One of the hot topics at this year's KronosWorks 2013 was the Affordable Care Act (ACA). Even with the delay in the company mandate, employers are taking this time to do extra research, specifically where it applies to implementation best practices.
The sessions I attended regarding the ACA were a reminder that, while strategy is important, execution is critical. Organizations are taking the implementation of ACA very seriously. The conversation was a thoughtful and lively exchange about how to implement this very complex law while maintaining the business operation and keeping employees satisfied with their jobs. Some of the key takeaways I learned during the ACA sessions include:
The Affordable Care Act requires a culture change. The ACA isn't considered an HR issue. It's a law. And organizations have to develop and implement a strategy that will be used on a daily basis. Organizations are viewing the decisions they make regarding the ACA as culture decisions (versus benefits decisions).
Every department needs to be involved in the strategy and implementation of ACA. This directly reflects the first point. Business professionals agree - you cannot manage the ACA after the fact. The professionals I spoke with talked about the many departments being touched by the ACA:
Senior leadership to set the strategy.
Human resources to ensure compliance and craft the policy.
Finance to manage resources and finances associated with the Act.
Operational managers to monitor schedules and manage daily activity.
Many organizations are having to revisit their staffing models. As a result, some employees will become full-time. Instead of trying to figure out ways to keep employees part-time, many organizations acknowledge that the ACA is making them ask the question “Should this be a full-time position?” In some cases the answer is yes.
Speaking of staffing models, another topic brought up was the notion of giving hours to the best workers. We all know how this works. There's a last minute project to be completed. Often because both skill and speed are required, we ask the fastest, most qualified employee. But what if we can't now because the extra hours will reclassify their status? Organizations are trying to figure out how this potentially impacts the talent they currently have and skills they might need if they have to develop a contingent workforce.
Employers are concerned about losing employees who don't want to be full-time. We often make the assumption that everyone wants to be full-time and it's simply not the case. Employers who have created part-time positions to accommodate employees are concerned that employees will leave because the positions aren't as flexible as they used to be.
Full-time employees who currently have benefits are impacted as well. In the past, full-time employees who wanted to cut back a few hours were fine - it didn't jeopardize their status and another part-time employee could pick up the hours without overtime. Now, full-time workers will need to maintain their full-time schedule because those hours being passed along to a part-time employee have greater implications than just payroll.
Everyone agreed the key to managing the ACA successfully will be effective management of workforce data, reports and analytics. Debbie Baum, HRIS director at the YMCA of Metropolitan Dallas shared their plan. “We're not changing our full-time/part-time mix of employees because of the Affordable Care Act. We're not going to cut hours to avoid paying healthcare. We are going to manage the scheduled hours staff were hired to work.” Unlike the YMCA, this level of data collection and review could be new and different for some organizations. It might take some getting used to.
The Affordable Care Act's complexity mandates that organizations dedicate time getting their strategy right on the front end. Smart organizations are using this additional time wisely, to identify their focus as a result of the ACA. Troy Jackson, employment and performance manager at Firekeepers Casino Hotel in Battle Creek, Michigan said it best - “We want to be an employer of choice. Employees who work full-time hours will get full-time benefits. It's the right thing to do.”
The Affordable Care Act is more than a new law about health care benefits. It's a definition of corporate culture.
Today's guest blog post is courtesy of our board member, Tim Porter-O'Grady, DM, EdD, ScD, FAAN, FACCWS. Tim brings a deep and informed perspective to the implications of the Affordable Care Act for workers, their employers and healthcare providers. What's your organization doing to get ready to comply with the Act?
The Patient Protection and Affordable Care Act (PPACA) is well on its way into the fourth year of implementation. Looking past the strident political machinations, human resource leaders need to now deepen their understanding of its components and characteristics and what it actually does to improve the lives of workers and how it addresses long-standing health concerns of management. For the first time in the history of American healthcare, there is a drive to achieve real health value and ultimately to change the health status of the American population.
