quest diagnostics is the leading provider of diagnostic testing, information and services. recently, quest conducted a study to answer the question many employers and employees ask: why do we need lab tests? “as a physician,” explained harvey kaufman, M.D., one of three study authors and senior corporate medical director at quest, “i come across employees who say, ‘i’m great, i’m healthy, haven’t seen a doctor in 10 years.’ i say great, but you don’t really know what’s going on in your body. the only way to find out is to get tested.”

so, to find out what’s going on in people’s bodies, quest conducted a study that included analyzing the results of more than 50,000 first-screening participants at 15 employers between 2003 and 2010. the study, “value of laboratory tests in employer-sponsored health risk assessments for newly identifying health conditions,” discovered that:

• 59% of those at high risk for high cholesterol were newly identified
• 28% of those at high risk for diabetes were newly identified
• 89% of those at high risk for kidney disease were newly identified

all of these individuals discovered their risk through their employer’s lab-based wellness program. those not newly identified had reported in their health risk survey that they were aware of their condition. “an enormous number of people were unaware they have these risks for common chronic diseases,” commented kaufman. this was particularly true for chronic kidney disease, the study authors found.

as expected, older participants had a higher prevalence of risk for all three conditions, but the study authors were surprised to find that one in four 29-year-olds had a newly identified condition. “our 20- to 29-year-olds are unhealthier than previous generations,” said fred r. williams, quest’s director of health management strategies and another study author. “they’re heavier and less active, but they’re also more plugged in, which means they’re more likely to feel they’re empowered in their health.”

the trick is to get them active in their health—and knowledgeable about it too. quest is hoping their study will be a call to action for both employers and employees. “26 million americans have chronic kidney disease,” explained williams. “by the time people score at a high risk, they may have lost 50% of their kidney function.” quest believes that their results will underscore the cost/benefit equation for lab tests as part of an overall approach to employee wellness—and that if they can “train” younger people to routinely get annual physicals, we won’t see the same rise in risk we currently see with today’s older generation.

besides reducing the health risk to the individual, there is also the opportunity to reduce the cost of health care. fewer and lower risks mean less health services needed, something that won’t be lost on employers. quest’s emphasis on lab results over self-reporting also won’t be lost on employers who are increasingly interested in an outcomes-based approach to wellness. “it’s easier to be ‘in denial’ based on self report,” said helen darling, president and CEO of the national business group on health. “we know people underestimate weight, overestimate height and underreport on unhealthy habits. with biometric screenings—you can’t distort or make yourself look better. employers would do well to have wellness programs with an emphasis on accuracy and data.”

my two cents: employers are rapidly adopting outcomes- or results-based wellness approaches. a towers watson study (see page 15) found that 33% of respondents plan to adopt this approach where incentives are tied to results, like lowering one’s BMI or cholesterol levels. in this vein, lab tests are a useful and necessary tool. they are a more costly approach than self-reporting, but a worthwhile investment, quest says, when you consider the cost of health care for those whose diseases have gone undetected. one thing employers will need to consider is the frequency of lab tests, particularly as our understanding of when preventive health screenings are useful and when they’re not evolves.

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read the full study.

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a new, brief study by altarum institute finds that we’re simply not comfortable being health care consumers. as part of the study, altarum asked 3,000 people to answer basic questions like:

• what kind of health care insurance do you have?
• what role would you prefer to play in important decisions about your medical treatment?
• have you ever asked how much your visit would cost before going to the doctor?
• when you received advice or services from a nurse, doctor, laboratory or hospital in the past 12 months, did you look for information about ratings of doctor quality before choosing where to go?

these aren’t challenging questions. in fact, if you switched out the health care focus and inserted house- or car-related topics, every one of us could answer the questions. we’d probably all have stories to tell about how many car repair shops we visited before settling on one or how many home contractors we haggled with over price.

when it comes to health care, however, things get shaky. we want to defer to medical providers or we’re uncertain whether we should question them. after all, they’re the experts. we’re also unable to investigate and compare. comparison shopping for health care isn’t as simple as visiting an expedia, amazon or consumer reports. today, the tools for finding out how much a visit costs or comparing providers are largely nonexistent, or extremely clunky.

