Evidence-based medicine has become a big buzzword in healthcare over the last few years. But certain non-traditional treatments, like chiropractic care, may also prove effective in certain cases.

The key –  Using these treatments also to – not instead of – conventional medicine may prove more cost-efficient in the long term.

What the latest research says

Do these five common complimentary treatments belong on your health plan? Here’s what recent research suggests –

1) Chiropractic care. Studies suggest these treatments might help cut absenteeism for workers with uncomplicated lower back pain, namely for individuals  who’ve had it for less than a month.

2) Acupuncture. Research shows acupuncture can help relieve osteoarthritis, chronic migraines, post-operative pain, low-back pain, fibromyalgia and carpal tunnel syndrome. There’s less evidence about its effectiveness as a tandem treatment for other conditions.

3) Acupressure. There’s no significant research to show this needle-free variation of acupuncture (a therapist applies pressure to specific points on the body) has the same medical benefits.

4) Biofeedback. According to the Mayo Clinic, there’s now some research to suggest this treatment can help with some types of chronic pain, particularly tension headaches and muscle pain.

How it works –  Monitors display a patient’s heart rate, breathing patterns, body temperature and muscle activity. A therapist then teaches the patient how to lower these readings via relaxation.

5) Aromatherapy. as yet, there’s no evidence of direct medical benefits. While it could be a relaxing treatment to reduce stress, few firms – if any – foot the bill on employees’ behalf.

When an employee ignores directions from a doctor, who’s responsible when the employee causes a serious accident on the job?

In some cases, it’s your firm that ends up on the hook – both for workers’ comp and for other people ’s injuries caused by misuse of a prescription drug.

Situations like these raise three questions that even HR/benefits pros have trouble answering. How are you – or supervisors – supposed to know what meds people  are on and whether they’re taking them as directed by their physicians?

In most cases, you won’t.

Are you able to find out without violating health insurance portability and accountability act (HIPAA) or other laws?

You can’t, unless the employee volunteers the info or a physician notes the effects of medication being the reason for the accident.

So when you won’t know and can’t find out, how on earth can your firm be held responsible after the fact?

It all depends on the circumstances. Three key danger signs –

• A supervisor already has knowledge of an employee’s medical condition, if not the meds themselves. Example –  the staff member requested a schedule change and said it was due to a particular medical problem

• the individuals has a history of erratic behavior that management suspects is medication-related, and/or

• the employee’s job involves potentially dangerous situations.

Spotting possible danger

A Florida case (Johnson v. Rentway) is a classic example of the two of the three large danger signs.

1. the supervisor knew an employee had insulin-dependent diabetes.

2. the worker was under physician’s orders to take insulin at specific times, which required the company to adjust the employee’s schedule.

But due to short staffing, the staff member was often forced to work shifts that overlapped with times he was supposed to take injections.

What’s more, the worker worked a potentially hazardous job (he was a professional truck driver).

In conclusion, the inevitable happpened. the employee suffered a diabetic blackout at the wheel, causing a serious crash that injured himself and another driver.

The employee filed for workers’ comp, and the injured driver sued the corporation. the firm fought – and lost- both cases. Total cost –  $5 million.

Having even one problem drinker on your medical plan – including a covered family member with abuse issues – can cost your company big.

Some estimates place the potential cost as high as $35,000 a year per case. What’ your company’s risk?

A lot of wellness programs are geared toward managing employees’ health risks associated with diseases like diabetes or asthma.

But unless the wellness program is integrated with an staff member assistance program (EAP), chances are alcohol abuse-related risks go undetected. Here are two strategies that’re getting good results.

1. Include alcohol in health testings

If you already sponsor confidential employee health-risk assessments, it’s easy to screen for alcohol risks, too. This may be as simple as making sure three questions are added to the current appraisal –

• How often do you’ve a drink containing alcohol?

• How many alcoholic drinks do you’ve on a typical day? And

• How often in the last month have you had six or more drinks?

For male workers, more than 14 drinks per week, or one or more episodes of heavy drinking suggests a possible problem. for women, more than seven drinks in a week, or one or more episodes of drinking four or more drinks, is a red flag.

Alternative –  When you don’t offer appraisals, you are able to refer workers to a free, confidential web-based screening.

