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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Mario Schlosser:  Mario Schlosser is the CEO and co-founder of Oscar, a health-insurance start-up that is using technology, design, and data to help humanize and simplify healthcare. Previously, he co-founded the largest social gaming company in Latin America, where he led the company’s analytics and game design practices. At Bridgewater Associates, Mario developed analytical trading models as a Senior Investment Associate. Prior to Bridgewater, he worked as a consultant for McKinsey &amp; Company in Europe, the U.S. and Brazil. As a visiting scholar at Stanford University, Mario wrote and co-authored 10 computer science publications, including one of the most-cited computer science papers published in the past decade, in which he developed an algorithm to securely compute trust in randomized networks.

COVID-19 Discussion with Mario Schlosser

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On February 29, the Economist published an article succinctly titled “COVID-19 is now in 50 countries, and things will get worse.” They were very right. Exactly a month later, on March 29, the World Health Organization reported that 203 countries, areas or territories have been affected by the outbreak. Countries have been working furiously to “flatten the curve” – lower the reproductive rate of the virus -- to ease the burden on healthcare systems, buy time to find new treatments, and reduce the total number of infections throughout the course of the pandemic. With “social distancing” the key weapon in this fight, approximately 2.6 billion people, or one-third of the world’s population, are now under complete or partial lockdown. Large gatherings, day-to-day activities and business as usual have halted.  While there is no escaping the disruption this crisis is causing, there is a lot that employers can do to support their employees and employees’ families that will have a meaningful impact. Our Health on Demand research found that employees typically have a good deal of trust in their employers, and the steps you take now to help maintain their well-being -- physical, emotional, financial, and social – will echo far in the future. Here are 10 ways employers can help empower their workers to push through the uncertainty and persevere: <ul><li>Err on the side of over-communicating. Consistent communication can convey strong leadership, avoid confusion and reduce anxiety. A well-organized and supported COVID-19 communications team can take in the evolving information, distill the key implications, and distribute it effectively to the workforce. Remind employees and their managers of the support resources available through the company and in the public. </li><li>Provide testing &amp; coverage information. Employers who sponsor medical, life, disability, accident and special-risk insurance (such as business travel and expatriate coverage) should be familiar with the terms and conditions in their policies testing coverages, eligibility requirements and unique provisions for quarantine. Employers should also pay special attention to public health, law, and policy updates in their geography for further implications to testing and coverage information. Consistent messaging by managers about access to health benefits and leave is critical during a crisis. </li><li>Support mental health &amp; wellbeing. The COVID-19 pandemic is already resulting in increased stress, depression and anxiety. Employers have a role in communicating information and providing mental health support for their employees. Educating managers, making services available for those affected, and communicating the availability of Employee Assistance Programs and other support services (e.g., tele-therapy) that are in place will help to mitigate the mental health impact of the pandemic. </li><li>Encourage telemedicine. If you are an employer that provides telehealth benefits, it is imperative to communicate to employees the support that is available to them and the services available. Unnecessary exposure to infection at hospitals and care centers can be avoided through virtual care. Telemedicine or other forms of virtual care are good options for many issues. </li><li>Assist with pharmacy changes. Employers should support early refills (including for behavioral health-related prescriptions) and home delivery through a local pharmacy in order to minimize trips by employees to the pharmacy. Many employer are considering or have implemented a one-time override to allow for 90-day supplies of specialty medications. Furthermore, some employers have also extended the duration of existing authorization approvals for items such as prior authorization, step programs and quantity limit overrides to limit administrative burden, while continuing to do so for newly initiated therapies. </li><li>Leverage reliable resources. In your communications, be sure to direct employees to reliable sources of information on COVID-19, such as the WHO, Center for Disease Control (CDC), and their local public health entities. Reinforce to employees and their families that they should reference those and communications from you as their sources of truth as opposed to the 24/7 news cycle or social media. </li><li>Manage communications with local health systems &amp; public officials. A robust preparedness plan comprises governance structures, clear protocols and lines of communication. It also includes assessing supply chain viability and collaborating with public health entities. The National Association of County and City Health Officials (NACCHO) has put together a Directory of Local Health Departments by state. Be sure to monitor local, state and national legislative updates to understand what else you can do to support your employees and society to flatten the curve. </li><li>Put policies &amp; processes in place. All employers should review their existing pandemic crisis management and response plans and establish new protocols for the current environment as needed. Employers should seek legal counsel and follow the direction of local public health department officials if there are concerns about known, suspected or high-risk cases. If an employee is found to have been exposed to COVID-19, there should be protocols for transport, communication and decontamination.  </li><li>Comply with occupational health needs. To ensure employee safety, check to see if company policies are in alignment with the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the Environmental Protection Agency (EPA). As businesses resume operations and individuals return to work during the COVID-19 recovery phase, all employers must manage fitness for work and other occupational health practices to keep the workforce safe. </li><li>Think innovatively. Many organizations are innovating to support their workforce. We have seen employers adding hospitalization cash allowances, enhanced mental health benefits, special caregiving benefits, even allowances for creating a comfortable home-working space. Employers are also finding new ways to manage employees in the remote working culture, with innovative training and tools. Looking outside the box for solutions can help employees to thrive inside their homes. </li></ul>While it is important to ensure that employees have access to continually updated information, it is just as important to show empathy to ensure your key messages get through. In addition, as your organization works through this stressful process, remember to take notes! Lessons learned will help pinpoint and address vulnerable areas in your business and human capital strategies in preparation for the next crisis.

