Is a Pharmacy Carve-out Right for Your Group Health Plan?

Pharmacy spend in the US is significant. Six in ten adults tell KFF.org they are currently taking at least one prescription drug and a quarter say they currently take four or more prescription medications.

PwC’s Behind the Numbers predicts a 6.5% medical cost trend in 2022, while drug cost trend reports show ongoing increases year over year and make up 20% of overall medical costs for employers.

Besides the cost burden on employers, employees can find that certain medications are not covered by their health plan. This increases pressure on employers to develop a sustainable strategy that provides cost-effective pharmacy benefits.

As a solution, many employers consider pharmacy carve-out plans as an option; however, carve-out plans are debated vigorously by health plan experts. By understanding what a pharmacy carve-out is and considering important factors, employers and brokers can work together to make the right decision.

What is a pharmacy carve-out?

A pharmacy carve-out is when an employer separates (carves out) their prescription drug benefits from their medical plan and contracts directly with a pharmacy benefit manager (PBM). A pharmacy carve-out is commonly used under the self-insured model. In comparison, fully insured medical plans typically have the pharmacy benefit as a built-in feature (bundle).

Advantages

Pharmacy carve-outs can provide transparency, flexibility, control, and accessibility to employers in the form of:

  • Better control over pharmacy benefit costs.
  • Access to the costs and data to evaluate program performance.
  • Greater flexibility to customize solutions in plan design and clinical programs to help reduce costs.
  • Standardized language in the PBM contract to allow increased transparency into pharmacy benefits, allowing employers to better understand and control spending, negotiate better deals, and ensure the program performs as promised. The contract itself can allow:
    • Access to pharmacy claims data.
    • Audit rights, such as a claims audit, operational assessment, and rebate audit.
    • Annual review to ensure rates are competitive.
    • Service performance guarantees.
    • Credits to help cover administration expenses or costs incurred when switching to a new vendor.

Disadvantages

There are a lot of variables that affect whether a pharmacy carve-out is the right solution for your company. It’s critical to understand the disadvantages of carve-outs before making your next move:

  • Carved-out plans offer short-term savings, though the savings might not be beneficial to an employer over the long term.
    • A July 2021 study compared the costs of bundled and carve-out plans and found that bundled pharmacy benefits are associated with reduced medical expenditures over the long term, resulting in annual per-member, per-month savings compared with a carve-out.
    • Another study found that savings from a carve-out plan may seem beneficial on the surface, but medical costs are 7.5 times higher in the long run. Therefore, any savings promised by a carve-out should be weighed against potential increases in medical spending by employers.
    • Managed Healthcare Executive also reported carve-outs could deliver short-term savings, but not long-term savings, due to PBM vendors’ approach to utilization management. For example, many employees are denied access to their prescribed medications and are unlikely to have their denial overturned on appeal. This results in employees paying for medicine out-of-pocket, added costs for employers if they pay multiple vendors, and a poor member experience overall.

Besides long-term costs, carve-out contracts for medical and pharmacy require multiple vendors, increasing the administrative burden on the employer.

Thoughtful considerations

After reflecting on the advantages and disadvantages of carve-outs, making the decision may still be no small feat. Fortunately, you can ask yourself important questions to help you with your decision.

  1. How much are pharmacy benefits currently costing your plan?
  2. How are you currently overseeing the pharmacy benefits program?
  3. What changes would be necessary for the new arrangement?
  4. How will the fees from your medical health plan vendor be impacted?
  5. Is now the right time to search for a PBM vendor (and possibly a medical health plan request for approval)?

When deciding to carve-out pharmacy benefit programs, employers and brokers should work together to consider critical factors such as internal staff expertise, current and future costs, and appropriate timing. However, your top consideration should be, “Does this make the most sense for our organization and our employees?”