that’s beginning to change. tools are becoming available that will make it easier to comparison shop. castlight health, for example, offers employers a way to provide employees personalized information on cost, quality and convenience. but being able to comparison shop is only half the battle. the rest lies with making us want to pick up the sword as health care consumers. this, too, is changing. the quantified self and e-patient movements have captured a segment of the population, and more people are looking online for health information. one in five internet users has gone online to find someone who shares their health condition, according to a peer-to-peer health study done by pew.

what the pew study suggests is that we’re comfortable investigating things in health that we’re comfortable investigating in other areas of our lives. we’re comfortable asking questions like: has this ever happened to you? how did you deal with it? what suggestions do you have for coping? the pew study also found that we’re more likely to investigate when we have a health crisis.

the altarum study suggests that we’re not accustomed to thinking about, let alone investigating, routine things, such as the cost of services or the quality of health care providers. watch this video to see how wildly participants fluctuate in their estimate of the cost of different services.

it boils down to this: employers have work to do. employers who want their employees to act as health care consumers will need to step in and teach them how to find and use these newly available tools—and tell them they have an obligation to themselves and their company to do so.

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this morning i presented on workplace wellness trends at people report’s 2011 best practices conference. i’ll report on the conference later. for now, i want to share the slides. they contain a lot of important data on what’s happening with wellness.

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a roundup of last week’s news that caught my interest.

1. worker costs rise. don’t expect salaries to

the connection between rising health care costs and stagnant wages and job creation is one you won’t frequently find discussed in corporate america’s messaging about health benefits. yet this causal relationship is critical for employees to understand. do your communications touch on it?

“The trouble is, this means employers are paying more for workers without actually paying their workers more. Higher benefit costs eat into profits without directly raising a company’s output in the way hiring more workers would. In fact, this can actually discourage hiring. And the more that companies have to spend on benefits, the less take-home pay goes to workers. This undermines the virtuous cycle of consumer spending and job growth needed to help lower the 9.1% unemployment rate.”

2. premiums, deductibles and cost sharing in employer health plans keep rising

i pulled a number of slides from the kaiser family foundation’s annual survey of employer health benefits for my post on walmart’s rollback. this article reviews the overall findings from this survey.

“But…coverage won’t come cheap, as premiums, deductibles and cost sharing continue to rise, sometimes even more steeply than in previous years. More employers are also moving to high-deductible plans that shift increasing expenses onto their employees, requiring them to pay more before benefits kick in. And companies are making it pricier to insure spouses and children.

“There is a bright spot, however: Employees who participate in the increasing number of company wellness programs can often reduce premium and other cost increases.”

 3. push for health-cost data

“gimme my damn data!” is the e-patient’s cry. e-patients know that having their own health data allows them to more successfully navigate the health care system and manage their care. this article shows how “gimme my damn data” is becoming the employer’s cry too. employers want pricing data available to their employees so their employees, in turn, can become better informed, better equipped health care consumers.

“But Web services that reveal health-care pricing typically have to be built using data that are collected by the health insurers, which are generally the ones processing medical bills for an employer’s workers. Some, such as Aetna Inc. and Cigna Corp., are sharing at least certain information with third-party firms when clients ask them to do so. In other cases, according to benefits consultants, vendors and employers, insurers are declining to let the information be handed over to the outside companies.”

4. investment guidance for employees long overdue

if you’ve managed or written financial communications, then you know most include a line that goes something like this: “X Company does not provide financial advice. be sure to review your personal goals with a financial advisor.” this lack of personal advice left many employees bewildered or among the ranks of nonparticipants. that’s changing, with a new law going into effect december 27.

“That’s what’s changing. Now companies, under the new exemption, can arrange for workers to get specific advice from the firm running their plan as long as the advice is based on a computer model certified as unbiased and as applying generally accepted investment theories, or the adviser is compensated on a ‘level-fee’ basis, meaning the fees do not vary based on investments selected by the plan participant.”

5. incentives & communication drive higher participation for marsh & mclennan companies

cohealth member ray goldberg explains how his company approached the design and launch of their wellness effort, healthy me. he offers many transferable lessons, like this:

“We offered a $150 incentive to colleagues, spouses and domestic partners enrolled in our health plan—but with a twist: To receive the incentive, participants had to complete the health assessment andcall to speak with a health adviser to discuss the results.

“Why did we do it this way? We had two objectives—to capture data on our health risks that didn’t show up in health claims, and to get participants to manage their health risks through coaching. In this approach, it’s easy for the participant to reach the health adviser—much easier than the reverse. And when they make that call, participants are expecting to discuss their health, so we expected they’d be more open to the idea of health coaching.”