Ten Ways for Employers to Assist Their Employees during the COVID-19 Outbreak

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Chief Commercial Officer

Prior to the COVID-19 pandemic, <a href="https://www.bls.gov/opub/reports/womens-databook/2020/home.htm" target="_blank">more than 57% of women participated in the US workforce</a>. While <a href="https://www.uschamber.com/workforce/data-deep-dive-a-decline-of-women-in-the-workforce" target="_blank">both men and women</a> suffered a 3% drop in labor force participation at the height of the pandemic, men have returned to the workforce at higher rates than women, with an estimated <a href="https://www.uschamber.com/workforce/data-deep-dive-a-decline-of-women-in-the-workforce" target="_blank">1 million women still missing</a> from pre-COVID workforce levels. Moreover, for those women that remain in the workforce, the struggle is real. <a href="https://www.mckinsey.com/featured-insights/diversity-and-inclusion/for-mothers-in-the-workplace-a-year-and-counting-like-no-other" target="_blank">McKinsey research shows</a> that working mothers (75%) are more likely than fathers (69%) to have mental health concerns. This is confirmed by Vitality’s member mental health assessment data which shows a 5% increase in women reporting moderate to high mental health risk scores throughout the course of the pandemic, compared to a 3% increase for men. Equally, we saw a 28% overall drop in physical activity in our members during COVID lockdowns, with women struggling to keep up their activity levels when compared to men, recording 32% fewer fitness points on average. In addition to the impact on physical and mental health, the pandemic highlighted additional systemic challenges that make it harder for women to thrive both in the workplace and at home. These include hidden disparities in employer health and wellness benefit offerings, lack of access to childcare and/or high costs—made more burdensome by the gender pay gap—and the always-on nature of remote work. As we’ve seen time and again, <a href="https://www.americanprogress.org/article/frontlines-work-home/" target="_blank">this is an even greater issue for women of color</a>. Because women are integral to the workforce, employers have a unique opportunity to help optimize their health and productivity. This can also have a broader impact on families and society given the role women typically play as caregivers and household decision makers, and the fact that physical, mental, and financial health are inextricably linked. To shift the wellbeing of women in a meaningful way, employers need to consider their potentially significant role as societal influencers in equity for women and re-examine not only the benefits they are offering, but also other factors related to the environment in which these benefits are offered.  Meeting employees where they are Well-being initiatives often appeal to the fit and healthy, leaving behind those who most need help, notably individuals facing health challenges and environmental barriers to engagement. To achieve real impact, well-being initiatives must go beyond boosting motivation, and attempt to understand the dimensions of opportunity and capability for diverse sets of employees. E. &amp; J. Gallo Winery is an example of an employer that has made strides to engage, connect and support their diverse workforce of 7,000 blue- and white-collar employees. One of the largest wineries in the US, the organization ensured that its workers had access to healthcare at their on-site clinic, which served as a central hub of health information to on-site workers and remote workers alike. Gallo has also been working hard to engage its diverse workforce, who work long hours and represent different cultures.  One strategy Gallo implemented was inviting employees to serve as advocates that deliver messages across the organization to build trust and create inclusive engagement. A top down approach isn’t always effective. People trust the folks they work side by side with and Gallo’s employee advocates serve as important conduits to health and wellness information and encouragement. When clothing retailer <a href="https://www.benefitnews.com/news/american-eagle-and-cdc-partnership-on-healthcare-inequity" target="_blank">American Eagle Outfitters closely examined the demographic, personal and community data</a> for its employees, the company discovered that essential workers in its distribution centers in Hazleton, Pennsylvania opted out of health insurance, while the Ottawa, Kansas facility had high rates of emergency room visits. American Eagle noted that these communities were also located in food and healthcare deserts.  In response, the company added healthcare centers in both locations to give employees affordable access to care, and hired a Spanish speaking nurse in Hazelton, since 80% of the employees there were Dominican.   