Seeking Employers to Partner in Addressing Kentucky’s Opioid Crisis

Kentucky businesses are collaborating in a cohort to help combat the opioid epidemic. We invite HR managers, benefits managers, occupational health managers, multi-employer trust fund administrators, or other individuals responsible for their company’s health and/or healthcare to join the KHC in this six-month journey to become partners in fighting our state’s greatest healthcare crisis.

WHAT CAN EMPLOYERS EXPECT TO GAIN?

Together, employers will learn from experts and one another how to optimize their healthcare benefits, data analytics, and workplace policies to address the prevention, treatment, and recovery from opioid misuse and disorder, and the diagnosis, treatment, and management of acute and chronic pain.

  • Best Practices | Learn from national experts and peers on benefit design and workplace policies
  • Benchmark Data | Learn the impact of the opioid and pain crisis on your business with custom reports available from the Integrated Benefits Institute (IBI) and other benchmarks
  • Expert Speakers | Learn more about relevant laws and appropriate care for opioid misuse and pain
  • Expert Tools | Use tools designed specifically for you to fight the opioid epidemic
  • Cohort Portal | Access exclusively for cohort members
  • Member Networking | Collaborate closely with KHC and other employers

WHAT ARE EMPLOYERS EXPECTED TO DO?

WHAT DOES THE COHORT INVOLVE?

The KHC’s Opioids and the Workplace toolkit will serve as the guide. The cohort will dive deeper into how the toolkit’s recommendations can be implemented by national and local employers.

  • IN PERSON-MEETINGS | November 1, 2019, January 17, 2020, February 28, 2020, and April 2020
  • WEBINARS | To supplement the in-person cohort meetings, there will be a series of webinars. Participating employers will determine webinar topics and dates by interest and availability.

HOW CAN AN EMPLOYER GET INVOLVED?

Participation in the cohort comes at no cost. To join the cohort, contact Natalie Middaugh, KHC Community Health Program Manager, at nmiddaugh@khcollaborative.org.

Pain – Reflections on the Employer and Employee Experience

We all experience pain. Perhaps you woke up this morning and on your way to the kitchen for your inaugural cup of coffee, you unexpectedly stubbed your toe. The pain is initially excruciating but soon subsides without much intervention. Other times, the experience might not be so fleeting. When picking up a heavy box, a sudden and sharp sensation in your back leaves you unable to stand up straight or walk without pain. The pain is so bad in fact, you are forced to miss the following days of work. After days of rest and at-home remedies don’t improve your situation, you visit your doctor in search of relief.

From here, there are many possible trajectories. Perhaps your doctor writes you a script for physical therapy and after a few visits, the pain subsides. The downside? Each visit sets you back $50 in co-pay costs and two vacation hours from work. Alternatively, perhaps this physical therapy doesn’t work, and you begin an exhausting process of trial and error. You visit the chiropractor, a pain specialist, an orthopedic doctor, and try a slew of medication regimes. Nothing seems to relieve the pain, and you have exhausted the options your insurance covers. You are unable to continue seeking relief without significant financial or time impact.

These situations paint a limited picture of the what millions of Americans regularly experience in the face of their acute and chronic pain. The experiences are individualized and their impact multidisciplinary. Pain management and the opioid crisis have been co-evolving, each significantly impacting the advancement or determent of one another. Often, prescription opioids are the first line of exposure to opioids for an individual who might go on to develop an opioid disorder. A rise in stringent prescribing guidelines have reduced the incidence of exposure, however this has not been without unintended consequences. Individuals who have relied on opioids to manage their pain have often been left without ways to manage their pain. System barriers such as insurance coverage for evidence-based modalities, care that is not comprehensive, or lack of clinical guidelines have impeded access to possible curative pathways. Individual barriers such as finances, time, or lack of knowledge add additional barriers.

EMPLOYERS SHARE CHALLENGES AND SOLUTIONS

Although not the only solution to this complex problem, employers have a role in mitigating some of the barriers their employees and their families may be experiencing in the face of their acute and chronic pain. On July 26, the KHC convened a group of employers representing various industries to discuss this role and explore the impact of pain on their workforce.