Benchmarking tools

A lot of experts say drug-free workplace policies and worker assistance programs (EAPs) are the two most proven solutions within companies’ grasp for minimizing the risks and costs of alcohol abuse by health plan enrollees.

To see when sponsoring an employee assistance program (EAP) makes financial sense, you can calculate your own firm’s current cost risk for free here. Plug in your business kind, locale and number of employees.

You’ll get a personalized estimate of annually direct (absenteeism, disability, ER visits) and indirect (presenteeism, turnover) costs from alcohol misuse by a covered worker or family member.

To design a drug-free workplace policy – or check if your existing one is up to par and compliant with the law – more guidance is available here.

It’s easy to feel like your PBM holds all the power over you. In most cases, it does.

A landmark 2004 study compared what pharmacy benefits managers (PBMs) charge employers’ plans to what they actually pay pharmacies.

Scientists found staggering overcharges – particularly for generic drugs. Unfortunately, four years later, the situation has scarcely changed. All too often, PBMs improve their own bottom line at the expense of the plan sponsor’s.

Chances are, it’s your health insurance vendor – not yourself – who contracts with the PBM to administer the prescription drug portion of your health benefits.

So how can you feel confident your firm is getting the best value and service? Start by asking your health-plan broker these four questions about the current or prospective PBM.

1. How does the PBM calculate price?

A lot of PBMs gain hidden profits off your plan through a practice called “differential pricing,” says consultant Gerry Purcell.

In other words, the PBM compensates one price to drug retailers and then sets a lesser discount off the average wholesale price (AWP) for your company’s plan. Example –

• the PBM compensates the drugstore the AWP minus 18%

• your plan and staff members pay AWP minus 15 percent for meds, and

• the PBM pockets the difference.

Now for some good news. You do have some leverage in this area. When your drug plan is covered beneath the ERISA umbrella, the PBM must disclose this info.

Ideally, you’ll find the rates are the same on both contracts. But when there’s differential pricing, insist your firm get the full discount.

2. What’s the PMPM?

One key cost figure PBMs can’t manipulate is the per-member-per-month (PMPM) cost of your plan. This number will show if your plan’s costs actually increased or reduced.

The PMPM is calculated by dividing the sum costs spent by the number of employees enrolled in the drug plan.

It’s also a excellent tool for comparing different PBMs to see which is the most cost-efficient for the size of your organization, says Peter Reed of Managed Benefits Strategies.

3. can we get rebates, too?

Some PBMs receive money from drug businesses that your brokers won’t tell you about – but might  be able to leverage to your plan’s advantage. Example –  Many PBMs get rebate checks from drug businesses (typically 50 cents to $1.25 per claim) for assisting increase the sales of their products.

When you push hard enough for it, your broker may able to work an arrangement where you either –

• split rebates from your plan evenly, or

• let the PBM keep the entire rebate in exchange for a price break on administrative fees.

Important –  Ask to find out all the payment types the PBM gets from the drug firms. Rebates are often couched in the form of grants or classified as access fees or formulary fees.

4. How do changes in the formulary work?

In most states, PBMs can change your plan’s list of approved medications without prior notice.

The problem –  PBMs often make mid-year switches that save them money, but may not save your organization or employees a dime.

Example –  If the PBM adopts a mail-order-only coverage policy on a certain formulary drug, an staff member who needs same-day access to the medication could  be forced to pay full price for it at a pharmacy.

Meanwhile, your plan is still charged the formulary price.To avoid such unpleasant surprises, insist the PBM give written notice of formulary changes, including the addition of new generics.

The best staff member recognition practices are often the simplest.  

Here’s one that’s recently been adopted at the publishing company where I work –  a progam called “See something good, say something good.”  It’s a way for workers to bring positive attention to things that their peers, managers and the company’s different departments do well.

How it works –  the business provides colorful index cards, placing them conspicuously in a few commonly traveled areas in the building. When employees and supervisors want to publically recognize someone else’s efforts, they can grab a card and fill it out. It takes very little time.

When the index card is filled out, the worker drops it into a wrapped box (there are two in the building). the boxes are later gathered and the cards displayed in a room the company uses periodically for meetings, presentations and quarterly worker appreciation events.

