Our Managing Partner, Karin Landry was quoted in a recent Captive.com article on potential savings when switching to a captive instead of the commercial market. Check out the full article here.

Executive Summary

In the ever-evolving landscape of employee benefits, wellness solutions have emerged as a pivotal focus point for employers with a long-term view of health and productivity. Recognizing the vital link between a healthy workforce and organizational success, employers are redefining wellness programs to meet the diverse needs of their employees.

Employee wellness programs have undergone a remarkable transformation since the start of the pandemic. Once limited to in-person fitness challenges and generic health screenings, these programs have evolved into holistic initiatives that prioritize the everyday wellbeing of employees (both inside and outside of work). Employers are now taking a proactive approach, aiming to not only prevent health issues but also enhance employee engagement, productivity, and job satisfaction. In a survey conducted by Glassdoor, 60% of job seekers reported that benefits and perks are a significant factor in considering job offers. A robust wellness program signals an employer’s commitment to employee well-being, making the company an attractive destination for skilled professionals seeking an organization that values their health and work-life balance.

What is the impact on healthcare spending?

Investing in employee wellness is no longer a discretionary choice; it’s a strategic imperative. The cost of poor employee health is significant, leading to decreased productivity, increased absenteeism, and higher healthcare expenditures. According to Harvard researchers, every dollar spent on employee wellness yields a reduction in healthcare costs of $3.27 and a decrease of $2.73 in costs related to absenteeism1. A similar ROI study conducted by the International Foundation of Employee Benefit Plans determined that employers save between $1 and $3 on healthcare costs for every dollar spent on wellness initiatives.

These cost savings are from both direct and indirect triggers, and it’s important to also include more qualitative factors like retention and productivity when you look at the cost/reward analysis.

Point Solutions Overview

Employee wellness is an important yet broad and nuanced space. Over the last decade, we have seen a significant increase in point solutions dedicated to well-being outcomes, some of which include:

What should I do as an employer interested in wellness point solutions?

For committed employers, point solutions should be just one component of an overarching wellbeing strategy that takes into account the following:

  1. Assessing Current Health Trends: Analyze health data to identify prevalent health issues and trends within the employee population.
  2. Designing Tailored Solutions: Use this data to inform decisions around point solutions. It is rare the overcommitting to point solutions will produce the desired results; we recommend a more pointed approach. Craft an approach that addresses specific needs, encompassing physical, mental, and emotional well-being.
  3. Benchmarking and Surveys: Compare your offerings to industry standards and continually assess its effectiveness through employee feedback and measurable outcomes.
  4. Incorporating Cutting-Edge Technology: This is where point solutions come in; leverage technology and tools to provide engaging and accessible wellness resources, from wearable devices to wellness apps.
  5. Promote Inclusivity: Ensure that wellness solutions cater to a diverse workforce, taking into account geographic, cultural, and accessibility considerations.

The journey towards a healthier and more productive workforce begins with employers’ commitment to holistic wellness solutions. As employee needs evolve, so too must wellness programs. By embracing innovative models, tailoring benefits to specific needs, and fostering a culture of well-being, employers can embark on a transformative journey that not only enriches the lives of their employees but also contributes to the overall success of the organization. Wellness point solutions, if tackled thoughtfully, can be a tool in your toolbox to arrive at a healthier, happier, and more vibrant workforce.

1 https://www.bravowell.com/resources/do-wellness-programs-save-companies-money

Demand for new weight loss medications continues to rise and employers remain concerned about budget impacts if they decide to offer these costly medications as part of their benefit package. These medications, known as GLP-1 agonists have skyrocketed in popularity and are thought to be “miracle drugs” by many. The reality is that weight loss requires a multi-modal approach and not all people who use them will achieve significant weight loss. Studies have shown that once discontinued, patients gain an average two-thirds of the weight back1. The reality is there is no miracle cure, but these medications have helped to destigmatize obesity and make clear the benefits of taking a multi-faceted approach to sustain weight loss.

Employer Case Study

As is the case with many organizations, weight loss drug strategy was recently of particular interest to one of our clients, edHEALTH. The client was interested in the positive impacts yielded but was daunted by the complex dynamic of long-term cost versus benefit.   