The conversation was kick-started by a presentation from the Integrated Benefits Institute on the prevalence of opioid misuse and pain related conditions in the workplace, and their impact on absenteeism and productivity. Following the presentation, Dr. Danesh Mazloomdoost spoke with the group on the pathology of pain and opioid use and the efficacy behind a biopsychosocial approach to managing pain as a symptom. The proceeding discussion among employers was guided by a few select questions:

  • How has chronic and acute pain impacted your daily business operations?
  • What healthcare or other data do you look at to measure pain assessment, treatment, and management in your population?
  • How well are patients getting access to effective diagnosis and treatment for acute and chronic pain using a biopsychosocial approach?
  • What are health plan coverage challenges for patients in accessing treatment modalities?

A theme in the discussion was the variables that exist in the workplace that cause pain or impede its management. Employee duties, whether they involve sitting at a desk or repetitive movements for hours a day, largely influence what types of pain employees experience. Scheduling and compensation structures often can keep employees from pursuing any type of treatment. For instance, an employee who is paid hourly may be more resistant to exchanging an hour at work for an hour at a doctor’s appointment. High employee turnover often doesn’t give employers an opportunity to make measurable impact on an employee’s condition. Alternatively, high employee turnover means that employers sharing a similar region or industry are often “inheriting” each other’s past employees. This fact demonstrates the need for a collective and synergistic approach from employers to setting priorities on their employees health.

Employers are also familiar with the barriers that exist within the medical system and health plan for their employees. There is concern around which treatment approaches are widely accepted, utilized, and covered. Referral processes are unclear – Are there centers of excellence for pain? What specialties are best equipped to manage pain? Employers also acknowledge the cost-sharing, utilization management, and coverage limitation barriers that exist for many pain management modalities.

Although these are hurdles to overcome, employers recognize the complexities around pain and the impact that is having on their workforce. Many have already taken measures to mitigate it’s effects, implementing innovative approaches around workplace accommodations, ergonomic supports, and preventive training.

DIVING DEEPER

This focus group discussion will help guide the KHC’s upcoming year of work around pain management. As an addition to the Opioids and the Workplace Toolkit, the KHC will be developing a section detailing employer best practices for supporting employees through this complex issue. The addition will be released in April.

Tackling Opioids in the Workplace

(Note: This guest piece was written by Tiffany Cardwell, Human Resources Consulting Principal, Mountjoy Chilton Medley and Director of Wellness, Louisville Society of Human Resources Management)

Tiffany Cardwell is a member of the KHC’s Worksite Addiction Group.

Opioids in the workplace is a topic that often gives pause for human resource professionals. The pause occurs since there are so many taboos and unknowns surrounding this issue for employers—no matter the size and no matter the industry. For the past year, I’ve had the wonderful opportunity to work with a talented team of experts through the KHC to create a toolkit for employers for supporting opioid prevention, treatment and recovery. Monthly meetings were held to focus on creating a tool for employers and their managers to assist with addressing opioids in the workplace. The toolkit was released last month at a half-day event where area employers explored the toolkit’s application and other relevant topics.

As an HR practitioner, I wasn’t quite sure what I would be able to add to the many experts who were involved with this initiative. What I quickly discovered is that everyone is in a continuous learning process with the subject matter of opioids. Although we had expert clinicians who have been practicing in the field for years, I was able to provide some insights from an HR professional consulting with managers daily who are doing their best to combat this issue. Although I do not have a clinical background, it was great to be able to share how we can create tools that employers will find easy to use and helpful as they address concerns with their direct reports.

Out of all of our discussions, I found it most helpful to become more educated about the definitions surrounding opioids. Using common language to speak with managers and employees provides clarity for this complicated workplace issue. Open communication is also key to successfully tackling opioids in the workplace. The more employees and employers are comfortable discussing this issue with each other, the quicker resolutions can be made to assist the employee to return back to work and effectively assist them through recovery.

If you have not downloaded your copy of the employer toolkit or reviewed it online, I encourage you to do so. Even if you’re not running into this issue now, it is helpful to proactively gain understanding about what you may run into in the future.

