High-deductible health plans have become an increasingly popular means for employers to keep health care costs under control. According to data released last summer by the Centers for Disease Control and Prevention, between 2007 through 2017, the percentage of adults 18-64 with employer-provided health insurance who were enrolled in an HDHP with a health savings account increased from 4.2 percent to 18.9 percent, while the percentage enrolled in an HDHP without an HSA rose from 10.6 percent to 24.5 percent.
Over the past three years, however, our benefits research at Gartner shows that their popularity has been leveling off, as deductibles for individual plans have actually been trending downward. (Gartner Total Rewards Leadership Council clients can view our full report on medical plan trends and observations for 2018 here.) This trend suggests that employers are having second thoughts about whether the benefits of HDHPs outweigh the downsides.
A new survey published last month by the nonprofit Employee Benefit Research Institute (EBRI) and research firm Greenwald & Associates provides some insight into these pros and cons. The survey found that people enrolled in HDHPs were more likely to compare cost and quality when selecting non-emergency health care and to make cost-conscious decisions like choosing generic prescription drugs over brand names. HDHP enrollees also more likely to be offered and to participate in wellness programs through their employers, including programs that involve biometric screenings.
On the other hand, this cost-conscious behavior may not be entirely voluntary: 30 percent of HDHP enrollees said they delayed care in the previous year because of costs, compared to 18 percent of respondents covered by traditional health insurance plans. While the EBRI study does not clarify whether this care was essential or non-essential, another recent study of diabetics found that switching to a high-deductible plan increased their likelihood of delaying essential care.
Earlier this year, Apple announced that it was establishing a network of clinics near its headquarters in Cupertino, California to provide primary health care services to its employees in Santa Clara County. The AC Wellness program has been on a hiring spree since then, bringing more than 40 health professionals on board, CNBC reports, citing a LinkedIn search. The hires include a number of former employees of Crossover Health, which used to operate Apple’s onsite clinics in the Bay Area and still runs them elsewhere, and which Apple had considered acquiring before deciding to design its own clinics instead. In keeping with the name of the initiative, these early hires indicate that AC Wellness is going to be more than just a medical clinic, suggesting a more holistic focus on wellbeing and helping employees maintain healthy lifestyles:
Most of the team hired so far aren’t doctors. In fact, the hires skew toward wellness professionals like nutritionists, exercise specialists and nurse practitioners. A lot of the hires have a background in alternative or functional medicine and there’s even a “wellness lead” — Jennifer Gibson, a former head of coaching at Vida Health, a health-tech start-up. Gibson, according to her profile, is passionate about things like nutrition, stress management and smoking cessation, which aren’t always offered at primary care practices.
The company has also brought on at least a half dozen “care navigators,” who don’t have medical degrees but do have a background in directing patients to the most appropriate care. In some cases, that might involve a followup conversation with a specialist or a lifestyle change that might alleviate the problem on its own. That could reduce costs as these navigators can better ensure that Apple employees and their dependents aren’t getting unnecessary care.
Apple is in the process of establishing a network of clinics near its California headquarters to provide primary health care services to its employees, CNBC reports:
This new primary care group — a group of clinical staff that is run independently from Apple but is dedicated to Apple employees — will initially only serve Apple’s employees in Santa Clara County, where its headquarters are located. Initially, it has two clinics in the county. Development appears to be well underway.
The initiative, called AC Wellness, will “offer a unique concierge-like healthcare experience for employees and their dependents,” according to its website. In addition to health care professionals, AC Wellness is hiring designers and analysts to help build and implement a preventive and behavioral health program, according to CNBC.
Part of the rationale for this project is undoubtedly to better manage health care costs at Apple, which has thousands of employees in California and 123,000 worldwide. The clinics appear to have a secondary purpose, however, as proving grounds for Apple’s consumer-facing health products:
The wearable technology company Fitbit, known for its ubiquitous fitness-tracking bracelets, announced on Tuesday that it was acquiring Twine Health, a cloud-based health coaching platform designed to help employers manage chronic diseases like diabetes and hypertension in the workplace and aid employees in lifestyle changes such as weight loss and smoking cessation. The company describes the move as an expansion into the workplace wellness space:
With this acquisition, Fitbit further extends its reach into healthcare and lays the foundation to expand its offerings to health plans, health systems and self-insured employers, while creating opportunities to increase subscription-based revenue. The acquisition will combine the power of the Fitbit platform to drive lasting behavior change with Twine Health’s clinical expertise and proven ability to help patients better manage their care through a highly scalable platform and coaching model. In the longer term, Fitbit will have the opportunity to extend the benefits of the Twine platform to its more than 25 million users and expand into new condition areas.
