or chief physician wellness officer as the title is sometimes called. The idea is not new, said Linda Komnick, a senior partner and co-leader of the physician integration and leadership practice at Witt/Kieffer. Companies and large organizations have employed them for more than a decade. However, it’s only in the past couple of years that they’ve started cropping up in healthcare.
"I would not call it a 'trend' yet," she told HR Dive’s sister publication Healthcare Dive. "What is a definite trend is that healthcare organizations are trying to be more holistic in supporting employees."
The idea of CWOs aligns with the shift toward value-based, patient-centric care. Hospitals are trying to differentiate themselves culturally while they manage cost and risk. And there’s growth in self-insured plans and the overall societal thrust toward wellness.
Last summer, Stanford Medicine became the first academic medical center in the U.S. to designate a CWO, naming Dr. Tait Shanafelt, a hematologist who spearheaded an anti-burnout initiative at the Mayo Clinic.
Creating incentives for wellness
Concerns about chronic disease and rising healthcare costs led the Cleveland Clinic to appoint the C-suite role a decade ago. The question was "could we change the culture and environment of the organization by figuring out incentives to help people stay well and then reward them for staying well?" said CWO Dr. Michael Roizen. "And what would that do to absenteeism and productivity?"
To do that, the clinic asked employees to achieve six "normal" vital signs — blood pressure, fasting blood sugar, body mass index, LDL cholesterol, healthy urine, learn to manage stress and see a primary care physician once a year. Those who meet those targets or are on a clear path to achieving them get the insurance rates and benefits in effect in 2008, when the CWO program took off. Everybody else gets rates in line with the current economy.
Preventing burnout is a big part of Roizen’s role. He said stress levels for healthcare workers were five deviations above the mean in 1983 when the Perceived Stress Scale was developed. To address the problem, the clinic offers an online stress management program. Those who take it see their stress and burnout levels fall by about 75% and 44%, respectively, he said.
The clinic also designated two physicians to work solely on reducing EHR clicks for physicians and uses scribes to assist its primary care practices.
There have been environmental changes as well, such as removing sugary products from vending machines, eliminating fried foods and trans fats in its eateries and making on-campus fitness centers free to employees.
The effort has paid off. In 2008, about 6% of clinic employees had six normal vital signs. Today, 63.8% of employees are in chronic care management programs and 40% have the six normal numbers. "That’s saved us, compared with competitors, $254 million for 101,000 employees in the past three years," Roizen told Healthcare Dive.
In addition, absentee rates dropped from 1.07% to 0.70%. That change alone, if all the clinic did was replace the nurses, saves about $7 million a year, he adds.
It’s a win for employees, too, Roizen noted. The lower insurance rates translate to about $200,000 more in retirement funds, and employees live about eight years younger, meaning their risk of getting a chronic disease is that of someone younger.
A holistic approach
Dr. Edward Ellison, executive medical director and chairman of Southern California Permanente Medical Group, hired a CWO six years ago after physicians ranked the organization "very low" on wellness support in an internal survey. The response stood in contrast to that of managers and other staff.
The survey was trigger of sorts, Ellison said. "I had been a practicing physician and I knew the stresses. I knew the challenges of the electronic health record and how it had made many positive gains for systems of care and caring for patients, but created an added burden for physicians." The survey was a "data point for me and what really prompted me to appoint a chief physician wellness officer," he said.
To increase physician satisfaction, the group now offers flexible and alternate work schedules, reduced hours, mental health resources and peer-to-peer support. Specified teams help physicians prioritize administrative tasks so that others can handle the clerical work. There is also a physician concierge to help with non-work life planning, social events aimed at reducing the isolation physicians can feel in their job. Doctors are taught to practice personal preventive care and provided access to workout equipment.
"You have to take a very holistic approach," Ellison said. "It starts with culture, but it’s also about the practical, tactical time in your day. It’s about reducing the hassle factor and some of the bureaucracy of systems, and it’s about personal care and resilience and connecting people so that they don’t feel isolated."
SCPMG has repeated the survey that showed physicians did not feel the organization supported their wellness. The response today: double-digit improvements on culture and wellness, Ellison said.
An evolving role
So what qualities does a CWO need? Healthcare organizations are still figuring that out, said Komnick. Some are tacking physician and employee wellness onto medical director, chief human resource officer or chief experience officer roles. For those focused on physician wellness, it helps to have someone with a medical degree or research credentials. Other assets include the ability to lay out a vision for long-term wellness and supportive programs and exceptional collaborative and communication skills to get people on board with new ways of working in organizations that are traditionally resistant to change, she said.