 

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Compensation Conversation – Talking to Employees About Pay

Talking to employees about pay can be uncomfortable, even when the news is good. In a survey given by West Virginia University, 70% of managers admitted feeling uncomfortable when talking to employees about pay. Assigning a dollar value to an employee’s work can be tricky, but it’s a meaningful conversation to have for the sake of bolstering trust, increasing engagement, and improving retention.

What is an employee compensation conversation?

An employee compensation conversation, or a salary review, is an employer’s evaluation process to determine if employees’ salaries fairly and accurately reflect their performance at work.

How often should you review employee compensation?

It depends on your company policies. Some companies review employee compensation every six months, and others review it once a year. At the least, reviewing employee compensation once a year should be appropriate for most organizations.

How should employers determine compensation for a salary review?

There are several factors to take into consideration when determining an employee’s pay:

  • Analyze market pay for the position: Assess internal data by looking at employee salaries to understand your company’s current state of wages. Then, get an update on current market pay data for the specific employee role from resources such as Glassdoor, the Indeed Salary Tool, or the Bureau of Labor Statistics (U.S.)
  • Evaluate employee performance: Employees often connect their worth in the company to their salary. However, you don’t want employees only to see their worth in terms of a dollar amount. Offer recognition for what your employees are doing well and have regular one-to-one talks. These factor into employee performance, as 86% of highly functioning organizations hold such discussions with employees and see productivity rise.
  • Decide on factors you feel are most important: While performance is essential in determining employee compensation, there are other factors to consider. These can be a combination of employee and company factors, such as:
    • Company structure
    • Company budget and size
    • Living costs and location
    • Employee retention goals
    • Historical employee performance
    • Length of service

It’s important to ask questions and discuss among leadership what items are most important to the company when it comes to employee compensation.

How do I talk to my employees about compensation?

  • Show appreciation: First and foremost, you want to show employees your appreciation for the work they do. Point out and give examples of their specific contributions to your business.
  • Provide background: Review the employee’s role. Talk about their current pay and where they currently stand.
  • Mention other value points: In addition to reviewing salary, you should also mention what else factors into their compensation, such as a 401(k), Paid Time Off (PTO), insurance, monthly reimbursements, or volunteer days.
  • Listen to concerns: Be sure to listen to any concerns employees have about their compensation or position. Listen to what the real ask is behind their concerns and find what they deem the most valuable. For example, pay may not be the most critical concern—they may want the opportunity to work on more challenging projects.
  • Communicate well: Be very clear and direct when explaining pay decisions. If the employee asks, offer suggestions and goals on how to improve their performance by the following salary review.

Handle compensation situations

You can’t anticipate how every salary review will go. But you can be as prepared as possible. Here are some possible scenarios and how to handle them:

  • Performance doesn’t merit a compensation increase: Talk about their current salary, why they’re not eligible for a salary increase, and give specific goals to work on, along with a time frame to complete those goals.
  • Performance is high but doesn’t merit a compensation increase: Share their current salary and why they will not receive an increase. Determine if something else can be offered (flexibility or opportunity to work on a specific project) and discuss how they can continue to advance within the organization.
  • Compensation increases, but employee feels like it isn’t enough: Share their current salary and how it compares to the current market for their role. If another co-worker’s pay is brought up, direct the conversation back to the specific employee’s compensation. Point out their key accomplishments and how those influence their pay. Finally, listen to what’s behind the concerns. It’s possible there are other things that could satisfy your employee’s needs.
  • When an employee’s performance and experience result in a compensation increase: Recognize the work that they have done and what they bring to the role. Discuss their compensation and how they can continue to advance within the company.

It’s a tough job, but someone’s got to do it

Talking to employees about pay is tough, but you don’t just want to tell them that you’re giving them a raise (or not) and send them on their way. By preparing for these talks and recognizing your employee’s contributions, you’ll enter these conversations with less dread and more ease.

 

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Photo by fizkes

 

Protect Your Small Business from Cybersecurity Threats

Is your business doing enough to protect itself from cyberattacks?