As the leading manufacturer of fitness tracking devices, Fitbit was already a significant figure in the growing drive to incorporate these technologies into workplace wellness programs by collecting employee health and fitness data and using it to target interventions. The company has been sharpening its focus on this market for some time now, Paul Sawers observes at VentureBeat:
When a district court in Washington, DC, ordered the US Equal Employment Opportunity Commission to rewrite its rules governing incentives for employee wellness programs last August, the court declined to vacate the commission’s current rules in order not to create disruptions in businesses that had already implemented programs based on them. The AARP, a lobbying group for older Americans and the plaintiff in the case against the EEOC, petitioned the court to amend its judgment and vacate the rules.
In its latest ruling, issued in late December, the court agreed to do so, but not until January 2019. Labor and employment attorney Jonathan E. O’Connell outlines the latest chapter of this legal drama at SHRM:
Also playing into the court’s decision to modify its prior judgement was the timeline offered by the EEOC for issuing its revised rule. The EEOC indicated that the new rule would not likely be ready until 2021. The court stated that such a lengthy delay was inconsistent with its expectation that the revised versions of the rule would be issued in a timely manner and thus also supported reconsideration of the court’s earlier decision. The court stated that “an agency process that will not generate applicable rules until 2021 is unacceptable” and strongly encouraged the EEOC to take steps to implement revised regulations faster.
Arguing on behalf of the EEOC, the Justice Department pushed back on that decision in a court filing this week, arguing that the court did not have jurisdiction to impose a deadline on the agency or force it to write new rules at all, Erin Mulvaney reports at the National Law Journal:
Psious, a virtual reality and augmented reality technology company, originally designed its products to help therapists combat anxiety disorders in patients via immersion therapy. For example, as Helen Lock of the Guardian reports, for patients with a crippling fear of insects, the therapist could expose them to their fears using VR without having to find a bunch of bugs in real life. The company has now expanded its offering to help businesses promote mental health. The vision is that instead of venting angrily around the water cooler or seething internally, there are always-on methods to support employees with depression or anger and provide an outlet to direct their feelings in a healthy way.
The technology can be used to manage a variety of maladies, including stress, ADHD, and fear of public speaking, according to the Psious website. But they aren’t the only ones: CleVR offers a range of VR systems that treat phobias through exposure therapy, while Guided Meditation VR can transport employees from their cubicle to a calm, quiet field, where they’ll be walked through breathing and meditation exercises. Some of these solutions are also suitable for treating PTSD, which can be helpful for veterans or victims of traumatic evens such as sexual assault.
Back in July, NewPathVR launched a portal called RE:NEW, which directs users to a catalogue of wellness applications. Charles Singletary at Upload highlights Google’s Happinss, the “rhythmic casual game” Thumper, and Fearless, another exposure therapy offering, among the different apps available.
While organizations have been using health and wellness programs to engage employees for decades, in recent years the rewards space has moved toward a more holistic view of employee wellbeing. Today, companies are feeling pressure from all sides to enhance their employee wellbeing programs. Employees are hearing more about the wellbeing benefits their friends are being offered at other organizations, our peers are innovating in this space, and vendors are constantly coming up with new services to differentiate themselves as they compete for our business.
Facing these combined pressures, companies have greatly expanded their wellbeing offerings in the past five years: Whereas in 2013, the average company had four wellbeing programs, by 2017 that number had quadrupled to 16. In a peer benchmarking session at the CEB ReimagineHR summit in Washington, DC, last Thursday, a plurality of rewards leaders said they expected wellness or wellbeing to be their number one area of change in 2018, more than healthcare or retirement.
Budgets for wellbeing, however, are not growing: Most companies we surveyed at CEB said their wellbeing expenditures were either remaining the same or decreasing from 2016 to 2017. As demand grows while budgets stagnate, many HR functions are being asked to do more with less in their employee wellbeing programs. Here are some facts for total rewards leaders to keep in mind as they try to get the most bang for their wellbeing buck.
Holistic Wellbeing Programs Have a Real Impact on Engagement
The shift in the conversation from wellness to wellbeing reflects a growing awareness that maximizing employee productivity and minimizing health care costs involves not just preventing or managing diseases, or even promoting physical fitness, but also helping to mitigate stress. That’s how psychological, emotional, and even financial wellbeing became part of the more holistic offerings we’re seeing today.
And there’s a good reason for this change, because organizations with well-designed holistic wellbeing programs see levels of employee engagement nearly 10 percent higher than average. Designing a progressive wellbeing program has as much positive impact on engagement as letting employees choose their own hours, and three times as much impact as providing dental and vision benefits.