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employees aren’t seeing raises—and it’s not because of their performance. it’s because of rising health care costs.

“Employees may not realize it, but they are getting more expensive.

“It isn’t that their paychecks have suddenly started bulging. It’s that other employment costs—like health and retirement benefits—continue to rise. Benefit costs in the private sector were up 4% year-on-year in the second quarter, more than double the 1.7% increase in wages and salaries. On Friday, the Labor Department’s employment-cost index for the third quarter is likely to show this trend continuing.

“The trouble is, this means employers are paying more for workers without actually paying their workers more. Higher benefit costs eat into profits without directly raising a company’s output in the way hiring more workers would. In fact, this can actually discourage hiring. And the more that companies have to spend on benefits, the less take-home pay goes to workers. This undermines the virtuous cycle of consumer spending and job growth needed to help lower the 9.1% unemployment rate.”

read the full article in the wall street journal.

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walmart reversed an earlier decision last week and announced it would no longer cover spouses or provide health benefits to future part-time employees. at the same time, the news coverage reported that walmart will apply a tobacco surcharge and reduce its funding of employees’ health savings accounts. these accounts are coupled with high-deductible health plans and help employees cover some of their out-of-pocket expenses.

walmart’s decision got a lot of press, but as at least a few articles noted, what walmart’s doing is not atypical. i pulled a few charts from the kaiser family foundation’s employer health benefits 2011 annual survey to prove the point (click on each to view a larger image). as this chart shows, employers frequently don’t offer part-time workers health benefits.

those employers who continue to offer benefits to part-timers are facing the same rising health care costs all companies are seeing. and those cost’s are more frequently being shared with employees. in this chart, you can see that the average annual premium for an individual is $5,429.

 knowing the trends and averages helps put reported stories like this in perspective:

“Tammy Yancey, a $9.50-an-hour gas attendant at a Sam’s Club in Pinellas Park , Fla., complained that she would no longer be able to afford health insurance from the company. Ms. Yancey, a smoker, said her premiums would jump to $127.90 every two weeks—or $3,325 a year—up from $53.80 at present, when she earns $12,000 a year from her job.”

tammy yancey’s costs are rising, yet her premiums are still under the average individual’s.

tobacco surcharges are also not news. a study by hewitt (now aon hewitt) found that 64% of companies impose or plan to impose a tobacco surcharge. some companies have already gone beyond surcharges and stopped hiring tobacco users altogether. it’s yet to be seen how well the “stick” will work versus more supportive methods such as creating a tobacco-free workplace, or as in walmart’s case, not selling tobacco while trying to get employees to quit. that presents a situation that’s tough to message.

it’s become common for employers to offer plans with high deductibles. we’re likely to see 73% of employers offer a high-deductible health plan and 47% offering only them.

while painful, walmart’s decision isn’t outside the norm. walmart reversed itself in response to changing economic times. they have tighter margins and tons of people knocking down their door for a job. employer interest in being an employer of choice waxes and wanes depending on where we are in the “talent wars.” and right now, the war’s being fought by employees, not employers.

so the bigger question is not whether what walmart’s done is “right.” it’s whether walmart’s decision signals anything unknown about the future of employer-provided health benefits? will more employers move to part-time and contract workers as a way to manage rising health care costs? will they continue to rewrite their eligibility rules? will employers consider the $153 billion in lost productivity because of health conditions while they pare back health benefits?

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related articles:

• choosing the right health-care plan
• premiums, deductibles and cost sharing in employer health plans keep rising

employees have been paying more for their benefits, but that doesn’t mean they don’t want them. or wouldn’t be willing to pay even more for them. so finds the 2011 mercer workplace survey, a national survey conducted by mercer’s US outsourcing business.

some of the topline findings from the survey are around value, price sensitivity and health care reform.

value

employees still highly value the benefits they receive from their employer. that’s echoed in other studies, such as metlife’s 9th annual benefits trend study. as with metlife’s study, employees in mercer’s study say benefits are one way their company shows it cares about them. even though 44% of the respondents are paying more out of pocket this year, 46% said their benefits are worth the cost.

price sensitivity

the perceived value of employer-provided benefits

what this study also shows is that employees are willing to pay more for the benefits they want. this also echoes metlife’s findings. employees indicated they were happier paying more for benefits than losing them. (at the same time, employees did note that their company should offer better benefits.)

