Monthly Archives: January 2013

When Culture kills Character! Lance Armstrong is not alone..

We have just been listening to Lance Armstrong on Oprah!

There is no question that what he did was wrong; he does not need the world to tell him that, he knows. He has to live the rest of his life with his demons.

Let’s think for a moment!

It is easy for us to judge and many of course would say,  “that we would never do that!” and many wouldnt.

Many of us will never face the pressure that comes with the highest of success and the incredible pressure that sustains people when they are the “best of the best” and appearing and being invincible is what everybody else tells them, and wants them to be because they also benefit.

Lance Armonstrong has many virtues that we all would like to aspire to have:

  • The courage and determination that overcomes cancer at all costs.
  • The competitiveness that brings success and self-realization.
  • The personal drive that says its possible to be the best.
  • A belief that whoever you are and wherever you came from you can do it and that gives hope to others.
  • An inner confidence to always believe in yourself.
  • A focus that brings all you have to the job in hand.

I have always been a Lance Armstrong fan and will always be in awe of what he did.

He did it at a time when the environment and culture we hear condoned what became a level playing field. There is no question thought the raw talent was there. It was the environment he mentioned that he worked in and had to adapt to.

You see sometimes it is simply too hard to not be the best. And don’t we all adapt?


The fact is that many of us are also in some way diminished by the environment we work and live in.

Many of us have worked in a “toxic environment” that has “cowed” us in some shape or form. That has asked much of our character.

There are many instances that we “tow the line” or condone things that “we” would not do but….

I ask my class to think about how they would perform if we had two side by side glass bowls one filled with car fumes etc and one with fresh air and then we were set free to perform. What would your performance be like then?

It is just that for some the fall from grace is much harder, further and more damaging. The way back is much longer and tougher.

We know the right thing to do but all to often doing the right thing is often harder then “going with the flow.”

For Lance maybe for a while there it did become all about the bike!Image

Health Care Reform for the HR Professional

HR professionals are now entrenched in an entirely transformed healthcare delivery landscape.  The Patient Protection and Affordable Care Act (PPACA) clearly will impact every stakeholder that currently delivers or supplies healthcare in the United States.

While the structural, financial, behavioral and market-based consequences of this sweeping storm of legislation will occur unevenly and are not fully predictable, this first round of healthcare legislation is designed to aggressively regulate and rein in insurance market practices that have been depicted as a major factor in our “crisis of affordability” and to expand coverage to an estimated 30 million uninsured.

Many HR professionals are getting hit from all angles – finding it difficult to continue to transfer rising costs to employees, unwilling to absorb double-digit trends, under-staffed to intervene in the health of their populations and uninspired to assume the role of market catalyst to eliminate the perverse incentives that reward treatment of chronic illness rather than its prevention – they must forge ahead to address the intended and unintended impacts on the estimated 180 million Americans covered under their employer-sponsored healthcare plans.

Consider the following as you brace for the “new normal.”

▪   Think Twice When Someone Suggests Dumping Health Coverage– Many smaller and razor-thin margin employers will be tempted to drop medical coverage and pay the $2,000 per full-time employee penalty – essentially releasing employees to buy guarantee-issue coverage through health exchanges, which will be available in 2014.  Aside from impacting employers’ ability to attract and retain employees (consider how many of your employees will fall into the class of individuals eligible for federal subsidies), the assumption that the $2,000 will remain the baseline assessment per employee for those choosing to not offer coverage is a dangerous variable.

▪   Pay attention to Section 105(h) now. – Many employers may be unaware that self-funded plans that discriminate in favor of highly compensated employees must comply with Code Section 105(h) non-discrimination rules.  As of the first plan year following September 23, 2010, these rules now will apply to non-grandfathered, fully insured plans.  Insurers may choose to exercise their right to either load rates for potential adverse selection or decline to quote because employers have failed to meet minimum participation percentages. . Penalties for not complying with the new regulations are $100 per day per employee.

▪   Understand the sources of cost shifting pressure – As Congress and state governments wrestle with Medicare and Medicaid reimbursements and begin to focus on fraud, over-treatment and accountability for clinical outcomes, providers will feel the increasing pinch of reimbursement reform and will pivot in the direction of trying to shift costs to commercial insurance. HR professionals will need to better track employee utilization patterns for in-patient facilities especially in high-use urban and rural commercial hospitals that also derive a large percentage of their revenues from Medicare. If a hospital derives 60% of its revenues from government reimbursement and 40% from commercial insurance, proposed fee cuts will impact facility revenues and create pressure to cost shift to private insurance.  An understanding of hospital utilization and consideration of tiered networks can help insulate your plans and drive lower costs.