This focus on value economics now means that there must be increasing evidence of impact in health services. The longstanding dependence on a tertiary care model where we wait until employees get sick and then undertake a flurry of activity to address the problem leads us to higher levels of cost and a lower capacity for a sustainable positive health outcome. Our primary care foundations or infrastructure is not yet so well developed to a level that we can focus on preventing the conditions and circumstances that lead to our highest priced illnesses and conditions. One need only look at the overwhelming problems we are now confronting with the challenges and cost of treating an uncontrolled level of diabetes directly related to obesity and the high sugar, high fat diet in the U.S. The costs associated with treating diabetes and its co-morbidities over a lifetime far outstrip the costs associated with early addressing the practices and behaviors that lead to them.
The PPACA now emphasizes efforts that directly address health concerns and issues that can prevent the later onset of illnesses. Regular screening for high risk health issues can now be incorporated into health plans in a way that addresses both illness prevention and related costs. In addition, free preventive services are provided for potentially high risk, high cost services such as abdominal aortic aneurysm, alcohol misuse, blood pressure, cholesterol, colorectal, depression, type II diabetes, HIV screenings, diet counseling and immunizations (hepatitis, herpes, papilloma virus flu, measles, mumps, rubella, pneumonia, tetanus, diphtheria, pertussis, and varicella). In addition, free counseling is available regarding obesity, sexually-transmitted diseases, and tobacco use. Since many if not most employee related sick days are the result of these identified health problems, there is a potential for significant cost benefit for employers to assure their employees participate in these free preventive services.
Provider performance now emphasizes those activities which prevent accelerating utilization of high intensity health services and repeated admission to health services because earlier services were inadequate or ineffective. Recidivistic health care will simply not be supported or funded if it represents poor provider practices or ineffective standards of care. The PPACA now requires that providers “get it right” by assuring the application of evidence-based protocols and best practices for defined episodes of care. Besides accelerating the potential for quality care, the impact on the cost of that care of more effective provider practices will be significant.
Providers will now be incented not only by price but also by quality. Competition between plans and providers now include measures of impact especially as it relates to comparable measures of quality of service. Quality measures will now include clinical comparative effectiveness and user evaluation of service satisfaction. Imbedded in health reform is the intent that the system must ultimately produce a healthy population, not simply treat its ails and illnesses. In fact, the notion that admission to a hospital bed is evidence of the failure of the system to better address the health needs of the person plays out as a theme throughout the PPACA. Beginning January 1st, 2015, physicians and other providers will begin to be paid for value not for volume. The question in this climate for the provider is not how much did I do for persons but rather did I make any difference for individuals in what together we chose to do in their best interests. Those providers than can advance the quality of service and care at the same time as carefully managing its costs will be positioned to reap value-based rewards.
For employers and their health plans, the net aggregate value of this shift in design, delivery and outcome in the PPACA provides one of the strongest efforts to date to get at real issues of health-driven care and service. It is now time for employers who have a large stake in a healthy workforce to reinvigorate their own efforts to partner with their health plans in the pursuit of early engagement health services, primary care health interventions, and the pursuit of healthier life choices. The impact of such an effort will accrue to both healthy workers and a healthier bottom line.
I'm writing this while sitting in a parking lot waiting for a doctor appointment. Spring has finally sprung here with its fecund riot of color and accompanying plague of pollen. I love the former. The latter never bothered me until a few years ago when I suddenly became allergic to something that appears in the spring. This new allergy led quickly to asthma, another new development in my fifties. Armed with easy access to doctors, Flonase, Advair, Albuterol and the occasional visit to Prednisone land that turns me into a steroid induced superhero, my asthma is under control.
But what if I didn't have this medical access? What if I had to procure medical services and medicines by paying 100% out of pocket? What if I wasn't able to pay those bills? Asthma debilitates millions and kills thousands of people in the US every year - many of those deaths preventable according to experts. And asthma is only one of many chronic diseases that families have to cope with.
Which brings us to the Affordable Care Act. Lots of controversy has swirled around the 974 page act. Its driving objective is to ensure that all Americans have access to affordable health insurance and thereby to affordable healthcare. Everybody needs to comply with its provisions- individuals and employers - and therein lies much of the controversy.
