M I N N E S O TAâ€™ S J O U R N A L O F H U M A N R E S O U R C E M A N A G E M E N T FOURTH QUARTER 2012 VOLUME NINETEEN NUMBER FOUR
Identifying lost productivity Michael Klachefsky
Midlife career changes Sunny Ainley
Long-term care collaboration Lucinda Jesson Permit No. 2655 Detroit Lakes, MN
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FOURTH QUARTER 2012 VOLUME 19 â€˘ NO. 4
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NEWS BRIEFS PEOPLE INTERVIEW Charles Stephens, MD The Heart of New Ulm Project
RECRUITMENT Midlife career changes
LONG-TERM CARE Own your future
LABOR LAW Minnesota unemployment insurance
View your home in a new way.
By Sunny Ainley
By Lucinda Jesson
By V. John Ella, JD
LEGISLATION Politics as usual?
HEALTH MANAGEMENT The iceberg effect
OCCUPATIONAL HEALTH Drug screening
INSURANCE PROGRAMS Voluntary benefits
By Natalie Wyatt-Brown, Esq
By Michael Klachefsky
By Maureen Young
By Kristi Fox
www.mppub.com PUBLISHER Mike Starnes email@example.com EDITOR Donna Ahrens firstname.lastname@example.org ASSOCIATE EDITOR Janet Cass email@example.com ASSISTANT EDITOR Scott Wooldridge firstname.lastname@example.org ART DIRECTOR Elaine Sarkela email@example.com OFFICE ADMINISTRATOR MaryAnn Macedo firstname.lastname@example.org ACCOUNT EXECUTIVE Iain Kane email@example.com ACCOUNT EXECUTIVE Matt Nichols firstname.lastname@example.org Employee Benefits Planner is published quarterly by Minnesota Physician Publishing, Inc. Our address is 2812 East 26th Street, Minneapolis, MN 55406; phone (612) 728-8600; fax (612) 728-8601; email email@example.com. All views and opinions expressed by authors of published articles are solely those of the authors and do not represent or express the views of Minnesota Physician Publishing, Inc., or this publication. The contents herein are believed accurate but are not intended to replace legal, tax, business or other professional advice and counsel. No part of this publication may be reprinted or reproduced without written permission of the publisher. Annual subscriptions (four copies) are $24.00. Individual copies are $5.00. Reprints of individual articles are available upon request.
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State Coalition Launches Healthy Minnesota 2020 A statewide coalition to improve the health of Minnesotans has approved a plan called Healthy Minnesota 2020. The plan was created by the Healthy Minnesota Partnership, a statewide initiative led by a group of business, academic, nonprofit, and governmental leaders. The coalition has been looking at what factors contribute to health and how to address health issues in the state. The Minnesota Department of Health (MDH) sponsors the coalition. “Where we live, play, learn, and work has a huge impact on our health,” says MDH Commissioner Ed Ehlinger, MD. “Because of this, our goal is to improve the social, economic, and physical environments of our communities so that all
Minnesotans have the opportunity to be healthy and reach their fullest potential.” The Healthy Minnesota 2020 plan will provide a framework for ensuring that every Minnesotan has a chance to be healthy, officials say. The coalition explored a range of factors that contribute to health, including social, economic, and environmental conditions. The framework it came up with recognizes that good health doesn’t come simply from health care providers or healthy eating, but is a result of many complex factors, including communities that promote healthy workplaces and schools. The Healthy Minnesota 2020 framework stresses three major themes: capitalize on the opportunity to influence health in early childhood; ensure that the opportunity to be healthy is available to all citizens regardless of where they live; and strengthen communities’ ability
to create healthy futures. “It is our hope that this provides a framework for different groups to work together to make sure that every Minnesotan has the opportunity to be healthy,” said HealthPartners executive Donna Zimmerman, a member of the partnership and a member of the Itasca Project, an employer-led alliance addressing metro area quality of life. “We are not only talking about health care or the medical system here but are talking about how we can achieve what we all want, which is to live in communities that help us lead healthy and fulfilling lives.”