“Opioids and the Workplace” Employer Roundtable Paves the Way for Continued Work

If you have visited the Kentuckiana Health Collaborative’s website in recent months, you may have noticed a small box in the lower right-hand corner of the home page. Minute by minute, hour by hour, and day by day this countdown marked the nearing release date of “Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery.” As part of the Kentucky Opioid Response Effort (KORE), the KHC spent the past year convening employers and key healthcare stakeholders alike to guide the development of a toolkit to provide recommendations and tools for employers to support their employees and their dependents in prevention, treatment, and recovery from opioid misuse and opioid use disorder (OUD).

As countdown ended on Thursday April 18, employers and other key healthcare stakeholders gathered at GE Appliance Park’s Monogram Hall for the release of the toolkit and to lay the foundation for next steps and implementation. The four-hour event, presented by the KHC Employer and Healthcare Purchaser Network, was full of presentations and discussions that explored the toolkit’s application and other relevant topics.

DIVERSE PERSPECTIVES BRING THE DISCUSSION FULL CIRCLE

Attendees kicked off the program by answering a poll about what they hoped to gain from the event.

To set the stage for the day, Patrick Kullman, an interventionist, shared his personal story of how an employer can be instrumental in supporting an employee facing substance and opioid related challenges. He was followed by addiction psychiatrist Dr. Kelly Clark, Addiction Crisis Solutions, who presented on facts and debunked myths surrounding opioids, addiction, and what it looks like in the workplace.

With the employee perspective at the forefront of the discussion and the record set straight on the chronic disease of addiction, a panel, moderated by Tiffany Cardwell, Mountjoy Chilton Medley, gave context to the challenges employers face in this area and opportunities for improvements. As employers and early adopters of strategies to address opioid misuse, Dr. Diana Han, GE Appliances, a Haier company, and Amanda Elder, LG&E and KU, highlighted their experiences and paths forward in adapting their data analytics and workplace policies to best support their employees and their dependents, as well as their business. Eric Bailly, Anthem, explored the health plan’s role as an employer partner for determining and provider optimal benefit design. Cynthia Doll, Fisher & Phillips, LLP, addressed many of the legalities that employers may need to consider. Highlights of the conversation included the available of Narcan in the workplace, workplace accommodations for employees on Medication Assisted Treatment (MAT), the identification and utilization of high-quality evidence-based treatment, and the Mental Health Parity and Addiction Equity Act (MHPAEA).

Panelists discuss challenges and paths forward in adapting policies to best support employees and their dependents, as well as their business.

As the lead author of “Opioids in the Workplace,” I presented on the toolkit itself, exploring what exactly employers can expect to learn from it and explaining how it can be used.

Dr. Brittney Allen and Dr. Katie Marks from the Kentucky Opioid Response Effort (KORE) closed out the day of by highlighting available community resources for people facing opioid related challenges, including Find Help Now KY and the Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator.

EMPLOYERS TO DRIVE CONTINUED WORK

“Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery” is now available on the KHC website.

Although the countdown is now at zero, the work is certainly not over. In the upcoming year, the KHC will continue to improve this toolkit based on industry advancements and employers’ needs and feedback. At the roundtable, attendees were offered a chance to communicate their needs and give input on the potential direction of the toolkit. Three key questions were presented:

  • The business community has an active role in supporting the health and well-being of their employees. What should be their primary role in addressing the opioid crisis?
  • What is your biggest personal obstacle in acknowledging substance use in your workplace?
  • What tools can help you overcome this obstacle?

A major theme of this discussion was employers’ role in addressing stigma and creating awareness among employees not only about opioid related risks and addiction, but about what their employer can do to support them. Challenges to fulfilling this role included communication among different parts of the workplace chain of command, lack of understanding around confidentiality, and community culture’s that lacked empathy. Tools to overcome these challenges aligned closely with what the toolkit already offers, but also called for increased interconnectedness and partnership among employers, employees, and community supports.

To continue this conversation, the KHC will be convening a cohort of employers to discuss the implementation of the recommendations presented in the toolkit. Additionally, the KHC will be taking an increased focus on how employers can play a role in chronic pain management – a prominent factor in the development of the opioid crisis. If you are an employer interested in getting involved with this cohort, please contact me at nmiddaugh@khcollaborative.org.