Cyber-attacks on small to medium-sized businesses (SMBs) have seen a sharp rise in the last few years. A 2019 report by the Ponemon Institute found that cyberattacks increased by over 20% between 2016 and 2019.

Data breaches cost not only time but also money. The FBI’s Internet 2020 Internet Crime Report found that the total cost of cybercrimes in the US in 2020 reached 2.7 billion, and with an average cost of a data breach for an SBM being $149,000 (2019), small business leaders must take the necessary steps to improve their risk mitigation for cyberattacks.

The first step is to familiarize yourself with the many different types of cyber threats that exist.

What are the most common forms of cyber-attacks on SBMs?

  • Phishing: Phishing attacks come in the form of communications disguised as coming from a reliable source. They can be emails that look like correspondence from company leaders or departments like the CEO, CFO, or Payroll. They can also be made to look like they come from a legitimate organization and prompt you to download a file, open a link, or provide sensitive information which will allow attackers access to your device.
  • Man-in-the-middle (MitM): MitM attackers intercept a two-party transaction. This usually happens when someone uses their device on an unsecured network such as public Wi-Fi. Attackers intercept the connection and steal information from the vulnerable computer, such as credit card numbers, bank account information, or passwords.
  • Malware: Malware is an umbrella term for many different attacks such as viruses, trojans, and spyware. Malware can be downloaded on a device by clicking a link that will install software onto the device. This “software” is designed to steal information or data, control the device, or otherwise impede the device’s functioning. Here are a few common types of malware:
    • Ransomware will gain access to sensitive files or data and deny the victim access unless a ransom is paid, often threatening to expose it, sell it, or delete it entirely.
    • Trojans are an attack using software that plants itself within an app or a program—often used to give attackers access to the device.
    • Spyware is software designed to track users on their devices and send the sensitive information it collects to a third-party attacker.
  • Denial of service: Denial of Service (DoS) cyberattacks target and overload a server’s capacity and bandwidth, resulting in a server crash that takes it offline from actual customers who want to visit the website or purchase something from it. This is done by overloading the server with requests so it can’t process legitimate requests.

How can you protect your business?

There are multiple cybersecurity platforms available for businesses that are easily found with a quick Google search. There are also many options for free cybersecurity software that can be upgraded with subscription services. Aside from implementing company-wide cybersecurity software on all company-linked devices, there are some standard practices that any business should be using, whether or not they have access to protective software.

1. Create a password policy

According to the
Ponemon report, 54% of SMBs have no insight into their employees’ password practices. Terrible password habits equate to seriously increased vulnerability to cyberattacks. Consider implementing
1Password or other password protection software programs that can be downloaded on every computer associated with your organization.

Ensure your employees aren’t saving their passwords in easily accessed folders. Have employees use password-generating programs to increase their passwords’ strength and ensure they don’t use the same password twice. A common way for cyberattacks to find saved passwords on devices is to do a device-wide search for words that are 8, 12, 16, and 24 characters long, meaning that even if employees save their passwords in a nondescript file, it’s easy enough to identify them. This is where secure folders and password protection programs come in handy.

2. Create a software update policy

Another common issue that causes device vulnerability is outdated software. Create a policy that requires employees to update their software as soon as a new update is released. Software updates are often released to fix security issues and vulnerabilities, so it’s critical employees don’t wait to update their devices.

3. Education and training

Finally, organizations must educate and train their employees to identify and protect themselves from potential cyberattacks. Start with including a training session during onboarding to ensure employees start with good practices from the beginning. Hold company-wide training sessions, and ensure you revisit the topic throughout the year.

 

Take a proactive approach

You may not be able to stop cyberattacks from targeting your business, but there’s a lot you can do to thwart them. By taking a proactive approach, educating your employees, and developing up-to-date risk management policies, you can save your business from dealing with damaging costs, harm to your reputation, and potential lawsuits. Take action early, and rest easy knowing you are protected.