The challenges for CWOs are huge and call for a wide continuum of solutions. "It’s not one size fits all, and we have to do this in the face of enormous change in healthcare, a lot of ongoing changes in reimbursement strategies and systems of care," said Ellison, noting CWOs have to navigate all of that while focusing on wellness and resilience.
Meanwhile, the problem of burnout is only getting worse. Ellison sees a parallel in airline passengers being told to don their own oxygen mask before helping others. "We need to make sure that our physicians are as healthy as they can be because they are then going to be able to be their for their patients and support them," he said. "It is in line with taking care of our patients."
To connect with millennials and Gen Z, know their story
Employers can't afford to overlook the unique requirements and inclinations of key segments of the workforce when it comes to both traditional benefits and wellness offerings and how they are defined.
By: Ryan Golden
HR professionals often discuss how to hire, support and retain younger workers — often reflexively referred to as millennials — and one critical component of these efforts is benefits. Employers can't afford to overlook the unique requirements and inclinations of key segments of the multigenerational workforce when it comes to the benefits offered and how they are administered.
The so-called millennial generation (defined as those born between 1981 and 1996) is now the largest segment of the U.S. workforce, according to the Pew Research Center. The needs of millennial employees are also generally shared by their colleagues born after 1996, known by the "Generation Z" moniker. But these two generations are more than curiosities — they are a growing force to be reckoned with. Experts are advising employers to re-evaluate their employee benefits strategies accordingly.
A world of difference
No two generations experience the same life events in the same order. That applies when speaking of the differences between the lifespans of, say, the generation called either traditionalists or the silent generation (born before 1946) and Gen Xers (defined as those born between 1965 and about 1980). HR should apply this same thinking to their younger peers, said John MacPhee, CEO and executive director of The Jed Foundation, a nonprofit focused on the mental health of young adults.
"It’s important that we understand that things are changing fast, and the world that emerging adults are growing up in today is quite different than even 10 years ago, arguably more than five years ago," MacPhee said during a webinar presented by the Disability Management Employer Coalition. "There’s heightened risks around sustainable employment [and] the gig economy — it feels less settled."
This changing landscape has revealed key differences in how millennials select and consume employee benefits, Emily Bailey, principal at OneDigital, told HR Dive in an interview.
"It really does cause us to take a step back and better assess how we're putting information out there," Bailey said. "[Younger generations] may not put as much value on certain benefits that the boomers and other generations that have been in the workforce for a while do."
Younger workers are particularly likely to forgo voluntary benefits like life insurance and disability insurance regardless of sagacity, Bailey explained, in favor of options that meet immediate concerns like tuition reimbursement.
Their preferences are also likely to impact delivery. Purchasing benefits, in the eyes of recent grads, will be held to the same standards set by e-commerce applications like Amazon, Bailey said. In short, millennials feel comfortable in a system that offers choice while allowing for a thorough evaluation of each option.
"That's not traditionally how we've presented employee benefit programs," Bailey said. "It's been kind of a one-size-fits-all approach, and I think that's going to have to change and that's what we're working to really do."
Employers can’t afford to throw out a slew of options that don’t stick, though. Offering decision-making tools is part of making the process easy to understand and user-friendly, particularly for younger workers, Bailey said.
No time to save?
Financial experts recommend that millennials set aside between 15% and 22% of their pre-tax salary, according to Jennifer Brown, manager of research for the National Institute on Retirement Security (NIRS), who spoke as part of a panel during an NIRS’ annual Retirement Policy Conference. But many younger employees are struggling to save even a single dollar. Literally. An NIRS report authored by Brown found that two-thirds of working U.S. millennials (birth years 1981-1991) failed to save for their retirement. A mere 34.3% participated in their employer’s retirement plan.
Breaking down the results of the report, the panel listed a variety of causes for millennials’ lack of retirement plan uptake, ranging from low wages and part-time/gig work situations to lack of trust in the financial services industry. A lack of proper financial education also plays a role.
"Part of this participation rate is the lack of education and knowledge," said panel participant and Pershing LLC VP Kathleen Johnson, "and that’s where you have a great opportunity here."