In order to build awareness and participation in “Say Something Good,” management put up fliers around the building, so individuals  from every department can see them, as well as visitors and job applicants who’ve come in for interviews.

The program, which was originally thought up by the head of our product advertising and marketing division, doesn’t cost anything apart from the cost of the index cards and paper. There’s minimal administration time, and it takes staff members only a moment or two to fill out a card on a fellow employee’s behalf.

But the return is tremendous, and the recognition possibilities are endless. It’s a good way to improve morale, encourage productivity and differentiate the company culture from work environments where the negative things seem to get the lion’s share of the attention.

When it comes to wellness programs, it can be tough to get past all the hype. Here’s how to avoid the three most common traps corporations fall into.

Trap #1. the “one-size-fits-all” approach

For good reason, your organization doesn’t simply copy other firms’ 401(k) plans or compensation designs. Yet, all too often, firms adopt ill-fitting wellness programs based on things that have worked elsewhere.

Your CFO may have seen data on the cost savings other corporations have achieved via certain wellness incentives. Or an old peer of your Chief Executive Officer (CEO) swears by the program at his or her own firm.

In response, the top brass pushes for a copycat program – for example, offering tobacco use cessation incentives.

That might  be a good idea, since tobacco-related diseases are a key driver of your company’s medical costs. But how can you be sure? is it good enough to have your staff members undergo a health risk (assessment|appraisal}?

Usually, the answer is no.

Health risk (assessment|appraisal}s are a great beginning place, but it’s often a mistake to stop there. the assessments help you get a feel for what your employees’ baseline physical problems are before you try to design a program around them.

This creates rough outlines of what your program goals should be and where to target staff member initiatives. When you want the maximum bang for your wellness buck, you’ll have to dig a little deeper for information. Key places to look –

• your organization’s medical-claims breakdown for the last three years

• prescription-drug claims

• worker absence information

• employee assistance program (EAP) use

• disability claims, and

• staff member demographics (workers’ ethnic, gender, age and dependent coverage status points to greater – and lesser – health risks associated with each category).

Trap #2. Leaving the program on autopilot

Many wellness programs often get off to a good begin and then fizzle out. Employers are left wondering what went wrong. Their mistake –  They failed to revisit the program on an ongoing basis – at least every other year.

Why it’s vital –  Your cost-drivers can easily shift as workers come and go from the company.

Example –  This year, emphysema and other use of tobacco illnesses could  be your largest cost driver. But two years from now, it could be obesity and diabetes.

Unless you continuously track the program and adjust your goals as necessary, you might not be prepared to meet those new challenges.

Trap #3. Unrealistic expectations

Usually, it takes at least a year and a half for companys to break even on the cost of a wellness program. as a rule of thumb, the typical program cost per staff member per month to the company is about $3 to $5.

If, after three years, you still aren’t seeing results, something went wrong. Currently, the benchmark ROI after the third year of a wellness program is $4 to $5 saved for every dollar spent.

How can you manage the cost in the short-term? In many cases, employers pass the cost of the wellness program on to the staff members. for example, let’s say you want to roll out a wellness program effective January 1 (or no matter what your first day is of the new plan year).

You can roll that $3 to $5 per worker per month cost directly into the employee’s monthly share of their healthcare premium. That makes the wellness program a budget-neutral expense for your organization.

But remember –  You get what you pay for – both in time and money invested. the less guesswork that’s involved in the planning and execution, the better the chance for success.

Variable compensation can be a excellent way to satisfy demand for higher pay while addressing  executive management’s need to boost productivity and keep base salaries under control.

But there are some major pitfalls.  Here are two proven ways to avoid the most common legal and return on investment risks.

Non-exempt employees

Beware if you use variable comp as a pay-for-performance strategy for hourly workers. Reason –  It’s easy to inadvertently run afoul of the Fair Labor Standards Act (FLSA) overtime rules.

Under FLSA, you must recalculate employees’ hourly wages to include all variable pay (such as individual or departmental bonuses) when figuring overtime compensation.

Failure to do so could cost your organization more in penalties and back-wage payments than the variable comp plan saved on the front end.

So it’s a good idea to double-check with Payroll to make certain the department knows to make OT adjustments after hourly employees receive bonuses.