Spring assisted edHEALTH in assessing a best practice avenue for weight loss drugs, keeping in mind that spending on obesity-related conditions result in approximately a 12% increase in total healthcare costs2.  Wegovy (semaglutide) has an average price of approximately $1,349 a month, or more than $15,000 annually. That is more than double what the Institute for Clinical and Economic Review (ICER)3, a private entity that provides an independent source of evidence review and creates cost-analysis reports, recommends, instead stating that Wegovy should be priced somewhere around $7,500–$9,800 per year to fall into the cost-effective threshold.

We worked with edHEALTH and its PBM partners to fully understand their weight loss medication utilization management and monitoring parameters. As a member consortium, edHEALTH is committed to providing their member institutions with the information needed to assist them in determining the best cost-management strategies. Therefore, a key part of our evaluation was to prioritize the education of staff and faculty on the protocols and side effects of these medications to potentially narrow the interest to those highly motivated groups. There is no one size fits all solution, but there are specific points of consideration and educational resources that can help organizations of any kind address this topic with stakeholders.

Additional recommendations included:

For example, edHEALTH hosts an annual walking challenge between member schools, with prizes and check-ins along the way. The healthy competition creates a simple yet effective way to get employees moving more than they might otherwise, and a tactic like this pairs nicely with an overarching weight loss strategy.

Considerations for Employers

Ultimately the choice to cover these medications is an organizational decision, but it’s critical to have all the information necessary to make this decision, starting with a robust view of your population demographics. With high rates of obesity for most health plan sponsors, a prudent and thoughtful approach to expanding weight-loss coverage will be required. Attempts like this to tackle the obesity epidemic could produce long-term savings with lower overall healthcare costs, prevention of progression of existing diseases, and most importantly a better quality of life and employee experience. 

No matter your decision on offerings, the more you can offer through communications and education will help your plan participants make informed decisions and understand their role in achieving and keeping weight off. To realize tangible results, all parties must be committed.

Our clinical pharmacist and benefits consulting team is here to help you assess weight loss as a component of your benefits strategy, including not only weight loss drugs but also wellbeing initiatives and data analytics for monitoring success. Get in touch for assistance in navigating this nuanced and rapidly evolving area.

1 https://www.nbcnews.com/health/health-news/happens-stop-taking-wegovy-ozempic-many-people-regain-weight-rcna66282
2 https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/
3 https://icer.org/news-insights/press-releases/icer-publishes-evidence-report-on-treatments-for-obesity-management/

As pharmacy and prescription drugs continue to drive healthcare costs for employers. Many are reevaluating their Pharmacy Benefit Manager (PBM) arrangement to ensure transparency, strategic alignment, and fair pricing. Click here to access our Q&A and generate your PBM Report Card.

A summary of our webinar with the Northeast HR Association (NEHRA)

When it comes to health and productivity programs, the past several years have been a time for Benefits and HR professionals to test out a range of initiatives in response to pandemic and post-pandemic challenges, priorities, and employee expectations. Now, however, the market is in a different place and it is time to assess the impact of recent program offerings; does the reward outweigh the risk?

The Big Picture

Today’s economy is creating urgency around making sure benefits programs are properly managed. High inflation rates touch everything; the impact doesn’t stop at the grocery store or the gas pump, it extends to already high healthcare costs. In addition to the economic reality, we have seen an increase in healthcare utilization coming from new treatments and technologies available, further increasing costs. Relatively low unemployment may have shifted attraction and retention goals for some organizations, but a rise in layoffs is having tangible effects on the labor market at large which trickles down to employer strategies. It’s not just employers facing challenges, though, as healthcare services have become unaffordable for many and consumers/employees are also feeling the cost burden.

As a starting point, take a look at your data to answer questions like:

You should then be able to assess whether or not your benefits align with your population as well as your corporate objectives. When determining true return on investment (ROI), it’s important to consider both human and financial perspectives.

Now that we have established a bird’s eye view of the risk versus reward equation, let’s drill down into key plan components that factor in.

1. Risk Management

There are a range of risks to consider within your benefits strategy. There is the risk of buying insurance, and the allocation of funds. There is the risk to your employees of undertaking a high cost treatment, if necessary, which may not be feasible for lower wage workers.

When it comes to benefits funding, the following graphic illustrates the spectrum of options available, where the risk taken by the employer increases as you move toward the right.


While a fully insured plan largely frees the organization of risk, there is typically a lot of overhead and administrative costs involved and less governance when it comes to claims management. Overall, though, we encourage our clients to consider this spectrum and determine where they fit in related to risk appetite, budget and resources, specific health trend, and more.