Medica Introduces New Joint ACOs Medica and four health systems in the metro area introduced several joint accountable care organizations (ACOs) in 2012, using a “defined contribution”
health insurance product that officials describe as a private health exchange model. Minnetonka-based Medica introduced the My Plan insurance product last year and says it allows employers to establish a set amount in a health care account, while allowing enrollees to customize their health plan to best meet their needs. The ACO component brings in local health systems to work on care coordination, managing costs, and improving quality of care. Since April, Medica and Minneapolis-based Fairview Health Services have been offering an ACO called Fairview Health Advantage with Medica. In July, Medica and Ridgeview Medical Center rolled out the Ridgeview Connect ACO, and later that month Medica and St. Louis Park-based Park Nicollet introduced the Park Nicollet First ACO. Earlier this month, Medica and St. Paul-based
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HealthEast Care System announced an ACO called Inspiration Health by HealthEast. According to Scott Reid, vice president of product strategy and development at Medica, his company has been working for several years on the problem of rising health care costs and what that means for employers and enrollees. Reid says the My Plan defined contribution model was developed by Medica and Minneapolis-based Bloom Health to provide more predictability in cost for employers and provide more choice for employees in designing their own health plan, while also giving employees more control over their health care dollars. The My Plan model has been attractive to employees and employees alike, Reid says, with 50 companies now using the product and approximately 15,000 enrollees.
Mayo Clinic Trains Providers on Truck Driver Exams Mayo Clinic in Rochester is offering training for health care providers to become certified medical examiners for truck drivers. Under new federal regulations, by 2014 truck and bus drivers will be required to get medical examinations by specially trained and certified providers. The goal is to prevent medical emergency-related crashes through what officials expect will be more intense health exams. “Often, the medical evaluation is the only opportunity for preventive care that a driver will receive,” says Clayton Cowl, MD, a physician in preventive, occupational, and aerospace medicine at Mayo Clinic. “Granted, it’s more regulatory burden on the drivers and their examiners, but I also view this as an oppor-
tunity for health care providers to make a difference in their lives.” The Federal Motor Carrier Safety Administration estimates 40,000 qualified medical examiners will be needed to perform roughly 3 million exams a year under the new rules. Cowl is the course director for a new series of training programs offered to examiners across the country.
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Allina, Blue Cross Offer Defined Contribution Plan Allina Health and Blue Cross and Blue Shield of Minnesota are teaming up to market a new insurance product that uses the defined contribution model and a network of Allina-affiliated providers. The new product, called Blue Choice, provides a defined contribution for each employee of a company with 50+ employees. Employees are given a fixed dollar amount and can choose from up to 20 Blue Choice plan designs. The model has copay plans as well as health savings account-type options. It will be available starting January 2013 to companies in the 11-county Twin Cities metro area. Blue Choice will work with the Allina Health Network, which includes all Allina hospitals and clinics, as well as some affiliated providers. According to David Kanihan, spokesman for Allina, the Allina Health Network will give Blue Choice enrollees a wide option of providers. “The network is not just institutions with the Allina name on the door,” he says. “It’s a very broad network.” Kathy Dunmire, vice president of product management at Blue Cross, says the market is seeing more demand for defined contribution plans. “The defined
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News to page 6 FOURTH QUARTER 2012
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News from page 5 contribution model is a way for employers to get more control over their health care costs while at the same time increasing the amount of choice for their employees,” she says.
State Launches “Own Your Future” Minnesota has launched a campaign to help people become more aware of the need for longterm care planning. The “Own Your Future” initiative has been in the works for some time and was launched by the Dayton administration on Oct. 2, with a new website and phone line where Minnesotans can find information and resources on long-term care planning. State officials say they envision employers playing an important role in the effort. Federal and state officials across the nation see a demo-
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graphic tsunami coming as millions of baby boomers begin requiring assistance for daily tasks or to maintain their health. Many Americans believe that Medicare provides for long-term care needs, but that is not the case, state officials note. Medicare and Medicaid pay only for long-term care in limited circumstances; and under Medicaid, individuals must “spend down” their resources until they qualify for assistance. The campaign is not simply about planning for nursing home care, as many other options are now available for seniors. A letter sent to Minnesotans between the ages of 40 and 65 encourages planning now for future needs to give individuals and families more control over their future. Employers, who are regarded as trusted sources of information about topics such as insurance, are being encouraged to share a toolkit—available on the
FOURTH QUARTER 2012
website—on long-term care with employees. The “Own Your Future” website can be found at mn.gov/ownyourfuture. State officials say they continue to work on the issue, including efforts to develop more affordable long-term care insurance options, and will consider changes to Medicaid to make financial planning for long-term care easier for Minnesotans.
HealthPartners, Park Nicollet to Merge In one of the largest consolidations seen in the Twin Cities health industry in decades, HealthPartners and Park Nicollet Health Services have agreed to a merger. The move, announced August 30, will make the new organization one of the largest health delivery systems in the state.