The KHC will also be offering a complementary webinar on May 15 from 12pm to 1pm to review the employer toolkit. The toolkit and registration for the webinar can be found here.

We know employers play an important role in driving health of their employees and their families. By continuing to engage and invest in their specific role of supporting them through opioid related challenges, employers will be best positioned to achieve optimal health and workplace outcomes.

Toolkit Released for Employers to Address Opioid Misuse and Opioid Use Disorder in the Workplace

Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery

Employers play an important role in influencing the health and safety of their employees, their families, and the communities they live in. Taking strides to support employees and their families can have a measurable positive impact not only in their lives, but in the success of a business. With the nation in the midst of an opioid crisis, the employer’s role as an agent of change is more important than ever. In the workplace, opioid-related issues are impacting businesses and the safety and well-being of their employees.

Outdated workplace policies and culture can be contributing to stigma and leave current and potential employees fearful of repercussions associated with seeking help. Addressing opioid-related issues in the workplace is new to many employers and finding solutions can be confusing and complex as most employers do not have expertise in this domain. Adding to employer challenges, a behavioral health care system that does not consistently provide high-quality, evidence-based care can exacerbate, rather than alleviate, the problems. In some cases, poor quality addiction treatment can lead to worse outcomes for patients.

As part of the Kentuckiana Health Collaborative’s (KHC) ongoing focus on high value behavioral healthcare and second year of partnership with the Kentucky Opioid Response Effort (KORE), the KHC has developed a toolkit to provide recommendations and tools for employers to support their employees and their dependents in prevention, treatment, and recovery from opioid misuse and opioid use disorder (OUD). Using this toolkit, employers can expect to learn:

  • What the basics of opioid use and addiction are and how it affects the workplace
  • How to use data to understand the status of opioid use, misuse, and OUD among employees and dependents with healthcare coverage
  • What benefit strategies direct employees to evidence-based care for prevention, treatment, and recovery from opioid misuse and OUD
  • How to design workplace policies that protect and support employees and employers and improve workplace culture
  • What legal issues may pertain to addressing substance use in the workplace

The toolkit can be viewed here. Today, approximately 80 employers and other healthcare stakeholders convened to mark the release on this toolkit and discuss the recommendations made and existing goals and challenges that remain. For employers who were unable to join us at this event, the KHC will be offering a complementary webinar on May 15, 2019 from 12 pm to 1 pm. Stay in touch with the KHC for reflections and updates this ongoing initiative.

KHC Employer Members Learn from Montana Commissioner

On February 7, the KHC hosted a special one-hour discussion with Marilyn Bartlett, Montana Commissioner of Insurance. Bartlett spent two years running Montana’s employee health plan, where she made better deals with hospitals and drug benefits managers and saved the plan from bankruptcy.

Bartlett shared Montana’s journey to save $15.6 million in 2018 over the estimate of what it would have paid without the change.

While her presentation and discussion with KHC employer members was not recorded, you can see her slides from the event here. In addition, detailed stories about her impressive work have been featured in Washington Post, ProPublica, Kaiser Health News, NPR, Full Measure, and more. Take a few minutes to learn more at the links below.

Round Table Reflections – Understanding Employer Needs, Goals, and Challenges for Opioid Use Disorder

Last week, the Kentuckiana Health Collaborative (KHC) convened a group of employers and experts at the LG&E/KU Cane Run Power Plant to discuss the needs, goals, and challenges facing employers as they address opioid use disorder (OUD) in their workforces. The event was conceptualized as a focus group to guide the development of the KHC’s newest project as part of the Kentucky Opioid Response Effort (KORE). With an expected release date of April 2019, the KHC is developing a toolkit for employers in implementing best practices for supporting prevention, treatment, and recovery from OUD in the workplace.