health care reform

employees seem to be viewing health care reform more positively since the last time mercer conducted this study. that doesn’t necessarily mean they expect to be better off. when asked whether they’d be better or worse off once health care reform provisions are in place, employees answered that they expect to be worse off when it comes to what they pay for care, their health benefits at work, and the federal income taxes they pay.

it’s a good thing employers are getting the message that they need to communicate about health care reform—even when there’s not a lot to communicate. mercer’s study found that more than a third of the respondents’ employers informed employees that they’ll be making changes as a result of health care reform. employers must continue communicating with employees so that sentiments about their financial well-being are confirmed, or negated, by the facts.

sidenote

this annual survey tracks changes in attitudes and experiences with employer-provided retirement, health and benefit programs. the executive summary contains terrific data on what keeps employees up at night about retirement savings. the focus on retirement may explain why the answers are only from employees who are enrolled in their employer’s health plan and are active 401(k) participants (mercer’s definition of active: contributing or with a balance of at least $1,000). frankly, it’d be interesting to see whether the answers about value and price sensitivity differ between those who are active and those who are not participating or inactive. for example, is there any correlation between being active, risk-averse and holding your benefits in greater esteem? or, wanting to pay more to keep your health benefits?

download the executive summary.

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we know employers want employees and their families to make healthier choices. we now know that as employees and consumers we want businesses to do more to help us. that’s one of the key findings from the edelman health barometer 2011, a global study on health behaviors and attitudes. edelman hosted a sneak preview for roughly a dozen health bloggers last week, of which i was one.

it’s this symbiotic health relationship between business and individual, as employee and consumer, that will be of the utmost interest to employers. (they should also look at the data about what motivates us to make healthy changes.) what edelman’s information shows is that an employer’s investment in their employees’ and our general health does more than manage health care costs, absenteeism and productivity. it also affects their competitiveness, brand reputation, pricing strategy, and investor and employer attractiveness.

employers get lower scores on lifestyle

edelman developed a set of questions to explore what or who most impacted our overall health, and whether that impact was positive or negative. respondents routinely cited themselves, their family and friends, and their local community as having a positive impact. things got a little sketchy when it came to their employer. the scale started sliding toward negative impact, particularly when it came to lifestyle in the US and environment and lifestyle globally.

edelman also found that respondents expect businesses to use their strategies, practices and policies to positively affect our public health. what this signals is that as consumers, we’re evaluating companies’ actions in the marketplace, as an employer and as a key influencer in public policy. unsurprisingly, we want companies to come clean about the health of their products. perhaps more surprising, we’ll judge employers according to whether they grant employees the time to take care of their health (82%), support the health of the communities where they operate(72%), or contribute their own or their employees’ expertise to improve public health (72%). we’ll express our dissatisfaction with a business’ strategies or policies with our pocketbook, our CV and our mouths.

the opportunity costs for health

i’ve spoken and written about what i consider to be the seven levers of workplace wellness. the last two levers are environmental and political. they’re the two that get shortest shift these days, but this study should ignite another look. employers who become a health agent and advocate for their citizens (employees) and the world’s will reap positive payback in talent wars, brand management, shareholder investment and market growth. this is a new way of talking about health to employers—a way that cuts beyond managing health care costs and into their deepest life vein.

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health 2.0 SF is the speed dating scene of the health technology world—except you sit pretty while tech companies, not a potential partner, take their best 3-minute shot. if you like what you hear, set up a date. they’re there for the asking. if you don’t, no worries. they’ll be vacating their spot, ceding it to the next company for their 3-minute spot.

i was there to moderate two panels at the first-ever employers 2.0 preconference workshop and to moderate another panel on social games at the main conference.

employers 2.0

employers 2.0 covered topics unique to employers’ concerns: workplace wellness, onsite medical clinics, and consumer tools for purchasing insurance and health care services. the panels i moderated gave me the chance to talk about wellness with some familiar faces—limeade and keas—and to learn more about stickk, a solution based on personal commitment contracts. luckily, we also had the employer represented by clif bar, pfizer and the pacific business group on health, a non-profit business coalition with 50 large-employer members. sure, we touched briefly on the employers’ role in creating a culture of health, using their influence to improve health care, providing well-rounded wellness efforts that focus on the four biggies (stress, nutrition, fitness and tobacco). but we also discussed the behavioral, financial, aspirational, communal and spiritual—and not in a “granola” way. we talked about career development, volunteering, and finding deeper meaning with the work we do and the relationships we form. each of these wellness solutions supports this deeper definition of well-being.