But by far, the biggest obstacle appeared to be a lack of access; 40.2% of millennial workers in the report cited eligibility reasons for their non-participation, usually due to a lack of requisite hours or tenure length, Brown added. A silver lining: millennials who were eligible for a retirement plan, and had that plan offered to them by their employer, showed a 93% take-up rate of said plans.
Mental health considerations are key
Wellness program popularity, combined with the industry standard of employee assistance programs (EAPs), have given HR a potent tool to combat stress, fatigue and other common mental health issues in the workplace. Millennials may be in particular need of this care.
"People are leaving home later than they used to be," MacPhee said. "They’re financially independent later. And as a result, adolescence is stretching out." MacPhee says there are even empirical findings that support a type of "quarter-life crisis," which results from the financial and social pressures younger workers face.
"When we look at populations of employed individuals, we definitely see an increasing need for information and programs to support health and wellbeing," Bailey added. "There's a marked increase in the results showing that employees and younger generations are looking for things like wellness programs or wellness incentives."
"It starts with leadership declaring that this is a priority," MacPhee said, adding that all relevant departments and constituencies need to have established policy in place to promote these programs.
Article top image credit: Kendall Davis/HR Dive
Mental wellness in the workplace
As mental health garners more attention as a workplace issue, not just a personal one, employers are finding considerable barriers may remain to implementing strong policies.
By: Kathryn Moody
By all accounts, Dennis Miller, CEO of an eponymous company that provides leadership coaching and executive search consulting, has had a successful career. He's served in executive positions across several non-profit organizations and is now a published author and speaker. He's also been enabled to do his work thanks to therapy for mental illness.
But it's only in recent decades that he has been able to openly address his experience, or even say that he first sought therapy when he was 20 years old.
"I talk about this deep secret I kept because I was so ashamed of it," he said. "I was a president of a major medical center but I still felt stigma."
As companies are pressed to push down healthcare costs, wellness programs have resurged as a way to encourage employee health, reduce claims and improve a company's recruitment brand. The market has responded in turn — meaning mental health may finally be emerging from the shadows.
"We're seeing this as a tipping point right now," Meena Ramachandran told HR Dive while serving as senior director of product management at Castlight. (She has since moved on to a new role with another organization.) "For the first time we are seeing huge demand for this type of support for employees and seeing support in ways that weren't talked about before."
Employers still face considerable challenges, particularly the specter of stigma and problems tracking utilization. But benefits platforms like Castlight and YourNurse are emerging to guide employers toward a more holistic wellness — and create a better atmosphere for employees in all walks of life.
"We are at a point in our culture and history that we can open up about emotional stuff, and it is not soft stuff," Miller said. "It's business."
Breaking through stigma
Blood pressure, diabetes and cholesterol screenings are all considered the norm. So are smoking cessation programs — set to cease a habit that was at one time considered normal. Openness about physical health, including cancer and diabetes, has improved over decades. But for many, mental wellness remains a topic fraught with shame and stigma.
"The business just kind of sees it as a labor issue only without realizing that the whole organization will do better when people are healthier," Miller said.
Ramachandran said her company spent close to a year speaking with users and combing the literature to distill the stigma issue down to four facets that employers can help tackle.
For employers, the first step is to encourage openness and instill awareness. Many employees do not realize they are struggling or experiencing symptoms of a mental illness. Finding ways to subtly encourage them to seek help, either through education programs or access to personalized healthcare platforms, is key.
Others are concerned that care won't actually be effective for their problems, Ramachandran said, tying directly into stigma and a belief that there isn’t an illness at fault but rather a personal flaw.
Cost (or the perception of cost) can be a barrier. Some do not realize that there is high-value care for mental health.
Perception of access can also be an issue.
YourNurse, a call service that guides employees through health benefits, tackles awareness through its one-point call system. Nurses respond to calls from employees and guide them toward the care that they need, rather than having an employee figure out on their own which service to call. Jamie Marcellus, RN, President of First Health Care, noted that nursing is a "trusted profession." Employees feel more willing to open up to someone they believe is truly listening to them.
Often, the reason for calling is the "tip of the iceberg," he added. The nurses can then arrange for the employee to receive the care they need for all facets of their health.
"As stigma starts to erode and as people become more aware of mental health challenges among the broader population, more employers are figuring out how to support employees during a time of need," Marcellus said.