Bringing together two large provider groups in the metro area is historic, but not surprising at a time when rural Minnesota is seeing many small health systems being consolidated into larger groups. Health care reform and market pressures have already led metro-based systems such as HealthPartners, Allina Health, and Fairview Health Services to gobble up small to mid-size practices. The agreement will create a 1,500-multispecialty-group practice that is tied to the insurance arm of HealthPartners, although the clinics and hospitals involved will continue to work with other insurers as well. Officials say the two groups will have a combined, consumergoverned board of directors. The overall group will maintain the HealthPartners brand, but clinics and hospitals will continue with their current names for the near future.
PEOPLE Maureen Rehfuss has joined Minneapolis communications firm Padilla Speer Beardsley as vice president of human resources and administration. In addition to her human resources experience, Rehfuss has served as president of the Human Resource Professionals of Minnesota and is an accredited senior professional in human resources. She also is a memMaureen Rehfuss ber of World at Work and the Twin Cities Human Resource Association. Minneapolis-based Allianz Life Insurance Company of North America has promoted Paul Salm to assistant vice president of compensation for human resources. Salm will be responsible for compensation and employee recognition to support client and business strategies. He will also manage compensation programs for more than 4,800 employees across Allianz of America, which includes Allianz Life and Fireman’s Fund Insurance Company. Before this promotion, Salm was a senior director in HR. Allianz also has promoted Bill Ryan to director of human resources. Ryan will lead the people strategy and will work with senior leaders in actuarial, finance, and legal. Ryan joined Allianz Life in 2002 as a client services team manager in the operations division and transitioned to the HR division as a service center manager. John Galarneault has joined Mercer’s Retirement, Risk & Finance business as a principal in the firm’s Minneapolis office. In his new role at the human resources consulting firm, Galarneault will help employers in the Twin Cities market develop and manage retirement programs that help them achieve their employee attraction and retention goals. Galarneault worked at Aon Hewitt for 17 years, where he helped build the company’s global benefits practice. He holds a diploma in international benefits from the International Employee Benefits Association. Minneapolis-based global hospitality and travel company Carlson has appointed Mary Plunkett as vice president of global talent management and development. Plunkett has more than 20 years of talent and organizational development experience, most recently as the global director of people and organizational development at Heineken. She has a doctorate in organizational psychology and a master’s of science degree in applied experimental psychology from St. Louis University. Audrey Ann Fenske, JD, has joined Minneapolis-based Faegre Baker Daniels LLP. She will serve clients as special counsel in the law firm’s ERISA, benefits, and executive compensation group, working from the Minneapolis office. Fenske brings more than 20 years of experience as a compensation and benefits tax/ERISA lawyer, including a broad background in U.S. and international regulatory matters. She has advised large multinational companies and mediumsized U.S. companies in a range of compensation and benefit matters, with a special focus on Audrey Ann companies with globally mobile employees. Fenske, JD Sara Hill, MBA, has been named chief human resources officer at business services company Ceridian. She previously was senior vice president for human resources at U.S. Bank and vice president of management effectiveness at Fidelity Investments.
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Embracing better health ■ How did Hearts Beat Back—The Heart of New Ulm Project get started? Dick Pettingill, who was CEO of Allina at that time, challenged the organization about what they were doing to help communities. Two giant projects were born out of Pettingill’s challenge; one of them was the Backyard Initiative in the area around Allina headquarters in Minneapolis, and the other one was the Heart of New Ulm Project. Kevin Graham, MD, head of the Minneapolis Heart Institute at the time, was a cardiologist who started coming down here to New Ulm more than 20 years ago. New Ulm had become really, really good at treating acute MIs [heart attacks]. The issue became, “What can we do to push the treatment upstream a little bit, to actually try to prevent early heart attacks and to prevent early-onset disease?” New Ulm got in the mix because of Dr. Graham’s familiarity with the community here, but also because it’s a town of 13,000 to 14,000, and over 90 percent of the people here had a medical chart. When the project started in 2009, we were already three or four years into an electronic medical record, which tied into Abbott Northwestern Hospital and to the whole Allina system, so that we had an excellent ability to catch data on people. It seemed like a great place to step in and try to do a project like this.
■ What can you tell us about your role in the project? The idea did definitely came from Minneapolis and from Allina, but from the get-go there was a tremendous amount of community involvement here. Before I even got involved, there was a lot of planning with 30-some people on the community steering committee. Then I was asked to join the project. What I am charged to do is take what goes on at the research office, which is located at the Heart Institute in Abbott Hospital in Minneapolis, and help coordinate that with the primary care and other provider staff here in New Ulm. We also have a staff of four to five people on the ground here who are interacting with businesses, the schools, restaurant folks, and the community.