 

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Why Your Team Needs a Boost in Emotional Intelligence

When talking about intelligence, most people think of intelligence quotient, or IQ. But what if another type of intelligence could push your team to extraordinary results?

The Institute for Health Human Potential states that over 80 percent of competencies that differentiate top performers from others are in the domain of emotional intelligence (EI), which refers to the ability to identify, understand, and manage our own emotions, as well as the emotions of others.

There is debate whether people are born with natural emotional intelligence or not, but you can lead your team to extraordinary results by teaching and developing EI awareness in your organization. An excellent example of seeing this in practice is a Motorola manufacturing facility that provided training in stress management and emotional intelligence. A stunning 93 percent of employees had an increase in productivity.

Build your business by taking the first steps in cultivating emotional intelligence within your team. First, reflect on your own EI, and then consider teaching emotional intelligence principles to the people in your organization.

Are you emotionally intelligent?

Let’s play a game! Put your hand up and put a finger down for every statement you identify with.

  1. You see patterns in your motives and behaviors and understand how your emotions and actions impact those around you.
  2. You can self-regulate your emotions in proportion to the given circumstances. Perhaps, you know how to ease tension, manage conflict, cope with challenging scenarios, and adapt to changes in your environment.
  3. You are intrinsically motivated and strive for personal development.
  4. When trying to understand where someone is coming from, you can draw on your life experiences and be compassionate about what they are going through.
  5. You are a team player. You understand others and their needs in a conversation or conflict.

Suppose you put all five fingers down. Great! You align with the five components of EI—self-awareness, self-regulation, motivation, empathy, and social skills. But don’t stress if you still have some fingers up because these are skills you can learn and develop.

Prioritize emotional intelligence training in business

Keeping emotions in check is vital for the whole team. When emotions run high, they change how our brains function by diminishing cognitive abilities, interpersonal skills, and decision-making powers. However, recognizing and managing emotions can elevate team performance and the company’s success.

The Institute of Health Human Potential reported that people with higher EIs:

  • Manage emotions when stressed or feeling overwhelmed
  • Resolve conflicts 
  • Coach and motivate others
  • Create a culture of collaboration
  • Build psychological safety within teams
  • Give and receive feedback
  • Meet tight deadlines
  • Deal with challenging relationships
  • Navigate change
  • Work through setbacks and failure

Teach others EI

Although some individuals are naturally more emotionally intelligent than others, EI is a skill that can be developed. EI training programs are abundant, and there are terrific tips for boosting your emotional intelligence and teaching your staff to increase theirs as well.

Become more self-aware

  1. Pay attention to how you feel throughout the day and recognize how your emotions influence your decisions and actions.
  2. Identify and understand your emotional strengths and weaknesses. How well do you communicate with others under stress?
  3. Understand that emotions can be fleeting and easily changed because rash decisions based on intense emotions can be detrimental to your success.

Practice self-regulation

  1. Find techniques that help you deal with your work-related stress, like exercise, hobbies, and family time.
  2. Keep your cool! You cannot control everything. Look for helpful ways to deal with stress.
  3. Give yourself time to think and plan before letting your emotions rule your decisions.

Improve your social skills

  1. Listen actively and attentively to your team members, peers, and employers. It shows passion and willingness to work with others.
  2. Keep an eye out for non-verbal communication.
  3. Avoid office drama! Conflict is inevitable, but you can focus on listening to others and seeing solutions to solve problems and minimize tension.

Become more empathetic

  1. Put yourself in others’ shoes.
  2. Pay attention to how you respond to others. Do you give others a chance to share their ideas? Do you acknowledge input, even in disagreement?

Work on your motivation

  1. Focus on what you enjoy about your job rather than what you dislike.
  2. Work to maintain a positive, optimistic attitude. Optimistic people tend to inspire and motivate others; be that person!

Imagine a more intelligent world

The simple act of drawing attention to the EI principles and having a brief conversation with the team will help elevate awareness of their behaviors and responses. Imagine what your team could achieve if everyone practiced the five components of emotional intelligence – self-awareness, self-regulation, social skills, empathy, and motivation.