If you'd like to join the conversation and tell us how you feel about the ACA, you can join Sharlyn Lauby (The HR Bartender) and me for a tweet chat on #KronosChat on 5/16 at 12pm. http://ow.ly/kMIqb. We'd love to hear how your organization is preparing for the full implementation of the Act in January 2014.
This week we're reading about:
Does HR Have a Self-hate problem? http://www.tlnt.com/2013/05/09/why-do-we-seem-to-hate-all-the-things-that-make-hr-great/
Can there really be a high-availability cloud? http://www.zdnet.com/can-there-really-be-a-high-availability-cloud-7000014887/
Why healthcare must embrace the cloud http://www.forbes.com/sites/centurylink/2013/05/02/why-healthcare-must-embrace-cloud-computing/
Puma optimizes productivity http://risnews.edgl.com/retail-best-practices/PUMA-Optimizes-Productivity86149
How Obamacare will affect your business http://smallbusiness.foxbusiness.com/finance-accounting/2013/05/08/how-obamacare-will-affect-your-business/
Will Obamacare lead to millions of part-time workers? http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/06/will-obamacare-lead-to-millions-more-part-time-workers-companies-are-still-deciding/
What should you pursue if you don't have a passion? http://www.npr.org/blogs/money/2013/05/09/182403459/i-know-im-supposed-to-follow-my-passion-but-what-if-i-dont-have-a-passion
There's a Little Bit of Expert In All of Us http://ow.ly/kKjzV via @hrbartender
Why Stepping Back and Making It Simple Solves Everything http://ow.ly/kSc1v via @TLNT_com
Connecting Work/Life Balance to Turnover http://ow.ly/kScco via @HRExecMag
In a Big Data World, Don't Forget Experimentation http://ow.ly/kSctD via @HarvardBiz
What a Flexible Workplace Has to Do With Trust and Creativity http://ow.ly/kSd6k via @Inc
Kronites are talking about:
New Time Well Spent #Cartoon: http://ow.ly/kK9Kj #overtime
RT @sreeseRNMBA: It was a "fanoos". Read about it at Time To Care http://ow.ly/kLm4y #NursesDay #Nurses #nursesweek #FlorenceNightingale
RT @SmarterCafe: The #cloud makes #Kronos want to be better. http://ow.ly/kN27P
Part-time Workers Confused by the #AffordableCareAct http://ow.ly/kPyii via @WF_Institute
“Dying ain't much of a living” http://ow.ly/kSbOy via @SmarterCafe
Hockey and the Cloud (in that order…) http://ow.ly/kSbSN via @SmarterCafe
@ODOT_Statewide Fast Tracks Workforce Management with #Kronos http://ow.ly/kKmO4
@PUMA Optimizes Productivity http://ow.ly/kKUhP via @risnewsinsights
Less Cost, Less Time, More Productivity -- Take Workforce Management to the #Cloud http://ow.ly/kKfVl
#Kronos Survey Shows Many Part-Time Employees Confused About #AffordableCareAct; Not Getting Much Help From Employers http://ow.ly/kMGd6
Times have changed. Your #HR and #payroll processes should, too. http://ow.ly/kKY3I #paycon
[INFOGRAPHIC] Are you confused about the #AffordableCareAct? You're not alone! Join #KronosChat on 5/16 at 12pm. http://ow.ly/kMIqb
Is 33% of a nurse's time spent on administrative work too much? http://ow.ly/kMQHR #NursesWeek
@sreeseRNMBA's interview with @am800cklw on addressing nurse fatigue within healthcare institutions. http://ow.ly/kNFI1 #nursesweek
#KronosCloud Growing at Breathtaking Rate; Kronos Reports Outstanding Second-Quarter Results: http://ow.ly/kP8sj
Webinar Reminder: Benefits one manufacturer saw with an integrated #HR & #payroll solution http://ow.ly/kP4PD #paycon
Our newest survey indicates that many part-time workers are confused about how the Affordable Care Act will affect them when it goes into affect in January, 2014. Our survey of 2,066 US adults, reveals that although the majority of workers (71%) have heard of the Act, many are confused about what the impact will be for them. And only 8% indicate their employer has communicated to them about the Act. As I've written about before, employers are generally paying a lot of attention to what they need to do to get ready. According to our survey, though, educating employees about how the Act is likely to affect them is not a focal area.