Attendants of the focus group were carefully chosen. It was important that the discussion represented multiple perspectives dependent on the size, industry, and status of OUD initiatives of employers. Experts were brought in to provide technical expertise and give additional insight.  The conversation was broken up into five domains: key metrics for evaluation, prevention, benefit design, treatment, and recovery. For each domain, our conversation was shaped by identifying goals, challenges, pertinent information for the toolkit, and any knowledge of best practices.

The focus group revealed many outstanding themes. First and foremost, there was a resounding amount of enthusiasm and recognition from employers in their role to address OUD not only in their employees, but in their communities. This was especially true when discussing prevention efforts. Another prominent point was the importance of building a culture of wellbeing and trust within the workplace. By doing so, prevention, treatment, and recovery among employees could be supported. A component of this culture would be innovation, particularly around mitigating the many barriers than often arise for employees in accessing treatment and maintaining recovery. Insurance coverage that is friendly towards virtual treatment options, Medication Assisted Treatment (MAT), defined treatment guidelines, and affordable deductibles was repeatedly addressed. Employers also recognized the importance of data and insurance benefit design in tackling this issue. Addressing OUD in the workplace will be a individualized process, as many barriers exist in implementing these changes and these barriers vary based on each employer’s demographics and capabilities. Despite this, the willingness of employers to engage in such a vibrant and transparent conversation left many of the group’s participants filled with hope and excitement for their organization’s future.

In conjunction with evidence-based research, information collected from this discussion will guide the development of the KHC’s employer toolkit. The KHC will continue to convene employers during our monthly Worksite Addiction Meetings. If you are an employer who is interested in joining this group or would like to share your perspective, please contact me at nmiddaugh@khcollaborative.org.

KHC Attends National Alliance of Healthcare Purchasers’ Annual Conference, Employers Take the Wheel

The Potential and Value of Worksite Clinics

Guest Blog written by Larry S. Boress, Executive Director, National Association of Worksite Health Centers (NAWHC)

The KHC and NAWHC joined forces on September 12, 2017 to discuss the rise of worksite health centers to address the unmet health needs of employees.

Employers continue to face health care benefit costs that outstrip the inflation rate, while quality, access and satisfaction with the health system is declining.

Many employers have decided to optimize their benefit dollars by offering an onsite or near-site clinic to their covered populations. This benefit solution is not limited to large manufacturers, as employers of 200+ can obtain the savings and improvements such a facility can bring to your bottom line, productivity and retention rate.

Worksite health programs were initially developed to provide first aid and emergency care to employees working in remote or dangerous locations.  Over time, many employers decided that offering a company nurse or doctor was a good approach to treat injuries and provide occupational health services

to comply with federal and state workplace requirements. The medical personnel, usually an RN, was also available to manage absences, prepare employees for foreign travel and provide a minimal level of acute care services.

According to a recent survey by the National Business Group on Health, close to 50% of large employers, those with over 5000 worker, have onsite or near-site clinics, and by 2020, two-thirds will have such facilities. The National Association Worksite Health Centers (www.nawhc.org) has found that 30% of employers of all sizes currently offer some form of health care services at the worksite. Today, the services provided at the worksite run the entire spectrum of health care, including not just medical, but dental, vision, physical therapy, chiropratic, lab and pharmacy services are being offered.

Leading employers are beginning realize that by offering the services that force employees to leave work, they can reduce the cost and better manage the health of their covered populations, while improving productivity, since they’ll have reduced the number of situations and the time off the job by workers seeking medical care.

An employer-sponsored health center can serve as the hub of the worksite wellness wheel in integrating and analyzing ALL the data from vendor and employer-sponsored health related programs and activities. At the same time, the onsite clinical staff  increase the engagement of their workers in the multiple preventive and condition management programs they offer. This type of population health approach effectively identifies unnecessary services, gaps in care, opportunities for savings and quality variations to be addressed.

Employers looking at or offering such facilities should be careful not to let their clinic become just another fragmentation of the health care system. Worksite centers need to connect and share patients data with a patient’s own physician. It also offers a source of primary and acute care for those 40-60% of employees who don’t have a personal physician.

Patients see their physician 1-2 times each year, for 7-12 minutes per visit – hardly enough time to enable the provider or the patient to communicate or drill down on physical and mental health issues.