2. Financial Management

Related but separate from risk management comes the financial management of your benefits program(s). There are three key activities that fall within this bucket:

The insights gleaned from the financial management arm should be embedded into your overall benefits and risk management strategy, rather than live in a silo.

3. Pharmacy

Pharmacy has been top of mind for employers, understandably so given the rapid rise in prescription drug costs, which now constitute anywhere from 20-25% of total healthcare spend in the U.S. Specialty medications account for 50% or more of pharmacy spend even though only about 2% of the population is using them. Brand and generic drug costs are also rising at rates we have not seen in the past, perhaps in correlation with inflation. Suffice it to say, employers are struggling to mitigate their own costs as well as the costs for their employees. So, what can be done?

Within the pharmacy benefits landscape, two areas have been getting a lot of attention: weight loss drugs and biosimilars.

Weight Loss Drugs

Chances are you’ve heard about a new wave of “Hollywood diet” drugs. There has been an enormous amount of marketing going on around these new weight loss drugs, especially in the realm of social media and influencers. All of the buzz has also gotten the attention of employers, who are asking us questions surrounding coverage, costs, and pros and cons.

To provide some background, of the four weight loss drugs taking center stage, only two have indications for weight loss, while the other two are being used off-label. Weight loss drugs are not new, but these varieties are showing results we haven’t seen before, and their arrival on the market is timely, as about 42% of the population is either overweight or obese.

From a health and productivity standpoint, we know that obesity increases a person’s risk of developing a chronic condition, which leads to higher healthcare costs. But we also know that there are financial and non-financial reasons to foster a happy and healthy workforce. Can and should weight loss drugs be an answer for employers?

These new drugs are retailing for about $1,300 a month, so we need to consider annual costs and the longevity of how long an employee will need to stay on the medication. For employers considering them to their plan, we recommend it being one piece of a comprehensive strategy that also includes wellness initiatives and/or a commitment from those prescribed the drug. In addition, you must build strong monitoring protocols to judge effectiveness and impact on overall plan costs and utilization.

The inclusion of weight loss drug coverage in a health plan will make sense for some employer groups, and not others. We recently talked with an employer client who saw enough value in even a 10% reduction in body weight to convince them to cover the drug. However, any decisions need to be based, once again, off of population data and corporate objectives. This is a new and evolving sector, so your strategy should remain fluid as we see developments.

Biosimilars

Biosimilars are non-generic alternatives to those specialized medications that are very targeted in how they work and on what conditions they combat. There has been a lot of anticipation surrounding biosimilars as a solution to the specialty drug cost crisis. At the beginning of the year, a biosimilar of Humira, the number one drug dispensed in the U.S. which is used to treat inflammatory conditions, entered the market as the first biosimilar. While there has been some impact, to date it has not been the silver bullet we were hoping for. We can see below that biosimilar adoption rates are all over the map depending upon the condition for which it’s being utilized.


For employers, what’s important is vigilance in understanding where your Pharmacy Benefit manager (PBM) has positioned biosimilars as far as coverage is concerned. We have found that PBMs are placing biosimilars typically at the same parity with the reference, or brand name product. In this case both Humira and its biosimilar would be considered tier 3 medications, which does not yield the anticipated savings. Why is this? Well, there may be additional rebates available to employers and health plans if they continue to use the reference product.

This is a complicated space that continues to change at a rapid pace. Overall, though, if biosimilars are working the way we want them to, we need to figure out a way for all stakeholders to embrace them as a lower cost alternative instead of being locked into brand name drug prices. In some cases, the drugs are life-changing, so we do want to cover them but in a more sustainable way. We work with clients to ensure they are informed of and ready for these advancements and nuances.

4. Targeted Point Solutions

The term “point solutions” now represents a large umbrella of tools, however it typically references programs that target specific diagnoses such as diabetes, oncology, and hypertension. In recent years there has been significantly more interest in point solutions from our employer clients, and, especially with multiple solutions running at a time, these can be a slow leak on spend. Now is a good time to take a step back to answer that risk versus reward question for point solutions.


The best place to start in assessing point solutions whose reward outweighs the risk is data analytics. Try to use any data you are getting from your health plan, internal teams, or the industry to benchmark your spend. In areas where your spend is high relative to benchmarks, do a deep dive for potential solutions that can help. Some pitfalls in this area include:

5. Absence Management

Absence management is highly correlated with your health plan performance, since the vast majority of your high cost claims will also include a leave of absence, so there are both plan costs and productivity rates at play here.