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Charles Stephens, MD The Heart of New Ulm Project Hearts Beat Back—the Heart of New Ulm Project is a campaign to reduce the number of heart attacks in the New Ulm area over a period of 10 years. The project is sponsored by Allina Health, which owns the community’s hospital, the New Ulm Medical Center. The Minneapolis Heart Institute is another partner in the project. As the project’s medical director, Charles Stephens, MD, helps with the design of clinical interventions and serves as a liaison between the project planners and front line practitioners at New Ulm Medical Center. Stephens, a family practice physician, is a graduate of the University of California, San Francisco.
■ The project is in its fifth year now. What are you finding? This program started as a free public screening in 2009. Over the course of about six to eight months we had a free screening program for anybody in the community over 18. We have over 5,000 people of our adult population of 10,000 who came through the screening. We found that, like much of Minnesota and much of America, people were too overweight, too inactive, and smoked too much. We used that as the initial data pool to look at what we set out to do here. The idea was to rescreen every two years, so we did another screening in 2011.
FOURTH QUARTER 2012
What we have found is that we have been able to make an impact on how many people are smoking, how many people are taking an aspirin a day, how many people at least are involved in doing some kind of thing—whether it is increasing their activity, or increasing the number of fruits and vegetables in their daily diet, or things like that. One of the things that surprised me has been awareness of the project. We had a phone survey a couple of years ago, and 94 percent of people in our area knew about the program. So that was incredible penetration of knowledge of the program. I see this as trying to create critical mass, a change in norms of behavior, be that smoking, general physical activity, choices in eating—both what you eat and how much you eat—to try to push back the big glacier of what seems like inevitably rolling toward increased obesity and higher cardiovascular risk.
■ The name of the community is on the project. Do people buy into it because of that? Yes, they do. This is not a totally insular community, but it’s a small community and it has this strong German heritage—there is still a sense of pride in being part of this community. I think this is an ideal community to try this in. Racially, New Ulm is not diverse, but on the socioeconomic spectrum, it really is quite diverse. We have only one hospital and medical facility, and most of the people have come here at some point. I think in a bigger community, where there are lots of hospitals and lots of different clinic entities and lots of different employers, you’re probably going to be working at finding groups that naturally coalesce, whether that’s a neighborhood community or some other group that somehow identifies itself, where there is already some community closeness. One other surprising thing that I saw in our community was from the person who works specifically with stores and restaurants. With convenience stores, when people come and grab their coffee on the way to work, just making a little change at the checkout helps, having healthy options like apples and bananas right there that are priced the same or cheaper than the candy
bars and power bars. The convenience stores have been really receptive to that and their sales of those things have significantly improved. I think things like that are easily exportable to a community anywhere.
■ How has the business and employer community responded? You see it everyplace. There are a lot of insurance company-driven wellness programs out there, and that’s happening here too. Sometimes we have competitions between businesses, some sort of weight loss program or monitoring. We have J.R. Schugel, a national trucking company with headquarters here. They went nonsmoking at their worksite, which was really a tremendous thing. There are still people who choose to walk to the corner and smoke on their breaks, but I think it’s one of those things that creates a new norm that makes it easier for people to give it up. Whether it’s a small electric motor shop or 3M and Kraft, the larger international types here, everybody has been pretty accepting of the project.
■ How do you work with employers? We are happy to speak to employer groups,
whether it be about physical activity or other aspects of our work. We are not certifying anybody as being a good program or employer, but we have recently started doing something with restaurants in town. We have a silver, gold, and platinum level involvement of the restaurant in terms of their offering lower- calorie, lower-fat choices; businesses get a little placard on their door.
■ What has been the most rewarding aspect of working on this project? The most heartening for me has been the project’s effect on people. You look at a patient that you’re afraid is just a walking time bomb who you’re never going to do anything to help, and then they show up out of the blue and say, “Did you notice that I lost 10, 20, 50, 80 pounds?” You just look at them and say, “Wow.” I have a great story. This fellow, who was maybe in his late 40s, went to one of the screenings and was shocked to find his blood pressure and cholesterol were way out of whack and he was overweight. I saw him after that as a patient, and we started him on medication for blood pressure and for cholesterol and other things. Then he had one follow-up and we saw that the medica-
tions were working, and then I didn’t see him for a long time. I got a note from him saying, “I’m doing well with my weight loss. I’m going to quit taking the medicines and then I want to get retested and see how I’m doing.” In one year, he had lost 98 pounds, he had gone off his cholesterol-lowering medicine and one of his blood pressure pills, his cholesterol numbers were perfect, and his blood pressure was well-controlled on one low dose of an inexpensive daily blood pressure medication. I said, “How’d you do it?” And he said, “You know, I just realized I needed to change, so I eat less when I eat, and I don’t eat between meals, and I just make sure I do something every day.” You hear so many stories of, “Doc, it’s just impossible. There’s no way I can lose weight.” And that’s probably true for some, but then you find a story like that where somebody loses 100 pounds and he loses the need for two medications and says my life is fine, I feel better, and I don’t feel like I’ve had to make any huge sacrifices. To me, that’s what it’s all about, just having people be able to go about their lives and feel a little bit better and not need to do have so much interaction with medications.