However, people are at their workplace 1000-2000 hours a year, which gives the employer a tremendous opportunity to engage, educate, monitor and motivate employees to learn about and address key health issues and conditions.

To enable employers to better understand and expand on the value of “health and wellness” centers, the National Association of Worksite Health Centers (NAWHC) was formed in 2012. The Chicago-based NAWHC (www.worksitehealth.org)  is the nation’s only non-profit association supporting employer sponsors of onsite, near-site and mobile health, fitness, pharmacy and wellness centers. It also offers a new “Guidebook on Measuring the Performance of Worksite Health and Wellness Centers” to enable employers to understand and use credible metrics and approaches to ensure their getting true value of their investments in their clinics.

An onsite health center can serve as a vehicle to achieve many health benefit objectives, including efforts to reduce medical cost trend by avoiding utilization of unnecessary care; improve health of covered population; integrate all worksite health care, preventive and wellness programs; and reduce absenteeism, while improving productivity.

The presence of the clinic can also increase the visibility and access to other benefit programs and services, now available via a warm handoff between providers and vendors.  The consolidated data now can track patient use of service and referrals and allow vendors to collaborate on a patient’s care management. Onsite fitness centers, often underutilized, can also be integrated into the health center’s physical therapy and cardio programs. Finally, the integration enables easy collection and measurement of the center’s performance and impact on the population’s health and employer’s benefit costs.

Tomorrow’s onsite center will serve as the integrator and hub of an employer’s health data and activities. In doing so, employers, with the cooperation or local providers the and support of their vendor partners, will finally be able take control of their health care spend, while assuring their workforce easy access to quality providers, at little of no costs. This will enable employers to achieve population health management and reduce cost, while improving health, productivity and their firm’s bottom line.

Larry Boress is Executive Director of the National Association of Worksite Health Centers and can be reached at lboress@nawhc.org.

The Rise and Evolution of Onsite and Near-site Clinics

A few decades ago, I remember sitting in a meeting with our company doctor planning new hire orientation, feeling miserable, and wishing I could just have him see if my cold needed to run its course or required a prescription. Instead, I took a half day off of work for a doctor appointment, but I longed for easy and hassle free access to a healthcare provider at or near work. Today, more and more companies are adopting onsite or near-site clinics, also known as worksite health centers, as a way to meet the healthcare needs of their employees.

Onsite clinics were at one time only for the largest of corporations, but companies with as few as 500 employees are now adopting a worksite health center model. According to Springbuk, the current market penetration of worksite health centers is 16 percent and is expected to surpass 30 percent by 2020. This means that up to 10 percent of the adult population under the age of 65 will receive their healthcare through a worksite health center.

There are three primary reasons employers are adopting worksite health centers: 1) improved access to care that enhances productivity and job satisfaction, 2) improved population health management, and 3) better management of healthcare costs. The role of worksite health centers is evolving from the occupational medicine clinic – like the one my company doctor ran – to primary care clinics. We are now seeing an evolution that focuses more on employee well-being by integrating population health, wellness, and evidenced-based medicine into a more holistic approach to employee health.

With the increasing adoption of onsite and near-site clinics, employers considering an investment in a worksite health center now have access to case studies and information about how well these clinics have supported companies’ long-term healthcare goals. On September 12, 2017, the Kentuckiana Health Collaborative and the National Alliance of Worksite Health Centers will host a half-day event to discuss the latest information on worksite health centers. Confirmed speakers for the event include:

  • Diana Han, MD- Global Medical Director, GE Appliances, a Haier company featuring their onsite clinic vendor, Premise Health
  • Larry Boress- Executive Director, National Association of Worksite Health Centers
  • Gregg Potts, MD- Senior Medical Director, Papa John’s International
  • Dexter Shurney, MD- Chief Medical Director/Executive Director Global Health/Wellness, Cummins Inc.

If you are considering a worksite health center or would like to learn more, be sure to join us for The Rise of Worksite Health Centers to Address the Unmet Health Needs of Employees. This event requires registration and is free to current KHC and NAWHC members. This forum will be held at the Jewish Hospital Rudd Heart & Lung Conference Center in Louisville, KY.