Organizations have a lot of work to do to get ready for complying with the Affordable Care Act in January 2014. Our survey found that 44 percent of part-time workers do not use an automated system to capture their time and 64 percent report their part-time employers don't use an automated scheduling solution. This means that a lot of folks are doing this work manually, and they'll have a hard time complying with the look- back and reporting requirements of the legislation. Perhaps more troubling, 36 percent of workers say that the hours they work are different from the hours they are scheduled to work, which could present a liability issue for employers.
According to Paul DeCamp, partner, Jackson Lewis LLP and former Administrator of the U.S. Department of Labor's Wage and Hour Division, “There are a lot of interesting data points in this survey and many of them should be of interest to employers around the country. Overwhelmingly, part-time workers are confused about how the Affordable Care Act will impact them in virtually every way and only 8 percent have heard anything about it from their employers. Organizations need to start a dialogue with employees to begin to shed light on this important issue and empower them with information as it becomes available.”
Our board member, Dr. Tim Porter-O'Grady, is similarly concerned saying “As with other segments of the population surveyed, it appears as though part-time employees are also uncertain and confused by the elements and implications of The Affordable Care Act. Their uncertainty relates very much to lack of familiarity with the details of the Act as it applies to full and part-time employees as well as how the act changes the landscape of health service. However, I'm not certain that the survey verifies that employees are any more knowledgeable and clear about their current health insurance coverage. The survey indicates the need for policy leaders and employers to generate clear and accurate information regarding health insurance coverage and the impact of ACA on the lives of their employees.”
Survey Key Findings:
You can learn more about how workforce management technology can help with ACA compliance here. In the meantime, though, start thinking about employee communications as a critical element of your strategy.
This week I spoke with our board member, Dr. Tim Porter-O'Grady about the implications of the Affordable Care Act (ACA) for healthcare providers and for employers. If your organization employs more that 50 full time equivalent employees, you are no doubt already grappling with what you'll need to do to comply with the act.
Tim, who consults with healthcare providers around the country, has a deeply informed perspective on what the ACA will mean for workers and employers. In our conversation, Tim reflects on the increasing responsibility that healthcare providers have to ensure their services are delivering the best possible outcomes for the money spent even as the pressure is applied to employers to ensure that employees can get the heath services they need at an affordable cost.
You can listen to a podcast of our conversation here: PPACA compliance podcast
In order to ensure compliance with the ACA and the drive toward evidence-based medical practice, both healthcare providers will be increasingly dependent on technology to track costs and predict outcomes. Other resources that might be useful to you and your organization in understanding the ACA:
Navigating the Affordable Care Act: Avoiding Penalties and Minimizing Costs - Kronos Webinar on March 6 at 11:00 am PT/2:00 pm ET
Mercer Report: Health Care Reform After the Decision. Mercer surveyed 1,215 US employers shortly after the Supreme Court decision last summer upholding the act. This report provides a brief overview of the provisions of the act relating to employer responsibility for providing employees with affordable health insurance as well as those employers' assessments of the financial impact the Act will have on business.
As Ben Franklin famously noted, "An ounce of prevention is worth of pound of cure". What's your organization doing to prepare for the ACA? And what are you doing to help employees manage their own health?
Our board member Dr. Tim Porter O'Grady submitted the following guest blog interpreting the radical transformation of the US healthcare system required by the Patient Protection and Affordable Care Act. Technology can help, but the biggest changes will begin with linking process to outcomes via intelligent process design and meaningful analytics.
Now that the Supreme Court has ruled on aspects of the Patient Protection and Affordable Care Act, the healthcare system is in overdrive as it attempts to reconfigure itself within the context of the Act (PPACA). The central driver for both the formation of the act and the response of the healthcare system has been the accelerating, some would say spiraling, costs of healthcare. In 2009, the gross domestic product percentage devoted to health care was just over 17%. In 2008 it was just over 16%; in 2001 it was under 15%. Clearly, the accelerating costs of providing contemporary healthcare and its growing portion of the gross domestic product have made continuing the existing tertiary care late stage engagement model impossible to sustain. As a result of the passage of the PPACA, major recalibration of the way health services will be provided over the next two decades is underway with shifts in policy, regulation, and program design. Growing emphasis on terms such as "value" and "accountability" are shifting the focus of healthcare away from emphasis on "process and volume" toward "product and value".