Making absence programs more challenging is the volume of stakeholders involved and laws with which you need to comply (as seen below).


Further, when we talk about absence management, we account for a wide range of benefits including short- and long-term disability, statutory disability, workers’ compensation, FMLA, ADA state paid family and medical leave (PFML), and others.

With absence, different than with medical plans, your company’s managers and supervisors are directly involved when it comes to plan design, governance, staff training, etc., so it is an area where you typically need to look inward to drive change.

When it comes to the risk/reward balance of an absence management program, employers can make sure corporate programs are set up the way they want, for example, promoting the right attraction and retention strategy. Remember that the more generous your programs are, the more they will cost and the higher the risk you take on. If shifting some responsibility to an outsourced partner, be sure you still have monitoring protocols in place.

Closing Thoughts

Across these five areas and more, we encourage you to get familiar with your organization’s plan and demographic data. Depending on your size, the level and depth of data available might be different, but there is always some data available, such as industry standards and benchmarks. Whether you are focused on weight loss drug strategy, funding, or point solutions, you can take those data-driven insights and apply them across these four pillars to determine your best practice.

If you are having trouble getting started, or could use specific guidance surrounding the topics mentioned, please get in touch with our team.

As today marks National Insurance Awareness Day, we wanted to share some current trends in the insurance landscape and considerations for businesses. Healthcare costs have skyrocketed for employers, it is estimated in 2023 that healthcare will cost employers $13,800 per employee.1 Over the years, as we have moved in an unaffordable direction, employers are increasingly turning to self-insurance as a mechanism for risk management and control over costs.

In simple terms, fully insured plans consist of employers paying a monthly premium directly to an insurance company to cover their employees (and dependents).  On the other hand, with self-insurance, employers take on a set portion of the financial risk of a program instead of paying a fixed premium amount. In 2022, 82% of firms with 200+ workers adopted insurance plans that were wholly or partially self-funded.2 Why is self-insurance so popular today? Here’s a quick snapshot.

Pros:
  • Lower potential healthcare costs in the long-term
  • Greater customization and flexibility
  • Provides faster, more detailed data to drive action
  • No change to employee experience
  • Recoup insurance carrier profit
Cons:
  • Requires more attention and in-house resources
  • Increased risk
  • Medical stop-loss coverage is highly recommended to avoid catastrophic claims impact

If you are thinking of transitioning to a self-funded insurance model, or have questions about medical stop-loss, please check out our alternative risk financing services overview, or get in touch.

1 https://www.healthcarefinancenews.com/news/health-benefits-costs-expected-rise-54-2023#:~:text=Average%20costs%20for%20U.S.%20employers,to%20professional%20services%20firm%20Aon.
2 https://www.statista.com/statistics/985306/self-funded-health-insurance-covered-workers-by-firm-size-us/

Employees have a whole host of responsibilities outside of work, and compassionate and strategic employers understand this and act accordingly. Below is our checklist of considerations for an employee benefits program that is family-friendly, enabling work-life balance and lessening the need to choose between job and familial needs, ultimately helping solve for some of HR’s biggest challenges: recruitment, retention, absenteeism, mental health and productivity.