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e’ve all heard the predictions about baby boomers or the aging population as these “second lifers” retire and look forward to the next phase of life. Many employers have hastily designed communication and outreach campaigns to attract and woo this large workforce group, fearing the impending labor shortage. But they often ignore an even larger pocket of capable professionals who may have 20-plus career years ahead of them. Mid-career professionals represent 53 percent of all workingaged adults in Minnesota (2009 U.S. Census Bureau, age groups 35–59) and have much to offer a company, if you know what to look for and how to develop these professionals within your own organization.
Issues to consider about mid-career professionals By Sunny Ainley
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Crisis or calling: What does â€œmid-careerâ€? really mean?
and willingness to tackle unfamiliar projects in the search for development and learning.
Career is defined as a long-term or lifelong job. Perhaps thatâ€™s How to identify a mid-career professional old-school thinking, as we can all enjoy multiple careers in our No one will walk in with a Post-it on her forehead with â€œmidworking years, possibly even after our traditional working years careerâ€? written on it, but you will find some commonalities. as â€œcareer volunteerism.â€? Whether you are meeting face-to-face or reviewing a paper The key word is â€œlong-term.â€? As we enter the early job years, most of us wander from job to job, often driven by better pay or aimless ladder climbing. We are not â€œMid-careerersâ€? tend thinking about long-term career to have practiced and development or lifelong development. Conversely, as we enter the transferable skills. â€œexitâ€? years, we are certainly not focused on what a long-term new work career might look like. rĂŠsumĂŠ, a mid-career candidate may demonstrate self-confidence Only during our middle work years do we tend to awaken to without arrogance. These professionals are the â€œsagesâ€? of the this transformational career period. The early and later work workforce, wise because of reflection and experience but with years are the bookends to the meaty mid-career years. These many more years of fruitful and fulfilling work ahead. years can be a time of disruption, discovery, development, clarity, The mid-careerer will tend to inquire about aspects of the job and satisfaction. or company that are outside of typical questions such as salaries, Mid-career is an emotional and purposeful crossroads benefits, and vacation and more about qualitative aspects such as between work life and personal fulfillment. It is the time in life the vision and culture of an organization, professional developwhen you question if the work that you do is meaningful and ment opportunities, management and leadership styles, and hiraligned to your gifts, values, and purpose. Many factors influence ing and retention practices. With these candidates, you will see mid-career change, such as loss of employment, personal/life and hear competencies, passions, gifts, values, and experience changes, greater purpose and satisfaction, and/or closer alignMidlife career changes to page 30 ment of work-life values. It can be either a crisis or a calling that pushes someone forward to investigate what other career options exist and what might be an authentic fit. Michael Smith, 43, had a lucrative six-figure IT job until the day he suffered a debilitating back injury. He struggled with his healing process and experienced limited access to quality care, eventually losing his job, home, wife, and most everything else. Frustrated and depressed, he researched his options, and enrolled in a health IT training program at Normandale Community College. This launched the exciting process of discovering himself, his gifts, and his talents, and mapping those to possible career paths that would allow him to work in his passions: information technology and improved health care. Michaelâ€™s journey was driven by crisis but transformed into fulfillment and clarity. Smith is now working for a large integrated health care provider, leveraging his deep IT knowledge to help the organization provide safer and better care for the patients his company serves.
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Why hire a mid-career professional? Most mid-career professionals are seeking companies and jobs that align to personal values and beliefs, naturally establishing a deeper level of commitment and shared mission. With 10â€“20 years of work experience, â€œmid-careerersâ€? tend to have practiced and transferable skills that easily translate between industries or disciplines, as well as a large network of contacts and resources that can be leveraged for work. Another benefit of experience is a well-developed emotional intelligence when communicating, dealing with conflict, and relating to others. Since these workers are more in tune with their strengths and interests, self-motivation is high for this type of professional. Hiring managers will also see a natural curiosity
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