When the company discovered a lack of access to public transportation between the Hazelton facility and the community where the majority of employees lived, executives worked with public transit authorities to create a convenient and affordable bus route. When employers address the broader socio-economic issues impacting their employees, it not only benefits the communities where they live and work but ensures a healthier and more productive workforce. The power of messaging and framing Employers can address socio-economic issues and offer the most robust benefits packages in market, but if benefits aren’t communicated properly, they will remain underutilized and unappreciated. When it comes to benefits, the rule is: over-communicate what benefits exist, and why they are important. However, this is not sufficient as a sole strategy, especially for people facing significant barriers to achieving their health goals and those who historically have been underserved in healthcare.  To understand how to maximize the likelihood that employees will take an interest in their health, Vitality recently collaborated with behavioral scientist Hal Herschfield, Professor of Marketing, Behavioral Decision Making, and Psychology at UCLA. We found that what, how, and who are all important factors in influencing employees’ health behaviors: <ul><li>Keep messages simple </li><li>Use a trusted source for communications</li><li>Clearly outline a limited number of next steps rather than providing a laundry list of possible actions, for short-term and long-term impact</li><li>Tailor communications wherever possible</li><li>Repeat messaging several times</li><li>Provide nudges, reminders, and incentives to help overcome inertia </li></ul> E. &amp; J. Gallo Winery Senior Benefits Manager Carmella Smyth notes the importance of a tailored approach, “A one-size-fits-all communication strategy does not work for such a diverse workforce. We have employees who work rotating 12-hour shifts, seven rotating days, day and night. Physically it’s hard for them. Psychologically it’s hard for them. From a communications standpoint, we start with simple sound bites to bring our employees information in the easiest way possible through emails, flyers, posters, and jumbotrons throughout all our plants.” The role of men in women’s health Finally, even the best-intentioned employers may find their benefits policies don’t support health equity, either in design or implementation. For example, research has shown the <a href="https://www.mckinsey.com/business-functions/people-and-organizational-performance/our-insights/a-fresh-look-at-paternity-leave-why-the-benefits-extend-beyond-the-personal" target="_blank">numerous benefits of paternity leave</a> to both mothers and fathers when fathers are given time off after expanding their families, and yet most companies still don’t offer equal time off for both the birthing parent as well as the non-birthing parent. Consider also parity in support for men and women with regard to fertility treatment and childcare.  Rising inflation and the threat of a recession are making it worse. An <a href="https://www.shrm.org/about-shrm/press-room/press-releases/pages/shrm-releases-2022-employee-benefits-survey--healthcare-retirement-savings-and-leave-benefits-emerge-as-the-top-ranked-be.aspx" target="_blank">employer survey</a> from the Society for Human Resource Management found that the share of employers offering paid maternity leave beyond what is required by law dropped to 35% this year, down from 53% in 2020. Paring down parental leave benefits is a short-term solution that only further entrenches health inequities and hurts employees, families and ultimately employers in the long-term. Given that <a href="https://www.weforum.org/agenda/2022/03/ceos-fortune-500-companies-female/" target="_blank">85% of Fortune 500 companies are run by men</a>, men play an essential role in influencing the workplace policies that impact women’s health. Organizational leaders decide what benefits are offered, and have the influence to adopt policies such as paid parental leave and flexible work schedules which <a href="https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/paid-family-leave-helps-women-stay-in-the-workforce.aspx" target="_blank">have been shown to help keep women in the workforce</a>. Leaders also play a large role in <a href="https://www2.deloitte.com/content/dam/Deloitte/us/Documents/human-capital/us-cons-culture-or-the-leader.pdf" target="_blank">influencing organizational culture</a>. When they model culture that is inclusive and supportive, it can shift culture or alternatively it could negate even the most equitable of policies.  Equitable and inclusive healthcare Achieving healthy behavior change at an enterprise level is hard. Ensuring that it is equitable and inclusive is even harder. Gallo and American Eagle show us we can improve health equity when employers are committed to the journey and serious about identifying the needs of their diverse employees and using all the levers at their disposal. Imagine the impact to the US workforce if this was the norm rather than the exception.