Reward the right things

In order to make the criteria for bonuses easier for workers to understand and management to measure, many firms prefer using strictly objective measurements. Example –  the plan may pay out based on how much money workers save their department in a year.

But what happens when staff members cut corners – on safety, service, quality, etc. – to reach the goal?

At some firms, staff members are still rewarded with extra pay, even though their actions potentially did more harm than good to the bottom line. for best results –

• set behavioral criteria for bonuses in addition to economic ones, and

• consider using a mix of firm-wide, departmental and individual economic performance measures.

Shopping for health plans through a broker is a fact of life for the vast majority of corporations. But how well is your broker meeting your needs?

And how can you work together better to minimize costs while getting maximum bang for your organization’s benefits buck?

What’s New in Benefits and Compensation conducted an exclusive survey of 195 subscribers to find out how they view their company’s relationship with their brokers. Here’s what they said –

Half see room for improvement

The good news –  Almost half of your coworkers rate their relationship with their current broker as “excellent.” But that means the other half see some room for improvement.

Thirty-nine percent of respondents rated their broker relationship as satisfactory and said they were at least “reasonably happy.” the remaining 11 percent noted “unpleasant surprises” while 4 percent are actively considering a switch.

Tools for making purchasing decisions

Of course, the No. 1 reason any organization works through a broker is to find the best deals on health benefits. But many of your coworkers pointed to a few areas where their brokers could help make their lives a little easier.

First and foremost, your peers say they’d love for their brokers to provide user-friendly – but thorough – return on investment data they are able to use to benchmark different plans.

It’s worth discussing with your broker how much arm-twisting the broker can do with medical plan carriers to get key data in your hands. Two specific areas of data benefits pros say they’d like help from brokers –

• obtaining and sharing claims cost data to compare to premiums, and

• benchmarking your typical plan costs against those of similar-sized firms in the region.

Regrettably, claims cost data is often hard to pry loose from insurers, at least for smaller employers’ plans.

Reason –  Without this data, it’s tougher to judge if your premium rate adjustment at renewal time is fair. Fewer than half of respondents (46.3%) say they’ve ever discussed such information with their brokers.

Obtaining benchmarking data on similar-sized plans assists you see how comparably your costs and plan designs stack up in your area. Roughly 43% of respondents say they’re armed with at least some of this info when it comes time to decide whether to stay with the existing plan.

Earlier renewals

It’s worth talking with your broker about ways to push for the earliest possible renewals – and strategies for making sure your carrier doesn’t hit you with any unpleasant surprises.

One notorious game insurance companies play with corporations’ plans is to wait until the last moment to reveal the new premiums at renewal. That way, there’s less time for negotiation – or to shop around with the insurer’s competitors.

About 28 percent of respondents report getting their renewals about 30 days before the rate kicks in. Different brokers use different benchmarks for securing renewals. A minority of respondents (19.5%) have seen them as early as 90 days ahead.

Taking work off HR/Benefits’ plate

The benefits brokerage marketplace is highly competitive. Some brokers try to set themselves apart by offering customers so-called value-added services.

Among your colleagues, the most well-liked services are those which relieve the company’s HR/ benefits manager of time-consuming tasks. Some examples –

• investigating  plan documents

• auditing (and, if needed, reconciling) carrier bills for errors

• monitoring plans for compliance (HIPAA, COBRA, etc.)

• offering tech support for a benefits intranet and/or employee self-service software, and/or

• assisting with employee education.

Which costs your organization more –  employees who miss work or ones who show up physically but take a mental PTO day?

For most corporations, it’s the latter. So why do even savvy upper-level managers and finance directors (we’re not just talking about the bean-counters) worry about absenteeism while downplaying so-called presenteeism as a drain on business productivity, not to mention the compensation and benefits budget?

In some cases, C-levels and supervisors seem to think that admitting that presenteeism even exists at the firm is akin to saying, “We’re a poorly run organization.” In reality, presenteeism exists in every workplace.

Virtually every employee, manager, supervisor and executive who has ever tried to “tough it out” at work when he or she has been sick has been a presentee on those days.

So has whoever who’s ever been distracted at work by non-work issues – whether it’s spending the day trying to resolve a personal financial matter, checking on a sick child at home or constantly checking for scoring updates from a sporting event.