Get familiar with your population and demographics
o   Does your workforce trend younger, older, or a balanced mix?
o   Are there cultural, regional, or gender-based considerations at play?
o   Do your claims demonstrate specific health issues among employees or dependents?
o   Are most of your employees remote, hybrid or on-site?
o   Does the nature of employees’ work or work schedule present any concerns (e.g., physical labor, night shifts, healthcare staff susceptible to illness)?
Evaluate family-oriented provisions that are already in place via your health plan, corporate policies, voluntary benefits, or wellness programs 
o   Where are there gaps or room for improvement?
o   Have you accounted for nontraditional families in a way that aligns with diversity, equity, and inclusion (DEI) goals? 
o   What benefits do you provide compared to similar companies with whom you are competing with for talent?
Armed with this information, consider a broad range of benefits or perks:
o   Paid parental leave (for mothers and fathers), including for adoption
o  Take it a step further by designing a plan that offers insurance coverage and/or assistance related to fertility treatments, adoption, surrogacy, and post-partum needs
o   Paid family leave / caregiver leave, for employees to care for aging parents, sick children, partners recovering from surgery, and more
o   Bereavement leave, so that workers have space to grieve and spend time with loved ones during a time of need
o   Flextime or alternative work schedules, for daycare pickup, doctors’ appointments, sporting events, and the like
o   Childcare assistance, such as an on-site facility or a stipend
o   Eldercare assistance, which could include financial and/or counselling and navigational help
o   Financial wellness benefits, for traditional use cases like retirement but extending to consider things like tuition, student debt and long-term care planning
o   Long-term care insurance, or related financial/educational resources, especially as states begin to consider statutory long-term care programs
o   Paid Time Off (PTO) – in many cases this represents a set number of days that can be used for various reasons, including the fun (vacation) and the not-so-fun
o   Enhanced mental health benefits or resources beyond standard EAP benefits for all members of the family
o   Pet insurance or “pawternity” leave – while it may seem offbeat, most pet owners consider their pets to be family members
Identify which family-focused benefits are most appropriate and feasible for your population, and fit with your company culture
Determine your budget or how desired benefits could be funded (e.g., fully funded by employer, fully funded by employee, or some combination) and contribution methods
Understand how different leave types and benefits would integrate with current offerings or if adjustments will be needed (e.g., phasing out sick banks for a more flexible paid time off policy)
Ensure compliance and cohesion with national, state and local policies surrounding family leave (FMLA, state Paid Family and Medical Leave, parental leave policies, etc.)
If appropriate, conduct a Request for Proposal (RFP) for any vendor-provided products or services
Consider engaging a consultant like Spring to guide you through this checklist!

Title:

Senior Consulting Actuary

Joined Spring:

I joined Spring in April 2019, around a year before the pandemic.

Hometown:

I was born in Maryland and grew up in both Maryland and California.

At Work Responsibilities:

As a Senior Consulting Actuary at Spring, I provide employers with customized solutions that manage costs and improve performance of employee benefit programs. Some of the most common programs I am involved with include retirement, life, and disability plans.

Outside of Work Hobbies/Interests:

Lately, I am enjoying running, hiking, and yoga.

Fun Fact:

I am a multi-state backgammon champion (Massachusetts and Connecticut)!

Favorite Part of Spring:

I genuinely enjoy the work we do. Every day, I get to work with bright professionals and industry pioneers to make a difference for our clients.

Favorite Food:

Sushi.

Favorite Place Visited:

Anywhere with a lighthouse, but especially the North Carolina coastline. I have seen about 200 lighthouses, and I look forward to seeing more!

As we wrap up Mental Health Awareness Month, it was only fitting that the New England Employee Benefits Council (NEEBC) hosted their Annual Summit just a couple of weeks ago. Mental health awareness and wellbeing resources are top of mind for employers and HR teams across the nation, and, as we saw at NEEBC, specifically a focus in New England. Some additional hot button topics during the conference included:

1) Inflation/cost control strategies

Maneuvering around inflation and costly claims are top priorities for benefits professionals nationwide and was a constant topic of discussion by both presenters and attendees. The first keynote panel focused on the “Current Economic, Political and Cultural Landscape:  Where We Are. Where We’re Going. Why It Matters.” They explored typical cost drivers, workplace trends (hybrid, remote, and on-site), and how HR teams can help preserve New England’s unique culture within their workforce.

2) Understanding the needs of your workforce

As many employers have shifted to remote and hybrid models, communication and understanding the needs of the workforce has been challenging for many. One session that really resonated with me included two benefits specialists from ZOLL Medical; they reviewed how benchmarking and survey data helped give their workforce a voice when it comes to their benefits. On the other side, they also looked at pitfalls and obstacles they faced initially and how they overcame them, and steps they took to optimize their survey process.

3) Promoting wellbeing and mental health

Finally, mental health and employee wellbeing continue to be top-of-mind at HR and benefits conferences across the nation. As mental health resources have become a mainstream benefit area, employers are now looking at alternative and new programs to stand out and retain/attract talent. A professor from Northeastern University’s Department of Health Sciences presented on social determinants and their impact on employee health and wellbeing. He leveraged his research to outline best practices and how HR teams can alter their offerings to fit the needs of a diverse workforce.

As a pharmacy consultant, I was excited to see the interest people had in Rx cost control tactics, PBM logistics, and specialty drug strategies. The costly and challenging landscape of pharmacy benefits should motivate employers to implement program changes; we can help. Here are some considerations and tools employers can utilize to address employee wellness, which, in turn has a direct impact on pharmacy costs. Thank you to NEEBC for another insightful event and we look forward to the next one.