▪   Don’t be intimidated by self-insurance – Many employers underestimate the advantages of self-insurance and overestimate its complexity and risk.  But, in a post reform world, firms with more than 200 employees should give serious consideration to partial or total self-funding.  Aside from the total transparency of fees, administrative expenses and pooling charges, employers own their own data. The sooner employers get comfortable with self-insurance as a risk financing strategy, the sooner HR professionals can construct loss control programs that can mitigate claims costs. By self-funding, employers may better manage their population’s health risk; may avoid a myriad of state-based mandates legislated to fund potential shortfalls should local exchanges prove inadequate to contain costs; and may increase flexibility with respect to plan design.

▪   Wellness Without Risk Management is Worthless. – Wellness has become a broad-brush term to describe any sponsored effort at health improvement. Forget wellness. Population risk management (PRM) is the operative term to describe a process of understanding embedded health risks and structuring plan designs to remove barriers to care and keep people healthy. PRM requires access to clinical data, cultural engagement and designs that have consequences for employees who do not engage. If employers do not understand the risk within their workforces, it is impossible to improve results or be confident that plan changes will drive a desired result.  For example, more than 50 percent of claims arise out of modifiable risk factors and as few as five percent of employees drive 50 percent of claims.

▪   HR is a “Force of Influence”. – Employers purchase healthcare for more than 180 million Americans – about 60% percent of all individuals who have healthcare coverage, but ironically feel less empowered, informed or in control of their spending or their employees’ behavior as they access the system.  HR professionals must become activists for public health improvement and change – promoting healthy behaviors, transparency and accountability while putting an end to public-to-private cost shifting, overtreatment, fraud, abuse and clinical variability.

As we hunker down and adopt this new legislation, the question for many in HR will be – will reform happen for you or happen to you?


Health Reform and the full impact of the Affordable Care Act continue to remind us that we can never be too prepared. Effective January 1, 2013 employers will have to start complying with the following requirements:

.                Health FSA deferral limits. Some employers still are fuzzy on the specifics of the new flexible spending account rule. Annual contributions to health flexible spending account will be limited to $2,500 effective January 1. If your group has a flexible spending account option, it’s time to start giving educational materials to your employees detailing this new limit and another requirement that comes along with this rule. Over-the-counter drugs can still be run through an FSA, but the plan participant will need a doctor’s prescription to get the lower co pay from your pharmacy benefit manager or health insurance organization.

.                Administrative simplification rules. Group health plans must comply with “administrative simplification rules for electronic exchange information and electronic fund transfers.” This provision contains the requirement that the plan sponsor also file a certification with the federal government verifying that the health plans are fully compliant with this rule. Penalties for failing to comply with the administrative simplification rules for electronic exchange information, electronic fund transfers and the reporting requirement of plan compliance carry fines. Those penalties for non-compliance are:

The fine is $1 per covered life, per day, up to a maximum of $20 per covered life, per year. A double penalty applies if the employers misrepresent any facts. The compliance and penalties apply to grandfathered plans. The system for brining this requirement to life must be ready to go on Jan. 1, 2013.

Employers must certify their compliance with these rules and notify the DOL beginning on Dec. 31, 2013.

.                Rise in the Medicare payroll tax. The Medicare tax rate for employees’ payroll will rise 0.9% for wages and earning over $200,000 – $250,000 for married couples filing jointly. In addition, high-income households will be subject to a new 3.8% Medicare tax on investment income starting 2013. Employers must collect the employees’ share of the tax and remit to the Internal Revenue Service. This additional tax law does not, however, increase the employer’s share of the payroll tax, effective for tax years beginning Jan. 1, 2013.

Employee notification of state insurance exchanges. Plan sponsors must notify their employees of the forthcoming stat insurance exchanges, which are slated to go into effect in 2014. Employers need to inform employees with a forthcoming DOL model notice effective March 1, 2013, or such later date set forth in future DOL guidance.


Gesundheit - Rezepte - Reisen


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