Many employers already have employee assistance programs (EAP) and other support programs in place for this purpose. But due to the fragmented nature of these programs — a different program for every need, be it physical, mental or financial health — employers are consistently concerned about the actual value they are receiving.
Breaking out of silos
Despite an increased interest in holistic wellness from employers, the health and wellness industry still tends to operate in silos, Marcellus said. Typically, organizations will sign with an EAP for mental health, a health assessment service for physical health, and so on. Inevitably, employers have challenges in maximizing use of these services while also addressing the complex, multifaceted issues employees face.
In response, the industry is shifting. Both YourNurse and Castlight provide a single touchpoint that employees can use to overview their benefits, easing confusion and encouraging engagement. YourNurse provides a single number that employees can call when they require assistance, while Castlight’s platform gives employees an overview of providers they can compare on cost and quality.
Breaking down reporting
But the current siloed state of wellness has led to another issue in the industry, particularly with mental health initiatives: reporting results and the end value of such services.
"Organizations will have five to six services they purchased and they have no idea of knowing what that’s worth," Marcellus said. "It’s difficult for organizations to really understand what employees are using, how, and if they are seeing value for that use."
Additionally, employees often have their own apps and devices they use to track their wellness that do not get reported to an employer, Ramachandran said. An aggregator has yet to emerge that safely tracks such wellness forms.
Current utilization calculations don’t help, either. Many providers capture every interaction with an employee and charge that back as utilization, regardless of whether value was gained from it by the employee.
"We force organizations to take a pause to look at who is accessing services," Marcellus said. In some cases, there may be a difference between actual utilization and what is recorded – a particular problem if actual utilization is higher than expected. If one in four employees are accessing services, for example, there may be a bigger workplace problem that needs to be addressed, he added.
In all, organizations should take care to better observe their utilization and find ways to optimize tracking of value added.
What employers can do now
As holistic wellness garners attention, mental health initiatives will continue — because, in many cases, employers are already "paying for it" in lost productivity, Miller said. Such initiatives can scale appropriately.
Castlight made headlines recently due to its ability to track employees' behavior on their platform and to push information when it senses an employee searching about a relevant topic. Technology will likely continue to play a large role in making wellness more rounded overall.
"The technology will evolve around those pain points that are being talked about by employers and employees," Ramachandran said. That includes combinations of telemedicine and behavioral health, as well as computerized cognitive therapy and other tech-enabled solutions.
"I would utilize the free expertise that you can get from associations, the county government and behavioral health organizations," Miller added. Invite them to talk to you, he said; "Start a campaign."
HR managers should be educated on how to recognize a potential mental health problem and how to approach someone about that problem: "Understand that you can be a good employer and a good business person, too," Miller added. "The good news is that you can get treatment. I did. You have to envision the kind of life you want to have and treat people the way you want to be treated."
How spending more on behavioral health can bring wellness savings
More employers are embracing the adage that sometimes you have to give a little to get a lot.
By: Kathryn Moody
Donna Sexton, the director of employee benefits at Costco Wholesale, speaking on a panel during a National Business Group on Health conference, remembered how she felt when she looked into the data on her employees' mental wellness.
The data revealed an average of two suicides a month over an 18-month period.
Her immediate reaction: "I don't know what we're going to do."
Suicide not only deeply, irreversibly affects families, but it filters through the whole ecosystem of the workplace, pushing the emotional, social and monetary cost of a single death "way beyond" other problems.
The mental health crisis is a "real thing employers are facing," noted Dr. Steven Serra, senior medical director at Aetna. The delivery systems remain fragmented. Even at organizations like Aetna with large networks at their disposal, many employees face six months of wait time before they can meet with a psychiatrist, Serra added. When employees do not receive treatment, it drags down the entire organization on every wellness front.
The problem: mental and behavioral health issues often appear alongside other chronic problems, including cardiovascular health issues, injury and the like — and equally as often, employees are unaware of the impact of these "comorbidities," especially on their day-to-day work performance.
That means employers may need to consider spending more to save more. This technique involves what Dr. Reena Pande, Chief Medical Officer of AbleTo, calls "good utilization," and it requires solid investment — and commitment — by employers to create positive outcomes.
Where behavioral health saps money
Depression and its ilk are difficult enough on their own, but they also exacerbate other health problems and make recovery more difficult. Because 50% of Americans deal with some type of chronic health condition, according to Serra, this is no small problem for American employers.