You would notice your team working together rather than against one another. You would see your people not only handling stressful situations and conflict but persevering to reach company goals. You would recognize a genuine and authentic team built on empathy and understanding one another. Most importantly, you will be a company that thrives together!

 

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Launching a Powerful Employer Brand

Whether you know it or not, your organization has an employer brand. Every company that has employees has one whether they spend time developing it or not. Essentially, an employer brand is the ‘personality’ your organization projects to its employees and prospective talent. It’s the reputation your organization has as a workplace, as opposed to the overall reputation your organization has to its customers and general audience.

And it’s important. Really important.

For one thing, having a strong employer brand can save you a lot of money. Harvard Business Review found that companies overspend on salaries by 10% when they have to compensate for a poor reputation. That’s not to mention the loss in prospective talent, which they found reduced by nearly half when organizations had a reputation for lack of job stability, dysfunctional teams, and faulty leadership.

According to Randstad, 96% agree that a crucial component influencing employee satisfaction is how well company values are aligned with employees’ personal values. And prospective employees seem to know that since 50% of job seekers would pass over a job with a pay increase if it was at an organization with a poor reputation.

The benefits of actively creating and managing your employer brand are well worth the effort—not to mention the value in avoiding the drawbacks of not doing so.

So, how do you develop a good employer brand?


1. Review your current brand.

Start by talking to your team and taking an internal temperature reading of how your current employees view your organization. Look at employee reviews of your company on sites like Glassdoor and Indeed. Check out our company’s social media and see what language you use around your employees: how you recognize them, engage them, and motivate them.

Take the time to go through your current employee-facing documents like your employee handbook to get a feel for how your organization is already communicating with employees. Finally, look at your competitors and get a feel for how they present their employer brand to identify how you stand apart from them. See what prospective talent is navigating when looking for a job in your industry.

2. Develop a message

While you may have heard of a regular value proposition, an employee value proposition (EVP) might be an unfamiliar term for you. Essentially, it’s a concise explanation of why your organization is desirable to work at, what sets you apart, and what it’s like to be a part of your culture.

Creating an employee value proposition can be a fairly involved process, but it’s definitely worth the time it takes to develop. Creating a strong EVP requires serious introspection about your company values, research into your employees’ needs and desires, and thoughtfulness about the future of your company. It will become the foundation of your employer brand, creating language for your recruiters to center their message around, and offering a guiding light for your company culture, priorities, and leadership style. And it will play a crucial role in helping prospective employees determine if they are interested in working at your company.

3. Create employee ownership

Before releasing your new EVP and clarified company values and culture into the world at large, it’s crucial that you create a foundation for it to take root and grow within your organization. Make sure that you’re projecting an accurate message that reflects what it’s like to work for you.

To ensure you’re communicating from a place of honesty, work with key employees (leaders, managers, and individual employees) to help execute and implement your vision. Review and update your policies, benefits plan, and managerial approach to find ways to align them to your EVP. Create ways for employees to take ownership of it so they can act as stewards, ushering the values and culture throughout the organization.

Ask if it’s reflected in:

  • New employee onboarding process
  • Employee benefits and perks
  • PTO policies
  • Employee development opportunities

4. Launch externally

Once you’ve created an employee value proposition that reflects the clarified values, culture, and priorities of your organization, you’re ready to begin sharing your employer brand with the world! Offer your EVP to your hiring manager, add it to your careers page, and use it as a guide for how you interact with potential talent.

Begin telling your story as an organization on social media, through how you interact with and promote your employees online. Team up with your marketing team to determine how best to communicate your message and start telling the story of your organization from within. It’s crucial to keep returning to your employer brand to determine if it needs to be updated as your organization changes and grows. Remember, since your employer brand exists with or without your effort, it’s so much better to actively maintain your employer brand than it is to let it exist on its own, without your guidance and ownership.

 

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