Employer Strategies for Equitable Healthcare

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Co-Founder & Chief Medical Officer

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Dr. Michael Le: Dr. Le is the co-founder and Chief Medical Officer of Landmark Health, the nation’s largest provider of in-home, value-based medical care. Dr. Le grew up a small town in western Massachusetts, where he watched his father practice small town medicine, including delivering house calls, black bag in hand, to frail patients in the community. Dr. Le is a passionate advocate for home-based medicine as the best setting of care for complex, chronic patients.  The COVID-19 pandemic has prompted many Americans to crack open their history books in an effort to draw inspiration and comfort from past crises we have confronted and overcome.  The Second World War provides an instructive case study.  To defeat the Axis Powers, we mobilized the full might of our nation’s economic, military and industrial capacity. We overcame the enemy, not just on the battlefield but on the home front as well: we re-tooled manufacturing plants, planted “victory gardens,” and organized scrap metal drives. The home front played a pivotal and enabling role in nourishing, dressing and equipping soldiers on the front lines.  Without the home front, we may have lost the war. A similar dynamic is unfolding as the healthcare system wages total war on COVID-19. Right now, our hospitals are the battlefront—many ICUs and ERs in hotspot areas are bursting at the seams with COVID-positive or presumptive patients. Today, just as we did during the war, we must not overlook the home front. We mean that quite literally: we must bring primary care to the home for our most clinically fragile patients, with the explicit intent of keeping those patients away from hospitals overflowing with COVID-19.  Home-based medicine is not a novel concept: in 1930, 40% of all physician-patient interactions happened in the home. By 1980, fewer than 1% of all primary care visits were house calls. The house call provider, once a cherished figure in the American healthcare landscape, became a victim of the mass industrialization of primary care.  But house calls are making a comeback.  As our nation ages, demand for in-home geriatric care is growing by leaps and bounds, and the volume of home visits is growing rapidly. Modern home-based medicine is advancing quickly and encompasses a broad scope of activities. As home-based physicians, we diagnose and treat medical, behavioral, and social conditions in the comfort of patients’ homes. We manage medications to reduce polypharmacy risk, conduct home safety checks, and facilitate conversations on advance care planning.  Homebound patients benefit disproportionately from access to in-home urgent medical care 24/7: if a frail senior feels short of breath on a Friday evening, or has abdominal pain on Christmas Eve, a home-based provider can be dispatched to the patient’s home to deliver urgent medical care, thereby avoiding an unnecessary trip to the hospital.  Across the country, though, there are millions of homebound seniors who have no access to home-based primary care. This problem is even more acute in the time of COVID-19, when the CDC is—correctly—instructing frail seniors to stay at home because of their susceptibility to the novel coronavirus. This vulnerable population, already socially isolated at baseline, is now even further disconnected from office-based primary care. Many practices are trying to meet this gap by offering telemedicine, which we applaud.  But let’s be frank: telemedicine will never replace the healing hand of a physician, particularly for frail seniors with chronic conditions. At Landmark, we use telemedicine as a complement to (not a substitute for!) in-home medical care, and that reflects the reality of our population: 20% of our patients have cognitive impairment or dementia; 40% has hearing or vision loss; and fewer than one-third owns and can operate a smartphone. Telemedicine won’t suffice for these patients; home-based primary care is the only scalable option standing between these patients and an overflowing ICU. Other players in the healthcare ecosystem have a role to play in promoting access to home-based medicine for frail seniors. CMS could incorporate home-based medicine into its network adequacy rules for Medicare Advantage plans. Health plans, in turn, should develop financial arrangements that reward high-quality, in-home medical care. And acute care facilities can partner more effectively with local house call providers to ensure that patients are safely transitioned from hospital to home.  Now is the time to recognize the vital role of the “home front” in the war against COVID-19. House call providers (both at Landmark and beyond) are racing to patient homes around the clock and across the country. These home visits are providing an essential service not just to these homebound and clinically vulnerable patients, but to the community as a whole. At a time when the nation is struggling with a daunting shortage of critical care beds, we on the “home front” owe it to our colleagues on the ER and ICU frontlines to keep elderly patients out of the hospital and safe in their homes.

How COVID-19 is Changing the Conversation Around Home-based Medicine

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