Handling such a problem relies on an employer investing money in the right tools and programs that reach workers — meaning an employer must first have a key understanding of company culture.
Sexton noted that Costco has "high company trust" from employees and focuses on reinforcing a "cost/value conscious culture."
"We don't feel super innovative, but we focus on culture to choose what to take risks on," she added. To maintain that company trust, she knew that meant getting to the bottom of their mental health crisis. Major depression causes a 46.9% loss of productivity dollars per year. Even worse, "presenteeism," also known as "working while sick," causes losses that reach as high as $78.7 billion a year.
"We tip-toe around mental health all the time, but it really matters," Pande said.
Luckily, a focus on holistic wellness, something many employers are looking at, is already a step in the right direction. AbleTo's approach — the approach that Costco bought into — sees behavioral health recovery as part of any health recovery process, and its program includes guidance in social support, exercise, nutrition and sleep.
"Good utilization" comes in when employers are willing to increase their spend on programs that are proactive and seek out employees who may be struggling. Spend on behavioral health goes up, but in turn, employers save on other aspects of employee health due to behavioral health's wide impact. In this example, Serra said, behavioral healthcare was bolted directly onto Costco's health plan and includes active outreach to those most at risk.
The trouble with access
In many cases, behavioral health is "almost a prereq" before an employer can aim for other health solutions, the experts said. But traditionally, access is a huge problem for behavioral healthcare. To overcome this, AbleTo utilizes remote and telehealth solutions to encourage employees to engage, capitalizing on a strong current trend.
"We make it really hard to get behavioral healthcare at work," Pande said. "We don't want to talk about it." The convenience is a real factor. Being able to obtain treatment at home at any time of the day or week means employees don't have to take time off work or risk "revealing their issues" to anyone, she added. At the end of the day, getting people to treatment is the key.
According to AbleTo, telephonic therapy works just as well, even in randomized trials, as in-person therapy. Evidence also shows strong reductions in medical utilizations after behavioral therapy, including: 31% decrease in hospital admissions, 48% decrease in hospitalization days, 56% decrease in depression symptoms, 61% decrease in absenteeism, 44% decrease in presenteeism and 44% decrease in activity impairment.
Cost is another huge factor. Costco, in a reflection of its values, 100% covers the cost of AbleTo treatment for employees. Sexton said the program has met great success.
"If we can reach 10%, we're happy," she added. "They reached 50% of the women called for post-partum depression." Those who were fine and didn't need treatment were "so grateful" that the company thought to reach out and consider their needs. Those who did need help were caught at a key time, before any problems could get out of hand.
ROI and proof of concept
The struggle to prove ROI in wellness is well-documented and problematic. Many modern healthcare applications have ROI top-of-mind, and behavioral wellness offerings are no exception.
Employers tend not to have seen ROI with similar programs, Pande noted, so "we knew from the outset that we had to prove that."
Due to the eight-week, telephonic model, AbleTo matches more modern expectations of ROI outcomes and is able to provide ROI in six months versus the old, long-term model of 10 years or more. Part of that involves AbleTo's willingness to direct employees to the treatment they need — even if that ultimately isn't in AbleTo's wheelhouse.
Partnerships are key, Pande said, as their strengths can be optimized by integrating the strengths of other providers when needed. This strategy is similar to how concierge services provide benefits, though AbleTo is built more specifically to handle behavioral health cases. They and other behavioral health providers extend a hand of support in order to address a need, using conversation guides to get to the real issues at hand.
While AbleTo uses claims data and other provided sources in order to reach the appropriate employees through phone, email and even texting in some cases, the key is simple: "We actually do it," Pande said.
"We tend to put the burden on an ill person's shoulders, which is not fair," she said. "We have to reach out proactively."
Article top image credit: Adobe Stock
Top trends in corporate wellness
As the workforce evolves and multiple generations with different priorities move into the workplace, the definition of wellness gets broader and more holistic. Gone are the days when employee wellness programs meant offering incentives to stop smoking, eat well and take walking meetings. Today the definition includes everything from mental health and onsite health perks to financial wellness and retirement planning.
included in this trendline
How generational concerns are changing the landscape
Mental health as an emerging wellness trend
What the data says about wellness now, and in the future
Our Trendlines go deep on the biggest trends. These special reports, produced by our team of award-winning journalists, help business leaders understand how their industries are changing.
Davide SavenijeEditor-in-Chief at Industry Dive.