next, we heard from cisco about their onsite clinic, launched in 2008, and from american well, an on-demand service that connects consumers and physicians. cisco’s comprehensive clinic offers a comfortable, inviting, convenient place for cisco’s employees and their family members to get comprehensive services, not just biometrics. the clinic offers primary care, laboratory and radiology services, and houses a walgreens pharmacy, vision care, disease management and employee assistance program counselors—even an acupuncturist. cisco offers employees who use the clinic a lower-cost structure, including waived copays. it’s a model that’s working for cisco, with satisfied employees reporting less time away from work and shorter wait times for care.

finally, six companies that offer tools for health care purchases, including insurance, demoed their product. it’s worth checking these out so you know what’s available to you and your employees now. as we move toward 2014, more tools and resources will be available to employers and consumers alike.

• health expense.com—helps employees track their medical bills and health insurance payments
• ehealth government systems—guides individuals to find the right health plan in an exchange
• connectedhealth—leads employees to the best health plan for their needs and offers additional guidance and support, including live support
• castlight health—provides unbiased information about price, quality and convenience of different health care providers so employees can truly become health care consumers
• trustnode—teaches employees how their plans work and helps match them to the best plan
• benefitsconnect (product)—handles online benefits enrollment for employers

massively multi-player games

i moderated this panel pulled together by rajiv kumar, CMO and co-founder of shapeup. joining us were jonathan atwood, ceo of zamee and michael kim, ceo and founder of kairos labs. the game approach these guys talked about comes from PERMA, a new model for well-being created by martin seligman. (thanks to michael kim for introducing me to PERMA and the book from which this acronym comes, flourish.) PERMA stands for: positive emotions, engagement, relationships, meaning, accomplishment/achievement. about now, you should be sensing a theme, as this echoes the conversation in the workplace wellness panel. games, these three felt, powerfully and effectively created an avenue for an individual to achieve all five ends.

demos, demos and more demos

but demos are the heart of health 2.0. it’s an astonishing rotation of over 130 companies hand-selected by the health 2.0 team for their creativity and impact—or potential impact, as some of these companies are being showcased for the first time and are looking for investment, alliances or buyers. companies that aren’t invited to demo can set up shop in the exhibition hall. it’s the leading showcase of cutting-edge innovation, and its intent is to keep its eyes—and ours—on what’s coming down the pike.

so, what’s coming down the pike? tools that’ll inform, guide and connect us. tools that’ll help us make better benefits and health care decisions, whether we’re working through an employer or buying direct as a consumer. tools that’ll connect us with others to pursue a lifestyle or help us overcome addiction or allow us to conveniently tap into a doctor from wherever we are, about whatever we need. tools that are personalized and work from where we are: physically, mentally or spiritually. tools that’ll make the technology we sometimes feel encumbered by our servant.

for employers, here’s a slim sample of companies to check out in addition to the ones already mentioned:

• mindbloom—released at health 2.0 by aetna, this “life game” is billed as a “fun, simple and effective way to improve the quality of your life.”
• onerecovery—focused on recovering addicts, this social network helps addicts, as well as their family, work through and keep to their recovery.
• healthtap—connects you to thousands of physicians who can answer your questions for free via online and mobile solutions.
• liv.n it—not yet released, this is a “mobile habit gaming network” from kairos labs that’s designed to encourage us to complete small, daily acts of healthy living.

after watching a slew of demos, you notice things you might not otherwise notice if you were using only one product. facebook features are infiltrating many products, with status updates, “likes” and so on becoming ubiquitous. i’m sure this aids ease of use, since it’s all familiar, but one has to wonder when we’ll have facebook fatigue (outside of facebook). similarly, i saw more than a few tweets suggesting that attendees are experiencing a similar fatigue with gaming elements. it’ll be interesting to head back out to health 2.0 next year and see what we’ve learned and where we’ve landed.

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i lasted 5 days. 5 days! what nailed me wasn’t health insurance (i opted out) or rent (i chose a place 50 miles from work), but deciding to treat a sick pet instead of letting it suffer or putting it down. what will nail you?

play the game spent and walk in someone else’s shoes. then reflect, if you’re a senior leader in your company, on how your terms of employment affect your employees.

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note: i learned of this game by reading sharlyn lauby’s wonderful post, the dawn of economic diversity.