The rising public and private costs of healthcare are insupportable by governments, employers, small businesses, and individuals. At the same time, costs of health service are rising and despite high levels of spending in healthcare, measures of impact, outcome, quality as tested by quality-of-life indicators such as health status, life expectancy, and infant mortality compares dramatically unfavorably with other developed nations. While advances in clinical technology have progressed significantly in the United States, providers lag notably behind the European Community, Australia, and New Zealand in the use of electronic health information systems. On top of these realities, the average annual health insurance premium for a family hovers around $14,000, nearly 55% greater than the family costs for healthcare in 2000.
There is simply no longer any doubt that major change toward higher levels of accountability from providers and a more clearly delineated health outcome needs to be more firmly embedded in a transformed health system. As all services generally become more "user-driven", emerging models of health service must also reflect "user" or "patient-centered" approaches to delivering service. At the same time, services must result in a net aggregate positive impact on sustainable health status of both individuals and populations. With this reality as a centerpiece for healthcare design, providers must now focus their efforts within a different context in a way that demonstrates the convergence between discernible and intentional processes and their goodness-of-fit with clearly delineated and measurable health impact and outcome.
The challenge with this shift away from process emphasis is reflected in the esteem that providers have for their own good process. Indeed, indicators and measures of productivity have historically been driven by workflow, time and motion, and physical efficiency measures. This overarching emphasis on process and productivity has done much to focus on efficiency but has had little discernible impact on effectiveness. Emerging understanding of the character of professional work and judgment-based decision-making points to the inestimable value of assessment-reflection-evaluation as a foundation for delineations of value-defined productivity. The factors that now emerge as important in professional work more emphatically advance the value of creating a goodness-of-fit between effective process and relevant outcome. Indeed, the structure of service payment in the provision of healthcare will reflect how the convergence between effort and effect demonstrates best practice. Comparative effectiveness data will now compare and contrast the variety of service settings devoted to addressing particular health concerns or the health of specific populations. It is here where the shift in the minds and efforts of providers from volume to value will be most challenging.
The historic vertically constructed and compartmentalized service infrastructure in healthcare that insulated providers within the walls of their own clinical categorization and role boundaries now must become more porous. Individual disciplines must now configure in a more intentional and enumerated interface with a community of other disciplines who play a determined and articulated role in a complex mosaic of population specific health-generating activities. Financial and service success in a value-driven equation now depends on the intensity of interface and relational effectiveness between each member of the service team and the aggregated convergence of effort they all exhibit in the achievement or advancement of particular health outcomes for given populations or services. In order to both achieve and sustain this quality and value paradigm several key dramatic systems and role changes must occur:
There has not been as dramatic and broad a systems shift in health services perhaps since the introduction of Medicare. Both broad and deep changes in the configuration and payment of healthcare services will call for different delineation of clinical work, relationships, productivity, effectiveness, integration, and impact. This cycle of change is early in its dynamic and it is far too soon to determine the extent of viable change and the degree of its impact. For the cynics, it may imply nothing more than rearranging the deck chairs, and for the optimists, the achievement of meaningful and sustainable community health.
As always, reality lies somewhere in the midline between these two extremes. However, what is not sustainable is an increasing acceleration of costs for health service and a concomitant decline in health status. What results in this dramatic health system transformation will, as usual, not look anything like what is imagined at its initiation. Innovation, creativity, availability to change, and adaptation will be the usual attributes that characterize successful transformation. Re-languaging health service, recalibrating service design, and evaluating provider and programmatic impact and value will be necessary for all participants and will require evaluating effectiveness within a just-in-time frame. Never having reconfigured in process and innovated on the go, healthcare leaders will have to demonstrate new competence and capacity for network management, emergent dynamics, collective enterprise, and new financial/payment arrangements. For everyone in America we are at the “Nike moment” in health transformation and it is now time to “just do it”.
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