In brief, unless we’re to believe that every employee is productive every single day, no corporation in the world is immune from presenteeism.

Some organizations that don’t bury their heads in the sand about presenteeism still don’t track it. Why? Ordinarily, there’s a belief that chronic presentees eventually get rooted out of the company.

And short of watching over every other employee’s shoulder throughout the workday, it’s too challenging (and even counterproductive) to attempt to estimate the cost to the organization.

Here are some strategies that firms have used to not only measure the cost but also reduce the problem.

Creating a cost estimate

If your organization is like most,  senior level management worries endlessly about health benefit costs without realizing undetected presenteeism is just as expensive, but easier to control.

Consider these facts from a recent CSG study –  Almost 10 percent of the average each year pay and benefits

budget is spent on non-productive (but treatable) workers.

Add in workers who call out at the last second and the percentage rises to 17 percent, as reported by SHRM.

But how do you estimate the actual dollars-and-cents cost to your firm?

Let’s assume you’ve 50 staff members, who make an typical $40,000 a year. Over the course of the year, the typical staff member is non-productive 2.5  percent of the time, due to assorted personal issues or minor diseases that serve as distractions.

In this instance, presenteeism costs your organization $50,000 a year. If you have a 5% presenteeism rate, the figure shoots up to $100,000.

While it’s impossible to entirely stamp out presenteeism, even small reductions in presenteeism add up to large bucks in controlling compensation and benefit costs.

The next step, of course, is doing something about the issue. Broadly speaking, the process generally works in three phases –

• review current policies and procedures for things that accidentally increase presenteeism

• get supervisors and workers involved on the front end, and

• stress the importance of work-life programs to  senior level management and supervisors.

Let’s look at each area to see how they work in real-life practice.

Unintentional effects

Three common ways many firms attempt to cut absenteeism often increase presenteeism –

1. Over-stressing attendance in employee’s annual reviews

2. Having supervisors check up on staff members who take sick days to verify they’re really ill, and/or

3. Disciplining workers for last-moment sick callouts.

From a practical and cost standpoint, the best solution might  be to switch from separate vacation and sick-day benefits to a single paid time off (PTO) bank.

When folks have no-questions-asked control over their off days, they’re sometimes more likely to use a PTO day when they’re sick.  Of course, you know that PTO carries some risks of its own.

Early detection

Fewer than one organization in 10 gets both managers and staff members involved in the process of spotting and eliminating presenteeism.

That’s too bad, says advisor Mary Beth Chalk, because it can been done pretty easily.

Ask a sampling of staff members to rate how energetic and productive they ordinarily feel at work, on a percentage scale. Have supervisors estimate their staff as well. Then split the difference.

The result is a pretty good barometer of your organization’s current and future presenteeism risk.

Work-life balance

Anything you can do to promote work-life programs at your firm can have a positive effect on the bottom line. Proven ideas include –

• rewarding supervisors who support flexible work arrangements

• sending sick workers home

• cover onsite flu shots, and

• actively promote your existing Worker Assistance Program.

Any benefits HR/manager can adopt these ways to make staff members feel more appreciated.

The common thread –  using your own communication skills as a powerful tool for increaseing morale.

1. Put in face time

When time permits, managers may want to put in some “face time” with workers. This in and of itself is a kind of staff member recognition. Example –  There’s a lot of value in simply walking around the building, chatting with workers.  Ask workers about the personal items they display at their workstations.

In the short-term, folks will notice and appreciate your interest.  Long-term, this may inspire ideas for rewards and incentive programs. the same technique works at  firms with multiple locations.  Make a site visit to get a feel for the morale. This is much cheaper – and often more effective – than designing a formal benefits survey.

2. Send ‘em personalized stuff

Looking for a simple way to show workers that HR/Benefits cares? Create a template from which you can send customized “Welcome” letters to new hires or “Happy Anniversary” notes for employees’ corporation anniversaries.

3. Target overlooked employees

Most firms have employees (e.g. part-timers) who aren’t eligible for the 401(k), health plan and other company-sponsored benefits.  Small gifts help firms connect with these often-overlooked employees.

Example –  on the first day of spring, send them a packet of flower seeds and attached a note from Benefits. Burston-Marsteller Worldwide has used this simple, low-cost idea and gotten good results.